30548 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
I
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. 3 0 5//1�T H
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
UILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAT
210309 S i l v c Ya-de..-to A e.. cit
O NER'S NAME: PHONE:CJ9iii_w ONTRACTOR'S NAME: /� �" LIC NO:
S Lt y e old YG (9A CA-/the q w v v NIC CONTROL N
HUEC/HNGINEER: LIC NO: ADDRESS: ❑
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELE PLUMB MECH
❑ ❑
LICENSE])
amCONTRACTOR
rp DECLARATION QTY. ELECTRIC PERMIT FEE
I hn 7W afrmt rant 1 nn. l me Bu ower previsions of Chapter 9 my mewing JOB DESCRI 'ION
��O ZO i.f.lith net,tt IXgbof DivisionJol the Business and Professions Cade,and mylicense is PERMITISSUANCE RESIDENTIAL
F full force and effect.
m
Di ❑SFDWL ❑KITCHEN REMODEL.
Q U W n Class Lip.N
hGL Daam Co..,., APPLIANCES—RESIDENTIAL ❑ADDITION OPLDMBING RE-PIPE
ARCHITECTS DECLARATION PANELS
F❑w I understand my plans shall he used as public records ❑MULTI-0NIT ❑STRUCTURAL
'Z O-, pu MODIFICATION
oz—, UP 10 200 AMPS
Licensed Pmfcssional ❑INTERIOR ❑CHIMNEY REPAIR
OWNER-BUILDER DECLARATION 201-1 WI)AMPS IMPROVEMENT
C 6 1 hereby nffrm Nm 1 nm exempt from the Contractoh Licemc Law for the OVER IOW AMPS ❑BATH REMODELIREPAIR ❑DEMOLITION
X 3 a U following nation,(Section 7031.5.Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER
W I- which requires a permit to construct,alter,improve,demolish,or repair any structure
.b]�'�g prior'.its iss.unce,also requires theupplicuu fnrsuch permit fileusigned statement SPECIAL C IRCUIT.MISC.
that he is licensed Pursuant nthe provisionsofthe Cnnnunnr'aLicenseLuw(Chapter 9
4f=00 (commencing with Secti.n]1kWlmf Division 3.1 the Bminess and Profession,Code)or TEMP.METER OR POLE INST. COMMERCIAL
d a eq that he is exempt therefrom end the basis for the allcgcd exemption.Any violation of
M Section 7031.5h any applicant fora ❑NEW BLDG/ADDITION ❑DEMOLITION
h y permit subjec¢the applicannuacivil penalty of p0\VER DEVICES
E_� not mom than Five hundred dollars(§500). ❑TENANT ❑FOOD SERVICE
❑ I,as owner ofthe property,or my employees with wages as their sole compensation. SWIMMING POOL ELECTRIC IMPROVEMENT
Ry. a will Jo the work,and thestmeture is not intended or offered for sale(See,9144,Business []OTHER1 .ce. and Potcodonx Code:The Cnlnmaors License Law does oat apply to an owner of OUTLETS—SWITCHES—FIXTURES
property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements arc not intended or offered for NEN'RESIDENTIAL ELECfR SQ FT.
sale.If.however,Ne building or improvement is sold within one yearofecmpledon,Ne S .FLOOR AREA S/SQ.FT.
er-builder will have the burden of proving that he did not build or improve for par.
pose of
❑L as owner,of the property,an,exclusively emanating with licensed contractors to TOTAL: ,
construct the p,,,jc,l(Sec.](WW,Buein ss and Profpainnn Code:)The Cnnlrucmr's U-
cense law does not apply to an owner nfpropeny who builds or improves thenen,and QTY. PLUMBING PERMIT FEE �J
whormumosforeu mjecuwit v on.actortM liccnsw pussuann.the Conuaaor's
License Lew. PERMIT ISSUANCE L�
� I. e er. M) Ininq ,B C N'
Uate ALTER—DRAIN&VENT—WATER IEA) "1, ,ygLUAT10N
WORKER'S COMPENSATION DECLARATIO .......'U
nett herebyform under It f BACK FLOW PROTECT.DEVICI?
a penally at perjury one of the following declarations:ns:
(have and will maintain stion37 371Coma,to)at
seldr.fartfir-Worker's ve arda- DRAINS—DOOR,RODE AREA,COND. STORIES TYPE CONSTRUCTION
cation,as Provided for mi Section 3]IX)of Ne lahr Calc,forth peRormunce of the
work for which this permit is issued. FIXTURES—PER TRAP
1 have and will maintain Workers Compensation Insurance,which his perm by Section
Myof the rkerLahor CoJgfomheprance carceofd work fDumbrthis permit is lastred. GAS—EA.SYS'1'EM-11NC.4OUTLETS OCC.GROUP APN
My Worker's Cnmpenmtion Insurance rumor and Policy Dumber are:
Cartier: Policy No.: GAS—PA.SYSTEM-OVER 4(PA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASFIINDUSTRL WASTE INTERCEPTOR
(This action need net be completed if the permit is forces hundred Dollars(S 100) BUILDING DIVISION FEES
m essJ GREASE TRAP PLANCHECK FEE
1,Day plirhat,n the performance. them t workfor meodijh this the W..kissued,,'C. shall SEWER—SANITARY—
nm en'ploy of person in any m:numnn as to bec.me suhjen to the Workcrv'Cnmpen- STORM 13A.200 FT.
Z cation Laws of Culifomia.Date
ENERGY FEE
OWATER HGTF.R WNENT/ELELTR
Z O Applicata GRADING FEE
ps NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEM?BEATING
become subject to the Worker's Compensation provisions of the Labor you must SOILS FEE
forthwith comply with such provisions nr Nrm
is peit shall he deemed revokeyoke d.
4 Q WATER SERVICIi
� z CONS IRUCTION LENDING AGENCY NEW RESIDIiNT1ALPLMB. S
Q.FE PAID ReceiplN
U O (forhereby which
Nat there is�issued
Cie.agency fonhcpMormance ar
� (•' the work for which this permit is issuM(Sec.J09],Cie.C.) Date
Lenders Name
LLQ Lenders Ackke, TOTAL: TOTAL:
(
a„ I certify that 1 have read this application and state that the above information is t-^ BUILDING e0
U zy comer I agree ct comply with all Illy mol reumy ntative off and swat lows relating as QTY. MECHANICAL PERMIT
ablevergcomwaion.and hereby militants partume,nmlives of this city mcnmr upon'he FEE SEES FEE
aMve-mc e)medagree
property for inspection purposes. PERMIT ISSUANCE
(We)agree to save,indemnify and keep harmless w City accrue
Cuptifino against LLE RI FEE
in
ofthe costs and expenseswhichmay in anyway accrue agaim'said City ALTER OR ADD TO MECH.
' consequence of the gmming of this permit PLUMB GLEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT'(TO 10,Ig0 CIM)
SOURCE REGULATIONS. MECHANICAL EE
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTIO TAX
S,gnatereof ApplicanUConuactor Date EXHAUST HOOD(WMUCD
HAZARDOUS MATERIALS DISCLOSURE HOUSING MITI sAT10N FEE
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO 100,000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Gds,Section 25532(a)'! HEATING UNIT(OVER 100.00 BTU)
❑yes ❑No
VENTILATION PAN(SINGLE RES(D) PAID
Will the applicant or future building occupant um equipment or devices which Date Receipt a
an hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER—COMP GHP OR 103,000 BTU)
Distort? TOTAL:
❑Yes �No BOILER—COMP(OVER I 00,00s)BTU)
I have mail the braallous materials requlrcmems under Chapter It of the Cali- AIR CONDITIONER
forma Health&Safety Code,Serdom 25505,25533 and 25534.I uwcrswnd But if the ISSUANCE DATE
buildingdoesnm curren0y have a tenon'.that it ism bilis tonmif Neoccu t NEW RESIDENTIAL MECH. SQ.FT.
of Ne a which must be me' to issuance of asCca ficate of Occupancy
rcquiremcn prior
Owner or authorized agent Due TOTAL:
ISSUED BY:
OFFICE
;® r
10300 Torre Avenue
Cupertino,CA 95014
Cita• oC
Ci-perth o Building Division
(408)777-3228
(408)777-3333 (far)
June 18, 1997
Homeowner
20309 Silverado Av.
Cupertino, CA 95014
SUBJECT Permit#30548
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
Pnnteo on Fecvclea Paaor