The URL can be used to link to this page

29723 F'"I HY luvrunlnsu IUN WIT"IN Ntu L.INhb-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUIL ING-ELECTRICAL PERMIT No. BUILDING DIVISION APPLICATIONIPERMIT PLUMBING.MECHANICAL (] n BUILDING PROJECT IDENTIFICATION - J L. 1 BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE OWPH J CONTR SNAMEELIC NO: O ;Z NIC CONTROL# .l Ili RITE /ENGINR: LIC NO: ADDRESS: ❑ 1 CONTACT: r PHONE:- . BUILDING PERMIT INFO - ,�� - -❑ ConsRltaot Fees Paid by Applicant(Initial) BLDG &X PLUMB, - MECH LICENSED CONTRACTOR'S DECLARATION ❑ ❑ "❑ 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing MOVERIWAMPS ELECTRIC PERMIT tFEE hoc with Section]tgo)m'Divi...m3°fth,13mineasand Parmasimu Cmde,and my licenseiaMOB DESCRIPTION W full force and effect ANCE R SID NTIAL 'JFVZ License Class Lic.p El SFDWL Uatc Cn""cmr -RESIDENTIAL ❑ADDTION (]KITCHEN REMODEL ❑PLUMBING RE-PIPE OZF.�w ARCHITECTS DECLARATION ❑MULTI-UNIT ❑STRUCTURAL a lundersmnd my plansshall beusedas poM1lic records MODIFICATION PS ❑INTERIOR[•5.�, � LrenseJ Profesmnul PS ❑CHIMNEY REPAIR OWNER-BUILDER DECLARATION IMPROVEMENT ly I hereby affirm that I am exempts from the Contractors License Law for theMPS ❑BATH REMODEVREPAIR ❑DEMOLITION W 3 d F following teas-n.(Sermon]631.5,Business and Professions C°dr Any city or county SIGNS ELECTRICAL. ❑OTHER W=0 wbch ceramics p t t consul, Ileimprove,demolish. pa y swcture -- tn P^°rt t t: I q .th ppiwi rf such prmitt tl gnedsmtemem &I 44A SPECIAL CIRCUIT/MISC. vW1Y 'hath licensedpursuant t thep s tilt Contractor IL"e Le (Chapter9 0.qYd's atom c' g anS rm ]0(X1) fD" 03 fth Businessande fie ns Code)or TBME METER OR POLL(NST. (;COMMERCIAL• o a that he is exempt themfmm and the bass for the alleged exemption.Any violation of iYCI k, F+ NSection 7031.5 by any applicant fora permit subjaides the applicant a civil penalty of POWER DEVICES 11 NEW BLDG/ADDITION ❑DEMOLITION ,more than live handled dollara($506). ❑TENANT q (]I,at owner of the ❑FOODSERVICE pmpmry,onnyemploultdinthwageeaa theirsole 01Bsinen. SWIMMING POOL ELECTRIC IMPROVEMENT .ad do the work,and Ne swcture is no'imended nn,ffemd fnrsale(Sec.]044,Rosiness ❑OTHER ro .ad Professions Code:The Convenors License Law does nr apply to an owner of OUTLETS-SWITCHES-FIXTURES O pro-perty who hoilds-r improves thereon,and who does such work himself or through his own employees.Provided marine,mmprovemenis are nm intended or-tiered for ' NEW RESIDENTIAL ELECTR SQ EP. sale.If,however'he boilifir,m mpmvemem tiled,wi,,uneyeanfemindetion,the S FT. 00 /' mer-builder will have the home"of peeving that he did not build or improve for par- Q' FI �lt.A tj S/SQ.ET poseorwod.), � .mow R G��' ❑I,as owner of the property,am exclusively contracting with licensed contractors to 14, ./.` K no,� i TOTAL: 'rIQ consumer the Project(Sec]IW4,Business and Profevsims Code:)The Connector's I., I +� 1 1(1(1 cense Law does not apply m an nwccr.f properly who builds or improves thereon,and QTY PLUMBING PERMIT - FEF- •L Is7�7 who contracts for Inch majccts with a c-ntiarot(s)licensed pursuant m the Contractor's License Law. ❑lam exemptonder Sec. ,B&P C far thisfcason PERMIT ISSUANCE VI- IXU I'CDI INT Owner Date ALTER-DRAIN&VENT-WATER(EA) WORKERS COMPENSATIONUATION DECLARATION BACK FLOW PROTECT,I hereby affirm under penalty of Initial-uone-f the following declarations: DEVICEions: � ❑I haveand will maintaina CenificateofConsemm self-Insurefor Workeri Compen- DRAINS-FLOOR,ROOF,AREA.COND.' Isatin,as provided for by Section 37M of the Labor Code,far the Performance of the NSTkUCT10N/ work for which this permit is issued ElFIXTURES-PER TRAP I have and will maintain Workers Compensation Insurance,as required by Section 37110 of the Labor Code,for the performance of work for which this permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS ' My Worker's Compenxatio°Insurance currier and Policy number are: ROU qpm Cartier. Policy N., t GAS-EA.SYSTEM-OVER 4(EA) ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASUINDUSTRLWASTEINT RCEPTOR (This section need not be completed iffle Korn is frons,hundreddollare($100) - GDIVISION FE or less.) , GREASE TRAP - I certify that in rhe prformance of In,work for which this PLANCHECK FEE "mem l0 3 ,permit is issued,Ishull SEWER- p Y any person in any manner sn ns to became orb eco w the Workers Compen- SANITARY-STORM EA.306 FT. ENERGY Q Z cation Laws of Cnlifomia.Dole - O Applicant WATER HEATER WNENT/ELECTR - I Vl NOTICE 10 APPLICANT:If,after making this Cenificme of Exemption,you should ING FEE become smbjenm the Worker's Compensation provisions of the Labor Code,You must WATER SYSTEM/TREATING {� forthwith comply with such SOILS FEE Coo Q PY provisions-this permit shall be deemed revoked WATER SERVICE , (� z CONSq'RUCTION LENDING AGENCY F (N I hereby affirm that there is a construction lending agency forthe performance Of NEW RESIDENTIAL PLMB, SQ. PAID [L•'yy the work for which this pumii is issued(Sec.309],Civ.CJ Dace Receipt U Lenders Name - - H aLcnder's Address TOTAL: 1 certify that 1 have read this application and state that Ne above len formation is TOTAL. BUILDING PEE 07 correct legree'o complywith all cityandro"nty ordinances andsmtele odI,m QTY. MECHANICAL PERMIT FEE V a billion g cnnswdion.and hereby authorize rcpresemativcs-this city m indecorum the SEISMIC PEE .hove-mentioned property for inspection pnrpnses. (We)agree to save,indemnify and keep harmless the City of Cupertino against PERMIT ISSUANCE ELECTRIC FEE IiaM1ilities,judgments,costs and expenses which may in any way accrue agatnn seal City' in consequence of the gmming of this pemdt. ,. ALTER OR ADD TO MECII. PLUMBING PEE APPLICANT'UNDF-RSTANDS'AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,0(10 CFM) SOURCE REGULATIONS. MECHANICAL FEE AIR HANDLING UNIT COVER Uldisa1 CFM) CONSTRUCTION TAX Signs..of"plmanr/Cnmmn°r Date EXHAUST HOOD(W/DUCT) HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEE Will the applicam or future metring-ccupans atom or handle hazamous has rerin, HEATING UNIT(TO 10X1,606 BTU) as defined.by'the Cupertino Municipal Code,Chapter 9.12,'andthe Health and Safety Code,Section 25532(v)1 `��///, HEATING UNIT(OVER 100.000 BTU) Yea �kNo ` VENTILATION PAN(SINGLE RESID) PAID Will the applicant or infuture building by the Bt use equipment or devices gemewhich - Date ReceiptN mit hazvrdoux air contaminants as defneJ by the Bay Area Air Quality Management BOILER-COMP(3HP OR 100,00I BTU) u DistricC —nn TOTAL: 7 8 ❑Yes BOILER-COMP(OVER IIXI,(g)BTU) 1 have mad the herardous materials requirements under Chapter 6.95 of the Cali- AIR CONDITIONER Dennis Health&Safety CW e,Sections 25505,25533 and 25534.I understand that it the ISSUANCE DATE building down not commall hvveatonant the'itmsmy respooslhilirytnnotify the mcupmt NEW RESIDENTIAL MECH. SQ.Fr. - -fthe memsw ' ustbomet primmissuanceofnCenifc I of Oc PL Owner nr uu o e -gem - pate TOTAL: ISSUED BY: OFFICE ecilvol, 10300 Torre Avenue Cupertino, CA 95014 Cupertu-lo Building Division t (408)777-3228 (408)777-3333 (fax) January 15, 1996 f Homeowner 10688 Hale Place Cupertino, California 95014 SUBJECT Permit: #29723 Dear Homeowner: We have been cleaning out our files in the Building Department, and contacting those people with permits which have remained "open". `• According to our inspection records, the subject permit has never 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 records show the subject permit as finaled, would you please contact us so we may complete our records? If the permit is not signed off your permit can be reactivated and 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 C k 1�