29601 APPLIqANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. 29601��O
BUILDING DIWSION APPLICATIONIPERMIT PLUMBING-MECHANICAL.
BUILDING PROJECT IDEWIFICATION '
BUILDINGADDRISS: . . SANITARY NO. APPLICATIONSUBMIVALDM
171 / 3 w 1 Li tot rsotry
U �iC7
OW NAME CONTRACTOR'S NAME LIC NO:
.72 PNONE -7• n YiN/C CONTROL?ARCHITEMMINGINEER: LIC NO', ADDR S5: P+ ❑
CONTACT:. PHONE (A, BUILDING PERMIT INFO
L S J) y ❑ Consultant Fees Paid by Applicant(Initial) te
BLDG ELECT PLUMB MECH
V ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE I harsh,apt.then I.m Ikenxcd under provi'ipns of Cbepar,9(.act QTY JOB DESCRIPTION
Oa'Z ith SeetHan l(Mp)Mlhvisi lafthe BlssimlesvaW Profes'vnC ad mylkrnse is ESIDENTIAL
�°p s 3D Sp /6 PL'RMRISSUANCE
O�U1F-- full f.ad cost SFDWL ❑KITCHEN REMODEL
F W D�et�me t� f w'vazror APPLIANCES-RESIDIls'1'IALADDUION ❑PLUMBING REPIPE
tFG=L ARowlECPS DECLARA'I ION PANELS - ULT6UNIT ❑STRUCTURAL
Z 0 v2I IUMetawWmy"ans'ball themad as public«cords MODIFICATION
OZ—O ' UP TO 2W AMPS INTERIOR ❑CHIMNEY REPAIR
Q'!)1=LL licensed Pmfeuinod NII-100DAMPS OVE\
C y�J OWNER-BUILDER DECLARATION OVER Ill(p AMPS REMOD AIR ❑DEMOLITION ,
< I hereby affirm that I am exempt from he Coptnttors License Law for the
O C UF+ following reran.LSs trap 70315,Buairc,awl Pmf.rotts Calc Any city or county SIGNS IJ,IiCTR1CA1, ❑OT ER
N:w N< which reyuirca u perma to captma,
smo,alimprove.dm
eolish,m rdtair any ws.m a /
1- prior to its iu.e,aLw oNLim'the a'ta icamfor.wch Permit o file.signal statement SPECIAL CIRCUIUMSC.
that be is licemd purawnt to tho provisions d Il.Convurols Licepse Law(Chapter 9 s
(amnt..ing with Smion7")ofDivisico3ofthe Bunn'old Pmfusiom Cooler or TEMP.MLTFR OR POLE INST.
L a this he is exempt therefromhuffs
and the for the alktdcm
expuon.Any violationITI
of ❑NEW /ADDON ❑DEMOLITION
`R 4 Section 1031.5 by any applicant fa a pemlit subjects the applicant to a civil penalty of POWER DEVICES
—y will d ❑TENANT FOOD SERVICE
not more than five hudad dWlun($3110).
FQ ❑I.as rens of the PrornY•tx my emplpyeu with u-organa thcirutle mmltitn, SWIMMING POOL ELECTRIC - IMPROVE(
C wio the wmk and the wocmrs is not lmerdd oroffmvl for sale(.Sec.10Ll,Business - OTHER
Wand Professima Code:Tl.Conaectar`s Licrnrs Law doe not apply to an wrier of OUD.F,LS-SWITCHES-FlXNRFS
d 3^ ptopwy who builds or improve Champ,and who does roan won himself or tluatgh
his own emplo ec .ryovidM mot wch improvements arc not intended or nlferW for NEW RPSIDI?NT'IAL M;CM SQ Fr.
tato If.however,Itw buildinea lm,n,amemk nld within ot.yearofcomplaian.the SQ.PT.FLOOR AREA 5/SQ.FT.
..builder will hove the human of provingInashedstrotbuildorimprovefapI
-
pose d salsJ.
❑I,m wrier of the PrRcnY•apr eul.sisely cvmmactieg with Bansed mnnxtms to TOTAL. PAID
ca¢stmct the rojst ISs.]DN,Brrurres ad Profc.csions Cade:)The Comnttoi s Li-
se Lew doe nm apply towawrmr of pnrpmy who buimc or impmvn thcacan.cab QTY. PLUMBING PERMIT FEE
whurnnwelafor...h,.jcc.withuesmwaor(9liccnsdpmxuanno the Contrennr`s •�� a �(S(�Q
Lica.c Law. I PERMIT ISSUANCE
I am exempt roster Sec. ,B&PC for Olio reamer
Ox. - ALTER-DRAIN&VENO'-WATER(EA) CITY ur uuv&
WORKER'S COMPENSATION DECLARATION BACK 19-OW PROTECT.DEVICE
I haehy aliirm urWer pensay of perjury one of the fallowing declvmtiooa.
I hove end will mviotnina Ceniftcum of Conram mwlf-invirc for Worker`s Cnio,.,- DRAINS-PLOOR,ROOI(AREA.COND. STORIES TYPHCONSTRUCIION
.cation,a provided for by Seed.3700 of the Lalwr Cock,for Ill perfrxntentt of Ilia
week fa winch this permit is muel. FIXTURES-PER TRAP
❑1 bate wad wul mein ain Worke .Co.,.im I..,as required by Settim
3700 ofthc labor Codc,for the perf«mnancc ofthe work for which this permit is issued. GAS-EA.SYSTEM-I INC.t OUTLETS OCC.GROUP APN
«kcj�CmlpcnsQlivn l rra cerncr rEcy No:num�Pfyc
fa A�Lf1 Pandl.1ic, r� GAS-IA.SYSTEM-OVHRJ(EA).
er. CERTIFlCATE OT EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE GREACIJINDUSTRL WASTE INTER CI:f?OR
(psis rentor rad m be rompkrN if tk pmnit H fora.huastnddawn IS 100) BUILDING DIVSION FPRC
'less,) GREASE.TRAP PLANCHECK FEE
I certify that in tk perf.a.fthe wart for whiehrhis permit is iuud,I"I SEWER-SANITARY-STORM EA.200 FT
rot employ any per,"in any msnncr m as m haeme Subject tba Wakeri Conten- - ENERGYFEE
O z nation Laws W Capmer a Dae WATER HEATER WNEN T/ELECTRtd
GRADING FEE
z O Applicant
N NOTICE TO APPLICANT:If,after making this Cmiflcate of ExempOan,you should WATER SYSTEAU RE\TING
I.cam..wbjcn to the Worker's Compensation mvisions of tl.Isla CMc,you marry SOILS FEE
Wfonhwith comply with s.b pmvisiom or this permit Mall be Jcamd revakd. WATER SERVICE '
a Q
CONSTRUCTIONLENDINGAGENCY NEW RESIDENTIAL.PLAIN. SQ.r`9'. PAID
^� 'z Ihcrsby off rm that there
��N�vacvnvmctiun ending agency fa the prfonmakc of Date Receipt
U. r- the wort for which this pemdt is issued(See JO)1,Civ.0 TOTAL
Lenders Nene
WI<dcr`s Addrtu TOTAL:
C I cutify Cham 1 have mW Nis epplicetion Ivst oats tsar the.trove infamlalion is BUILDING FEE
UVol amen.I.grtc lnmmply om.11 city and county...dirwnasaadatammwsreln6ngto QTY. MECHANICAL PERMIT FEE
z b.imingmnsinntion.awl bereby.mltuixe rc,sm*aptarive of this dry to enter.rm the SEISMIC ITS
r 'above-menti pt.,My
for inpceion purposes. PFRAIIT ISSUANCE
(We)earn to save,indemnify ad kap bvmkrs tttc City of Cuport agar.. ELECTRIC FEE
IiabJimies,judj.coats east expense which may in any ay r.spin.aid City ALTER OR ADD TO MCCI1.
in mn.goerce M the .in,of this Pemtit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.005 CFV) MECIIANICALFEE
SOURCE REGULATIONS. -
AIR HANDLING UNIT(OVER 10,00)CFM) CONSTRUCTION TAX
Sigmturt of Applicent/Conmacta Date EXHAUST HOOD(W/DUCD HOUSING MITIGATION FEE
If.VARDOUS MATERIAIS DISCLOSURE
Will tk applicant or future buiWing occupant atme orhsrxlle hvarkAsnwerial HEATING UNIT(TO 100.10X1 BTU)
us deGrJ by the Cupnina Mualclpul Crile,CTapttt 912,r J the Ileulth opt Sufcry
Cade,Swian 25532(.)? HEAPING UNIT(OVER 101,1X(1 BTU)
❑Ya C]No VENTILATION FAN(SINGLE RESID) PAID
Dvc Rarir•
Will tk a,coapt i furors building by the cat use as Air Qnl or Jevkex which
pit hnunLma air cmmntinanu u defrcJ by the Pay Amu Air Quality Marugemenl BOIIF.R-COMP(lHP OR 101000 RTU) TOTAL:
IT.ctntt] I.e
❑Yu ❑Nn BOILER-COMP(OVIiH IIDX
(1, )BTU)
I nava rail d.flvudous rear is p.na under Chapter 695 of Ore Cali- AIRCONDITIONER ISSUANCE DATE
rya
(ams Halth&Sfay Code Senian 3505,?5533 vst s333J.I wMstad that if ttr NEW RESIDENTIAL MEET. SQ.FT.
dtildin8 riot cuaanttlyhavea motion smynespoonbiirymnnifytheoampv.
of0e mapdort i .roc of.Cemr,apt
art e m ate TOTAL I ISSUED BY:
OFFICE
•0c,
10300 Torre Avenue
Cupertino, CA 95014
�il�
Cupertlll0 Building Division
(408)777-3228
(408)777-3333 (fax)
May 14, 1997
Homeowner
19917 Twilight Ct
Cupertino, CA 95014
SUBJECT Permit 929601
Dear Business Owner:
We have been going through our files in the Building Department, and contacting those
people with permits remaining "open.
I', • According to our inspection records, the subject permit has not been finaled. Many times
an inspector will sign the permit in the field, but neglect to report all of the information to
the clerical staff for input into the computer. If your permit card shows the final sign-off,
would you please contact us so we may complete our records? If the permit is not signed
off, an inspection could be scheduled for final closure of the permit.
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
•
Pnorer,w;Recmw]Pave,