S 0817 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
BU ILIIING-ELEC'RICAL P[`$MI'r NO.
CITY ON CUPVISION PLUMBING-N'IECIIAN ICA 1, V 0817
III
DI
APPLICATION/1'F.RMIT
BUILDING I'ROJCOI'IIIFNTINICAI'ION
r SANITARY NO, APPLICATION SUB ITFAL DATE
BUILDING ADDRESS:
OWN 'SNAME_ 10NE: ON' TON'.' AME: LIC O:
,. NIC CON TROL#
4 RCHITECTMNGINFIR Lic NO: A k' WS
CONTACT PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) R ELECT PLUMB ME I.
❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE JOB DESCRIPTION
1 hereby affirm Iha(I um licensed under pmvislons of Chapter 9(commencing
OC'Z with Section]t f 3.flhe Busr:e Pdfessinnl I Jnrylicenwis RESIDENTIAL
WOO PERMIT ISSUANCIi
a�0 in full force eRec OSPDWL El KITCHEN RIiM013E1,
.e"U License le l.ia APPLIANCES—RESIDENTIAL ❑AUDITION ❑PLUMBING RI;-PIPE
i-Z m Ilam Convector
mGy OMUhTI-UNIT ❑STRUCfURAI.
RCHITI?CPS DP.(..
p.O t/s ' Q/f PANELS ODIFICA'I'ION
Z p,nZ 1 understand my plans shall he used m public..,it,
UP T0210 AMPS QINTERIOR iIMNCY REPAIR
OsN.^Oty I.icensed Professional 201-1000AMPS IMPROVEMENT E]SWIMMING POOLS
edd23OWNER-BUILDER DECLARATION OVER Into AMPS ❑BATH RIiMOUEURIiPAIR []DEMOLITION
1
aim, 1 hereby affirm that 1 em exempt from the Connector's License Law for the
x 06V following rennin(Section'/031.5,Business and Pofessinm Code:Any city or countySIGNS ELECTRICAL [I OTHER
I+1 W I••' which requires a permit In Construct,xlmn improve,demolish,or repair any structure
G o, prior to it,issuance,alut requires the applicant avouch Per it to Men signed statement SPECIAL CIRCUI'I'MISC.
Aar—
x that bass licensed pum...tto the preakimsnfthe Cumuli License law(Chapter 9 fOMMERCIAL:
�COp (commencing with Section 70001of Division 3 afthe Business and Prfessions Cale)or TEMP.METER OR POLE INST.
40.m C thin he is exempt therefrom and the finis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
it LSection 7031.5 by any applicant for n nn permit subject&the applicant a civil penalty of POWIik DEVICES ❑ ❑
TENANT FOODSERVICE,
FW•ZN4) nm mom than five hundred do[]...($500). IMPROVEMENT
SQp I]I,a owner oflhe property,or my employees with wages as their sole compensation. SWIMMING POOL ELECTRIC []OTHER
will dathework,and lhesauclure isma amndedoroBCrell fmsale(Sea.]nW.Business
rn
a 3 and Professions Code 'the Curucmr's License Law doss nn apply to ua owner of OUTLETS
property who builds or improves mention,and who does such work himself or through
his own employees,provided thio such impmvemcnts are not intended or.feted for NF.W RESIDENTIAL.ELECI'R
suit.If,hnwevec the building or improvement is sold within ane year olrnmplCron,the SQ.FT.BOOR AREA SISQ.PI'.
mer-builder vall have the burden of proving that he did not build nr improve far pur-
pose of ssle.). TOTAL:
0 I,as owner of the property,am exclusively contracting with licensed Contractors m
onsvuct the project(Sec.7014,Boniness and Professions Cosi The Contractor's Li-
Vase Law dncsnot apply loanowner(if property who lands or improves thereon,end QTY, PLUMBING PERMIT FEE
who cummcu for such pmjects with.contmnorpd licensed pursuanuo the Contractor's
License law. PERMIT ISSUANCE
0 1 am w emia and,,Sm. .B&P C for this reason
ALTER—DRAIN&VLNT—WATER(FiAI VALUATION
Owner Data
WORKER'S COMPENSATION DECLARATION BACK PLOW PROfGLT.DEVICE '
I hereby.(fon under penalty of perjury one of the following declnations:
141aI I have and will maintain a 11,fiicom o(Cnnsen to sell-imure for Worker's Couplet- DRAINS—FLOOR,ROOF AREA,COND. STORIES TYPE CONSTRUCTION
tion.us PowidM for by Section 3710 of the labor Code,far the performance(if the
rah this permit is issued. FIXTURES—PER TRAP
wt I have and will maintain Workers Compensation Insurance,as acquired!by Section GAS—list.SYSTIiM I INCA 011'IT.FTS
3]ql of rho EaMa GWe,Inn the perfnr a ce.lure work for which thisper lis ieumd. OCC.GROUP APN
Cmicnr Rlnsum +Sd'h.�i Policy GAS—EA.SYSTEM-OVER 4(PAT
Carrier. V�/�f/o Nas�
CERTIFICATE F EXEMPTION FROM WORKERS' GREASIANDUS1'RL WASTE?INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
("Hossection need not hecompleted iflhcpcmnitixfmonehundred dollara(SHOI GREASCTRAI'
or less.) PLANCHF.CK PEC
I Certify that in the performance ofthe work for which this permit is issued,l shall SEWER—SANITARY—STORM EA.200 FT.
not employ any person in any manner so as to become cahiect to the Workers'Coilmi ENERGY FF.I?
Z .rain.[.,,we mCclibsmi.,Dale WATER HEATER W/VENT/HLECTR
GRADING Illi
Z O Applicata `
y NOpICH TO APPLICANT:If,after making this Certificate of Etu m,fnn,you should WATER SYSTEMITREATING SOILS FEE
hecomctehictl to he Wroket's Compensation poo,kiomof the Labor Cade,you must _
G fnnhwiN romply wish such pmvi.vianc or this panni(shall he deemed revoked. WATER SERVICE?
CONSTRUCTION LENDING AGENCY NEW RESIDENT'LAI.PLMB. SQ.FE PAID DateNeetlplM
hereby Grind the,'hem is a construction lending agency for the performance of
�pthe work for which this pctmh is sound(Sec.3097.Civ.C.) 1 Cy•AL,
0 F•; Lenders Name
�W[ Lendcr'x Address TOTAL:
1 certify that I have real this application and stale that the above infommtinn in BUILDING PPI' /
rCoj Co.,.l agree(.comply withell City andcnutty dndinumcs aadstmc laws mating m QTY, MECI IANICAL PERM IT DIY F-HE Vv
Z building Conswnion,and hereby authorize rcpresenlalivesofthiscily menlerupm the SEISMIC THE Q
shove-mentioned pmpmy for inspection purposes. PERMIT ISSUANCE ELECTRIC PEP
(We)agree m save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and Expemes which may in any way accrue against said City ALTHR OR AUD'I'O MECH. PLUMBING THE
in consequence of the gtnnting of this a.mil.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNITGO 10,000CFMI MECHANICALPEE
SOURCE?REGULATIONS.
AIR HANDLING UNIT OVER 10.000 CFM) CONSTRUCTION'I'AX
Signaturen(ApplicanUCommctor Data EXHAUST HOOD(W/DUCr) HOUSING MITIGATION FEE
EIAZ RDOUS MATERIALS DISCLOSURE
Will the applicant orfmure building occupant store or handle Incautious noned.l HEATING UNIT G 0]POLLS)BTU)
as defined by the Cupmino Municipal Code,Chapter 9,12,and the Health and Safely
Cade.Section 25532pd? HEAPING UNIT(OVER 10)(TX10 BTU)
❑YE• /ff�N VENT I LATION PAN(SINGLE RESID) PAID Dee Receiptp
Wuthe.pillion or future Wilding medieval as equiplfen(of devices which-
e IJHP OR II10,fA70 BTU)
mil hueNnus sir conmminams as d y the Bay Area Air Quuliry M.nagelmm TOTAL
Zal!l BOILER—COMP(OVER IIXI,(XX)BTU)
El Yet, No
1 have read the hazallous materials neon made,Chapter fi 95 of the Cali- AIN CONDITIONER ISSUANCE DATE
fomiz Health o`' Code.Sections 2 S. .I understand that if the RESIDENTIAL MECI?, SQ,PT.
huildin6 doe tcu tan ha ' vmy resrymsibt mnohfy int
n(Ne real
eaf a Can
%nT��pgi)
Owners. mWtIoalagent s Dom TOTAL: ISSUEDBY:
OFFICE
x
_ ® 10300 Torre Avenue
Cupertino, CA 95014
Cits 0f
ituperdino Building Division
(408)777-3333 (fax)
February 23, 1999
Owner
7586 Waterford Drive
Cupertino, CA 95014
SUBJECT: Permit# S0817
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, 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 OF CUPERTINO
Christy Akatiff, Administrative Clerk
Printed on Recycled Paper