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30363 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY - CITY OFCUPERTINO - BUILDING-ELECTRICAL PERMITNO. ' BUILDING DIVISION APPLICATION/PERMIT - PLUMBING IMECHANICAL 3036 BUILDING PROJECT IDENTIFICATION '� UILDINGADDRESS: - SANITARY NO. APPLICATION SUBMITT DATE 10sa9 Cit �C�Q - GA L ERS NAME. PHONE: CO�'TRgTOR' NAMB�'` n I LIC NO: X7,GiI ' CH IAPPA ya4- sa-8`1>4 / —J (rt, cJ�l4�T; NIC {'�j ONTRO M IRC ITECT/ENGIR: LIC NO: RESS: - ❑ V o,4C v CO..N'.T^AACT•: L - PHONE: BUILDING PERMIT INFO Wei ❑ Consultant Fees Pais)by Applicant(Initial) BLDG ELECT PLUMB MECH foo-3a7-asap, ❑ ❑ . If LICENSED CONTRACTOR'S DECLARATION I herebyaffirm that 1 am licensed under envisions of Cha-ler 9(commencing QTY. ELECTRIC PERMIT FEE p v g JOB DESCRIPTION {CIZZ00 with iftweeudeffef Division3ofthe Ausiness and Professions Code,andm llnnnseks OR 'RESIDENTIAL: - �U�FOO Tense lass elTem, y PERMIT ISSUANCE j License Class Lic.# �' ❑SFDWL [_1 KITCHEN REMODEL b+ Wfipate Contractor APPLIANCES-RESIDENTIAL El ADDITION ❑PLUMBING RE-PIPE F Z. I ARCHITECTS DECLARATION ❑fr� MULTI-UNIT El STRUCTURAL 0 O1 urstood ndemy pl:ms shall be used as pre ublic cords PANELS MODIFICATION UPTO 200 AMPS p4t9z '[I INTERIOR El CHIMNEY REPAIR u7 Licensed Professional 201-IOMAMPS IMPROVEMENT ONERBUILDER DECLARATION OVER IOOOAMPS 'EIBATHREMODEUREPAIR IEMOLMON d'0.P'Q I hereby affirm th tW1 exempt Fortune Contract s License t f C L Lfar the )�� 3 0W0.V following reason (Sect 70315 Business dProfessions C d Any city or county SIGNS ELECTRICAL [I OTHER wer ; W which regores a permit t canswct alter p e d mulish p any swcwre V` , - �— �� prior to its issuance also q ' the pplic t for suchpermit t rile asigned statement SPECIAL CIRCUIT/MISC., i+ that he is licensed pursuant Other ro previsions of the Contractor's License Law(Chapter 9 alp0 (commencing with Section 7000)ofDivislan 3 ofthe Business and Professions fesss Code)or TEMP.METER OR POLE!NST. V ,COMMERCIAL: L see' that he is exempt thartfirma end the basis for the alleged exemption.Any violation of ❑NEW.BLDGIADDITION [IDEMOLITION ?y5 ro W Section 7031,5 by any applicant for ape.!,subjects the applicant m a civil penalty of POWER DEVICES w..y TENANT ❑FOOD SERVICE ZM not more than five thundrede dol tars($SWl IMPROVEMENT 0 ❑Lo the corofthe property,remyempldyeeswithwages as their ea compensation, SWIMMING POOL ELECTRIC will do the t, The Contrarian, License La a doesrod art applc.7O44,Business ❑OTHER W 3 and Professions Code:The Contractor's License Law dues not apply s if owner of OUTLETS-SWITCHES-FIXTURES Q' progeny who employees, pr improves thereon,improvnd whoements nts m not inrk ter sed or anhrough - his own employees,provided that such improvements are not intended or offered for NAW RESIDENTIAL ELECTR SQ PC owneehowevcgthevethe burding or improvement isut sold he within one yeor imprvetforthe SQ.FT.FLOORAREA 8/SQ.FT. owner-builder will have the burden of proving that he Jid not build or improve far purr- n. y Time of salon. -,Business TOTAL: co I,as owner of the property, exclusively contracting with licensed contractors to VVV consumer the project(See. Li- verse Lew does not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FEE who contracts for such pmjems with econtractors)licensed puixuam to the Convocmr'e n) ' License Law. PERMIT ISSUANCE ❑I am exempt under Sec, B&P C for this reason Owner pate S ALTER-DRAIN&VENT-WATER(EA qI VALUATION "WORKER'S COMPEN NDECLARATION BACK FLOW PROTECT.D'E'VICE + /99Vs I hereby affirm under penalty of pe jury one of the fallowing declarations: ��•/I V ❑ I have and will maintur.Cenilicatenf Consent w self-insure for Worker's Compen. DRAINS-FLOOR ROOF,AREA,GOND. sation,as provided for by Section 37M of the Labor Cade,for the performance of the "STORIES'[,, TYPE NSTRUCTION work for which this permit is issued, FIXTURES-PER TRAP L E]I has and will maintain Workers Compensation Insurance,as required by Section - 37Wofthe Labor Code.for the performance of the work for which this permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCCGROUP APN My Workers Compensation Insurance carrier and Policy number are: • 1 Carrier: - Policy N., GAS-EA.SYSTEM-OVER 4(EA) 1 CERTIFICATE OF EXEMPTION FROM WORKERS' - COMPENSATION INSURANCE GREASF/INDUSTRL WASTE INTERCEPTOR (This section need net be completed ifthe permit 6 income hundred dollars O100) - IxW;k'lZyIVISTONFEES or less.) GREASE TRAP PLANCHECK FE I certify that in the performance ofthe work for which this permit is issued,i shall SEWER-SANITARY'-STORM EA.2W FT. not employ any person in any manner so as to become subject to the Workers'Compen- ENERGY Z sation Laws of California.Date nk O .Applicant WATER HEATER WNENT/ LECTR GRADING B NOTICE TO APPLICANT:IL after making This Cenifiend of Exam tion,you should s r WATER SYSTEM/IREATING a [" become subject to the Worker's Compensation provisions of the Labor Cake,you must SOILS FEA {p11 G forthwith comply with such provisions or this permit shall be deemed revoked. WATER SERVICE CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.ET. PAID _ UO Iheretiyaffirmthm Opeou construction lending agency ferthe Perfo..maof i me Recciptp V. the work for which this permit is issued(Sec,3097,Civ.C.) MFEE OL) Lender's Name TOTALLender's Address - +' TOTALI certify that I have read this application and state that the above information is EVJ correct.l agree 0 comply with all city and county ordinancesand state laws relating to QTY. MECHANICAL PERMIT U Zbuilding construction,and hereby authorize representatives ofthis city to enter upon the above-mentioned property for inspection purposes. PERMIT ISSUANCB(We)agree to save,indemnify and keep harmless the City of Common against E. .iabilities,judgmems,costs and expenses which may in any way same against said City ALTER OR ADD TO MECH.in consequence of the granting of this permit. EEAPPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTPIR HANDLING UNIT(TO10,000 CFM)SOURCB REGULATIONS. t L FEEAIR HANDLING UNIT(OVER IO,O00CFM7IONTAX Signature of ApplieantlConaactor Date EXHAUST HOOD(WIDUCT) HOUSING MITIGATION FEE a HAZARDOUS MATERIALS DISCLOSURE Will tcitiniicam or Nmre building occupant store.,handle hazardous material HEATING UNIT(TO 100,000 BTU) as defined by Ne Cupertino Municipal Code,Chapter 9J 2,and the Health and Safety' Code,Section25532(a)? HEATING UNIT(OVER 100,1100 BTU) - Dyes , ' ❑No VENTILATION FAN(SINGLE RESID) PAID Date Receipt# Will thelton nit containment,cant or building by the nt useBay Aequipment.Aiality or deviceswhich BOILER-COMP LHP OR 100,000 BTU) mit hazaMous air contaminants as refined by the Bay Area Air Quality Management TOTAL: District? ❑Yes 71 No BOILER-COME(OVER 100,000 BTU) ' I base ad ou the hazards materials recruitments under Chapter 6.95 of be Cali- AIR CONpIT1ONER reISSUANCE DA fomia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.Ff. building doze not currently have a tenant,that it is my responsibility to notify the occupant sof the requirements which must be met prior to issuance of a Certificate of Occupancy, , Owner miutbodzedmgent Date - TOTAL: ISSUED BY: '' OFFICE • 10300 Torre Avenue 011" nov ( l. Cupertino,CA 95014 Cupertino Buildine Division (408)777-3228 (408)777-3333 (fax) March 24, 1997 Homeowner 10329 Brittany Ct. Y Cupertino, CA 95014 SUBJECT Permit#30363 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 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, Adm inistrk • Primed o,,Recycled Pacer