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29056 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDLNO-ELECTRICAL, P17RMITNO, 29056 S O ^ ♦� BUILDING DIVISION APPLICATION/PERMIT PLUM BLNG-MEJVCHANICAL SL,J�I6 BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: SANITARY NO. API'LICAT'ION SUBMITTAL.DAT 6 �� l �4� S 0WNER'SNAME: P UNG CON' 'OR" N117: LIC NO: ♦ NIC CONNTROL# RCHITECf/ENGI EER: LIC NO, ADD 'SS: ❑ /^©91C CONTACT: PHONE: BUILDING PERMIT INFO A �i1.�/"-J z-1^ ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLA_RA'1-'1/ODN f, T rti� I{-y QTY ELECTRIC PERMIT FEE Oµ1100licensers IrX1- 'Ll`G 1 nyrenr arum that 1 am Eeenaw nodus provisions nr chaeta 9 anmttxndng JOE DESCRIPTION µ with Scction70110)of Division 3ofine Buxinessand Pmfcssions Coale,and my licenselis F�� in full force and affect. PERMIT ISSUANCE yW WL ❑KITCHEN REMODEL QrU License Class Lic.N APPLIANCES-RESIDENTIAL ADDITION ❑PLUMBING RE-PIPE G G'Ode Contact. ARCHITECT'S DECLARATION ❑MULTI-UNIT ❑STRUCfURAI. F.Drn PANELS ZO,a2Z Iadcnotordmyplanschall housed as public rccards MODIFICATION DZ—� uPla 2g1AM1'ti ❑INTERIOR [I CHIMNEY REPAIR ❑'!1 QY�, Licensed Professional 201-IK)OAMPS IMPROVEMENT s OWNER-BUILDER DECLARATION Y 6 1 hereby affirm thd I am exempt from the Cummdur's License Law for the OVER Pan AMPS ❑BATH REMODEIIREPAIR [I DEMOLITION RaU following reason.(Sectiun'/031.5.Business and Pmfiesionn Cale.Any city or county SIGNS ELECTRICAL � ❑OTHER tL y which requires a permit m rom,ow,,illy,improve,demolish,or repair any wrucome �Rr _ ��yW�; prior to its is.w.ance,also requires the applicant for such permit to file asigned.vamment SPECIAL CIR-UI.F161I55' /J fC� thommunccenttd pumam mthe of Disions,f the CnnweorandProomw(Chape)or sF--rF-{p,� ya�G (cat he ingwith$adromand of basis for the Business andon,Any Code)or TEMP.MLTq�t'aRJ'Of.B INST. a.ax e tent he is exempt therefrom and the basis for the a s she exemption.Anyil Penaon of ❑NEW B I UI♦TION ❑DEMOLITION W� Section ID31.5ve any hundre dr1l s($50nnit subject the applianunacivil#,ally of POWER DEVICES �1 AN s� 6�/V�[�3FOOD SERVICE r 2,} not more man five hundmlJollan 145 W)' IMIhtOVEMENT ,y(/� =-S [] I,as owner ofthe properry,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC fol ��VT ad []OTHERwill do the work,and the structure is nm intended uroRered an sale(Sec.J041,Business Wim and Profession.Gavle:The CBntmctora License Law docs not apply m an owner of OIITLF,1'S-SWITCHES-FIXTURES property wlm builds or improves thereon,and who Lincs such work himself or through his own employees,provided that such improvement are,not intended or offered for NEW RESIDING[Al.ELEcrR SQ FT. aide.If.howsva,the building or improvamant issold viturnone year of msmpletian.the (( SQ.FT.FLOOR AR[iA1 LSQ.FT. owner-builder will have me burden of proving that M1c did oat b�ildmimprove for pus- IX O lye V `J��1S lam/ 1,construct ower of the property,um exclusively contracting wile IimnseCcnmmdom i- TOTAL: G aem. athe es ran(Sec.o cr Business and ry,who haions Codc:)The e,thrown, Li- wmcLawdoesmm�pplymawith. orpmpcnywhosedporimprova Contra,and QTY. PLUMBING PERMIT FEE aJ who amwgs for such pmjat with a contractors)licensed pursuant m me Commemr s {^ License I.uw. PERMIT'ISSUANCE I are exempt under Sea ,B&P C for this reason _ ALTER-DRAIN&VENT-WATER(EA) VALUATION Owner Dae �f WOR KERS COMPENS ATION DECLARATION BACK FLOW PROTECT.DEVICE O / D 1 hereby affirm under penalty of perjury one of the following declinations: Q Ihevc used will taindina CenifcareofConwntioelf-insurcfor Worker's CumNn- DRAINS- kLOOR. ,ARP.A,COND. STORIES TYPE CONSTRUCTION cation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. FIXTURES-P AP i]I have end will maintain Worker's Compensation In,...,,as requitrA by lection 37W of the Labor Cod,lin the performance of the work for which this#,lent is Issued. GAS-EA.SY'TE M1I- ETS OCC,GROUP ANN My Worker's Compensmion li mmne.carrier and Policy number Lin: Carrico Policy No.: GAS-PA.SYST' < CERTIFICATF.OFEXEMPTION FROM WORKERS' GNEASE/IN'1 t4T STE I R COMPENSATION INSURANCE BUILDING DIVISIJFN FEES (Thissection need not he completed ifthe permit is forum hundred dollam($ILO) GREASE TRAP S ser less.) PLANCHF,CK FEE I cattily that in the xrformance ofmu work hor welch this permit is issued,l shall / not employ any person in any manner so as to brimo ecuc subjecthe WorkcnContain- SfiWER-SANITARY ell fiA�l??QI'. ENERGY FF,B ♦6! O Z sation Laws of California.Data WATER HIIAI E&VAI'IEL Z Q Applicant pp GRADING FI?I? y lip NOIHCE'TO APPLICANT:IL after making this Certificate of Exemption,you should WATER SYSTEM?TIOE ,,p a ; become subject to the Worker's Cumlxnsatiun provisions ofd¢Leber Cale,you mull SOILS FEE LUfsmmwith comply with such provisions or this permit shall he Jcenxd rcuokcd WATER SERVICE ps CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMH. SV.I'C ID V O lherebyal inarnat there iso consauction lending agency forth,parformanaof Uate R ci i# Lt. F the work lbs which this permit is i.caOil(See.3097,Civ.C.) Lender's Name �' Wlender's Address TOTAL: gy 1 cenlly mat I have rad this upplicdion and state that the above information is BUILDING PI?L' ♦Di F., Tri correct.)agree a comply with all city and county ordinances and star,laws minting to QTY. MECHANICAL PERMIT FEE V z building construction,and hereby outhonze repmammtives of this city to enter upon the SEISMIC FEE aWve-mentioned property for inspection purposes. PERMIT ISSUANCE (We)agree to save,indemnify and keep hunnlcas the City of Cupertino against F.LECIBIC FIiE liabilities,judgments,costs and expenses which may in any way Occurs,against said Cry ALTER OR ADD TO MECH. / 6 inconsequence of me granting of ibis Permit. PLUMBING PEE f► APPLICANT'UNDERSTANDS AND WILL COMPLY WITH ALL NO OINT AIR HANDLING UNIT ITO 10,000 CPM) MECHANICALFEE SOURCE REGULATIONS, ♦ 16 - AIR HANDLING UNIT(OVER I0,000 CPM) CONSTRUCI'[ON T X St urcofA anUConracnrz ata EXHAUST HOOD(W/DULT7 HOUSING MITIGATION HAZARDOUS MATERIALS DISCLOSURE Will the applicant or lumre buildingaccupxnt store or handle h:n.ardous reaced HEATING UNIT(TO 1011"BTU) as defined by the Cupenim,Municipal Code,Chapter 9.12,and the Health and Safety Cale.Section 25532(,17 HEATING UNIT(OVER 1041.000 BTU) ❑Yes ❑Nn VENTILATION FAN(SINGLE RISIU) I'AIU D.I. Will the applicant or future building o,cupant use equipment or devices which Ree Ipt# t hmardous air contaminants as defined by the Buy Area Air Quality Managc'trat BOILER-LUMP OBIP OR 100,00 BTU) TOTAL.: DiofimY BOILER-COMP(OVER 1 W,O(p BTU) E]Yea ❑No I have rad the harmJous materials requirements under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE forma Health&Safety Code.Sections 25505,25533 and 25534.1 understand that if tea NEW RESIDENTIAL MECH. SQ,FT building does not currently have a arm,that it is my responsibility to notify the occupant of the"miremems which ran be net prior to torturer,of a Certificate of Occupancy. Owner or mtlwrized agent Data TOTAL: ISSUED 1{Y: OFFICE Inspection Query for a Specfic Permit 10/8/97 Ins ecfo Urilf i Pass/Fall XGOd@7l D 2F D 2F D 2F JB 2P JB 2P B 2P S 2F D 2P D 2P D 2P S 3P JS 2F JS 2 P JS 3F JB 2 C B 2F B 4F B 2P CC 1P CC 2F CC 1P CC 1F CC 1F CC 1P CC 1F • O 1P O 1F O 1F O 1F O 1P D 2F D 2F D 2F D 2F D 2F B 2 N ES P JB 2F JB 1 F B 1F B 1F B 1F CC 2F CC 2F CC 2F V 2F 2F 2F O 2F O 2F O 2F O 2F Page 2 Inspection Query for a Specfic Permit 10/8/97 • PERMIT#,; ITUS'ST„SITUVSTREET[!o2 4*,,INSDESCRIPTAM InsT"""D'ATEDESIRE1 DafeDone 9056 10396 STELLING RO RGH ELEC 10/23/96 9056 10396 STELLING RO RGH MECH 10/23/96 9056 10396 STELLING RO RGH PLMBG 10/23/96 9056 10396 STELLING RO PLMBG 10/24/96 10/24/96 29056 10396 STELLING RO ELEC 10/24/96 10/24/96 29056 10396 STELLING RO MECH 10/24/96 10/24/96 9056 10396 STELLING RO INSUL 10/28/96 10/28/96 9056 10396 STELLING RO FRAME 11/1/96 11/1/96 9056 10396 STELLING RO INSUL 11/1/96 11/1/96 9056 10396 STELLING RO INTER SHR 11/1/96 11/1/96 9056 10396 STELLING RO STUCKO WIRE 11/5/96 11/5/96 9056 10396 STELLING RO SHEETRK NAIL 11/5/96 11/5/96 9056 10396 STELLING RO SHWR/TUB 11/5/96 11/5/96 29056 10396 STELLING RO PRESSURE TEST 11/5/96 11/5/96 29056 10396 STELLING RO SHEETRK NAIL 11/6/96 11/6/96 9056 10396 STELLING RO GAS PRESSURE 11/6/96 11/6/96 9056 10396 STELLING RO IGAS TEST 1 11/7/96 11/7/96 9056 10396 ISTELLING RO SHEETRK NAIUGARA 11/7/96 11/7/96 9056 10396 ISTELLING RO SHOWER LATH 12/4/96 12/4/96 9056 10396 ISTELLING RO ELEC 12/18/96 12/18/96 9056 10396 STELLING RO ELECT RELEASE 12/23/96 12/23/96 9056 10396 STELLING RO ELECT-F 1/21/97 1/21/97 9056 10396 STELLING RO PLBG-F 1/21/97 1/21/97 9056 10396 STELLING RO MECH-F 1/21/97 1/21/97 9056 10396 STELLING RO BLDG FINAL 1/21/97 1/21/97 • 9056 10396 STELLING RO MECH-F(2ND) 1/16/97 1/17/97 9056 10396 STELLING RO BLDG-F(2ND) 1/21/97 1/21/97 9056 10396 STELLING RO ELECT-F 2ND) 1/21/97 1/21/97 9056 10396 STELLING RO PLBG-F(2ND) 1/21/97 1/21/97 9056 10396 ISTELLING RO MECH-F 2ND 1/21/97 1/21/97 9056 10396 STELLING RO BLDG-F 2/27/97 2/27/97 9056 t10396 STELLING RO BLDG ENERGY FINAL 2/27/97 2/27/97 9056 STELLING RO ELECT-F 2/27/97 2/27/97 9056 STELLING RO PLBG-F 2/27/97 2/27/97 9056 STELLING RO MECH-F 2/27/97 2/27/97 9056 STELLING RO 9056 STELLING RO BLDG-F (ONE ITEM) 3/4/97 3/4/97 9056 STELLING RO FIRE FINAL FIRE 2/28/97 2/28/97 9056 STELLING RO BLDG-F 3/7/97 3/7/97 9056 10396 ISTELLING RO BLDG ENERGY FINAL 3/7/97 3/7/97 9056 10396 STELLING RO ELECT-F 3/7/97 3/7/97 9056 10396 ISTELLING RO PLBG-F 3/7/97 3/7/97 9056 10396 STELLING RO MECH-F 3/7/97 3/7/97 9056 10396 STELLING RO BLDG-F 3/11/97 3/11/97 9056 10396 STELLING RO BLDG ENRGY-F 3/11/97 3/11/97 9056 10396 STELLING RO ELEC-F 3/11/97 3/11/97 9056 10396 STELLING RO MECH-F 3/11/97 3/11/97 9056 10396 STELLING RO PLBG-F 3/11/97 3/11/97 9056 10396 STELLING RO BLDG FINAL 3/14/97 3/14/97 9056 10396 STELLING RO ELECT-F 3/14/97 3/14/97 9056 10396 STELLING RO PLBG-F 3/14/97 3/14/97 9056 10396 STELLING RO MECH-F 3/14/97 3/14/97 9056 10396 STELLING RO BLDG ENERGY FINAL 3/14/97 3/14/97 • Page 1 '• 10300 Torre Avenue Cupertino,CA 95014 Building Division (408)777-3228 (408)777-3333 (fax) October 22, 1997 Owner 10396 S. Stelling Road Cupertino, CA 95014 SUBJECT Permit#29056, Single Family Dwelling 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