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29622 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PHRMI r NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL L a4J Vh L L BUILDING PROJECT IDENTIF'ICAI[ON BUILDINGADDRMS: SANITARY NO. APPLICATION SUBMITTAL DATE �I ak OWNF, 'SNA E: 1'ZONE: ON' CTOR:S NAME s LIC6yL NO:.AMINg \ ` NIC CONTROL# RCHITECVENGI iER: I LIC NO:11 DRF S: ❑ '(INTACT: PIIONF: I1DY' - �1l BUILDING PERMIT INFO / be,_/ Qg ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH 0 El El eji� LICENEDCTOR'S DECLARATION QTY ELECTRIC PERMIT FEE I hereby affirm than 1 mnxt I em under pnnhsion.,of Chupler 9(commencing JOB DESCRIPTION with Section]fAMp of DivisionJafthc Bminessand l'rofessinnsCMe,andm Iic,..i, in full farce and —F 11 y PERMIT ISSUANCE RESIDENTIAL' �UZ�j License C1.1 Lica ` J - OSFDWh El KITCHEN REMODIiI. y6L Onto Com.aur APPLIANCIS-RESIDENTIAL. OADDITION O PLUMBING R&PIPE g.Dw A ITECT'S DIiCLA O MULTI- NIT O OZI understand my planssM1ll be awlae public remNPANELS MODIFICATION Z UP'102IXIAMPS �'/t„F"U Licensee Professional ❑INTERIOR OCHIMNIiY REPAIR ,ej OWNER-BUILDER DECLARATION 2BbI1N111AMP5 IMPROVF.MIiNT CC 0 a GG 1 hereby affirm that um exempt from the Contractor's License Law fur the OVER 10(10 AMPS ❑RATH REMODEUREPAIR O DEMOLITION 1U following remF on.JSection 1031.5.Business and Professions Cade:Any city or county SIGNS'ELECTRICAL OTHER AA% )91a I Qi 3(y Hv1 which requires a permit to consumer,alter,improve,demolish,or repair any stromure `� �/Y✓^'\'��-- w.a] primm its issuance,also reyvims the applicant for such pmintto Glc a signed statement SPECIAL CI RCUIT/MISC. } that heir licensed pursuant p o me mapporm of the Contractor's License Law(Chapter 9 QO (eammencing with Secenn?0Gft or Division 3 of the Business and professions Core)or TEM I'.M 17 117R OR POLE INET. 6 S that he is exempt there]..and he hats for the alleged tr cmpriot.Any violation of ' Slain,1011,1 by any applicam for a permit s.biters'no a Picasso a civil ❑NEW BLDG/ADDITION ❑DEMOLITION t more than five hundred dollars($51p). PO pcnvhy of pOW1iR DEVICES ❑TENANT ❑FOOD SERVICE Ol,muwner of the p.peny,or my employees with wages as their role compensation, SWIMMING POOL ELECTRIC _ IMPROVEMENT o will do tiro work,and the saudure is not intended or offered for sale(Sec.7044,Business ❑OTHER 6 3 m and P.Pessions Code:The Contractors License Law does not apply to an owner of OUTLETS-SWITCH FIRES ' properly who builds or improves thereon,and who does such work himself or through his own employees,provided that such impmvemcnn arc not intended nr affereJ for NHW RESIUENTIAI.EI SQ PP sale.If.however,the building or improvement is sold within one ycmofmmplcrion,the SQ. .F 0 S/SQ.FT. nerbullder will have the harden of"proving that ec did not builder improve for pur- pose of sale.). ❑ 1,as owner of rhe p.peny,am exclusively contracting with licensed coded ms to TAI- NOV 2 n�I�� construct the protect(Sec.]00rofe 4.Business and Pssions Coda,The Cnmrenor's Li- cense Lew does not apply to an owner of property who bui Ids or improves thereon,and QTY. PLUMB IT PEE who cnnwcta far suchprojerv,with a contractors)lice ns ed purauenno the Coo.mcmh Ur DUI-' Lorimer law. PERMITISSUANCE CITY Ch1INU El 1 am exempt under Sec. ,B&P C fpr this so rean ALTER-DRAIN&VENT-WATER Owner Date VALUATION WOR KERS COM PENSATION DECLARATION BACK FLOW PROTECT.DEVICE I hereby-6117 under penally of perjury one of me following decla.tions: I Ihaveundwillmainmina Cenificateof Consenttoself-insurefnr Workcr's Cpmpen- DRAINS-FLOOR,ROOF,AREA.COND. STORIES -TYPE CONS'T'RUCTION %tion.m d for by Secdon 3700 of the Labor Code,far lee perrourname of the work for which this permit is issued FIXTURES-PER TRAP - I have and will maintain Worker's Compensation Insurance,as requlral by Section 3700afthe Labor Code,forthe perfarmamceufthe workforwhich this permit isiscued. GAS-EA.SYSTEM-1 INC.4 OUTLETS My yI��LpT r and Ynlic �G�ray� IOCC.GNOUP Pois i 1 APN CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GRF.ASEflNDUSTRL WASTE INT'ERCEPfOR (Thismmionneedmt becompletedifthepermit isfororchundreddolian lSl W) - BUILDING UI VISION PF.ItS or less,) GREASE:TRAP PLANCHECK EEE Toy any Peat in the any mmanceo he as it) beta a subjech tho the Wien'CLI shallrier- SEWER-SANITARY-STORM EA.200n. not employ any parson in any manneno sun become subject la the Workers'Comoro- ENERGY FEF. Z cation Laws of California.Dole2O Applicata WATER HEATER WNGM'/ELECI'R GRADING FEE y NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEM?BEATING ai become subject to the Workers Compensation provisions of the Labor Code,you mail SOILS FEE LLI forthwith comply with such provisions or this permit shall he deemed revoked. WATER SERVICE CONSTRUCTION LENDING A .gency NEW RESIDENTIAL PLMB. SQ.IT. PAID U. 0 l orafar which thuthat thereisaco (Ser.3nlending agency for the performance of Dam Receipt U. F the work for which this pewit is issued(Sec.309],Civ.CJ , 0 U Landers Name TOTAL: l.c dens Address TOTAL: y I certify that 1 have read this application and stale that the above information is BUILDING FEE tti y correct.I agree to comply with all city and county ordinances and.nate laws relating to QTY, MECHANICAL PERMIT FEE V Z building construction,andhemby authorize representatives ofthis city to enter upon Ne SEISMIC FEE above-mentioned property for inspection purposes. PERMIT ISSUANCE (We).gree to save,Indemnify and keep harmless tee Chief Cupertino n,mr,tt ELECTRIC FEE hihiliuc,judgments,costs.nit expenses which may many w.,.cc.e...msvid City ALTER OR ADD TO MECIL - incnnseyuenccof the graining of this permit PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT AIR HANDLING UNIT(TO 10.001 CPM) SOURCE REGULATIONS. MECHANICAL FEE AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX - SignatureofApplicant/Contractor Dam EXHAUST HOOD(W/DUCD HOUSING MITIGATION FEE HAZ RDDUS MATERIALS DISCLOSURE Will theapplicantorfuture building oNOman,norenr handle hazallous material L HEATING UNIT(TO IM."BTU) as defined by the Cupertino Municipal Code,Chapter 9.@,and the HeAlft and Safety Cade.Section 25532ft(H HEATING UNIT(OVER 100,000 BTU) ❑Yes ON. - VENTILATION FAN(SINGLE RESID) PAID % r��I.11 applm or future building occupant use equipment ordevices which Dam Receipt p t haair contaminants as defined by the Bay Area Air Quality Management BOILER-COMP QHP OR 100,000 BTU) ,inner? TOTAL: r7 Y. 7 N BOILER-COMP(OVER 100,000 BT11) I have revel the hazardous ma¢rials requirements under Chapter 695 of the Cali- AIR CONDITIONER ISSUANCE DATE frani Health&Safety Code,Sections 25505,25533 and 25534:1 undersmul than drive NEW RG-IDENTIAL MECH. SQ.IT building docs not currently have a tenant,that it is my respomibiliry to ratify the occupant nr the requirements winch must he met prior m issumme of if CenNcme of Occupmcy. - .I Owner or authorized agent - Date TOTAL: ISSUED BY: OFFICE 0Cior 10300 Torre Avenue Cupertino, CA 95014 *-Liperthio Building Division (408)777-3228 (408)777-3333 (fax) June 18, 1997 �l 5 'mac Homeowner 858 September Dr. �c Cupertino, CA 95014 l / SUBJECT Permit#29622 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,the subject permit has not had a final inspection. 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 dispose of the file and remove the records from our computer. Thank you for your assistance. Sincerely, CITY OF CUPERTINO Christy Akatiff, Administrative Clerk l� Printed on Recycled Paper