S0386 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
sCITY OF CUPERTINO BUILDING-ELECI'RIC'AL PE MITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL O3HV
BUILDING PROJECTT LDENT111CATRIN
BUILDING ADDRESS: ,1,,` SANI'GRY NO. APPLICATION SUflMITTAL DATE
�Q $ .-rAtirAtit n e , C1, eesRTI Am I eA �jso
'N' 'S NA E: PHONE CONTRACTOR'S NAMIi: LIC NO.r_ WC CONTROL M
t rf7 fion r! 7r-970 ❑
pRCHITECI'/FNGINEER: LIC NO: ADDRESS:
CONPA TE PHONE BUILDING PERMIT INFO
�+ ❑ Consultant Fos Paid by Applicant(Initial) BDG ELECT Ei.UMH MECII
-72.50-8-7o7 ❑ y ad ❑
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
I h eby affirm ihau I um licensed under Pnvishms of Chapur 9(commencing 306 DESCRIPTION
,OOZO with Smlion]DMgof Division 3 ofihe Biomass not Pntli.csionc Gxk,and my l ion.¢is RESIDENTIAL'
�� PERMIT ISSUANCIi
�I-F in full form and afar. ❑SPOWI, CHEN REMODII.
QUU Remo Clnx La.N pPl'LIANCFS-R151UF.NTIAL � ❑ADDITION PLUMBING R6PIPE
v <c, Ua¢ TS DEor ❑MULTI-UNIT ❑SfRUCIURAI,
ARCHfITArS DECLARATION
~�K I unJcmyd my Plas shall hu towed as PM1Iic re vob PANI?IS MODIFICATION
c.Z-Q UP10200AI11PS ❑INTHR ❑CIHMNEYRHPAIR
F-�2F'YJ uttnuJ Pmfcsai.vl 7111-I000AMPS VEAIENT ❑SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER IIXIaAMPS EAIODFJJREPA1R DDEMOLDION
Q 1 hereby affirm that 1 em exemM from Nv Cimaalm's Ueemn Law Gx me
y O d UF follmvin,mamn.(Section 7031.5.Business and Prnfwxi,rls Code:Any chy or I.mil SIGNS 1:JiCTRICAL ,I
3 a N whiet«yamics a permit to eanammt,alcor,arm...r,&nmli,b or repot,uny swewru
F OS prior to iu i.uuarve.it Ix,uires his,applicant fa,,.h lermil Ed Me v lltincd slmeTem SPECIAL CIRCUITNISC.
HOCNet he is lkanal puowwt 1.Ne pavuion,N the,Ctai actors Ixcnse law(Chapla9
I+I�00 Icormncrcing with Scoter 90W)of lEvisim3Nlhc Nuxiassend F'mfesaiana Codc)or TEMP.MFT ER OR POLE INFE
a ce that So ie csemp therefrom and the nr is for Jm alleged cacmpi.n.Any vi.Imion of D NEW 11). A I( ❑DEMOLITION
u' Seaton 7031.5 by a.Y oppliont fora Permit zubyzns'be upplicannu nell ll Pmvlry of IY)WI?R UL'VICES ❑TUNANT ❑FOOD SERVICE
cot more than five M1undrud dollars(3500). IMPROVEMENT
?Q Dl.uoxwof Nc pmpcny.umycmpwyaa with vases ax Nor adc ampcmatinn, SWIMMINGPOOLELECfRIG
fir wJl do the wmtam lhcawc,meis n�+mteNN orndcnN fm sale lSa.9Bt4,Btvilteas ❑OTHER
end rrnfasinns Co e:The Cmva ims uernxe 1,.does non apply m w owncn N ODII,I:TS-SWITCIIIS-IB X'IURFs
pnnleny wM builds nr improves thcmxi,and wM dixx such wnr4 h..a.1 a-Nnegh
this own employes, rovidad Nat such impmvcmend o2 nd imawc+l or olfc d nor NEW RESIDEKI'I Al,ELECIR SQ UT SQ,FT.FLOOR AREA HSQ FT
.nr-herder-ihe builJiotaren fPi sidasold dO o.neyarofnfirm,for Ne
nler�M1uiklcr will M1aac the barren of pmvin6 nor he did nm W JJ m inmmve for pur-
porchfwla.) P A 1 D
D 1,as m mr.I t e p ,PeE,am exclusively mmrdetin,with liven al inn nm m TOTAL:
onswm the pro)ed(Sm.96M,B d.ecs and Profoxim l Cork:)D,Corar dos Li- AUG
om,a law does,..,apply to annwncr of Profen who build.or lmpoves hereon.and QTY. PLUMBING PERM IT FEE Wwho rnntracE f«such her (s)pujectx wim a ocIinrcN pm,hanl to be ConvactNs u
Licm.se Le, NERMIT ISSUANCE
D I am exempt umkrSm. .It&P C dj his no �1
AIJIeR-DRAIN&VENT-WAI'I!R(EA) V' INC/
Dy
WORKER'S COMPFI ATION DECLARATION "IMI�CEnOR
PR(dtCT.DEVICE
I hcety aRnm uQr pari oI paphy one N de following dcclarmiom:
D Ihavcardwillm inteinaCmi(roof Cons.nuoxelf-Insumfm WM&%Cmil nn LOOR.RUDE AREA.COND. STORIES TYPE CONSTRUCTION
-1k,ore pmvide-d for by See, n?700.f Ibe Lh.r Gx4,fnc he Prfonne , ul the
work for which Nix Permit is l wrd. -PER'I'It AP
D 1 h,,e and will mmandin Worker.Campmation Inure .os nwiml by Section
3]OOofthe Labe Code.for the pafmtwxe N Ne work for what,this pmnit H issoad SYXBW—I INC.J OUTI.LTS OCC.GROUP APN
My Workers CmnPensomn brodoweevm ar and Poliry numbs ere:
Carrier: eoliry No.: SYSTEM-OVER 4(EA)
CER'DI9CATE OF EXIiMPTION PROM WORKERS' DUS'IR.WASTEIN'IIJICEPI'OR
COMPENSATION INSURANCEBUILDING DIVISION FEES
(Ifiis.s¢timnttdtwtbaeampMal iflle permit ufor arc huvidl Jdlan(SIf10) AP
orlw.l PLANCIIECK FEE
I ccnify Nat in the Prfomuncc ofmc work fm which him am at is iuvcd.I shell SI!W ER-SANITARY-SIY)RM EA.200 FT
nm employ any Plum m uny mamsr nn vis m M1eeunc ruby_tin m'hem
c Wod,—'CnPen- ENERGY IEE
Z wlxm laws of C.1domiu.Date WAIIiR HF,AO R WNEN-IELECTR GRADING ItiE
Z O ApPlicaot ).
NfJ110E TO APPLICANT:If.eller mvl:inp this Cerlif Ie.(F eml+iern.you should WATER SYs-rES TREAUNG
fn SOIL\IIJi
a [' behmiffi EP, Nc W.hcr's CnmPmaelf..,vamt ma of Noensed CMed mora
fanhwiN comply whM1 xceh povixxmx ur Nlx Pfntit atoll Iw dancd revoked. WA'll?R SERVICE
6. CONSTRUCTION LENDING AGENCY NL'W'RESNENI'IAL]FILMS, SQ 17. PAID Dye ReaiplM
I ,,ab,idiom Nm mu
Idem Is,anuction rn
lending aseY to Ne PA'omurce'If
U O CONSTRUCTIONIle work for whim(his Prmil u icsuNec
(S .]1199.Civ.C.)
Dox l' 1<nkr'n Nan, TOTAL.:
Istdcdn Adtn, TU'1'A L:
0. I anifY that I have rend Nis applkali.n and one Nat the alive infmmetiom is BUILDING FTE,
h comer-l vine mmmply with all city ami rnuwy,oruirsarce,aadsivc lows rawiny t. QTY_ MECHANICAL PERMIT FEE SEISMIC FEE
U Z buildinye.t.a.n.vd he Y uvMriae nclraenDtivl afark city taenleraPon Ne
abovcn,vdm ad Pori fer inspetim purporca PERMIT ISSUANCE, ELECTRIC FEE
(we)agree m save,indemnify ofd keep hamdeis the City of Cupnirm aguinu
IiaM1ilirea.juJgments.vmla and evpen.¢s whkh toren hover wry accrue aguin�saiJ City AidHk OR ADD'IU MECH. PLUMBING FEE
in mm,S ercc of the Bramng N this prmtil.
APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO It"CFM) MECHANICAL M:.
SOUR .REGULATIONS. V a
AIR HANDLING UNIT(OVIiR 111,(x10 CFM) CONSIRUCfION TAX
Sigeuure of Apficon✓Cdh—hde Dme EXHAUST HOOD I W/DUCT) HOUSINGMITIGATION ITP
HAZARDOUS MATE IS DISCLOSURE
Will the epplicanl«far.building acupem sure m hank huannas materiel HEATING UNIT(R)I W."BTIII
as define!by i e Cuperlinn Municiral CMe,Chaim 9.12,and the[Icahn eN Safely
Cdv,Section 25532(u)1 I IHA'1'ING ONE T(OVFlt oiit'ru)
F1 Yes F VENTILATION PAN RCSID) PAID
• Date ReciM N
Will me affifcim or fume huildi.,hceau ort use cauipmcm or da ices wnich BOLI Ilk_COMPIlliP OR IfN),n1M)PTU)
anis M1v air nmlemivnu oris Jcfmd by Ne Bay Aro Am Qualify Mawgcnent TOl'AI.:
1 INwrO1 BOILHR-COMP(OVER Il)j)(10 H'IU)
Dyes DNo
vd be,haanrdem,matelals NR CONUITIONE0. ISSUANCE DATE
hese I
rtsluimrcm herder CTy+cr 695 d Nc Cdi-
fanu Heald,&&rIvy Cade.See ions 1`505.15533 ara1 YU.1 unhruud Nat if no NEW REdDFINITIAL MECH. SQ.Er
briding does nor cumcmly Imse a 1.1,r1m its my nxPoeoiladal m notify the overlap
ofthemlui.an,which mow boort Prior m 1.."of a Cenif yc Nfkmrvxy.
Ouse,or earthI'm Dye TOTAL_ ISSUED BY:
OFFICE
^T
®: 10300 Torre Avenue
Cupertino, CA 95014
Gitr of
cuperthio Building Division
(408)777-3228
(408)777-3333 (fax)
February 4, 1999
Homeowner
899 S. Tantau Ave
Cupertino, CA 95014
SUBJECT: Permit# 50386
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
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