S 1770 (2) .APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-EI.F.C"IRICAL PI! B'FNo
BUILDING DIVISION APPLICATIONMERMIT1 LUMBING-MECHANICAL. 1770
BUILDING PROJECT IDE\11F'ICATION
NG ADDRESS:
I1111LD SANITARY NOAPPLICATION SUNMEC AL DAT[
�/s y� �IOZ19 41>4 I AIAY C c1fZ-1f rl'✓s
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IONE�-s jL CON'I'NACTQk'.tifln L LIC NO',
J/�- NIC C()N'I'ROL p
ARC)11'1'IECfII!NGINERR: I.IC NO: ADDRESS: ❑
)N'I'ACT: PHONE i: BUILDING PERMITINFO
�.0 �i 4� I�6-� /- /ZJ /L ❑ Cnnsndtanl Fees Paid by Applicant(Initial) BLDG US.=' PLUMB MECH
H' 7[7 lJ ❑ ❑ ❑
LICENSED CON"UAC'IOR:S DECLARAI'[ON QTY. hI,ECPRIC PERMIT FEE
1 hereby amml that L am licensed under provision.of Chapter 9(cmattmnaing J013 DESCRIPTION
net:Z whhS,,i a 7k )of Divixion i of me Buninfoo enA ProfcsaonF Cud,a, my license is RESIDENTIAL:
I'IERMI'1'ISSUANCfi
C W in fnit liner and fllccl, C SI'DWL C KI'ICIII!N REMODEL
WUU License Class Lic.x APPLIANCES—RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
g¢W Dale Catara t,
LL ARCIRTECI"SUE
CI,AItNtON ❑MULTLUNIT ❑S'I'NUCI'UHAI.
~yZ IundcrstanJm 1 %hall as hIRNII rN PANFI.S MODIFICATION
OZ my oil public UP To 200AMPS ❑INTERIOR C CHIMNI:Y REPAIR
I:." Q LisnxcJ Prnlcssionul 201-11)(MAMPS IMPROVEMENT CSWIh1MINGPOOI.S
C 2— OWN13R-ItU1LUlER DF:CLARAI'ION [I BATH RIiMODI?I/REPAIR ❑DIiM01.1'1'ION
OVER EIXM)AMI:S
tY C Q 1 hereby..Worm that 1 am exempt!rota the Contractor's license law for the CaSTIER
yU Inllnwing re,on.(Seetitsi 90315,Buxinexu and 11 It,.,etnne Cuff:Any city nr mnlnly SIGNS ELECE'RICA],
'31+•Fa' which requires a permit it)construct,almilp darolooh,or repairY slmcatoe �<t-�!!ET
pros 1 'H q the ( suchpe nil. fl % .%
signed SPECIAL CIRCU[Tried INC. yN��/�
S.Iy�jy Gell II nu n tl n PIN C 1 ba 1 I' 1Ch,ser9 COMMERCIAL:
mRW (cam g with SectionWEBB) f6 ".h 3 Ith B nx JI f. 'Codd," I EM P.M 1!TEN OR POI.E INS'1'.
m p,c E (hal he is exempt therefrom and the basis lin me alleged eo....I ioa Any nolmi—.of ❑NEW NLUG/ADDITION C DEMOLITION
w—"" Sfcliun7031.5 by any nptilicunl bar.B,rnlil xubjecthe e applicant to a civ'd faulty of POWER DEVICES CTENAN'f CFOOD S17RVICE
FZ_y th
.11.than five hundred dollnrs($5g). IM )VI-MFN'I'
1,as owner ofthe progeny.or my anduvees with wages a'their sole compensation, SWIMMING POOL ELECI"RIC PER
tS 'IIdu e work.that lhmun,...m is not lntanded.....Smartt linmlf(Sec.7W4.lfuxinenF
F
3 w and e.,v u)builds ur Fhe Cnnlmfmr's Lnd w Lnw duo nm apply es 1nl..senor al UU'I'LI!'I'S-5\VI'rCHES-PIX'1'UI2ES
ta, no ow y who iyee,pr vided ea thereon,and whn d..e,such rintA himself..r through
hie awn mnplayfu,provided tlml such inlpmvanema an,nm intended or olTCmd for NEW RISIAI!NTIAl.Ii1.EC1'k SQ tT.
sale.If fnsever.the building nr improvement is Fuld within nuc ycundcolnpinlnq lhf :7i
E/SQ.FT.
!,builder wRE have me blamed of So vin,that he did nils builA ar impmvf far pur-
s reason —
Rmc..f Falcl.
❑I,av towner ill the prnllfny,Ym txflavivcl..'....totaling with I...lomJ coon, ra la
eansmm the project Sc,7044,Busincsx and Promssiam Ctde:)'Ibc Contractor's I.i
-
ConwLnwAmsnolapplymanownerof prnpeny who builds or improves thermal.and Q'TY. PLUMBING PERMIT FEE
whn mlmale lursufh pr..jcu4 with a Cunaacm(of Iicco,d pu mn,othc Cunt rnaur's
E.iccnsf law. PERMIT ISSUANCE
I um e<mnpl unilc�l'cc. .B A P C fur 1 i
s /T AI;I lilt-DRAIN&VIiM'-WAITER 11!AI
O tld
Am WORKER'S COMPRNSATION OBPI.ARATION BACK PLOW PROTECT DEVICE
I M1emFy ull'to cad,pvnah,of perjury anc of the t'..Ilnwing dredUni ioneu
'11 havanndwillmainlam u Cenif me offensenuo ttll'-imure for Worker's Compcn- DRAINS-FLOOR,BOOR AREA.CON) Sf(1R11iS 'fYIEF CONS'I'RUC'IION
as provided fur by Section)71x1 of She I.abon Coal,for the performance of the
011 fur which this permit io i—ed FIXI'URCS-1'ER l'kAl•
1 have and will maintain Workers Conlpfnsulion Insuratma as required by Section
3700bflhm Lahor Code.far the performance nfthe work far which this permit is issued. GAS-EA.SYS TEM-E INC.4 OUTLIifS (ICC.GNUUP AI'N
My Workc,,Compfns111111 Inonrmmm maria end Pot iq nnnlhcr are'.
Currier. Pill icy No.: GAS-EA.SYS'IT:M-DYER J(EA)
CURTI FECATT OF EXEMPTION FROM WOR KURS' GNEASPIINDUSTRL WASTE!INTERCEPTOR
COM PENS A'1'[ON INSURANCE BUII.OING DIVISION ItFS
ED,Fcaion need am hecnntplfmd if the permit is fa.one hundred dol Im,U II V)
GREASE'fkAl'
I'I.ANC11ECK ILII
or,le".)
laytoy Malin the pry bourrccnl,tobek...c c i,this She Wuor,issued. tpolldoolSF:W'IiR-SANITARY-STORK EA.20K)IT,
nm en+ploy anY grana in-fly nnlnner sn us LL+Mcnnu Fuh,'Ien hr the Wurkrl'.2 Cnnp+cry ENERGY Ilii!
Z sdion Iowa rel California.Dale WAFER I IEAFER WIVL'NT(H.ECTR GRADING FEE
zC) ApPlicum
^ NO'ISEE'10 APPLICAN'1:H.utte-nakinglhir Cnilicma..f Elrfnyaum,You nhnuId WAS HIR SYS'I'LMnBRAS INC.
f" Income sob'e t to the WmUr`v Com lion - f the Labor Ctde.you moot SOILS Flili
pens Permit
iommo
� FC ti InnhwilM1 comply with such pn+viainn'ilr lhi'{nmlil shallShe deemed revoked. W'AFIER SERVICE
W �
CONSTRUCT ION LENDING AGENCY NEW RESIDENTIAL PLMR. SQ.n I'AI1l
J Z Dam R, 'i p
V � (herell)'af11nI1111a11hf.eltafnmlNCliOn leading agency for the performance of
I.I. F'1 She work fur which nils pc nn 11 iX IswN(So,.3097,Ci,C) TOTAL:
O 1,ca& s Name TOTAL:
,r {U LcnJfr's AAdms. BUILDING FEE
1 1 funlly Ihnl I have mad fi it applicminn and saJf the,the ahilvm information is
F' N ! met[.glee
m romply all all city and counly and ancesandunmlawsmqudagm QTY. MECHANICAI,PERMIT FEE SHISMIC ITI!
J building aanMlacrion.and hereby amh..ve representatives ofthis city menmr cpm She
uNowo-lnenlioned....putty fn,lmpcftiun pur,-vX PI?It MI's ISSUANCE! ELICCfRIC ITE
(Wo)agree to wave,indcnmity and keep handle"the City rel"Cupertino against X
limbilities.judgmemo,costs andexpeawsahich mayinany way accrue againFlsaid Cil., ALTER OR ADD TO MECH. PLUMBING FEE
no necgnrnce of the grunting of Ih IX periont.
APPLICANT UNDERSTANDS AND WIE"1.COMPLY WE 111 ALL NON-POIN'I AIR HANDLING UNI'I'(To lo.000 CFM) MECHANICAL FEB.
SOURCE REGULATIONS.
AIR IIANDI,ING UNI PROVER IB.INxI CFM( CONSTRUCfION'I'A%
Signzlumof ApplimanV'co emr ])ate EXHAUST'HOOD(W/DUCT) HOUSING M UIGAF10N hili
HAZARDOUS MATERIALS DISCLOSURE!
Will the eppllnrdullitembuildtngnfeupunt aorcialsndlc hvnrdnusmamriul HEA'L'ING UNIT(101100M BTU)
to Jefirml by the Cupentinil Municipal Cada Chapter 9.12,and the Health..it SafetyMAI
NIT IOVIiR 100.001 BTU)
Cock,Semon 255020117
EjYc' 7N ON SAN(SINGLE RUSH)) PAID Datc Receipt#
Will me uPPlictm nr future building tneup.nt use equipment or devices whichOMP OI{P OR BTU)
it hmunlnuX air onuulninulno ao ddinfd by the Ray Arca Air Qonlily Manugcmmd USE f "not, OMP(OVER IO0.(Xt0B'IU)
❑Yc, F1 No
'1 ONE ISSUANCE DATE
have mail the ha-Nous mal
mquirflnents under Chap¢rM19$of the Cilli-
forma flenith&$ulety Ctde,Sections 25505.25533 and 25534.I udeorand mm if hoENTIAL MECH. SG�IT.buildingduosnm.umndy haveatenant mal It is I'll re'pruibiliry..fthe Iryuirfmmnt,which mast M met poor,,i'wanferel aCuniOaae at(kcupancy.OwnerorlmthorircJugfmAa. TOTAL: ISSUEU RY:
OFFICE
10300 Torre Avenue
Cupertino, CA 95014
CUN, o1,
Wupei talo Building Division
(408)777-3333 (fax)
February 23, 1999
Homeowner
11593 Upland Way
Cupertino, CA 95014
SUBJECT: Permit# S 1770
Dear Owner:
We have been going through our files in the Building Department, and contacting those
people with permits remaining "open".
According to our inspection records, this permit has not been signed off by the Building
Department. 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 remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY O-FF CUP�ERTINO
Christy Akatiff, Administrative Clerk
Printed on Pecycled Paper