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S 1234 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING.ELECTRICAL PLyJ{iT No, 1234 BUILDING DIVISION APPLICATION/PERMIT PLUMBING-NIECBANICA I. \V BUILDING PROJECT IDENTIFICATION BUILDIN(y ADI�ES� � SANITARY NOAPI'LICAI'ION SURMI TIAI,DATE SR'S/UN\AM 1'110 E: CO R CTOR"NAME: fit /( N/C CO 9ROL p ARCHNEC'OHNGINEER: LIC NO `f ADDREtiS'. n. ❑ _oMl'ACf: PnoNli; BUILDING PERh11'f INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MF.CH LICINSFDCQNTRACIOR'S MiCLARAHON QTY. ELECTRICPERMIT FEE hereby afrmt mat 1 are licensed ander pnommus+a ChaDar 9(commencing JOB DESCRIPTION DoZ with Sedion7lx10pd Division3of Ne Bmines..anJ Pmfeuinnn Gtde.and mY licen¢is RESIDENTIAL: IAO PERMIT ISSUANCIi aci o f in full force and eRtt OSFDWL ❑KITCHEN REMODEL aUU Lison .II�. Lic.p APPLIANCES-RESIDENTIAL 0ADDITION ]PLUMBING RE PIPE F,�W Date Cmnmamr w,y ARCIBIECfS PECL ) ON I'ANIA,S ]MULTI-0NIT 0S'I'RUCTURAL FmZ I undersand my Flanssnall Ile used mpublic records MODIFICATION CZao up DO 200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR F�.f.W Licensed l'ndcsslonsl 201-1000AMPS IMPROVEMENT OSWIMMING POOH j OWNER-BUILDER DECLARATION OVER IM)AMPS 0 BATH REMODEL/REPAIR 0 DEMOLITION a 1 nerchy affirm find I an exemm and the Commcnu's License Law fat dm A1yxC 0.U Ilmwing mason.(Sedinn 7031.5.Baines i 11'rdccslons Cost:Any city fir cr It SIGNS 17I,1=RICA, ❑OTHER 613 W y which ruluirr_r li permit us constrain,abort Impmvo,demolish,fir repair any drnnerc F�Oa prior to its issuance,also requires the applicmn for such prennito rile a signedstmemOn, SPECIALCIRCUI'TIMISCG35'se-zo t7 . that he is licensed pursuant ro the provisions of the Contractor's License law(Chapter 9 �yra�0 (commencing with St7fl(10)nf Oivisinn7ofIn,Brsinexv and('mluslots Cale)or 'I'EMP METER OR POLI:INST. COMMERCIAL: 4 o that he iv exempt therefrom and the basis(,it he alleged eswnption.Any vimmion of 0 NBW BhDNADDI9'ON [:1 DEMOLITION Section 903 L5 hY anY anPPlicunn fora perndt.v'ubjectc the appliuml to n emlpeneliyuf POWER DEVICES ]TENANT ❑FOODSERVICE mannnrc hall live hundred dollars($500). OTHER RMIIJ'1' =aOLasowner ak,the pmppeopmr myempinyceswithwagnmlheirsole mmpensmlon, SWIMMING POOLIi1.13CTRIC '� fF0 willJmhe work.and the gmnurt is..imendcJ oroo-eredfnon,apply to aousiness ❑OTHER all3 ro and Pmfeesioms Code:The Cnmracwr's License Law does not apply m an owner of OIff1.IT5-SWI'fCHGS-Il%Tllk' N. property who builds or improves thereon,and who does such work himself or thnnaght his own canpbyecl,provided that such ImpravenmnU arc not intended or oficrul lit, NEW ROSIDEVPIAI,ELFSQ sale IL lmwevaq the budding of inconvenient is sold within oneyca,orcomplmiom The SQ.F[ FLOORARHA $/SQ.I'L ownerboldiar will have the burden of proving That he did an build or improve for pur- poseof saline /.00 E] 1,as r of the prnpeny,am exclusively contracting with licensed comments m coasmm be pmjen(Sec.7044.Business nod Rafe omit Calc:)The Common-,I Li- seLawdoesnotapNyatanownerofptnperty who huilds or inyuoves theru).,und QTY. P f PEE who ennmaws for each parjw0 with n umuaco-tr(s)Ilmnsed pnrxuum 6t the Cnanhm.... License Law. 1'IikMl'1 % 5 0 l am exempt under Sec. ,It N P C for this reason Owner Date sAl.1 DRA � Ie' -.R (HA) VALUATION "11WORKIiR'S COMPENSATION DHCLARA'1'ION 11 FLOW ITR 'ELT,DEVICE Ihcrehy aIRnn under penalty of pcdnry nuc ol'the fullawingd era a ] l have told will mairl,inac"IificmcofCartenue self-iauumfnr ref's Cnngwry to DOR.ROOF.AREA,GOND. STORIES 'PYPE CONS'IRUC'I'ION ninn,as provided for by Section 3]00 of the Labor Calc,lit the per he ark for which this permit is issued FI URF_S-PEA TRAIT I have and will run in Worker's Compensation Insamac e,vx rtyuire 'Sedinn 3700af Ne Labm Code fmnha pcontruarreof the work for which Nis pemni ' GAS-EA.SYSTEM-1 NG40U'fl.FTS OCC.GROUP APN esu MYWor 'tion Indy(�p and Poli' n m: Cartier: Imo; 1/l�•s rPolicy No x GAS-HA,SYS IEM-OVER 4(HA) CF.RTIFICAFE OF EXEMPTION FROM WORKERS' C,RI'v15I%INDUSTRI.WAST[LNTI3NCIiF10R , ID COMPENSATION INSURANCE WILDING DIVISION IALS x )Gbiss«Iion resistant lac completed ifNepcmif,is furore handled dollars(S I W) OREASETRAP or less.) PI flE s Icemlfy Nmin Naperinnnmm,n,,in become for saltie Nis permit isisvuul,l shell nal employ anY person In any manner sr ustn hcmmembjmtlo The Wnrkad Cnny+vry pliWl?R-$ANI'1'ARV-STORM IiA,21111 FT. tcN m.0 ,Z amino Laws of California.Dam WATER I IEA'ITR W/VENT/FLEM 14 Applicant - GRADING Fp.E fA NOTICE'lG APPLICANT:If,afmr making Nis Cenificale of Escmption,you should WATER SYSTENIfOREATING F'Tbecome subject to the Worker's Compensation provisions of the Labor Cale,you must SOILS FEE ti LaZI fothwi0i comply with Inch provisions or tis permit shall he deemed revoked WAI I.R SERVIC17 UO CONSTRUCTION LENDING AGENCY NHWRESIDEsGIALPLMB. SQ.FT. PAID Date Ree ' tp I nanny affirm aha Nem is a ronsmctinn lending agency fin the perfamwnce of the work for which this permit is issued(Sec.3097,Civ.C.) h Lendcts Namerr�� TOTAL: V Lender's Address TOTAL: 43- V 1 amity Not I have ,all this appl walioaa und sone that Nu above infnrmdion is BUILDING FIT rn correct.I agree at comply with all city and count'ordinances and sate laws elaun6 m QTY. MECHANICAL PERMIT FEE U building construction.and hereby authorize representatives of this city to enter upon the SEISMIC FEB `+ above mentioned pm,my for impccticn pmpl PHRMI'1'ISSUANCE (We)agree to save,indemnify and keep harmless the City of Cupertino against ELECTRIC FEE liabilities fudgnmds,inn and expenses which may in any way accrue against said City ACTIN OR ADD TO MECI I. ssspmncc afthe grunting A this permit.APPLICANT P': O APPLICANT UNDERSTANDS AND WILL COMPLY WII'll ALL NON.POINT AIR HANDLING UNI'T(TO 10j)(MCF10) SOU C kF;GULVUON$, MI?CfIANICALIN nI? ll7 AIR HANDLING ON]*](OVER 1I,000C M) CONSTRUCTION NNX Volvo enf ApplicanOCnnwcmr Dm EXIIAUSTHOOD(WIDUCf) HOUSING MI'HGA1'I NFEE HAZARDOUS MATERIAI D 'CLOSURE GOD— WillNcapplicam firlhmmhuildingoccupan storaorhnndlohumrdotisliwmrnd IIIIAIINGUNI'f(Toi(x),OIXIIffUI as defined by the Cupertino Municipal Cale,Chaplet 9.12,and The Health and Safely Coda Section 25532(a)? DUN) NG UNIT(OVER 100,000 BTU) Yes No VENTILATION BAN(SINGLE RGSID) PAID ' Dam Recei tN Will Sc,if,co um or furore budding oecopaB use cyulpanem or devices which BOILER-COMP(7111'OR IIIgf1111111'N) it mit hazunlnus ulr canuamimmtx ax defiant by the Bay Area Air Quullry Munugcancnl (Y1A © - equal (OVER IWOOD RTU) ❑vel O No I have mad the hamMiles mmemid,re,mverrems under Cnapmr 6.95 of the Cali AIR CONDUIONER ISSUANCE DATE fomin Health A,Safely Cale,Suctions 25505,25.133 and 25534.1 nmdceamnd that it he NOW RESIDHVI'IA.MACH. SQ.FF, Q v filudingdoes nal cutrendy hued u meant,tion h is my msponsibilhy T.I tify The na'n, I of the"orcmema which must be and poor to issuance ofCell ircal,of Occupancy. p n � Owner or amhnnzN agent Dam 'roTnl.: -/ . L$!UEDRY: ( OFFICE 10300 Torre Avenue ` Cupertino,CA 95014 CitV of upertino Building Division (408) 777-3333 (fax) March 5, 1999 u Homeowner 10461 Scenic Circle Cupertino, CA 95014 SUBJECT: Permit# S 1234 Dear Property Owner: 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. f 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 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY 'fY OF L'UPERTINO BUILDING-ELECTRICAL PERMI'TNO. 30192 O J w9 Z BUILDING DIVISION APPLICATIONIPERMIT PLUMPING-MECHANICAL J1 "11 BUILDING PROJECT IDENTIFICATION INGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE to Y6 / SIC42AIC- 16110" d. -? 4 OWNERS NAME: PHONE: C TNA TOR'$NAME: LIC NO: IT N/C - CON'IROLM ARCHITECT/ENGIN iHTL LICNO'. AD RESS: ❑ CONT'ACf: . PHONE, BUILDING PERMIT INFO AG2BLDG ELECT PLUMB MFCHSMN u q V17, - 8'600 ' LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE I hereby afrrm mal I ern licensed under provisions rf chapter 9(commencing JOB DESCRIPTION {y,�OoQZZ wish Section 7")of Division 3 ofthe Business and Professions Code and m license is F.�� in full force and effect. - Y PERMIT ISSUANCE. RESIDENTIAL QFUV License Class Lie.p ❑SFDWI. ❑KITCHEN REMODEL NGL Dane—Contractor APPLIANCES—RESIDENTIAL DITION ❑PLUMBING RIi-PIPI? ARCHITF.CI"S DECLARATION PANELS F.7m ❑MULTI-UNIT ❑STRUCNRAI. O !2 Z 1 undernenJ my plans shall be mad!os public records - MODIFICATION :J UPT0200AMPS r4tI�d Licensee l'rokssirnal ❑INTERIOR ❑CHIMNEY REPAIR hPOWNER-BUILDER DECLARATION 201-1000AMPS IMPROVEMENT I herehy uUrm that I-opt exempt form the Corrosion',License Law for the OVER IIXNIAMPS ❑BATH REMODEUREPAIR 0 DEMOLITION xG C.U following reason.(Srstion 7031.5,Business arld Professions Code:Any city or.,only SIGNS ELECTRICAL ❑OTHER W 3 fi F which requires a permit to construct,tdner,improve,demolish,or repair any s racmre t�0 priermits iomenae,alsn requite the upplicem for such penniuo 6leesigncJ sla¢mem SPECIALCIRCUIT/MISC. M. that he is licensed pursuant the providimaidthe Contractor's License Law(Chapter9 DO (commencing with Section](MHryofDivision3oftheliusinese and l'ntl'es onareCade)or TEMP,MET ER OR POLE INST COMMERCIAL, d�6 c that he is exempt therefrom and me lwxis for the alleged exemption.Any violation of Section]0315by anynpplictm for a persubjects the applicant lr a civil Firmly of POWER DEVICES, NEW BLDG/ADDITION El DEMOLITION mit y t more than five hundred dollars($500). ❑TENANT ❑FOOD SERVICE pz^Q ❑ Las awnerofthe property,ormyemployees with wages as theirsoletompcmation, SWIMMING POOL ELECTRIC IMPROVEMENT +� will do the work,and the structure is not innended or offered Rnsale(See.](144,Business _ ❑OTHP.R 163 and Professions Code:The Consraini License Law does nos apply to un owner of OUTLETS—SWITCHES—FIXTURES property who builds or improves thereon,and who does such work Herself or through his own employees,provided that such improvements arc not intended m offered for NEW RESIDENTIAL EIEC IR SQ FT. sale.IL however.the building or improvement is sold withinone year ofcompletion,the SQ.FT.FLOOR AREA LSQ.ET owner-builder will have the burden of proving that he did nm build or improve for pun ' pose of ul owner ❑I,as ow r of the Sm.70,1 .Business exclusively amtmcons with licensed cnmmcnua m TOTAL: / conswct the prnjent(Sec.]Ott,wro and Professions Codei The Conhemor's and cense Lntersbr suchshes plr tots with aommeorty who sedpds orant famemproves Corton,and QTy, PLUMBING PERMIT FEE who counters Law.Ern such projects with a cumrucmr(s)licensed pursuant m the Crnhucmr's License Law. PERMIT ISSUANCE. (] lam exempt under Sea ,pk PCfor this reneon ALTER—DRAIN&VENT—WATER(RA) Owner Data 'ATION Wm under Penalty on DECLARATION BACK PLOW PRO'TECT'.DEVICE I hereby ill mai under penalty pe jury me of me following declarations .] stand. as and will for tain aby SeCertificatetio37M of the Labor Codeto .fort for performance Camper, DRAINS—FLOOR,ROOF,AREA,CONE) STORIES TYPE CONSTRUCTION anion, a provided for by Section 3]fNl of the LaMu Cede,for the perfnnnance nl'the work for which this permit is issued. FlXTURFS—PER TRAP ❑I have anti will maintain Workers Compensation Insurance,h his ircd by Section My ofthmrker v hotColi Cndesfor mthe pcme.cancer ad work for which this pemdt is issued. GAS—EA.SYSTEM-1 INC.4OUTLETS OCC GROUP APN My Worker's Cumpensmion Insurance carrier and Policy number um: Comer. Policy No.: GAS—EA.SYSTEM.OVI?It4EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASFJINDUSTRL WASTE INTERCEPTOR (Ibis section resistant beemellae4 ifthepenNt is forme hundred dollars($lop) BUILDING DIVISION FEES or less) GREASE TNAP PLANCHECK FEE an 1certify mal in the anymnof theworkfor which It to AmoWtisissuSEWER—SANITARY—S'1'ONM I?A ed,Ishall _ not employ y person in any manner mme so ax or subject the Workers'Cnmpem .21X1 FT. ENERGY PEE O Z satirn Laws of California.Data WA'I'L'R HEATER W/VENT'/ELHCTR O Applicant GRADING FEE q] NOTICE.TO APPLICANT If,after making this Certificate of Exemption,you should Wgf'ER SYSTEM(TRF.ATING become subject m the Worker's Cum mpeation provhions of the Ldwr Code,you most SOILS PER Lia forthwith comply with such provisions or this permit shall he deemed revoked. WATER SERVICE: Q 0. CONSTRUCTIONLENDINGAGENCY NEW RESIDENDAL PLMB, SQ.FTPAID V O (hereby affirm that there is u construction lending agency for the perfomamee of ate Receipt Fthe work for which this permit is issued(Sec,3097,Cr,C) O U Londe/s Name - TYITAU header's Address TO'T'AL: 1 certify amt 1 have mad this application and sone Bert the abuse information is BUILDING FE ta/I correct.I agree to comply with all city and county ordinances and state laws relining to QTY. MECHANICAL PERMIT FEE V Z huildi....nswction,and hereby amhorize representatives of this city lr enter upon the SEISMIC FE' abovernentomed prrpeny for inspection purposes, PERMIT ISSUANCE (We)agree to save,indemnify and keep harmless the City mf Cupertino against ELECTRIC EH Iiahilities,judgments,coateand expenus which may in any way accroe against said City ALTER OR ADD TO MECH. in x"m e,of the gmntingof'his permit PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANIILING UNIT I'm l,.,,CFM) SgURCE GULATIONS. a n9_ MECHANICAL FF.E W// a/ AIR HANDLING UNIT 10,000 CPM) CONSTRU.CTIOa TAXn Signature of ApplicanVAZAC tnvtm ,m EXHAUST HOOD EVMUCD RDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEEH W,Uheapplicml or furore building oecupam score nr handle M1azardous mmeriul HEATING UNIT(TO 1110,000 BTU) as defined by the Cupertino Municipal Code.Chapter 9.12,and the health and Safely Code.Section 25532(01] HEATING UNIT(OVER Ind."BTU) ix ❑Yes �N VEN'IILA1'ION EAN(SINGLE RISID) PAID Will thea applicant or future building Date ­1{IIRBebipt p pp gby the .Air Quality Management BOILER—COMP OR IIXIpfq BTU nit hazWnus air conmminams as JefineJ by the Be,By Area Air Quality Management ) isaict? BOILER—COMP(OVER 100.000 BTU) TO'T'AL: F7 Yet; �Nr I have read the hazardous rtmmriab requirements under Chapter 6,95 ofare Cali AIR CONDITIONER - ISSUANCE:bureau Health&Safety Code,Sections 25505,25533 and 25534.1 understand fiel tithe NEW RESIDENTIAL MECH. SQ.FT. building does not curtemly have a tnant,then it is my reson psibility m notify the occupant of the orimmenu m,which must be met prior m issuance of a Cenllicule of Occupancy. Owner or authorized agent Data TOTAL: ISSUED OFFICE