S 0323 (2) �PPLJCANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPER'pINO BUILDING.ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATIONIPERMIT rLumnlNr.-MBcunlqu:nl. O3 �.
BUILDING PROJECT IDEN'1'IF'ICA'r1ON �J
UILDING ADDRESS: SANITARY NO. APPLICATION SGBMI'I'(At.DA'1'Ei
94 WFC AJ til
UPS NAVE. PHON CONTRACT'OR'S NAME: LICNO: NIC ONTROLa
7
LfC/R wamosaJ 'IWI.42N
CHITECT/ENGINEER: LIC NO: ADDRESS: ❑
COM'ACT: c .PH �� / BUILDING PERMIT INFO
L�-.0 c Y'V' �+IJ ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MUCH
•1 ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT PEE JOB DESCRIPTION
I hereby o1Rrm that I am licensed under provisions of Chapter 9(commencing
aZ with Section 7000).1Divinion J offline 11.1mrssond Poofessions Cole,und my license is RESIDENTIAL
gF-1O I'I?It MIT ISSUANCE
� in toll force and dI,
lect. ❑SPDW
KITCHEN RIiMODIiI.
r, License Clore _ Lice - APPLIANCES-RESIDENTIAL [I ADDITION ❑PLUMBING RISPII'1H
F W Dats, Contractor
y py ❑MULTI-UNIT ❑5'I'RUCTUItAI.
F=y AkCIJI'1'F.CT'S DECLARATION PANELS
MODIFICATION
OZy l ander"tend n y pbms.ted be used as public records
r G UPT02MAMPS I-]INTERIOR El CHIMNEY REPAIR
Licensed Professional 201-10b)AMPS IMPROVEMENT Q SWIMMING POOLS
Q EZ1 OWNBR.BUILDER DECLARATION
tat .4 OVER 1000 AMPS [I BATH REMO JR
0AIR ❑DIiMQI.I'I'[ON
6 I hereby affirm that I um exempt from the Contractor's License Law for the ❑OTHER
kO y V following reason.(Section 101 L5,Business and Professions Code:Any city or county SIGNS ELECTRICAL
41'3e which requires a permit to constrict.alter,improve,demolish,or repair any stu cwre
prior to its issuance,also rcquircs the Vitiator for such Permit o file a signed statement SPECIAL CIRCUIT/MISC.
F!!jam That he is licensed parsurna to the provisions oflhe Centimeter's License low(Chapter9 COMMERCIAL:
W�C�O frommencing with Sttli.n 70001of Division3ofthe Business and rrofessions Cudel or TEMP.METER OR POLE INNr.
6 a c C that he is exempt therefrom and the basis hour,alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑BHMOLITION
�y Scene.7(31.5 by any applicant fill.permit subjects lheapplicanno a civil pcmd,of POWER DEVICES ❑TENANT ❑FOOD SERVICE
art more than five hundred dollars 1S500E. IMPROVEMENT
SSC ❑I,.sowneraflhepmpeny.or my employees with wages."their sole compensation, SWIMMING POOL ELECTRIC ❑OTHER
will do the work,and the ancnure is a.,intended.roRered forsale(Sec.764,Business
Win 3 and Professions Code:The Contractor's License Law does not apply to an owner of OUTLETS-SWITCHES-FI%Tl)RCS
progeny who builds of improves thereon,end who does tech work himself.,Ihnmgh
his own nnployeea,provided that such improvements are not intended m offered for NEW RESIDENTIAL ELF.CTR SQ P-L SQ.FT.FLOOR AREA &/SQ.PB
sale.IL however,the building or improvement Es sold within one year of completion,tine
e,twi ch,will have the burden of proving that he did not buil)m improve lin pury
p.a.if sale.) TOTAL:
❑ I,m owner at Ibe property,nm exclusively contracting whin licensed contractors to
instruct the project(Seo 7144.Business and Pmfessons Codcp'Ihe Cormwtor's I—
cense Law does not apply m an owner or property who builds or improves therein,and QTY. PLUMBING PERMIT FEF; p t
who contracts for such projects with a conwctioun licensed pursuant to the Contractor's Y-
License Law. PERMIT ISSUANCE
❑ lam ex em pt under Sea ,EI&P C for this reason
ALTER-DRAIN&VENT-WATER(EA) jkbT.UATl0N
nu Dore
WORKER'S COMPF.NSAT DECLARATION BACK FLOW PROTECT.DEVICE
I hereby.Rion under penalty of perjury one of the following declamtionm
001"'I see and will maintain.Cenificme of Comentto self-inmre for Workers Compen- DRAINS-FLOOR,ROOF,AREA,COND. -- _. STO TYPE CONSTRUCTION
sutian,as smvidad for by Section 37M of the Labor Code,far the performance of the
work for which This permit is issued. FIXTURES-PER TRAP
C] [have and will muimmit Workers Compensation In mmntt,as rcquircd by Section
J71X)nflhs,laMsrCMe,fnrthe performance of the xork far which this permit is issued. GAS-EA.SYSTEM-1 INC.40UTLIRS OCC.GROUP MIN
My Workers Corarsu satin Insurance carrier and Policy number are:
Carrier: Policy No.: GAS-EA.SYSTEM-OVER 4(EA)
CHR TIFICATE OIr EXEMPTION FROM WOR KERS' GREASUINDUSTRL WASTE I NIERCEITOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
fI'hiv&action need not be completed iflhe permit isforonehunsinddollam($100) GREASETRAP
PLANCHECK PEE
or less)
I cemly that in the performance (the work forwhich this Permit is issued,I skull SEiWER-SANITARY-STORM IIA.201 FT.
not employ any person in any mars r so as to become subject w be Worker"Compete ENERGY FEE
Z sution Laws of Cohnan'nu Date WATLR I]HATER W/VENTOLECTR
12 Applicant I GRADING FEE
NOTICE TO APPLICANT:If,after making this Certificate of Esamgti.o,you should µµpi ER SYSTEM,TREA'TINO
rn sans FEE
abecome snoop m the WorkersvNem s his provisions of the Labor Codo you must
{4J forthwith comply with such prowl"ions nr this permit shall bedeemed revoked. WATER SERVICE
Q PAID
I °'
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.IT. Qum Receipt
VQ (hereby affirm that is a construction lending agency for the performance of
LI. ti the work far which this permit is issued(Sec.JOB?,Ci,C.) TOTAL:
O BUILDING FEE
IOTAL:
U Lender's Name _
D.1 Landers Addrcns
I I certify That 1 have read this application anti sora That the above infonnatimn is
II
V) correct l agree to comply with all city and county carbonates and state laws mlating to QTY. MECHANICAL PERMIT FEE SEISMIC FEE
V Z building eontlmni.n,and herehyauthrmim reprcaaaaaivcs of this city ts erre,mann the
ahov-melnioned property for inspection purposes PERMIT ISSUANCE ELECTRIC TEE
(We)agree to s...indemnify and keep harmleu roe City of Corina, grind
liabilities,judgments,casts end sapient...whichon,many way seems,against said City ALTER OR ADD TO MUCH. PLUMBING FEE
I.consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(To 10.100 CFM) MECHANICALFHE
SOI CB REGUTAT,IONS.
AIR HANDLING UNIT(OVER 13(100 CFM) CONSTRUCTION TAX
treanr Dme EXHAUST HOOD(WIDULT) HOUSING MITIGATION FF.F.
HA7.ARDOUS MATER ALS DISCLOSURE _
Will thenpplicam or Boom building occupantstore or handle huzmJnus minaret HIiA1'INO UNIT(0100,000 B'I'UI
;afl��n
defined by the Cupertino Municipal Code,Chapter 9.12,and the Heofth snit Salary H5ATINO fJNIT(OVP.R I(NI,(kMl BTU)
de,Section 25532m)!❑Yea ❑No V17 TIIATION FAN(SINGLE RESIDE PAID
Dam Receipt e
Will the applicnt or future building occupant use equipment or devices which BOILER-COMP OHP OR 100,(X10 BTU)
it hmuudom air contaminants as defined by the Bay Area Air Quality Management 'IOTAI.:strict? BOILER-COMP(OVER 100,000 ED U)
❑Yes r-1 No
I have read use hmuareas ma¢rials temente under Chapter 6.95 of the Cali. AIR CONDITIONER ISSUANCE DATE
5.2
bombe Health&Safety tcurretly haea Sections t,thati25577esp25534.I understand Thatifthe NEW RESIDFATIALMECN. SQ.FT.
building arcs re currently healbmttenant,that o is my responsibility to notify the panugam
of the reyuirtmenu which mull be met prior m issuance of a Cenificmc of(kcupancy. -
Ownensr.athomed age.l Date TOTAL: ISSUED BY:
OFFICE
01c:1
10300 Torre Avenue
Cupertino, CA 95014
of
Cltpertiiio Building Division
(408)777-3333 (fax)
February 4, 1999
—
Homeowner
10—
\
19964 Wheaton Drive p2/�
Cupertino, CA 95014
SUBJECT: Permit# 50323 7
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
•
Prinled ce Recycled Paper