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31166 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.-USE BALL POINT PEN ONLY _ IT. OF CUPERTINO BUILDING-ELECTRICAL PERMITNO. /] a� C BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL J 1 v BUILDING PROJECT IDENTIFICATION BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAD S—Qe; tea S NEME: PHONEi CONTRR' r�AWC: IC NO: W/�! NIC CONTROLk CHI'ECT/ENGINELIC NO: ADDRESS: L CG cT. PHON BUILDING PERM INFO NC v �`� r�reg Consultant Fees Paid by Applicant(Initial) BLDG E PLU MEC LICENSED CONTRACTOR'S DECLARATION I PERMIT ISSUANCE QTY. ELECTRIC PERMIT FE I hereby affirm that 1 am licensed add er.....War,of Chapter 9(commencing JOB ESCRIPTION Z wiNSection7")ofDivisionJofNe Bunimas.dProfesni.ns CWd,andmy license i., RESIDENTIAL: F• p in fullforeeand effect. MUV License Class Liu.p ❑ WL ❑KITCHEN REMODEL ��4d1 Date Comrncmr APPLIANCES—RESIDENTIAL ITION ❑PLUMBING RE-PIPE ARCHITECTS DECLARATION, PANELS MULTI-UNIT ❑STRUCTURAL Z O`�Z� 1 understand my plans shall he used as public records MODIFICATION OZ40 UP 10200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR Licensed Professional 201-100(l)AMPS IMPROVEMENT p�kS❑ OWNER-BUILDER DECLARATION I 13 BATH REMODEUREPAIR ❑DEMOLITION ,51y 1 hereby affirm that 1 am excinpt from thee Cnntrvctnts License Law for the OVER 000AM x 36 U following---,_vi 7831.5,Business and Pmfessians Cede:Any city or county YI O improve, SIGNS LL[ RICA [_1 OTHER which s a pe,mit to,.nsma,vl¢q demorepany ..am prior no its issuance,also requires fleupplicam for such permit to rile a signed statement S .A nT/ IS . vW1y that he is licensed pursuanu.Ne provisions of the Commcmrs License low(Chapmr9 5p0 (carrmeming with Section 7000)of Division 3 afthe Business and Professions Code)orTE ) I COMMERCIAL: O.y M oC that he is exempt thercfmm and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION WSection 7031.5 byinyapplictut for.permitmidects theapplicat too civil penalty of POWE DEVICE' ❑TENANT ❑FOODSERVICE F ZF Y t mom Non five hundred dollars($500). - IMPROVEMENT ❑� ❑I,asowner.f the propcny,or my employees with wageemtheir sole compensation, SWIMMIN LEMIC will da the work,and thesuuemre is nm Imm�JeJ oroffereA for solo(Sec.7lW4,Business ❑OTHER 3� and Professions Gale:The Contm ams License Law dres not apply to an owner of OUTLETS—SWITCHES—FIXTURES property who builds or improves theman,and who docs such work himself or through his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ FT. sale.If.however,the building.,imp rmement is sold within oneyem of completion.the SQ.IT.FLOOR AREA ' $/SQ.ET. ower-builder will have the burden of proving that he did not build or improve for par- e of sale.). ❑1,as owner(if the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Cod:)The Contractors Li- cense i-c e Law does not apply to an owner ofpropeny who builds or improves thereon,and QTY, PLUMBING PER IT PEE �� whanmrnslimrsuchpro,ject.with.,mammo,to Iicwnsal paramatm the C.almmara �� _ A License law. PERMIT ISSUANCE u ❑Iameacmptundm Sec. �,B&PCfor Nisaamn cr Dale ALTER—DRAINAtV (EA) Y Vr k,vry WORKER'S COMPENSATION DECLARATION BACK FLOW PROTE . EVIC3 wn IherebyafOrm under penalty of perjury one of the following dedarmiam: 0 1>e �� ❑I haveond willmaimainoCenifcaa of Consenunself-Insure for Worker's C.mpem DRAINS—FLOOR.ROOF.ARA, Nl. w STORIES TYPE CONSTRUCTION .nation,an provided far by Section 3700.f the Labor Code,for Ne pedmmame of the work for which this permit is issued. FIXTURES—PER TRAP ❑ 1 have and will maimm.Worker's Compensation Immance,ns required by Section 3700ofthetaxa Code,forth,performance mine work forwhich this permit is issued GAS—FA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN My Workers Compensation Insurance carrier and Policy number ere: Carrier: Policy No.: GAS—EA.SYSTEM-OVERS(FA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASEdNDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES (This section need not ed completed iOhe permit is forone hundred dollars GREASE TRAP odess.) I certify Net in Ne perfonnonce ofthe work for which Nis permit is issued,Isbell PLANCHECK FEE not employ any person in any manner so as a ec bome tt subjecothe Written'Compen- SEWER—SANITARY—STORM EA.200 FT. ENERGY FEE Q .Z Applicant of California.Date Z 2 AA licvm WATER HEATER WNiNVELEGIR GRADING FEE y NOTICE TO APPLICANT.If.after making this Certal,me of Escmpti.n,you should WATER SYSTEMITREATING abecome subject to the Worker's Compensation provisions of the Labor Code,you mast SOILS FEE fonbwith comply with such provisions or this Tenant shall be deemed revoked. WATER SERVICE aQ ate- z CONSTRUCTION LENDING ding ,mY NEW RESIDENTIAL PLMB. SQ.PT. PAID U. T herebynotionthis Front ifaed(Sec.30 leading agency fnnhe perl'ammncenf� Data ReceiptN � F the work for which this pmnit is issucJ(Sec.Lq],Civ.CJ 0 U Lenders Name TOTAL: UJ Lenders Address 0. I certify that 1 have read this application and state that the alcove information is BUILDING FEE ..w N mirrem I.,.a,.comply with all city and I...tyardirmaesaadatatelawsmlmingm QTY, MECHANICAL PERMIT FEE U building construction,and hereby authorize representatives of this city to enteruponthe SEISMIC FEE above-mentioned property for inspection purposes. PERMIT ISSUANCE (We).gree to save,indemnify and keep arm p hless the City of Cupcnino against ELECTRIC FEE liabilities,judgments.costs and expenses which may in any way nectar against said City ALTF,R ORADDTOMECH. O n consequence of the granting of this permit. PLUMBING FEE - APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) o SOURCE REGULATIONS, MECHANICAL FEE AIR HANDLING UNIT(OVER 10.000CFM1 CONSTRUCTIONTAX Os' Signatmeof ApplicantlCommcmr Data EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant score or handle hazardons material HEATING UNIT(TO 100,800 B'TO) az defined by the Cupenino Municipal Cale,Chapter 9.12,and am Health and Safety Coda,Section 25532(a)'t HEATING UNIT(OVER 100,000 B'TU) ❑Yes E]No VENTILATION FAN(SINGLE RFSID) PAID Dam Receipt M Will the.pplicami..is a or future building by o ccupant use equipment ordevices which BOILER—COMPOHPOR IOg000 BTUI :mit haxerdous air conmminan[s ax Jetined by Ne 13ay Arca Air Quality Munugemcnt TOTAL. Disaia? BOILER 100,003 BTU) i \ Yes No - 1 have Head the hammous materials AIR CONDITIONER DANCE DATE regoiremems undm Chapter R.95 of Ne Call- Health&Safety Cade,Sectors 25505,25537 and 25534.1 understand Nat if the NEW RESIDENTIAL MECH. SQ.FT. building does not currently have a tenant.that it is my responsibility to notify the occupant of the«quimments which min he met prior io issuance of a Ct aiticate of Ov,upancy. Owner nr authorized age., Date T ISSUED BY: OFFICE i y`P,d. F,® t ,p,,,,_a 10300 Torre Avenue Cupertino,CA 95014 City of Cupertino Building Division (408)777-3333 (fax) February 4, 1999 Homeowner 7565 Heatherwood Cupertino, CA 95014 SUBJECT: Permit# 31166 \� 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 Christy Akatiff, Administrative Clerk • Printed on Recycled Paper