31353 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO - BUILDING-EL CTRICAL P17RMITNO. ^ n r�
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-M.CHAN'ICAL 3 3 J
BUILDING PROJEC IDENTIFICATION -
t
BUILDING ADDRESS: ^ / / � /.-���� 'SANITARY NO. API'LICAi'ION SUItMITI'AL UAIE
' OWNER'S NAME: / n �%,fQ§5� /TU/ CONTR T _/. ICiIVP/ NIC CONTROLa
4RCHITECIENGINEER: �(W//I/`/ LIC NO: ✓� ADDf 5/ rsv, /) iL S ❑
CONTACT: ,,��//�T PHONE: / LCJ/" l//L/�O-�U/1 BUILDING PERMIT INFO
/��O .////7O� X12/] ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB M'c
K� -</1`� (/ ❑ ❑ ❑
LICENSEDCONTRACPORS DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby afford that 1 an licensed under powkions of Chapter 9(commencing JOB DESCRIPTION
Z with Section ttp0)ofDivision3 ofthe Businessand l'mfcz+ions Coce,xnd mylicrwris
wo, in' PERMIT ISSUANCE I RESIDENTIAL:
�Iy1- anse full m'e and<Rcc�z ❑SFDWL ❑KITCHEN REMODEL
QUU LicenseCas Lich— APPLIANCES-RESIDENTIAL I ADDITION ❑PLUMBING RF--PIPE
rF Q C Date 1 Convector ❑
F Dwa ARCHITECT'S DECLARATION PANELS ❑hfULTI-UNIT ❑STRUCTURAL
OZ 0 o-Z 1 understand my plans shall Is,used as public records MODIFICATION ZUP TO 200 AMPS
-0 [I INTERIOR [I CHIMNEY REPAIR
F4FuI Licensedprofessional 201-1000AMPS IMPROVEMENT
`(y FOWNER-BUILDER
at I am exempt
from
DECLARATION
Contractor's
ON OVER IMAMPS ❑BATH REMODEUREPAIR ❑DEMOLITION
Xx Q I hereby affirm that 1 am excmpl tram the Corllmcmr's :License Law for the
X�aU following reamn.(Seaion]OJLS.Business and Nofessions Code:Any city or countySIGNS ELECTRICAL ❑OTHAER n
YI 3 0In which re9uircs issuance.
also re comwe,aper,improve,h wernit to
or repmr ed zwaure ,/f OA/ L I_%7 Q/'.1P
I'F'S-�� prionolecense pursawrequirce lhovisiosofs,suchractor ofileazigncd smmmcm SPECIAL CIRCUIT/hfISC.
that he is licensedpunuammlhepmvisiumoftheCommemrkLicenseLaw(Chapter9
(commencing with Section]OXBef Division 3 of the Business and Professions Code)or TEMP,METER OR POLE INST. COMMERCIAL'
6 6 e C that he is exempt therefrom send the basis for the alleged cscmprion.Any violmion of ,',W BLDG/ADDITION ❑DEMOLITION
Section 703 L5 by any applicant for apcmtitsubjects the applicant a civil penalty of POWER DEVICES
—y T NANT ❑FOODSERVICE
FZ} not marc than floc hundred Jnllars(85(X1). PROVEMENT
2Q ❑ 1,as owner of the property,or my employees with wages as their.sole compensation, SWIMMINGPOOLELECTRIC-
�F.m will do the work,and the urawlww is not intended croffered for sale(Sec.90,14,Business R ,
S3 ae and Professions Cele:The Contractor's License Law does not apply ml an owner of OUTLETS-SWITCHES-FIXTURES
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 ELECTS SQ FT.
sal,If,however,the building or impnrvumem ixa.IJ withinoacyearofrnmpletion,the - SQ.Pi'.FLO $ISQ.FT
poer-builder will have the huNcn of proving that he did not build or improve for pur-
❑seafsale,. - c 19 6
1,ns aorto of the property,am exclusively eonweling with licensed contractors - TOTAL: Nov
onstmct the projml(Sm.]1144,Business un0 I'nrl,axlnnx Code:)Tha Contruchui's LI- -
c rex(or xulymjmunpvaciafp.oQTY. PLUMBING PERMIT FEE
whwmmeoaLpeat,
with as ,actor(s)Ilcened puruant ser the Contfuctnr'xNUr CTII yV
1.'eense Law. - CITY Wr
PLRMI I'ISSUANCE
1 am exempt antler Six. ,D&P C fonhis reason
ALTER-DRAIN&VENT-WATER(EA) VN.UA'I'ION
_
WORKLR SCOM I'I,Nrjm,or DT C1 ARAl'I(lN RACK 1-LOW PROTECT DEVICE
Ih by affirm unJcrpcnally nfpcD yrn fthc
Own Dole hrB:: biclanl ms: '
J I have and ill maintain aCerfificamel Consentt ll-ansarc f K k :Contpcn- DRAINS-FLOOR,ROOF,AREA,COND. STORIES TYPE CONS]RUCTION
moan,as provided for by Section 9700 of the labor Cadc.no the performance of the
w kf,,whichthis p. filisizwcd. FIXTURES-PER TRAP
1 hav and will m n Workers Com,pareation Ins required by Section.'
00 of the LaMsrCalm for the perfnrmancc nflhc work for which this permit is i...rd. GAS-1? .SYSTEM-I INC.40UTLET.S OCC.GROUP APN
'My Worke aOa nc carrierand1'o1i, a
Carrier. Policy Na. GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF ;XEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASEANDUSTRL WASTE:INTERCEPTOR
BUILDING DIVISION PEES
(Thio sediun nudnot bemrnpletcd if the permit is faronc hundred Jallun($Ifg) GREASE TRAP
or less.) � PI,ANCHECK PEE '
I cenify that in the Performance ofthe work for which this prewit is issued,l shall SEWER-SANITARY-STORM EA.201 FT.
on
not employ any persin any manner vs as In became object to the Workers Counties- ENERGY FEE _
Z Smartw
las of C.1ifun i,Date WATER HEATER WNENT/ELECTR
Z Q Applicant GRADING FEE
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should 4WATER SYST[M?RGATING
a > become subjeel to the W lace,Compenmtion porso or,of the Labor Code.you mu.a SOILS TGE
forthwith comply with such Provisions or this permit shall he deemed revoked. WATER SERVICE
ao
7 Z. CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ,FT PAID Date Receipta
V Q khereby which
that iso issued
lending agency for the pcdonnance of
the work for wfiich this permit is izmN(Sec.}Ty],Civ.C.)
L[. Fr Lendeh Name TOTAL:
V Lcndcis Addms TOTAL:
I ecnify that I have read thix application and stair that the aMve information is - BUILDING FEE
F to correct.l agree to comply with all city and county ordinances and sale laws mhtingm QTY. MECHANICAL PERMIT FEE
U Z building convection,and hereby authorize repremnatives of this city to enter upon the SEISMIC FEE
above-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree Ira save,indemnify and keep has.nles,the City of Cupertino al ELECTRIC FEE
Iiabilities,judgmenrs,casts and exnema which may in any way accrue against said City ALTERORADDTOMECH. PLUMBING ITS
in consequence of the granting of this permit
APPLICANT I' DGRSTANDS AND WILL COMPLY WITH ALL N IN-POINT AIR HANDLING UNIT ITO to."CFM) MECHANICAL FEE
v (�` -1
SOURCE
AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTION TAX n
Si ins f, ,IiamVC.mrwox, Dmc EXHAUST HOOD(WMUCT) HOUSING MITIGATION FEE
HAZARDOUS adATERIALS DISCLOSURE
Wdllheappliciume,ilmrc buildingoccupant.anrcor handle hazaNanx material HEATING UNIT(M 101,000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code,Section 25532(io? ,_,,[/ - HEATING UNIT(OVER 11X1,010 BTU)
ED Y �,V
VENTILATION FAN(SINGLE RESID) PAID
Data Receipt M
Will the ppbca t a,I t v be i1,1m,ocatiparl use r,uipmest or devices when
t naramons air cmunnimmis asdefined by the BayArea Air Quality Management BOILER-COMP(3HP OR 100,000 BTU) IO1AL. -
a'r ' :regl rc BOILER-COMP 100,000 BTU)
E3 Yes /r�/r,( , ----
1 buvl read the h z rd uterialx nems u sw,Ch pl�r G95 of the Cali- AIR CONDITIONER I$$UANCE DATE.
forria Health&S019 Code,Sections 25505 25533 and25534 1 mideranind that If the NEW RESIDENTIAL MECH. SQ.FT.
buildgd a yalw1 N,IhaI Y 1 ,butyl tly11J'a1
au t. i t ryr� scof a Clnt //Ivj)t(I Irk
Owner s r euth aired agent //iDate/� TOTAL: ISSUED BY:
OFFICE
I
10300 Torre Avenue
00 t 1, Cupertino,CA 95014
cupel tmi o Building Division
T' (408)777-3228
(408)777-3333 (fax)
June 18, 1997
Homeowner
20128 Las Ondas
Cupertino, CA 95014
SUBJECT Permit#31353
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 had a final inspection.
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 dispose of the file and remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
Printed on Recvr;:ed Pane,