29803 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO O
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: � SANITARY NO, APPLICATION SUIIMI'1'1'AL UATL
SNA PHONE: ON'fR 'f57p. AME: LIC NO'
L NIC CONTROLN
\RU ECT/ENGI R: LIC NO: ESS: ❑
P✓
CONTACT': PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial ,BLUQ BLEcr PLUMB MECH
L10ENRED CONTRACT'OR'S DECLARATION QTY. ELECTRIC PERMIT FEE
I hereby affirm mat turn licensed under pnwisfons of Chapmr 9 lcommencing JOB DESCRIPTION
D00 with Section 7000)of Division 3 ofthe Business and Professions Code,on yliclsois RESIDENTIAL-
O O PIiRMI'r ISSUANCE
an Tulle Oe and effem' ❑SFDWL ❑KITCHEN REMODEL
F.V License Cla. Lle k
N<� Cnnwcmr APPLIANCES-RL•SIUENrIAI. ❑ADDITION ❑PLUMBING RE-PIPE
ARCHITECT'S DELLA ATIGN PANELS ❑MULTbUNIT ❑S'rRUC'I'URAL
ZFonz IunJcmanJ my plans shall he used os boldin recoMs MODIFICATION
OZ
^ UPTO200AMPS ❑INTERIOR ❑CHIMNEY REPAIR
1-somod Professional 201-IIMAMPS_ IMPROVEMENT
fq� that I a OWNER-BUILDER U the Co TION
6 1 hereby afprm that 1 am exempt from the Commcnors License Law for the OVER 1000 AMPS [I BATH RF.MODEIIREPAIk C DEMOLITION
k�ppy5,,
0'U following amom.(Section 7031.5,Business and Professions Cede:Any city or county, SIGNS ELECTRICAL [IOTH17R
FLLO y which re9nirea a permit or conswct,alter,improve,demolish.or repair any structure
prior to its issuanex,also requimsrhe applicant for such perminn fileasignedsnetemem SPECIAL Cl RCUIT/MISC.
QI that he is licensed pursuant to the provisions of the Contractors License law(Chapter 9
00 (commencing with Section 7")of Division 3 ofthe Business and Professions Code)nf TEMP.METER OR POLE INST COMMERCIAL:
6 Q. that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑DEMOLITION
�4'ectlon 7031.5b Ic tfara mtit subjects they I tto.civil alt f POWER DEVICES ❑NEWBLDG/ADDITION'
h 1 y any app i un pe / pp icon pen y o ❑TENANT ❑FOODSERVICE
not more Than five hundred dolour y($501))e .
Lmowner of the IMPROVEMENT
O ❑ the
my employees with rthc(Seeecompcnsiiess SWIMMING POOL ELECTRIC
will Professions
r to work.andthe he Coreisrani Limarprofferedsnot apply to
an Business OTHER
.gym+ and Prnfwho bildso Thema,tot. license Luodocsnotapplytolf owner of OUTLETS'-SWITCHES-FI TURf?S
pfopcaI who builds or improves Herron,end who dors such work himself or through
his own employees,building that such improvemona is old within
arc not yearofora offered for NEW RFSIDENTIAI,ELL R SQ PI'.
monsaleer-uweventhevethn burden
is he id noneild or
improve for
EQ.Fr.FLOOR AREA E/SQ.FP
Tomo budlder will have the buNen of proving that he did not build or intpmve for pnr-
poseof owns
❑ 1,ru owner of the property,um exclusively Professions
with.,.....comm-1 to TOTAL: pH
caucus the project(Smunity
o an wner of and property
who bus ds orImproves
The es ether mre rat k" p
cense Low dceoract
such
tots iTIEa ofpuiperty whcb dpuruant to the Contractor
QTY. PLU TNG PER I ' FEE
who contracts for such projects withucnnoucmrts)licensed pursuant the Commmor's APR
License Lew. PERMIT ISSUANCE _ AP C
El 1 nett exempt under Sec. ,B&P C fortis mason f/
73:100m,ho
xmm Dae ALTER-DRAIN&VENT'-WA ( of r Up VALUATION
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE I _ 1�['��/��/T/�^
I hereby affirm under penalty ofperjary one of The following declarations: 4�/CS(J(J o
I have and will muinneina Cenificatenf Consent toolf-intme for Worker's Compem DRAINS-FLOOR,ROOF AREA D
tion,as provided for by Section TIM mine Labor Cade,for the performance of the - STORIES MISCONSTRUCTION
rk for which this Tomtit is issued. FIXTURES-PER TRAP
I have it will maintain Workcls Can,...him Insum im,as required by Section
labor fm the perturmance ofthe work for which this permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC GROUP APNy Wa keoro noon Insurance carrier and folic (Jmeo Policy Nn �am.•'-1s� GAS-EA.SYSTEM-OVER 4I EA)
CERTIFICATE OF EXEMPTION FAOh1 WORKERS'
COMPENSATION INSURANCE GREASOINDUSTRI"WASTE INTERCEPTOR BUILDING DIVISION FEES
(This section need sol he emtpleted i r the permit is for one hundred dollars 1$100) GREASE TRAP
t or las.)Tthat in the performancewjthis Permitissued, SEWER-SANITARY-STORM❑A.210 Ff.
PLANCHECK EE
not employaay person in inymanner so as It becameuhct m he WmIeriCosmoor.
ENERGY FEE
11 Applicant
of California.Date
O WATER HEATER WNFN'TIELF.CTR
{� Applicant GRADING PEG
yt NOTICE TO APPLICANT:IL ufc,ranking this Cemficnte of Exemyo
ption, u should WATER SYSTEMIMPATING
a �bec
mose .him,to the Wmwev Compensation provisions m The Iahnr Code,you must SOILS PEE
IfJ forthwith comply with such provisionsor this permit shall be deemed revoked. WATER SERVICE
U
UO CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PL MR. SQ.Fr. PAID
L herehy eflirm thauheme is aconswetion longing agency for the peRormantt of Date kmaidit
� N the wnrk for which this permit is issueg(Sou.309'I.CIv.C.)
O U Lenders Nome TOTAL:
Lenders Address 'TOTAL:
I cvaify that T have read This...liomion and atom phut the above formation.is -- BUILDING FEE
Z) correct.l agree to comply with all city and county ordinances Emit stem laws relating to QTY. MECHANICAL PERMIT FEE
C.) Z building construction,and herebyanthoriae representatives ofthiscity menterapon The SEISMIC FFai
r shove-mentioned property for inspection purPoses I PERMIT ISSUANCE
(We)agree to save,indemnify and keep harmless the City of Cupseninu against ELECTRIC FEE
liabilities,judgments costs and expenses which may in any way.maua against said City TITER OR ADD 7YlMT:Cfi.
in consequence of the granting of this permit, PLUMBING IEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1"NON-POINT AIR HANDLING UNIT(TO Top"CFM)
SOU EREGULKH N. - MECHANICALME
{L AIR HANDLING UNIT(OVER I10,00p CFM) CONSTRUCTION TAX
ignatureof Appi connector l Date PHAUSTHOOD(W/DUC'l) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant some or handle butarJnus material HEATING UNIT(TO Ifl BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,orad the Heuhh end Safety
Code,Section 25532fa)7 BEATING UNIT(OVER 100,000 BTU)
❑Yes 7 N VENTILATION PAN(SINGLE RESID) PAID
Will the applicant or future building occupant use equipment or devices which Date Receipt g
mit hazallous au contaminants as defined by the Bay Area Air Quality Management BOILER-COMF(3HP OR 100,000 BTU)
OisWa? TOTAL:
❑Yes 0 N BOILER-COMP(OVER Rff"BTU)
I have readthe huaal materials napdactumv under Chapter 6.95 of the Culb AIRCONDITIONER - ISSUANCE DATE
fomia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the NEW REST DEN DAL MECR. SQ.Pr.
building docs not currently have a tenant,that it is my responsibility to notify The occupom
of the requirements which must he met pain,m issnanceof a Certificate of Occupancy. IMP
t
Owner or amhonmd.,car Date TOTAL: ISSUED BY:
OFFICE
�®
10300 Torre Avenue
Cupertino, CA 95014
C-Lipertll10 Building Division
(408)777-3228
(408)777-3333 (fax)
January 22, 1996
' Homeowner
10312 West Acres
Cupertino, California 95014
SUBJECT Permit: #29803
Dear Homeowner:
We have been going through 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 Clerk
S �
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO0.
. BUILDING DIVISION F_-,'.,BU1W1NG PROJECT umztmFH:AnoNi".ex. 29803'
BUILDINGADDRESS: II SANITARY NO. "PLICATIONSUBMTTTALDA
'N
NAME
PHONE: COc U CONTROL N
f)(6'/ er
07 AM
Cr/ENGINEER: LIC NO:
F
7S*n , 7�
j��,rt.�7��BUILDINO PERMIT
..... . . El Consultant Fees Paid by Applicant(initial)
IF
'W .INSPECTIONS" ,N.,;DATE INSPEC. ELECT PLUMB MECH
FOUNDATION/PIERS/H.D.S. INSPECTION RECORD JOB DESCRIPTION
UFER GROUND NOTE: ALL GRADING AND DRAINAGE RESIDIINMIAL
PAD/SETBACK-CERT SHALL BE INSTALLED TO COMPLY WITH 0 sFDwL 0 KITCHEN REMODEL
THE APPROVED PLANS AND CITY OF CIADDITION 0 PLUMBING RFPM
GARAGE SLABS/PREGUNITE C STANDARDS. 0 MUl.TI.UNTr 0 STRUCTURAL
.MILR REjEiUNTItABOVE,HAS1I3EEN.sJ0 MODMCATION
AONS
IN 1; ION 0 INTERIOR 0 CHIMNEY REPAIR
UNDERGROUND/SLAB CALL AFTE�RN (12�P30E M - 4:00 PM) IMPROVEMENT
❑BATH REMODELAtEPAIR 0 DEMOLITION
PLUMBING 777-3228MON AYTO FRIDAY 24 HOURS BE- [3 oTjiER
I - FORE IT DI INSPECTION.JOB ADDRESS
ELECTRICAL
1DO 140T fOUR FLOOR'UNnLABOVF'HkS BEENSIGNED #ARF NEEDED WHEN PHONING.
COMMERCIAL-
PLUMBING ATTENTION CONTRACTORS: Bt.MADDITION DDEMOLITION
NO PERSON(S)SHALL PERFORM WORK ON—ANT
0 FOOD SERVICE
MECHANICAL IM INIPROVEIVIENT
THIS JOB SITE WITHOUT BEING IN CO *k_7
ELECTRICAL ON
PLIANCE WITH WORKERS'COMPENSATI,
FRAMING VENTS INSURANCE REQUIREMENTS. 0.
INSULATION
INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP.
ROOF SHEATH/DIAPHRAM
PLUMBING
TUBS&SHOWER PAN
7Y
MECHANICAL
ELECTRICAUPOOL BOND
FRAMING/STAIRSIE.EGRESS
INSULATIONNENTILATION
EXTERIALSHEAMOLD DOWN
DrTERIOR SHEARMOLD DOWN
SHEETWROCK/SHEETROCK SHEAR
EXTERIOR LATITW-SCREED •
SHOWER LATH
Si
SCRATCH COAT
SEWER/WATER
m-pok"YjApPiRov ixI '�
56 . 49
T
OCCUPANCY
ELECTRICAL
GAS . 7,"'
GAS TEST
GRADE APR. 2
FIRE
oill ";wr a.
HANDICAP S
ELECTRICAL
PLUMBING
MECHANICAL
ENERGY
CERTIFICATE 0TOCCUPANCY.El
VISUAL FINAL ONLY
BUILDING
IMPORTANT: ISSUANCE 3
ATE'
jOP BUILD1NG'IStjN.9TtPTRMIVy y I PLEASE READ REVERSE SIDE BEFORE
I;UNT I DIN' G:P1h 46 CALLING FOR FINAL INSPECTION!! - 7F.
f3
4,
'INSP � - � fi
ISSUED BY..
—APPLICANT'S POSTING COPY