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29432 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITYOF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDINV DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. . 29432 RUII 1 G PROJECT IDKNTIFICXFION BUILDING ADDRESS: b - ) SANITARY NO. APPLICATION SUBMITTAL DATE CFoss G�/rtF-�s STwe*s CRwl� ® Vc C.J{ ¢c(N0 O NERSNAME: T PHONE:���� I ;'S ME: NO: amiBALI 1a1f NIC COONNTfffROL# RCHITRCI'IENGINI?iR � r LIC NO: ESS \ CONTACT PHONE: 1�f BUILDING PERMIT INFO w F-I 1(yl�l� / )f' 1 41 r) -3p Q O7Bo El Consultant Facts Paid by Applicant(Initial) pLU ELECT PLUMB MIiCH d/ LICENSEDCC`OWRRACH)R'SDIiC1.ARATION. QTY ELECTRIC PERMIT 118E e z 1 nercby affirm mm I am licensed under provmsmna of chapter 9 anmm6nring - JOB DESCRIPTION {{[[11 with Sraion]f1041 Division 3ofthe Businessond Professions CMe,and my license is FOO in fullforac and eIea. 4.��# (t,w, PERMIT ISSUANCE RESIDENTIAL: �FUzV Li cense Class Lie# J / �' Y OSFDWL O KITCHEN REMODEL NQS Date Cmammurr 'APPLIANCES-RESIDIiMI'IAL [-]ADDITION ❑PLUMBING RE-PIPE F7ra ARCHITELTS DECLARATION PANELS ❑MULTIUNIT [I STRUCTURAL 2 O I undarswnd my plans shall M used m pontic records MODIFICATION 0z" UVI02WAMPS h�n F'; Licensed Pmfessional ❑INTHRIORIsRVP. El CHIMNEY REPAIR 201.1000AMP5 IMOMIiNT OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the OVER IOW AMPS, ^ � 0 BATH REMODEUREPAIR 0 DEMOLITION a following rcusom l$ecdon 7031.1, rofe ,Business and Pssinm county Code,Any city or cnty ✓ SIGNS ELECTRICAL � OOTHER LL O which regmrcs a penrdt to construct.alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement SPECIAL CIRCUITMISC, a� that he ish"reclpursmmtto the pmvisinnsoftheConnector's LicamaLa.(Chmprer9 - 00 (aommencingwith Smith 7000)of Uivision3,41hellmincssand Pr�fes,marcMe)ar, TEMR METER OR 1401,17 INST. COMMERCIAL: a 4 that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NSW BLDG/ADDITION 0 DEMOLITION - y Section]031.5 by any applicant for o Permit subjects the applicant to a civil Penalty of POWER DEVICES NANT OFOODSERVICE F Qn more than five hundred dollars($500). I,as owner of Neproperty.orm em to employees with wages as their sole cont tion, SWI G OL ELECTRIC I sROVEMFiNT FG`O ❑ Y P Y 6 pensa will clothe work,end the structure is nal intended oroffercJ for sale(Sm.]DW,Business ❑OTHER 3 and Prafessians Code:The Command's License Law does not apply to an owner or iOUTL - ITCHES-FIXTURH property who builds or Improves themon,and who does such work hlmselror through his own employees,provided that such improvements are not intended or offered for NEW RESIDE LIJECTR SQ Pf. sale.If,however,the buildingor improvement is sold withimonc ywrof rompsti.m.the SQ.PT.FLOOR AREA VSQ.EL caner-builder will have the burden or proving that he did not build or improve for pur- C pose of sum.). ❑1,esowner ofthe Sm.701Pam exclusivelynd contracting with Cod :)ensed The i- cnnawet the pmjttt(Sec.]014.Business and Lirfessinns Code)The Conwmnrs Li- came Law does not apply to an owner of properly who builds or improves thereon,and QTY. PI. G PERM IT who contracts for such projects with a commonr(s)licensed pursounno the Cant rearors s License Law. O l am exempt under Sm. :B&P C for this reason PERMIT ISSUANCE 1 Owner Uate ATF.R-DRAIN&VENT'-WATER(PAT VALUATION 1 WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEV ICF. 1 1 �e- Ihereby aRrmunder pena0yofperjuryone ofthe following declamtions: ns ILJ`WJ\ s© '4S [have and will maintain a Certificate of Consent tdsel-insure for Workers Church- DRAINS-FLOOR,ROOF,AREA,COND. soden,as provided for by Section 3900 of the Luber Code,for the performance ol'the - STORIES I TYPE CONSTRUCTION work for which this permit is issued. FIXTURES-PER TRAP I have and will maintain Workers Compensation Insurance,as required by Section 3100 of the labor Code,for the performance or the work for which this permit is issued GAS-EA.SYSTEM-I INC,4OUTLETS (ICC GROUP - APN ii My Worker's oro nsation Imurancecaricrnd Policy nu fuer v.. - Cwrier. Policy Nn: r'OAS• EA.SYSTRM-OVER 4(EA,) ERTIFICATE OF EXEMPTION FROM ORKIiR.' �s COMP17NSATION INSURANCE ORP I WASTE INTERCEPTOR (Thissmtiermadembe nnnpleleJ 11 the permit is Forane hmWred tlollurs[$100) 91)ILDI O )N Ig3E5 or less.) GREASE PLANCHECK PER I codify that in the Performance offlic work for which this Permit is issued,I shall SEWER-SANITARY-STT EA.200 FT. not employ any person in any manner so ash,become similar n the Workers'Coupon- ENERGY FEE O Z anion Lows of California.Date WATER HEA'rHR W/VEN'1'/ELECT R Z O Applicant GRADING PER NOTICE TO APPLICANT:IL after making this Certificate or Exemption,you should WATER SYSTEM/TREATING F+ become addict,to the Worker's Compensation pmckilm of the Lahor Code,yon most SOILS FRP. Wforthwith comply wirsuch provisions or pemtit shall m deemed revoked. WATER SERVICE ' Q :D zCONSTRUCTION LENDING AGENCY NI7W RESIDIINTIAL PLMIL SQ.Ff. PAID UO 1Indebyvffirm that there N.mustrncnest luWing ngovcy for he perf ume,e of Dme Ruelpt Fthe work for which this gamut is issued(Sec 309].Civ.C.) _ O U Lenders Name - T AL: LTJ Lenders Address ) 1 cartify shot I have read this application and stale that the above mar motor is BUILDING _ rap cored.I agree to comply with all city and county ordinances and state laws rclming to QTY. MECHANICAL PERMIT E U Z huildingemenuhim,and M1ertby amhove rcprcxmetives of this city nammropnn the SEISMIC S ` shove-mentioned proparty for inspection purposes. PERMIT ISSUANCE ` c)ogre In save,inde and keep ha t as the City of Cupertino against ELIiC'RIC FEE liabilimajudgm is. six aspirin, birth mo any my he inalmdCity 'TER OR ADD TO MECH. ulin n quence g this PLUh BI. FEE 1 'IJ g I TAN C WITH ALL NON-P(pp1INT AIR HANDLING UNIT(TO 10,OIXICFM) MECI CAI 'L'E St JUICE REG ' PIONS. Is Ir�/is,/ I /yI7 AIR HANDLING UNIT(OVER 10,1010 CFM) CONSI'RU ONTAX ignam pp sv Contractor -Data EXHAUST HOOD OVMUCT) HOUSING ITIGATION PEP, ZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant rare or handle hazardous motorial HEATING UNIT(TO I W,000 BTU) as defined by the Cupertino Municipal CMe,Chapter 9,12,and the Health and Safety Code,Section 255320)] / HEATING UNIT(OVER W,(XIO BTU) O Yes No PAID jbildVENTILATION FAN(SINGLE RLSIU) Date emipl# Will the applicant or future building occupant use equipment or devices which BOILER CHIP OR 1(10,000 RTU) nit hazardous air amtamimena as defined by the Bay Arca Air Quality Management ,f i istricfl BOILER-COMP(OVER 100.000 BTU) Ycs No I I have read the hamrdousmaterials rcquircmums under Chapter 6,95 of he Cali- AIR CONDITIONER I TE rma earth&Sefety Code,Sections 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. dnes not ufLmlyhave a tenant,that it is responsibility to unify the minimalf they quircmwts hie mm hem Gpryor_toissune 'o Cenif iRl of/cup auNorize igen / x7f Dme TOTAL: ISSUEU OFFICE . • ® 10300 Torre Avenue Cupertino,CA 95014 Cit' of, Cuperthio Building Division (408)777-3228 (408)777-3333 (fax) March 18, 1997 Owner/Manager UNITED SAVINGS BANK 20510 Stevens Creek Blvd Cupertino, CA 95014 SUBJECT Permit#29432 (tenant improvement) Dear Property Owner/Manager: We have been going through our files in the Building Department, and contacting those • people with permits which have remained"open". According to our inspection records, the subject permit has never been finaled. Many times an inspector will sign the permit in the field, but neglect to report all of the information to the clerical staff for input into the computer. If your records show the subject permit as finaled, would you please contact us so we may complete our records? If the permit is not signed off your,permit can be reactivated and an inspection could be scheduled for final closure of the permit 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 Pamerlon PecvoLo Pipei