30530 APPLIOANI TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY ..,
CITY OF CUPERTINO BUILDINGELECTRICALPERMIT NO. .
BUILDING DIVISION APPLICATION/PERMIT -PLUMBING-MECHANICAL - 30 5 3-V)/�1
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: / •SANITARY NO. APPLICATION SUBMITTAL DATE
O 'SNA O E: CONTRACTOR'S NAME _ "• LIC NO: �.l
p � t` _ NIC CONTROL
- c
ARCHITECT/EN INE LIC NO: ADDRESS: - ❑
CONTACT PHONE:
BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) - BLDG ELEC PLUMB MECx
J,tt- ACTORS DECLARAT ON QTY ELECTRIC PERMIT FEE
El:
' ❑
G•r 1 hemP.thAlomlfcen under provisions of Chapter 9(commencing OB DESCRIPTION hSecraft vision 31fthe Business and Pmmesions Cade,and my license is
FWr in full forty and effect. _ PERMITISSUANCE
.�U� License Class Lick` [1SFDWL. _ D KITCHEN REMODEL
y4W Date Conn ,., APPLIANCES-RESIDENTIAL ❑ADDITION " [I PLUMBING RE-PIPE
E,p>y> ARCHITECT'S DECLARATION _ PANELS UMULTLUNIT ❑STRUCTURAL
'y O sy�ynn p 1 understand my plans shell be usedus public records
0z^ - UP TO 200 AMPS MODIFICATION
Ep'{O1 Licensed Professional D INTERIOR ❑CHIMNEY REPAIR
OWNER-BUILDER DECLARATION" 201-1000AMPS " IMPROVEMENT
p, 4001< I hereby affirm that I am exempt from the Contractor's License Law for the: OVER 1000 AMPS D BATH REMODEUEEPAIR D DEMOLITION,
�d O 6,U following reason.(Section 7031.5,Business and Professions Code:Any city or cnumY COMER
{d a{s,F SIGNS,ELECTRICAL
`Dywhich es a permit to canstruct,alter,Improve,demolish,or repair an t t
requires P ysm m -
mrddllsuch file
y+ permit losstatement, SPECIAL CIRCUITMISC.Roche islicensedpursuantnt Neprovalopeofthe Contractors License Law(Chaplar9
00 that he
exempt
]000) fD' s m3ofNe Bus nese antlAny
ovilation I TEMP.METER OR POLE INST, w-DMM R IA '
that he is exempt any applicant
li and the basis for the alleged exemption.to Any violation of - EINEW BLDG/ADDITION D DEMOLITION
IiiCl,"a_,ne,
Section 7031.5 by any epplicom fore permit subjects the applicant too civil penalty,of POWER DEVICES
1F.. t mom tan rive hundred dollars 0500). - El TENANT El FOOD SERVICE
C'�Q D I,as owner ofthe property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
SAA( q will do Ne work,and the structure is not intended metered for sale(See.7044,BusinessDOTHER
Ad 4 d Prafessc
ions Code:The Cman ur's License Law does not felly to..,..car of OUTLETS-S W ITCH -FIXTUR
property who builds or improves thereon,and who does such work himself or through - -
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL EL-EZTR - SQ PT.
sale.If.howeveq the building or improvement is sold within one year ofcompletion.the SQ.FTtFLOOR AREA - $/SQ.FT.
owner-builder will have the burden of proving that he did not build of improve for Aur- n 4" LI fit
pose of sale.). �' I'n
D 1,as owner of the property,am exclusively commands with licensed contactors m TOTAL:'ily 7
waswct the project(Sm.]M4,Business and Professions Code)The COmracmre LI- L'^n O ..n
cense Law does not apply to an owner of property who builds or imp covers thereon, QTY PLUMBIN RM FEE Ga— 1 X99
who contracts for such projects with a contraotorM licensed pursuant the Contractor's . '
License Law. PERMIT ISSUANCE .Lf- `� y
❑lam exempt under Sec. ' ,B&P C for Nis reason- Lou,
Owner ALTER-DRAIN&VENT-WATE ( _
Date -VALUATION
P WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE'
by afflrm under penalty of perjury one ofthe following declarations
eve and will ivaintaln a Certificate of Consenrto self-insure for Workers Compen- DRAINS-FLOOR,ROOF,AREA,GOND. STORIES TYPE CONSTRUCTION
cation,, hied for by Section 371X1 of the Labor Code,for the performance of the
wit rwhich this permit is issued. ' FIXTURES-PERTRAP
war
have and will maintain Workers Compensation Insurance,
as required by Section
3700 mile La or de,for the performance ofthe work for which this permit is issued. GAS-EA.SYSTEM-PINC.4 OUTLETS
My Worker's ,ti noun frierand Policy nu r - OCC.GROUP APN
Cemer: �Policy No.: GAS-EA.SYSTEM-OVER4(GA) -
CERIIFl ATE OF XEMPTIONFROM WORKERS'
COMPENSATION INSURANCE GREASPIINDUSTRU WASTE INTERCEPTOR '
(This section need not he completed iOhepermhBUILDING DIVISI NFEESls Intone hundred deltas
or leGREASETRAP
ss) PLANCHECK FEE
Toy any tat in Ne parforanymn6nce tofthe work for subject
bjech tto fare Wisissued,'Cona,all SEWER-SANITARY-STORM EA.200 FT..
not employ any person is any manner so as ro became subject m Ne Workers'Compen ENERGY FEH
,� Aramis Laws of California.Date 01
O
Applicant � WATER HEATER WNENT/ELECTR '
PP GRADING FEF. UK
y
NOTICE TO APPLICANT If,ager making this Cenifica¢of Exemption, .0 should WATER SYSTEM/TREATING
'(~ become scomp y the Worker's Campeor ibis pfovisioal of Tho Labor Code,you must SOILS FEE '
fonhwi@comply with such provisionsmthis permit shall he deemed revoked. WATER SERVICE ,.
Q
g]y CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMR SQ,FT. r PAID
U rthereby affirm that there iaeconswetion lending agency for the performance.f '•Date Rec of
w !� the work for which his permit is issued(Sec.3097,Civ.C)
p FFA''
Ledi Name ". =TOTAL: '
yyy U IsadeY.Address • TOTAL:
I c rt'fy'l t I have read this application d state that thebinformation is BUILDING FE
to comcm 1 agree to comply with ell city and c ty mduance,and sone law,elating to QTY, MECHANICAL PERMIT 'FEE
U Py buildran,conslartionau
.and hand, Nonon
zerpreseminnesoftho city to enter upthe SEISh1IC FEE
above-mentioned property for inspection purposes.(Wel,agree to save,indemnify and keep harmless the City of Cupertino against PERMIT ISSUANCE ELECTRIC FEE
liabilities,judgments,casts and expenses which may in any way accrue against said City' ALTER OR ADD TO MECH.
in consequence of the granting of this permit. PLUMBINGFEE
APPLICANT UNDERSTANDS AND'WTLL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM)
SOURCE REGULATIONS. - tt MECHANICAL FEE, -
" e AIR HANDLING UNIT(OVPB Ig000CFM) CONSTRUCTION TAX
Signature of Applorma/Contractor Dam EXHAUST HOOD(W/DUCT)
HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION ME
-, Will the applicant or future building cesarean store or handle meanders material HEATING UNIT(T0100,000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12;and the Health and Safety
Code,Section 25532(a)7' , HEATING UNIT(OVER 100,0M BTU) -
Fi No
VENTILATION FAN(SINGLE RESID) PAID
Will the applicant or future building occupant use equipment or devices which Data Receipt N
nit hazardous air contuminann as refund by the Bay Area Air Quality Management BOILER-COMP CHP OR 100,000 BTU)
i'anct]
❑Yes No BOILER-COMP(OVER 100,01))BTU) .. ,
I have revel the hazardous materials re mean oder Chapnr 6.95 of Nc Culi- AIR CONDITIONER - ISSUANCE.D
forma Health& fety Code,Sur ,2 3 d 25534.1 un stand that if the NEW RESIDENTIAL MECH. SQ.Ff.
building ice. antl f t n Iha - y to notify Ne occupant ...
of Ne rah mus met sof a Cc of upon, '
authorizer Dare - TOTAL: ISSUED BY:
OFFICE.
• &-. (,I
10300 Torre Avenue
Cupertino, CA 95014
Cupel hio Building Division
/ (408)777-3228
(408)777-3333 (fax)
1
April 3, 1997
Homeowner
7875 Lily Court
Cupertino, CA 95014
SUBJECT Permit#30530
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, 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
..
Pnnmd on Pecvdcd Paper