31095 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO. 0
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENT'IF'ICATION
BUILDINGADDRESS:
�� I ' SANITARY NO. APPLICATION SUBMITTAL BAT
OWNER'S NAME: PHONE' CON]'R�CIORUS,NAtME: M� LICN% 7
ld— ( .L//✓S � ii 252 �'�o f�xsl�C....--/1.JS „/ N/C COI�1.�
iCHITELT/ENGINEER: LIC NO: r ADDRESS:
5' ' / ❑
CONTACT. PHONE: BUILDING PERMIT INFO
s ❑ Consultant Fecs Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ ❑ ❑
LICENSED COMsed unOR'Sder
DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby affirm that I am licensed undo provisions of Chapter 9(commencing JOB DESCRIPTION
BOZO with Section]gMl)of Divisimr3of the BusinessanJ l4ol'es.ei,re Cndc andmyliccnse is RESIDENTIAL:
FF•• in full force end c-j[cct.'.,/�n� PERMIT ISSUANCE
aUV Limnu Clu c.M 17 ❑SFT)WL ❑KITCHEN REMODEL
Z APPLIANCES-RESIDENTIAL
Dam�Gsnwem ❑ADDITION eJMBING RUPIPE
on ond,be T$DECLA 'fl N ❑MULTI-UNIT ❑STRUCTURAL,
I u demsond my plans shall be,used As public reemck PANELS
Z t Lx , MODIFICATION
02 UPT0200 AMPS
f-4fm Licensed Professional DINTERIOR ❑CHIMNEY REPAIR
Oat I am exempt
DECLARATION OVER201-IA)AMPS1000AM IMPBACH R MODR
I hereby affirm that I em exempt Imm the Comrucmr's License Law for me OVER IU(IOAMPS ❑BATEI REMODEfJREPA I0. D DEMOLITION
3 a F following reason.(Section](131.5,Business and Professions Cole:Any city or county SIGNS ELECTRICAL []OTHER
=O y which rtyuGes o permit to camormL alter,improve,demolish,or repair any souclu e
F.
prior to its issuance,Also requires the applicant for such Permit file a signedsmtemem
m SPECIAL CIRCUIT/MIS
{vv{�u��} that he is licensed pursuantmthe provisions of the Conlmmor's License Law lChupter9
OOa (commencing with Section 7000)of Division 3 ofthe Business and Professions Code)or TEMP METER OR POL IN COMMERCIAL•
0 4 Nat he is exempt therefrom and the buts for the alleged exemption.Any violation o! ❑NEW BLDG/AUDITION ❑DEMOLITION
Ito Section 7031.5 by any applicant for a permit subjects the applicant o a civil penahy Of POWER DEVIC•S
F Z} t more than five hundred dolim($500), ❑TENANT ❑FOO[)SERVICE
C ❑1,as owner or the procn,orm employers with wages as their sale cam IMPROVEMENT
propon,, yMin Y 8 compensation, SWIMMING POOLE
Fo will da the work.and theswdure is not imm�dedoroRered for sale(Sec.704,1,Business ❑OTHER
L3 An, and Professions Cade:The Coatmena's License law does but apply to An owner of OUTLETS-SWITCHES-FD(TU
property who builds or improves thereon,and who does such work himself or through
his own employms,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SO
We.If,however,the building or improvement is sold within one yew ofsnmpation,rhe SQ.FT.FLOOR AREA $/SQ.PT
owtmrbuilder will have rhe burden of proving that he did not build or improve for per-
pose of sale.). -
1,As owner-1 the property,um exclusively contracting wish licensed emato mts m TOTAL:
construct the project(Sec.70 ,Business And Professions Code:)The Convector's Li-
conse Law does not Apply to An owner M`pmPcry vshu builds or impresses doemon,and QTY. PLUMBING PERMIT FEE
whoeoAu N farsochprojects with neoannewds)licensed promiumo the Contmcmes
License Law. PERMIT ISSUANCE �,SQ
❑1 um exempt under Sec. ,B&P C for thio reu>on
ALTER-DRAIN&VENT-WATER(EA)
"c'
Dam VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE I Cs C//-)
I herebyaffirm under Penalty of perjury one of the following declarations: / ( &//0
I huveandwillmaintainnCerificamofCunsentmself-iromcnor Workers Comcea- DRAINS-FLOOR,ROOF,AREA,COND.
cation,As provided for by Section 3700 of the labor Code,for the performance of the STORIES TYPE CONSTRUCTION
work for which this permit is issued. FIXTURES-PER TRAP a, QO
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
37M ofthe labor Code.Funds,performance afthe work for which this penoit is issued. GAS-G.SYSTEM-1 INC.4OUTLETS OCG GROUP APN
My Workers Compensation Insurance carrier and Policy number are:
Carrier. Policy No.: GAS-EA.SYSTEM-OVER 4 TA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASE/INDUSTRL WASTE INTERCEPTOR
(This section need not IN,completed ifthe permit is fortune hain rcddallam($100) BUILDING DIVISION FEES
or Fess.) GREASETRAP PLANCHECK FEE
Loy anythstinthe Performance ofth Iwork oorwhich this tPermit he Wisissued,I shall'Compen- SEWER-SANITARY-STORM EA.200 Pf.
not employ ypemun in tiny moon o mbecoic -t to Warkers'Compen- �O ENERGY FEE
,z sasiob Laws lift Dam
z O A licant WATER HEATER W/VENT/ELECTR
PP GRADING FEE
ti NOTICE TO A PI NfUlffmr a g Ce (Exemption.you should WATER SYSTEMaREATING
F become subject m Ne Worker's Com enssti,n provisi0irs of the labor Cade,you Ante( SOILS FEE
forthwith comply with such Provisions or this permushall be deemed revoked. WATER SERVICE
0. 0
CONSTRUCTION LENDING AGENCY
7 z NEW RESIDEMIAI.FILMS. SQ.FT. PAID
I)0, lhereby affirm ffits .arc isaco (Sce.3nlendil agency for theperformaneof Dam ReeeiptM
� H the work for which this permit is issued lSce.309],Civ.C.) '
Lender's Name 'TOTAL:
IU Zanders Address TOTAL: a
0. 1 cenify Not 1 have reed this Application and stele that the,hove Mooradian is BUILDING FEE
V) correct.l agree to comply with all city and county ordinances andsmro laws existing to QTY. MECHANICAL PERMIT FEE
V Z .building construction.and hereby authorite representatives of Ws city to enter upon the SEISMIC FEE
above-mentioned property for impection purposes., PERMIT ISSUANCE(We)agree to save,indemnify and lose,harmless the City of Caveman,against ELECTRIC FEE
Iiabilities,judgmcnts,cosksand expenses which may in any Way Accmc almnamid City ALTER OR ADD TO MECH.
n consequence Mthe granting of this permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM)
SOURCE REGULATIONS. MECHANICALFEE
AIR HANDLING UNIT(OVER 10.0n)CFM? CONSTRUCTION TAX
Signature of ApplicancUmmocmr Date EXHAUST HOOD(WIDUCD HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Willtheapplm torfotum building occupantstomorhandle hamNous material HEATING UNIT(TO 1(1(1,000 BTU)
as defined by the Cuvemine,Municipal Cole,Chapter 9.12,And she Health and Safety'
Code,Section 25532MU HEATING UNIT(OVER 100,000 BTU)
❑Yes E]No VENTILATION FAN(SINGLE RESID) PAID
Will the opPlicam or fumrc building occupant axe Wuipmem nr Devices which Date Reccipt 0
it hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP LIFT OR 100.000 BTU)
rsWet]
❑Y C]No BOILER-COMP(OVER IW a00 BTU) TOTAL:
I have real the hazardous materials rx,dowems abler Climate 6.95 of the CWT. AIR CONDITIONER ISSUANCLATE
tomo Heald&SafetyCede,Sections 25505,25533 And 25534.1under der l that ifthe NEW RESIDENTIAL MECH. SQ.IT.
buildingdoes net instantly have a mount.that it is my mnan ibility to notify the occupant
Ownerorauth omsdAgent Date TOTAL: ISSUED,,: 1f
nFFICF
,k® 10300 Torte Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
(408)777-3333 (fax)
November 19, 1997
Homeowner
7540 Tiptoe Lane
Cupertino, CA 95014
SUBJECT Permit #31095
To Whom It May Concern:
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
!�/IL^.r`rl Cll n'4%/'12tl IIICP/