29977 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 29977
BUILDING PRUJEC'T IDE:NTIFIC\TION
BUILDING ADDRESS: SANITARY NO APPLICATION SUBMITTAL DATE
10 a0 e fine G 25'-Ct9
OWNsR'SNAME PHONE CONTRACTOR'S NAME: LIC NO:
r a e NIC CONTROLp
RCHI /ENG( EER: LIC NO: ADDR O El'to s � Co lot
CONTACT: ,,// �/ BUILDING PERMIT INFO
4.1 T�•/— /j 7O ❑ Consultant Fees Paid by Applicant(Initial) B ELECT PLUMB MECH
6c11 ran, - W, el<`
LICENSED CONTRACTOR'S DECLARATION QTY ELECFRIC PERMIT FEE
I hereby affirm that 1 am licensed under provision,of Chapter 9(commencing JOB DESCRIPTION
- O�Z with Section 7000)of Division J ofthe Business and Professions Code,and my license is RESIDENTIAL:
T'ISSUANCE
E &= in full force and effect ❑SFDWL .n ❑KITCHEN REMODEL
aUU License Class Lie. APPLIANCES-RESIDENTIAL ❑ADDITION °
F W Connector
r'l)❑PLUMBING RF PIPE
G Dale
E.Drn ARCHITECTS DECLARATION PANELS ❑MULTI-U1T '❑STRUCTURAL
Z O h Q I understand my plans shall le used a,public amrds El IM1TERIOK �M MODIFICATION
04— UP TO 200 AMPS 3 •{ CHIMNEY REPAIR
;'4'W Licensed Prole::i el 201-IM)AMPS IMPROVEMENT (sI (p)
C"1 W-� OWNLR I3UILDIik DECLARATION OVER9WOAMPS .❑BATH REMODEVREPAIR ❑DEb10LITION
0.'�Q I hereby ff m that I
am b n the Contractor,L cen.a La for the y
k,O y U follo g n(Section 7031.5.Baines, +d Prof..on,Cods,A )city or cranny SIGNS ELECTRICAL + ❑OTHF,R ✓1�C)+s..,_
W a W E"
Iqq^� which requires rex a permit I c num alter, demolish, r repair any s
tuadre
d� ,s V
primm its issuaare,.1orcyuires(be applieunt Fncach pcnnlno flea signcA Valemedl SPECIAL Cl RCUITIMISC.
at
that he is licensed pursed m the pmvioonsof the Cnannnm's Liccnac Law(Chupmr9
W�'00 (commencing with Section 90(10)ef DivisionBal(be Hammes,and Professions Crdn)or TEMP.METER OR POLE INST. COMMERCIAL:
4 0.ea That he is exempt therein i 0 and the Isco,hi,the alleged esempiion.Any viol;nirn of ❑NEW BLDGIADDITION ❑DEMOLI'T'ION
W-1 Section 7031.5by.any applicant for is partial subjects the applicant to a civil penalty of POWER DEVICES ❑ ANT ❑FOOD SERVICE
F Imo a than fisc hundred Jallars($500). .1PROVEMEM1T
S ,as owner of Penitent, r my employees with wages as their role compensation, SWIMMING PULL ELECTRIC
F'H will do One work,and the structure is nm intended or offered fersale(Sec.9(b4.Business HER
d 3 ao and Professions Code:The Contractor's License Lew does not apply to an owner of OUTLETS-SWITCHES-FIXTURES
property who builds rf improves the rwn,oil who dons such work himself or through
his own employees,provided than such improvements are not intended or offered for NEW RESIDENTIAL ELECTS SQ 17..
,.I,,If.however,the building or improvement is sold within one yearrRompletion.Ihe SQ.FT.FLOOR AREA $/SQ.II'.
owner-builder-d.) will have the burden of proving that he did not build or improre for par- � 6�� f�
f sa `Q
s owner of the property,am exclusively contracting wit licensed contraamrs to
a to project(Sec.TIkW,Business and Professions Code:)The Contractors Li-
nselswdoesnotapplymanownerof property who builds.,improves terern.and QTY. PLUMBING PERMIT FEE ,
who contracts for such projects with a commetoq.$)licensed pursuanuo the Conteaoes
License law. PERMIT ISSUANCE
❑I p n er Sec. ,B&PC'rrti ,.
�wZr ea 1 Date ALTER-DRAIN&VENT-WATER(EA) VALUATION
-WORT 'S O
AlmRMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
I hereby affirm under penalty of perjury one of the following decimations: GJV `•h
_]I have and will maintain a Certificate of Consent to for Workers Comped- DRAINS-FLOOR,ROOF.AREA.GOND. STORIES TYPE CONSTRUCTION
..tion,as provided]for by Section 3700 of the Lothar Code,for the performance of to ,
xork for which this pnmil i,issued. FIXTURES-PER TRAP
L]1 have and will maintain Worker's Compen.vation Insurance,as required by Section
37M of the labor Code.for to performance of the work for which this permit is issued. GAS-EA.SYSTEM-I INC.a OU'1'LIiD OCC.GROUP APN
My Worker,Co r,mottion Insurance currier and Policy number are
- Carrier: Policy Na: - GAS-EA.SYSTENUOVF-R 4(EA)
CERTIFICATE i 01r EXIiMP`[ION FROM WORKERS' _
COMPI2NS AI'ION INS U RA NCE, GREASFJINDUSTRL WASTE IN'I'IikC1iFIY)k B U I L D Lr tXV t I(�<FEES
(Thkwiction need rot hecampluad iOtie permit is tit hoe hundred dol tars($1DIA GREASETRAI'
or less.? � PLANCHF,CK FF,F.
I cenify that In the ped ommlanaenf the work for which this pemit,ix issued,lx hull SEWER-SANITARY(S ORM EA.2011 FT.
.not employ any person in any intoner sed us In hcno;nc anbjea[,,,he Wickes'Comped- ENERGY FEE
O ,Z satien Laws of Calilimiia.Dam aWATER HEATER W/VENI'/ELECI'R GRADING FF,F.
Z Applicant
h NOTICE TO APPLICANT:IL nfw,making this Cerin icule of F.,cormen,yen should WATER SYSTF-M/TREAI'ING
become subject tr Ihe Workcts Compemadon pro,kin is of the Later Cade,you most SOILS FEE
forthwith comply with such prrvi,ion,orhis panel,hull be deemed revoked WATER SERVICE
0. 0
Z) zCONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PhMR. SQ F7. PAID Dare Re to
U thereby affirm thauhcre isanmumction lending agency fonhe performance of
One work for which this permit is issued(Sec,3007.Civ.C.)
{L F Lender's Name L
C..7 Lender's Address - - TOTAL
1 cenify that 1 have read this apphamimi and suite that the above information is BUILDING FEE
F' tn Correct.I agree to comply with all city and county ordinances and state laws relating to QTY, MECHANICAL PERMIT FEE
V,Z building construction,and hereby authorize representatives of this city to enter upon me SEISMIC FEE LIO
above-mentioned property for inspection purpose,. PERMIT ISSUANCE '
(We) g.Ir save,indemnify and keep hamdcss Ihe City of Cupertino against ELECTRIC FEE liabilities,judgments.costs and expenses which may in any way acme against said City ALTERORADDTOMECH. PLUMBING FEE
in consequence of to granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT - AIR HANDLING UNIT(TO By"CFM)
MECHANICAL FEE
SOURCE REGULATIONS.
AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTION TAX
Signature of Applicam/Contmetor Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS NIA(ERIAIS DISCLOSURE
Will the applicant or future building occupant uore or handle haaatdou.ma¢dal HEATING UNIT(TO 100.0110 RTU)
as defined by the Cupertino Municipal Code.Chapter 9.12.and to Health and Safety
Code.Section 25592(x)'1 // HEATING UNIT(OVER 100,000 RTU)
(]Yes. F❑1Yo + PAID
_ VENTILATION FAN(SINGLE RESID) 'Dote RecaiptN
Wll Ih pplicu t f h ilding occupant use equ p t J vices which BOILER COMP(BHP OR 11XI,IXX)13'1'10)
mil h - J 'nm t' defined by the Itay Area A Q lty Matmgemenl
�>istri t ° TOTAL
❑5, � BOILER-COMP(OVCk IgIINXI BTU)
1 huse rend thctn't I roman"'rc tX under Cha ter fi,95 of the Coli- AIR CONDITIONER ISSUANCE DATE
Toro a H Ith&S' ty'no'
1 S f . 25505 25593 J 25534 1 I m d that If the NEW RESIDENTIAL MSCI I. SQ.FI.
ML
gd icumn0yb d�I t ....
m t yrep 11-1Il tfy theoewpam tt\`�
aft q ' t h' h tbs tpdn t ice nG CerTf ate fOmupwcy.
Ownef or author zod agent Date TOTAL: ISSUED BY:
OFFICE
® 10300 Torre Avenue
Cupertino,CA 95014
.,�•-`Cirsof
Cupertilio Building Division
(408)777-3228
(408)777-3333 (far)
January 30, 1998
Homeowner
10120 Lockwood Dr.
Cupertino, CA 95014
SUBJECT: Permit# 29977, Addition
Dear Homeowner:
We have been going through our files in the Building Department, and contacting those
people with permits remaining "open".
A According to our inspection records, this permit has not been finaled 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 dispose of the file and remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administra ' Clerk
Pnnmv on Peciceo Pacer