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30109 APPLICAHTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO - BUILDING-ELECTRICAL. PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING P OJEC-MECHANICAL 30109 " BUILDING PROJECT IDF.NTIFIL'ATI(IN BUILDINGADDRF_SS: SANITARY NO. APPLICATION SUBMITTAL DATE ©IqQ s- fx OWNER'S NAME: PHONE: CONTR OR'SNAME: LIC NO: NIC CONTROL# *RCHITECf NGINEE ` LIC NO ADORE S. ❑ I is CONTACT: P ONE: BUILDING PERMIT INFO 'gJ,��JI�fl �/�' (}/'yY� ❑ Consultant Fws Paid by Applicant(Initial) ,PLLDC; ELECT PLUMB MECH {I( LICENSED 10ENSED CONTRACTOR'S DECLAR/ATION��/ ❑ QTY ELECTRIC PERMIT FEE 1hereby affirmivisthat 1amfftheBJinss nd Preonzof Cock, YQommencin% JOB DESCRIPTION iwxZ with Section]Oo0)ofDivisi�n Jofthe Business and Pro@,,ions Cale,and license is /' RESIDENTIAL: uI0 PERMIT ISSUANCE FU5 mfall force anJ elle ❑SFDWL [I KITCHEN REMODEL Tai [-loanu Class Contranor APPLIANCES-RESIDENTIAL []ADDITION ❑PLUMBING RE-PIPE F.Din ARCHITECTS DECLA ATI N PANELS ❑MULTI-0NIT [I STRUCTURAL z O y z I understand my plans shall be used m public recoNs MODIFICATION O Z.-0 UPT02MAMPS - ❑INTERIOR OCHIMNEYREPAIR E4t:W Licensed Professional 201-1000AMPS IMPROVEMENT W Y� OWNER-BUILDER DECLARATION I - OVER VXXIAMPS O BATH REMODELIREPAIR E3 DEMOLITION C Q I hereby affirm m Thal I aesemft from the Contrcmr's License Law bertha (3 L F following reason (Section]113 L5,Business and I'rolessions Csd<:Any city or county SIGNS ELECTRICAL [j OTHER W LL y which requires a factor to constrict,alter,improve,demolish,o repair any structure E' +�y Triorl t - Ix 4 :Ih ppl chps all 1 'Cgnd,tiovecnl SPECIAL CIRCUITMISC. A. r � N rvth licensed prsue n IM1 provisions l C m n rs is L (Chaprer9 W C�0 (aoreemacmgWlls Section 7000bofDi,mrn-o (hall in sr td Pm(csjim,Cak)or TEMP.METER OR POLE INST. COMMERCIAL: d 6 p that h pr tM1 f d theba. II pt Any i f ❑NEW BLDG/ADDITION ❑DEMOLITION k^� Seco 70115 by yapplicantf r t pl n Ip ally f POWER DEVICES W^'mp ❑TENANT ❑FOOD SERVICE . �zr 37 mm� eN T h dnIJ11 - Olq �xQD ❑I frh l pc ty y I t fie: th I s pest SWIMMING POOL ELECTRIC C: IMPROVF:MEN'f 'illd or sale 6'3^N and P r employees, ov d Nat s ch ta d I d 1, k h '1,mi B ' s 7 ❑OTHER andP I Code TI C I Law e I (Seel n rf OUTLETS-SWITCHES-FI%TURF,S property h builds f J Jh his o y nip rr ns are cor incedcaloroffered for NF.W RESIDENTI LE R SQ FT. sale.If.however,the building nr mainivcmcm issold within one ycmnifconifI I ohm SQ.FT.FLOOR AREA $ISQ.FC owner-builder will have the human of proving that he did not hnilJ or improve p9,c f. 1 ) Ej ith Own1,er ftheproperty,KER'Sexclusively I r g licensed contractors to P - -W TOTAL: , yyJ t r A construct project H d Professions de The nmd Li (; 2hre cew Law does t apply to fp pony h builds improves thereon.and QTY PLLMBIN E FEE Cl who eoruets formeh pngvts w'IM1 asanwunr(yl licensed Pursuant.,he Cmmram', h1996 �f/BL.Ye License Law. ERMIT SSUANCE I am exempt made(Sec. B&PCfothisreasn ALTERDRAN&VENT VALUATION ENSATION IECLARATUsOeN T BACK FLOW PROTECT.DEVICE A- OT I hereby affirm under penalty of perjury one of the following Jcclamiona: / 1 ❑I have and will maintain a Certificate ofCosenr to self-insure for Workefs Compen- DRAINS-Fl.00R,ROOEAREA,COND. STORIES TYPE CONSTRUCTION soma,as provided for by Section 3700 of the Labor Code.for the performance of the work for which Ibis permit is lsemed. FIXTURES-PER TRAP 0 1 have and will maintain Worker'.Compensation Insurance,as required by Section 37Mofthe LmrCate,for the ferfrmarneeofihe work for which this permit is issued. GAS-EA.SYSTEM-I INC.q OUTLETS OCC.GROUP APN C Worker'sC gyT1yIR16 yppc[t'yrti-Poli Policy uI ,a '�1 Cameo IY-Y1150 Policy Policy I%s s/�F� GAS-EA.SYSTEM-OVER S(EA) ' - CERTIFlCATEOFE RMPT10N FROMWORKERS' COMPENSATION INSURANCE GREASFIINDUSTRL WASTE INTERCEPTOR BUILDING (7secimin need not be completed tribe penin is for one hundred dollars - NisDIVISION FEES or less) GREASETRAP PLANCHECK FEE 1 cenify that in the perfonmanecofrhe work for which I spelisten'ed,Lshall SEW ER-SANITARY-STORM E1.21X1 Fi. not employ any PersianPersianin any manner ai as its i M1srme j nCompcn- ENERGY FEE OZ sarin.laws of C' o ia.U e WATER HEATER WNENVELECTR Z O Applicant GRADING THE h NOTICE TO APPLICANT:If,after making this Cesilicat •amnion you shigaw WATER SYSTEM/TREATING 3 become s.bjed to the Workers Courpensmlon Provisionsof the Labs Csde,you muss SOILS PET: forthwith comply with such proviviom or this perms shall be denned rev.ked. WATER SERVICE y zCONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ,PT. PAID U O IMrchy affirm that there isuconstruction lending agency for the performance of Data Receiptp the work for which this permit is issued(Sec.3197,Civ,C.) C) U Landed,Nana 'TOTAL U LcndcT'.,Addreav TOTAL: i cenily that 1 base read this afpllcmion and stere that the above information is - BUILDING IT A .Hi fn eorrcec l agrento comply with all eily tin dcoiinty...rhoneesamd ,an laws refractim. QTY MECHANICAL PERMIT FEE U building construction,and hereby nnthmizc rcfrcmnoJlvcs of this city ,,enter uponre SEISMICIWE above mentionsilproperty fp t parrisoses. PERMIT ISSUANCE ` (W) 8 r J 'y keep1tr I, h Cly 1Cpsf gain,,' Ii1,ECTRICFTE • ♦j hiflel'i ludgmcm,mt std aspera,which uy in any way yninst sod City ALTER OR ADD TO MECH. p in asequence of the granting of chis permd PLUMNING Tsai !� APPLICANT UNDERS NDS AND WI IMPLY WITH ALL NON-POINT AIR HANDLING UNIT'(to 10."CFM) MECHANICAL FEE SOURCE REGU,ATI 5. ' AIR HANDLING UNIT(OVER Io,Bf10 CFM) CONSTRUCTION TAX Signature nfA eardCommcmr Dam EXHAUST HOOD(WMUCD HOUSING MITIGATION FEE HAZARDOUS IATERIALS Ill. (ISURE . Will the applicant or future building occupant store or handle h...nOms material HEATING UNIT(TO 100,0071 BTU) as defined by the Cupertino Municipal Coca.Chapter 9.12,and the health and Safety Code.Section 25532(x)° HEATING UNIT(OVER 100.000 BTU) ❑Yes F1 No VENTILATION FAN(SINGLE RES ID) PAID Will doe applicant or future building occupant use equipment or devices which Dam Receipt X mit hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(3HP OR 100.000 BTU) TOTAL: DistricC p Ye[ 0 N - BOILER-COMP(OVER 100.0g)BTU) I have neat IM ou M1avvds materialsiamaterialsrequirements tarter Chapter 6.95 of be Cali- AIR CONDITIONER ISSUANCE DATE forma Health&Safety Code.Seclies,25505.25533 and 255311 uMerslarW than if die NEW RESIDENTIAL MECH. SQ.rL �� building cases not Ny have a tenant,that it is my nspnnsibility to notify the occupant 10.0 of the requirement,which must b:mel prior o issuance of a Ccrtifietwe of Occupancy. X Owner or authorized agate Dae TOTAL ISSUEI OFFICE - 10300 Torre Avenue • Cupertino, CA 95014 L'.11.0 �il Capel-thio Building Division (408)777-3228 (408)777-3333 (fax) November 3, 1997 Homeowner 10199 Lockwood Drive Cupertino, CA 95014 SUBJECT Permit #30109 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, 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 lerk Pnnfetl ort Fec�c;,ja Papal