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30338 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY IK�^( ' CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO, 3OV38 BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. J BUILDING PROJECT IDENTIFICATION BUILDING ADDRPSS: - - SANITARY NO. APPLICATION SUBMITTAL DATI F7GEN Wi+ CvL of-N n b Jy t1(� NER'g NAME; �'l,� A'D d51 7 C JACI' �, AME: LLl lire I 1�1 t L ,L GGJJ NIC CONTROL p RCHITE if iNGINEER: LIC NO: ADDRESS: �Ir f S �I V� 4f ❑ ix CONTACT. PHONE' 45p1 Ys- 87 /J BUILDING PERMIT INFO �� g, ❑ Consultant Fees Paid by Applleant(Initial) BLDG . ELECT PLUM MECH ❑ ❑ ❑ LICENSED CONTR CTOR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby.frim mal 1 am Reaaed ander Pmvirmna of Chapter 9 feammeneme ]OB DESCRIPTION .- DaZ with SecfionJglO)ofD'vi ion 3ofthe Busiassoral Professions Curie,and mylicense is - RESIDENTIAL: y�00 �� PERMIT ISSUANCE F .. in full force un ,6t.ii �UV License Clasx Lica ❑SFDWL ❑KITCHEN REMODEL ��{ai1 Dale ' Commas APPLIANCES-RESIDENTIAL ❑ADDITION [I PLUMBING RE-PIPE Z`Oy RCHffELTS DECLA� ❑,MULTIUNIT []STRUCTURAL b PANELS ndcnand mr Planar. d as public records MODIFICATION �^�^/^j�A !b! (ftp- UPT02W AMPS El INTERIOR ❑CHIMNEYREPAIR Laery ro��onal c 201-1000AMPS IMPROVEMENT OWNER-BUILDER DECLARATIONeContraOVER II1fI0AMPS ❑BATH REMODEVREPAIR [I DEMOLITION K Q I hereby affirm Lha 1 R-exempt from the or'e License Lew for the LLO h U following remain.(Section 7031.5,Business and PmfeW...Code:Any city or county SIGNS HLECTRICAL ❑OTHER O F which requires a permit m consnuct;alter,improve,demolish,or repair any structure pnnrmirs{ssuame.alsndaimmathe.pplicam forsuch pireard to file.signed smenem SPECIAL CIRCUITIMISC. yThat he is licensed pursuant o lM provisions ofthe Contractors License Law(Chapter 9 (dmmencing with Section7000)of Division 3 ofine Business and Professions Count or TEMP,METER OR POLE INST. COMMERCIAL: C', 12 a that he is exempt therefrom rand the haxis for the alleged exemption.Any violotinn of ❑NEW BLDGIADDITION ❑DEMOLITION ,^�m Section 7031.5 by m,ripplicant for a p.I,subjects the applicam to.civil penalty of POWER DEVICES not more and five hundred dollars(1500). ❑TENANT El FOOD SERVICE Q I.as owner of the ro norm emlo«s with woes as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEM Q ❑ P It Y Y P Y 8 pens. ❑OTHERzsap ill do rework,andr: oContis rots Livensnded Law roffemd sole 15m.toad Business raIll nd Professions Code:The Contractor's License Law does not apply toanowner of OUTLETS-SW11'CI{FS_FI%TURES �' .. properly who builds or improves msucon,and who Jax such work himself or through his owroweverethe provided rant such mens iseoldwithin arc ns attended m olfemA for NEW RESIDENTIAL FIECTR S sale.ondidev will have burng or in ofpmvent is he iid noneildori improve torpor. SQ.FT. A S/SQ.Pp nwnerhuilder will have the harden of proving that he did not M1uiIJ or improve far par ' 01.asa.ae, NOV 04 I,as owner of the Sm.70y ,Business exclusively Profescons with Iiccno Contractors contractors i- TOTAL. 1996 cons,Lo the es not(Sec..as wneias rry who Code)The Com emor. nd cense Lawdsxnmapply toan owner of whosedprsuant 1.me thereocom'. QTY. PLUMBING PERMIT (` 1' who ence Lamfor such projects with ecunwcmr(s)Iicensed pursuant me Commcrors "II Y VI• LUr, I'3 License law. PERMIT ISSUANCE CN IND ❑lam exempt under Sec. ,Bffi PCfor this reawn ALTER-DRAIN&VENT-WATER(EA) VALUATION Owner Dme WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE - 1 hereby affirm under penalty of perjury one of the following declarations: I have and will mainmin a CenlfemonfConscnuo self-insure for Waders Camped- DRAINS-FLOOR,ROOF AREA,COND. STORIES TYPECONSTRUCiON anon,as pmvidcd for by Section 3700of the Labor Code,for the poommoance of the k for which this Permit is issued. FIXTURES-PER TRAP ��Q'`1 have and will dia and Worker's Compensation Insurance,as rWaired by Section Q700 of are lalror Code,for the Performance of the work for which this permit is issued. GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN My rWorkep5gtitdW nsv rpRce comer and Policy nwohyyue/�'1.P�tl/ . I1�G YYNH Policy Nn.: GLa'1'Y GAS-EA.SYSTEMOVER4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASPANDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES (Thin section need not Mcompleted if the pcnnit is Tirane hundred dollar IS 100) GRCASC TRAP or less.) PLANCHECK FEE I cenlfr that in the performance ofine work forwhich this permit is issued,I shall SEWER-SANITARY-STORM EA.200 FT. ecu not employ any person in any mama so ac me gbjo the Workers'Co.,.. ENERGY FEE ,Z ration Laws of Califo ie.Da¢ ryilo WATER HEATER WNENTNLECTR y� C Applicam - GRADING FEE G V2 NUTICE 10 APPLI NT:If,after making this Certificate of Exemption,you should WATER SYSTEMRREATING - - a; haome subject o the Workers Compensation provisions of are Labor Code,you must SOILS FEE [8I� forthwith comply with such provisions or oris permit shall be clamed revoked. WATER SERVICE CONSTRUCTION LENDING AGENCY, NEW RF.SIDENI'IAL PLMB. SQ.PT PAID V 0 l herebywhiffimlthathemmiti issued(m.30?7lending agency for me Performance of Date Recciptp fi the Landeek for which this permit is issued(Sm.309J.Civ.C.) � U larders Namc TOTAL: Lender's Address - TOTAL: 1 certify that 1 have mad this application and state that the utwve informefinn is BUILDING FEE lZi correct.I agree to comply with all city and county ordinances and state laws mining to QTY. MECHANICAL PERMIT FEE U Z building construction,and hereby aumanae representatives ofthis city In enter upon the SEISMIC FEE above-mmuori d property for unitarian purposes. PERMIT ISSUANCE ELECTRIC FEE (We)agree m save,indemnify odd keep handless the City of Cupdrimr against liabilities,judgnamu,casts end expenses which may in any way accrue against said City ALTER OR ADD TO MECH, in consequence of the granting of this permit PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,(100 CFM) MECHANICAL FEE SOURCE REGULATIONS. /r IM�A,� C Amy- nfkl . AIR HANDLING UNIT(OVER 10,060CFM) CONSTRUCTIONTA% Signature ApplicadV t many 1 Data `/ EXHAUST HOOD DViDUCI) HA RDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEE Will the applicant or future building ampant store or handle hmwrddus national HEATING UNIT(TO 100,000 BTU) as defined by the attention Municipal Cod,Chapter 9.12,and the Health and Safe, Cade,Section Z532a)? HEATING UNIT(OVER 100,000 BTU) El Val ❑No VENTILATION FAN(SINGLE RESID) PAID Will the applicant or future building t use equipment or devices which Data Receipt N pp d by the BBOILER-COMP(HIP OR 100.000 BTU) Or hauNaus air conwnman6 u defined by the Bey Acre Air Quality Management TOTAL: maJ❑Yes ❑Nn BOILER-COMP(OVER 100,000 BTU) - I have read the h ma us mcdds reqmts uireenunder Chapter 6.95 of the CanAIR CONDITIONER ISSUANCE DA E forma Health ffi Safety Code,Sections 25505,25533 and 25534.I undersand That if the NEW RESIDENTIAL MECH. SQ.FT. building dms our currently have a terns,that it is my responsibility to notify the common of the requirements which most be met prior to issmam of.Certificum of Occupancy. Owner or dumodecd agent Dam TOTAL: ISSUED BY: vie OFFICE 1 ® {` 10300 Torre Avenue CILV of' Cupertino,CA 95014 Cupertino Building Division (408)777-3228 (408)777-3333 (fax) June 18, 1997 Homeowner 20386 Clifden Way Cupertino, CA 95014 SUBJECT Permit#30338 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 Clerk Printed on Recvclod Paper