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B 0146 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERM17 N0.X0 146 BUILDING DIVISION APPLICATIONIPERMIT PLUMBING.MECHANICAL 50001 BUILDING PROJECT IDENTIFICATION BUILDING ADDRES SANITARY NO. APPLICATION SUBMITTAL UA II O NA %5 NT. �G3 �- Qa ,7, /•L L� I •3J o (�gQ.V'' K(� NIC CGMI'aOLK RCHITECIENGINEER: LIC NO: ADDRESS: ❑ CONTACT PHONE: BUILDING PERMIT INFO � � �i ❑ Consultant Fees Paid by Applicant(Initial) Rrl,U�4 ELECT PLUMB MECH 4/dL J/ i I& ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATIONELECTRIC PERMIT FEE 1 hereby affirm that 1 am licensed under Provisions of Chapter 9(commencing QTS' JOB DESCRIPTION OOZ with Section 700B of Division 3 of the Business and Professions Code.and my llama isRESIDENTIAL u1�O O . q q PERMIT ISSUANCE F,F m toll force and clfcc. 9'3 / WI. ❑KITCHEN RIiMODEL �VV License a Lic.p APPLIANCES-RESIDENTIAL OADDITION [I PLUMBING RE-PIPE [-Zed Dvte Contractor vr60. OMOLTI-UNIT El STRUCTURAL ,�O rn ARCHDITCpS DECLARATION PANELS MODIFICATION Z O o Z I understand my plans shall he used as public records OZ=y UP TO 200 AMPS C]INTERIOR ❑CHIMNEY REPAIR Licensed Professional 201-1000AMPS IMPROVEMENT O SWIMMING POOLS OWNER-BUILDER DECLARATION OVER 1000 AMPS 1:1 BATH REM 1 P ODEMOLI 107' w sj M Q 1 hereby affirm that 1 am exempt from the Contractor's License Low for the is k 0:V following recon.(Semon 7031 S.Business and Professions Cede:Any city or county SIGNS ELECTRICAL O HE,rg�e 3 a which requires a Permit m mnsmuc,.alter,improv,demolish,c r repair any swcture primrm in ism.nce,also requires the applicant for such permit to file u signed statement SPECIAL CIRCUIT( .C. j (V1#J TJ �. Ihmhcixlicensedpunuanuomn,mO,mmofhe Cnmmmmrs License Low(Chapter 9 OMM R IA m 00 (commencing with Section(k)fB.f Division Sof he Business and Professions Cnde)or 'TEMP.METE POLE INST. �L, d q C that he is exempt therefrom and Ne basis for the alleged exemption.Any violation of O NEW BLDGIAODITION O DEMOLITION ttXl 1i,�• Section 7031.5 by any applicant for a Permit subjects the applicant m a civil penalty of "EU�RSQ ❑TENANT ❑FOOD SERVICE not mare than five hundred dollars(8500). - IMPROVEMENT 1,as owner of me rt,oro employees with wares as their sale compensation, EC'I'RIC ❑ property, Y P Y E .BOGTHER 11 do the work,and the she come Concis not intendedorLaw reddo s no,apply tII a. Business 3� and Professions Gsle:The Contractors hicenx Lew does not apply m an owner of .S-FIXTURES property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements we not intended of offered fur EUE R SQ FT.sole.If.however,sbe building or impmvcment is sold within one year ocmpleSQ.FT.FLOOR AREA 81SQ.Ff. wneobuiMer will have the made.of proving that he did not build or improve forse of sale.). EJ 1,as owner of me progeny,am exclusively contracting with licensed contractors tofT summin,the Project(Sec.7014.Business and Professions Code:)The Contractors Lb cense Law docs not apply m an.wnerof property who builds or judroves,hereem.and QTY, PLUMBING P' - 11 F E who contracts for such propos with s emaracsodid licensed pursuant m me Communes License Low. PERMIT ISSUANCE O lamcumptuader Sec. ,B&PCfuldd1ma1.n ALTER-DRAIN&VENT-WATER(EA) VALUATION Owner Date , WORKE'R'S COMPENSATION DECLARATION BACK FLAW PROTECT.DEVICE O �� I hereby affirm under Penalty of Perjury one of the following declinalks s: I have and will maintain a Cenificate of Consent to self-insure for Workers Compen- DRAINS-FLOOR,ROOK AREA,COND. STORIES 'IYFE CONST RUC`HOI .adioa,as Provided for by Scum.37W of me LaNn Code,for she performance of the work for which his permit is issued. FIXTURES-PER TRAP O 1 have and will nomma n Workers Compemsulion Insurance,as required by Section 3 700tuffic"llCMe,for sb�eP�'ifo^^�pa ceof the work for which this Permit isissued. GAS-EA.SYSTHM-IINC.4OUT S OCC.GROUP APN MY Work tia{�sprvle�JT'aaiersdpd PodicY ,G Cartiee ��(((NMMM'I aa//11 policy No.: // GAS-F.A.SYSTEM OVER 41 ) CERTIFICATE OF EXEMPTION FROM WORKERS' GRF.ASOINDUSTRL WA INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION FENS (This sermon need not Mcomplewlifmc permit is(mane hundred dollen(51 W) GREASE TRAP or less) PLANCHECK FEE Ic,nify that in the pedonnance ends,workfar whichthis permit is issued,l shall SEWER-SANIT Y-STORM A.210 FT. not employ any poen in any moronism at m become subject to the Workers'Compen- ENERGY FEE Z soli..Lew,of Coliform..Data WATER HE R WNENTIELECTR GRADING FEE O O Applicant l r~N+ NOTICE TO APPLICANT:If,otter making this Cenificnte of Exemption,you should WATER. STEM?BEATING SOILS PEE hecome subject mine Worker's Compensation Provisions of the Labor Code.you must s a it f.Mwih comply with such provisions or this permit shall he natured revoked. WAT SERVICE psQ �yyyja CONSTRUCTION LENDING AGENCY . RESIDENTIAL PLMEL SQ. PAID UO (hereby affirm that them is a contraction lending agency for the perfommnce of J Dare eveiptX V. F the work for which this permit is issued(Sec.3097,Civ.C.) TOTAL: O Lenders Name 1-' Lender's Address T BUILDING FEE (y 1 rtify mat I have mad this a,plic lioFEE n and state mot the above information is tceQ � ,G correct.l agree to comply with all city and county otdinancu and state laws relating to QTY, MECHANICALPERMIT G�� SEISMIC FEE U Z building conewni.n,ond hmcbyauhvmmmpmxeurallvesef his city m enter upmme - ahove-mentioned property for inspection purposes. PERMIT ISSUANCE ELECTRIC FEE (We)agree to save,indemnify and keep harmless me City.f Cupertino against liabilities.mdgments,cnslsand cxMxs which may in any way acemall,mm,said City ALTF.RORADDTOMECH. PLUMBING FEE in consequence of the amount,of this permit. APPLICANT UNDERSTANDS AND WI LL COMPLY WI"TI l ALL NON.POINT AIR HANDLING UNIT(TO 10,000 CF/) MECHANICAL FEE SOURCE REGULATIONS. AIR HANDLING UNIT(OVER IB(!CFM) CONSTRUCTION TAX Signature of Alplicall/Carroman Dole EXHAUST HOOD(W/DUCT HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will he appli,aul or future Wilding occupant store.,handle humiliate,material HEATING UNIT(qb IIXI BTU) us defined by the Cupertino Municipal Code,Chapter 9.12,and he Itealth and Safety HEATING UNIT(OV/100,100 BTI❑ Code,Section 25532m)] ❑Yes ONo VENTILATION FIN(SINGLE RESID) PAID Dade RateiplX Will the applicant or future building occupant use equipment of devices which BOILER-C P(3HP OR If0.1XX)BTIII mid saran dons air contsminaurs as dcfincd by the Bay Area Air Quality Management TOT Fum." BOILB COMP(OVER DOn."BTU) ❑Yea ONn I have read the hamcdoue materials requimmems under Chapter 6.95 of the Cali AI ONUITIONERIGgIJpNq YIE ,,).,a Health&Safety Code,Sections 25505,25533 and 25534.1 undcntand that if me 13W RESIDENTIAL MI CH. SQ.FT. l/9 7 `( built ingdoes i o cunently have a tenant,that i,is my re,ioniludity moodily the welmo g .f the mquiremenu which muss be mel prior to issuance of a Cenificale of Carel duct'. lam/ ' `L' Owncrcr euthnrimd.In. Date TOTAL: ISSUEDBY: ` ` d AfAfJO OFFICE 1 s ,{ 10300 Torre Avenue Cupertino, CA 95014 �.ItC of' Cupertino Building Division (408)777-3333 (fax) February 9, 1999 Homeowner 10094 Congress Place Cupertino, CA 95014 SUBJECT: Permit#B0146 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 j Christy Akatiff, Administrative Clerk • Printed an Recycled Paper