S 1618 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OV CUPERTINO
BUILDING-MECHANICAL A6 1'FgJdIT"°. 1618
BUIL. ING DIVISION APPLICATION/PERMIT 1'LIIMIfING-TIT IDE
NICICL l`J
ItU1LDING I'ROAEL'T IUENI'INICATION
g OUIhDINGADDRD � ^ SANITARY NO. AI'I'L�I'ION SUBMITTAL DA'I'F.
JC / Ic WD.
t WNF.IX'S NAME: / � 1'HONF.V r'4 y, COM RACTOR'S NAMH.: LIC NO:
L NIC CONTROLX
CHfITCT/LNGINEER: LIC NO: ADDRESS: ❑
CONTACT: PH BUILDING PERMIT INFO
Lam, S-1 A/ /R� ❑ Consultant Fees Paid by Applicant(Initial) III UG ELEC PLUMB MECH
K 6(J ❑ ❑ ❑
LICENSE[) OMMACFOR:S DECLARATION QTY. ELECTRIC PERMIT FEE
I hereby affirm Thal I ate licensed Under,a o,,lolta of chapter n(commencing JOB DESCRIIy
PION
yD00 w'ImS,,Iion]IR1(fut Dirhhm3olbe lteaincxsnnl 11.. irnts Code,end my lOcnso is RESIDENTIAL'
FOO in full force and effect. I'IiRMIT'ISSUANCI? ❑SPIIWL ❑KITCHEN REMODHL
,<UV Livemc Class Lie.# APPLIANCES-RESIDENTIAL. El ADDITION (3 PLUMBING RE-PIPE
F+5S W Oalc Conaechtr
Fly ARCHITFCTB DECLARATION PANELS ❑MULTI-UNIT ❑STRUC'FURAI.
z I undersmnd lny plans shall be used as public records MODIFICATION
OZ'+O UPTO 200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR
F-��W Licensed Nafir,6oaal 2101-10010AMPS IM120VI:MIiNT SWIMMING POOLS
OWNER-BUILDER DECLARATION \ rV'^'J\TH RCNODEIIRIiI'AIR Q UIi.M
C C (NATION
6 icense Law for the OVIiR I hereby affirm that I am esenlpl from the Comento",LIIXX1Ah1PS
O E U following none...ts"tion 711315.ion,inms and 11ntf,ions Coda,Any ruy o ,mmy SIGNS ELIiCCRICAI. ❑OTHI?R
Iu 3 W. -41
0 F which requires a peond m conomet.aher,improve,demolish,or media any etre vmo
^ Ran pnet I t,i—mer,.]a.nami,e, he pplicam hastichpe rankm fl .'& eJ statement SPECIAL CIRCUIT'/MISC.
R'y Ihmh II n tl p III C t t 1 L ICh ptcr9
ZOO (cumnam'¢with Srctnn]000)'If Uiv'xian lot the Bas ux,and Poole"Or,Code)nr I'11MP M l 3 1 Hk OR POLE I COMMERCIAL:
66 e C tum he is exempt therefrom and he basis for the alleged cacaa,oam.Any violation of ❑NEW BLDG/ADDFI'ION El DEM
x^H Sum m]0}LS tty any applicam foralwrmit suhjems the upplicannoaCivil pcnaay of POWER DEVICESor [I TENANT ❑FOOD SERVICE
tot nm than five hundred Jullw's(551111).
`yY OTHER IiMIiN'f
udic nrnldheprcpeny.ormycmploycenwimemal fostheirmlucom.lhusi s% SWIMMING 1'001. .E`'fltl
WFm and doth,work.Code,
The Contraaun%Licens Law
os notsale
to q4,Business E ` ❑OTHIiR
LLl a y and property
who
Crede:The ovo lthervo Lind w Law dttu not work
nausea an owner of OUTLET' 1"f(:HGS '% S
h propeny whe huie,m improves Iherenn,and who does nisch work dedor nr Ihrongh q
his own employees,provided hot such improvements are not intended or otlercd for NFWt NI'If51 .LEC' SQ 1'1'.
sale.IL howeveq the building or improvement is sold within one year ofcomplction,Ihe lk SQ.FI'.FLOOR AREA ESQ.Ff.
terhuilder will hove he harden ol'prnving Ih:u he did sol build ni Impmvc for par.
Fosenf seleJ.
1,as owner of the propeny,am reclusively umvacting wins IicenuJ rommmon I
rmloOl Ihe p..,,(Sea 7044.Racine,and Prufessinm Code:)'Ihe Conuumnr's LI j
come Low does not apply to an owner of properly who buddc or improv es Iherenn,end LUMBING PERMIT
w
ho mmmets fist such projects with a conlmdads)licensed!pursmnn ht me Conlmnars
Li c Inw. 'IiR .SUANCH U
l a:tl pt under Sec B k l'C for shin rvasmt
A .R-DRAINA VENT-WATER(IiA) VALUATION
Dam
\ Rnder OM of vr, yo .ARATFON BACK PLOW PROI'IiCT.DEVICE.
herebyitwill sunder penalty lxrjuryoncofmcfollo,ng declaration,
I]Ihave and w,,Ifor by Section
Cion 37oe of the Lao ,Codd,bathe
Wmkets Compere- pRAINS-II.00R.ROOF,AItIiA,GOND. STORIES 'TYPE CONSTRUCTION
cation,an provided for by Section 3]1X1 of the Lulvn Calc,for the perfomwnm of the
work fuI'which IIIi,perinil is issuer!. FIX'FUI2FS-PER'1'RAP
I have and will maintain Worker'.,Compensation Imumnee,as required by Section
3700afthe Lrlxn Gale,forthe performance oflhe work for which lhispemdil is issued. GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN
My Worker's Gmtpensatian lnvamncu otmer and Polley nontbevarc: m 1
C.,,: Policy Not GAS-IA.SYS'I[zM.Oq.R AEA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASIHANDUSTRI.WAS 11;INTERCEPTOR
HOLDING DIVISION R?IS
['Ibis sedlnn aced not he cmnplclW iflhe pennhkl or one hllndrecl solid,(SInot GREASH'HRAP
or
less.)(I
ITE
Icetoy mm in the perfnmwneeofine heeorne,abjeork tm,th,Woo icsacd.open- SEWER-SA ITARY-STORM EA.200 IT
nm employ any person in any manner ser us m hconme suhjeq m Ihe Wnrkure'Cnmpen- ENERGY FEE
,"{ cation Laws of Culifttmla,Dale WATER IIHNITR W/VENT/EI.CCTR
OQ Applicant GRADING PER
z NOTICE TO APPLICANT:IL after making this Cenifieme of Exemption,you should WATER SYS DEMO REATING SOILS FEE
hecalni,hco p y Ihe Wut,TO .......tto his praft,lna of the Lnhul'Code you moot
W � fonhwim comply with such provisions or This permit shall he decoct rcvakal. WATER SERVICE
Q
Uz CONSI lludherem.,ONLENDINCn,AGENCY NEW RESIDENI'IALPLMH. SQ 17, PAID Date Recei,It
UO L for
this pe dmmisacrntswclimtle,Cim llgcnuy forlbcperfnrmm�cc of
'he dworkeli's for which this permit is issued(Su.3fN],Civ.C.)
u' F" Lender's Nance TOTAL:
U Lender',Ackhm,
}I a _ BUILDING FEE
1cmee thatIhavereadthisyand coupty andslate Thal Ihe state intonation is
LF. FA mrrcm.lagree li 1, ad toothy
thall yciti and o,n,..nowe,,sand state rower a,m'he QTY. MSCI IANICAL PERMIT FEE
U lding 1.
� buildingumruucfinn,unJ herehy aulhoriercpmsenmlives of this city In unwr upon the SEISMIC FE6
above-mvntloned property for mspectim purposes. I'ERMI'I'ISSUANCI?
(We)agree to sore,indemnify and keep handless the City of Concrete agma,t ELECT RIC IEEE
Iiabilites,judgments,costs and expenses which may in my way mome agai asl said City ALTER OR ADD'10 MECH.
semens of be,grunting of Ibis pcoml.
PLUMBING IT,
APPLICANT UNDERSTANDS AND WIT.].COMPLY WITH ALL NON POINT AIR HANDLINGIINIT(TO 10.10()(1 CIlM)
MECHANICAL PEE
SOURCE REGULATIONS.
AIR HANDLING UNI'P(OVER 10,000 CFM) CONS'I'RUCTPON TAX
Sigmmrc of Applicam/Cnmewl., Dam EXIIAUS'f HOOD(W/DUCT} HOUSING MITIGATION RE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building necupanl mole nr handle bunnlnw nlmerild HCOINO UNIT('FO 100,000 n'FU)
as defined by the Coleman Municipal Code.Chapter 9.12,and tire Ihealth and Safety
Code,Section 25532m)Y HEATING UNIT(OVER 10h000 BTID
❑Yes [1]No PAID
VENTILA'T'ION FAN(SINGhI112BSIDl ]);it, Receipt#
Will the applicam or future building accupant use equipment or devices which I{OILER-COMP IJHI'OR 111(1,000 BTU)
emit hamrdnu•sir roanmadt us defined by Ihe Bay An.Air Quality ldmu,rmenl TOTAL:
District?
El Yes ❑Nn MOILER-COMP(OVER 100,0001f u)
I havo¢vJ the henml...sntmeril,regnirclnenlsunder Chapter 6,95 or the Cull AIR CONDITIONER
ISSUANCE IJATfi
fornix health.@ Safety CWC,Sections 25505,25533 and 25534.1 nnJelmand Ilial if the NEW RESIDIRlfIAI.MECIL SO.PI'.
huilding does ma currently has,a tenant.that it ismy A%Ruoihilirym amify meoccupato Q jq
of the requirements which mm,,be mel prior In issuance of a Ctamfic:ae of Occupancy. �,/�)J+
Ownunrtanumoricd agent Date TOTAL: ISSUED BY ✓ ����
1 OFFICE
161 V-4
10300 Torre Avenue
Cupertino, CA 95014
of
Cupertino Building Division
(408) 777-3333 (fax)
February 9, 1999
Homeowner
10303 Scenic Road
Cupertino, CA 95014
SUBJECT: Permit#S 1618
Dear Homeowner:
We have been going through our files in the Building Department, and contacting those
people with permits remaining "open".
• According to our inspection records, this permit has not been signed off by the Building
Department. Many times an inspector will sign the permit in the field, but overlook
reporting all of the information to the clerical staff for input into the computer. If this is
the situation and your permit card shows the final sign-off, would you please contact us
so we may complete our computer records? If the permit is not signed off, please call to
schedule an inspection for final closure of the permit.
Because of the large volume of paperwork within the building department, we cannot
separately monitor the progress of each permit. We ask that you give this notification
your immediate attention. If we do not hear from you within ten (10) working days we
will remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
-J
Christy Akatiff, Administrative Clerk
Printed on Recycled Paper