27907 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
' BncBNEC' -
ERMn'No.CPIY OF CUPERTINO PtIG- FCIIAN[CA,.
BUILDING DIVISION APPLICATION/PERMIT BUILDING PROJECT
]DEN'1INICATION Q
BUILDING ADDaR�ESSSS� (y�,/w�1L ^ SANI'T'ARY NO. APPLICATION SUBMITTAAL'1DATE
"J 1"z r'/�—fa� Y�' UNITY LOT It
OWNERS NAME: PHONE: CONTRACTOR'S NAME: LIC NO:jqftA CON'IROLM 1
4, f Lf J G ON C.
RCI(I'IECT/ENGINL•ER: LIC NO: ADDRESS:
T.
CO A PHONE: " "'t r¢ a a- " • BUILDING PERMIT INFO
QTY: '4 s °FLEGTRI PERMIT 2 -IrF,E'
§ ky �Y1 ha4wr. & 3 t -
_ ELB PLO 0 MUCH
PERMIT ISSUANCE
LICENSED CONTRACfOR'S DECLARATION APPLIANCES-RESIDENTIAL 1 DESCRIPTION
cxz Inuabff
yarmthat l am licensed under provisifC
nnsohapter9(commencing with
�00 Section 700B of Division 3 of the Business rand Professions Cale,and my license is in PANELS
yU� full ad effect.
FZW License nu ClClass Lic.Y IIPTO200AMP5
ri<y Datc Contractor "rC/} 201.1000 AMPS
FNS ITfiCI'S DE 1. ATIO // SQ.tT.IlOOR RPA 8/SQ.Ff.
20v, pj4k�t•Y./• OVER 1000 AMPS
OZ—M IunJersP nJ my plans shell be uud es public records. �
SIGNS ELECTRICAL
yw� Licensed professional
` —�(/ «�J
mownisOWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
x . 1 hereby ufli.that 1 am exempt from the Contractors License Law,for the
W3u-anfollowingreasm,Section 101IS,Iiuxiuess rand Professions Gale Any city or county TEMP.METER OR POLE INST.
which requires permit to construct,alter.improve,demolish.or repair any structure
T� prior to its issuance,alsotequires the applicant forsuch permitm file a signed statement POWER DEVICES
Gp that he is licensed pursuant to the provisions of the Contractors License Law(Chapter
is. 9(commencing with Section]00Bof Division 3 of the Businessand Professions Cade) SWIMMING POOL ELECTRIC VALUATION
tai or that he is exempttherrEmo and did basis for the alleged exemption,Any violation of
Section 9031.5 by any applicant for a permit subjects the applicant to a civil penalty of OUTLETS-SWITCHPS-FIXTURES
not more than five hundred dollen f$Slio). _
NEW RESIDENTIAL ELELTR SQ ` L was
m ❑ I,asownerofthepmp ny,ormyemployecawithwagesastheirs lecomp .rt .n, .FT. STORIES PT:CONSTRUCTION
o. wPldorhe work,and the structure is not intendedmoffered forsule(Sec.9044,11miness
and Pmlessions Cade:The Contractors License Law does not apply to an owner of
p'mpeny whobuiMsnrimproves thereon,and whodrws such work himulfmrhrough hie
OCC.GROUP RPS.UNITS
ownemployees,provided thatsuchent is said
nstsarcme,clondes moffered for sale.IL
however,thehave
l the burden of patent is that
he didnot build o improve foron,the owner- A .I
'builder will have the burden of proving that he did not build or improve for purpose of
via)
❑ Lus nwnerof the propmy,nm esdus velyarmmcting wuh licensedrnnvecto sat QTY Y- a i t PLUMBING PERMIT' FEE"° OOD zliAPN
construct the pmject(Sec.7044,Business and Professions Code:)She Co dracmrs =�\
Licenu Lsw,does not apply to an ownerofproperry who builds or improves thereon,and PERMIT ISSUANCE
who contracts forsuch pmjecn with acamractor(s)licensed pu mortto the Contractor's ALTER FA PCB SUMMARY
Lie use Law. E- )
❑ I am exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DhVICF. OU >
S NITA Y N
Owner Date RBCIiI 1p
ROOF,
FLOOR, AREA,COND.
WORKMAN COMPENSATION DECLARATION DRAINS- CI(OOL TAX Y_N
❑ Thereby affsm that lhave acertifcute of consent no ulf-insure,orerectifiable of
FIXTURES-PER TRAP s RECIi1PTY
Workcrs'CompenvuJon lnuranceorucvrtifed copy Ncreof(Sec.3g00,Lub CJwhich PARK YN
covers Yall employeRHC ffvf#
PoliynL GAS-EA.SYSJEM-1 INC 40UTLETSp
BUILDING DIVISION FEES
Com Cay H GAS-EA.SYSTEM-OVER 4(CA) PLANCHECK PEE,
Certified py is heed yll be hed.
Le,
Certified copy is fled will Ne city inspection division. GREASF/INUUSTRI.WAS'I'Ii INTBRCI!PI'OR GRADING ECF.
CERTIFICATE OF EXHMPOON FROM WORKERSGREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This action need not he completod if Ne permit is foronc hunNed dollars($Ilio) SEWER-SANITARY-STORM FA.200111'. IiNiiRGY FEB
or less.)
I amity that in Ne performance of the work for which this permit is issued.I shall WATER HHATFR W/VEN'OHLECIR
not employ any person in any manner so as to become subject to Ne Workers PAID
Compereadmi Lawsof Califomia. Date WATER SYSTEMTREATING Date Receipt#
zAPPEicant
O NOTICE q'OAPPLICANT:If,afermaking this Cenifcuteof Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
yy bacomcsubjea to the Workers Compensation provisions of the Labor Code.you must
F�, 7 forthwith comply within such provisions or this Permit hall be deemed revoked. BUILDING FEF. a/Y
(� CONSTRUCTION LENDING AGENCY SFISMICFEE
Z 1 hereby afford that there is a construction lending agency for the performance of
V O�+ the work for whichthis permit is issued(Sce.3(11 Civ.CJ 'f ELECTRIC IrEE �-
pLender's Name
Lcndaes Address QTY, MFCI IANICAL PERMIT. FEE PLUMBING FEN.
V 1 certify Nat I have read this application and state that the above information is
0. correct.la rmmcom I th all cit ticoum Ninunca,militate laws Main m PERMIT ISSUANCE MECHANICAL IPE
6 Pyhe yen yo g
F-' Z buoc-adatiouuilp..andhorr by imsia orizereprcsemmivn of this city menter upon the CONSTRUCTION TAX
L) z above-mentioned property for innify add keep baba ALTER OR ADD TO MSCI I.
(Wed agate nt save,indemnify ens keep may in
the City o Cupertino s against
liabilities,judgmenb,cosb andexpcnuswhich may in any way seems against said City AIR HANDLING UNIT(TO lli,fpO CFM)
in consequence of diagraming of @ia/I�rmit al _ /"�
f/'sAir� /'/.\(/r'J'(/7- c%/!N- AIR HANDLING UNIT(OVER I ti,fNq CFM)
Signamm of ApplicnnVContracm v ' Date EXHAUST HOOD(W(DUCD
PAID
IIA]ARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO Iffly lBTU) Date Receipt#
Will the aply'want or future building occupant store nr handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and Ne l Lcalth and Safety I[EATING UNIT(OVER IOq()(g)BTU) TOTAL:
Cade,Section 25532(e)1
El Yes ❑No VENTILATION FAN fSINGLH RESID)
Wilhhea licam or Pomubullsin yuipmen BOILP.R-COMP(JIIPOR Igi,(gO BTU)
ISSUANCE DATE
pp gmuupam usec mrJevicee which emit
heavrdoua air contaminants as defined by he Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU)
DistdaO
❑Yes ❑No NEW RESIDENTIAL MBC". SQ.[4. I_
/,� p
1 have read the linamdom
us arermN requirements under Chapter 6.95 of the AID
O
Cnlil'nmiu Health&Safety Code,Sections 25505,2553]and 25534. I understand Net ss�
if the building does not currently have u tenant,Nat it is my mryonsibility to notify the 0
aecupum of the re idiaments which must Na met prior m issuance of a Certificate of /s
Occupancy.
Owner or authodced agent Data TO 1 ISSUED BY:
OFF p
H �.
ul' C
• ® 10300 Torre Avenue
Cupertino, CA 95014
CAIN,
Cupertlllo Building Division
(408)777-3228
(408) 777-3333 (fax)
September 23, 1996
Larry Hara
8025 Rainbow Drive
Cupertino, California 95014
SUBJECT Addtn:, permit #27907
Dear Homeowner:
We have been cleaning out 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
• 10300 Torre Avenue
Ocitvof Cupertino, CA 95014
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
September 23, 1996
Larry Hara
8025 Rainbow Drive
Cupertino, California 95014
SUBJECT Addtn:, permit 427907
Dear Homeowner:
We have been cleaning out 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. ,C/
Sincerely,
CITY OF CUPERTINO v
Christ=Administrative
�1 �v
•
Printed on Recycled Paper
APPLIC4NT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINOPLUM
ECI n, rlsknuTNp.
CAL
BUILDING DIVISION APPLICATION/PERMIT PINGPROJECTICHANI11C 27907
BUILDING PROJECT IDENTIFTCAT'ION��
BUILDING ADDRESS: SANTT'AkY NO. APPLICATION SUBMITTAl.UAII.
80 ✓J
x �/v S) UNIT# LOTY r � �
DOWNERS NAME: A 1.11ONE: CONTRACTOR S NAME: LIC NO: y NIC CONTHOLp
k : f -�1 ✓snooll
�RCHITECT/ENGIN ER: LIC NO: DRESS:
G ac//f/6 i s t �L� /� u'� 17
COh A 151ONE: ca: ssr .wvwrswx„EnM1 �r ti'SF F awl r htg�p
:7 "y r�a. #.]_, 4- UD,DLVG PERMIT INFO
QW;v- EIjECnI'RIC PERMITat"yf��”' :xiii•.�'•Etrd
L ELE PLII B MECH
PERMIT ISSUANCE
LICENSED COhTRACfOR'S DECLARATION APPLIANCES-RESIDENTIAL
Inez Ihembyaf nerthat l en BeensedetdetproviaionsofCTapter9(commencing with 1 DESCRIPTION
X00 Section Tt100)of Division 3ofthe Hadaressead Professions Code,end my license is in PANELS
W_ full fora mJ effect. ^�
%VU UP TO2W AMPS 1{/{Ip`J
`zte License[less Lt..
<a pate �[unvactor�y "/(i} 201-IOW AMPS
"�rn C' SQ.FT.FLOOR kEA $/SQ.PT.
-qZ A ITECpSDE uRAnO
7y0 I understand my plans shall be usedDpublic recoI L.o'-�>Ce4tOVER TWO AMPS 1
r;Fm SIGNS ELECTRICAL
g j LittnsW Prufassional I ✓ U�:Jd
�ne< OWNER-BUILDER DECLARATION SPECIAL CfRCUIT/MISC.
O c I hereby affirm Nat I am exempt from the Contractor's License Law for the
C< following reason.(Section 9031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST._y, which requires a pennino common,area,improve,demolish,or repair an"butrom
prior to its issuance,also requires die apPlown forsuch emat to fileesigned statement POWER DEVICES
Y C p
that he is licensed pursuanno the provisions of the Convectors License Law(Chapter
7FL 9(commencing with Section 7000)of Division 3 of the Business and ProfessionsCode) SWIMMING POOL ELECTRIC VALUATION
_Jw or that he is exempt therefore and Ne bazislor me alleged exemption.Any violation of OUTLETS-SWRCHFS-FIXli1RFS "` �'1 Ny O
_z� Scetion 7031.5 by any applicant for a permit subjects the appliantto a civil penalty o! ` L w
not ml.mo%nfioftheve doWny,ormdollars SSW). NEWRESIDENTULELECfR _SQ.FT. STORIES PE CONSTRUCTION
ax
F'p Lazowrk.and epropenparsnatimoyedorofwegesetthei(Sec.7ompermati.,
_3— will do coons C d e:The Cunt isno Contractor
License
Law
t f but.,Iy,.an,Business
and Professions Code:The Comaremor'a License Lew des not apply tom owner of
is
propertywhobaaIdsorimprovestb imw oendw todessuchwork n.selfmtomughhis
employees,pingor improvement
sold hien ne yew oftdaroffered for ole.lf,
OCC.GROUP RES.UNITS
noldiar mill have
brimprovementissoldwithinone neem of cprove for thrower- A
build«rill have the burden of proving that he did not build or improve for purpose of ee
cele.( v. w � M S t Y ; OOD ZONE APN
❑ I.0 rafthe propeny,amro
ezclusivelYnuacting with nscontractorsQTYlicecontractors to _ r�f ••,jt iah„-uh«;eT..:+•m.:C.;PLUMBING PERMIT 4 FEE i;�7r�u : 5t.:sn irai
consumer the proj«t(Sec.'IIs34,Business and Professions Code:)The Contractors IrPERMIT ISSUANCE
License Lam'des not apply to an owner of property who builds or improves thereon,and
who cantons for such projecu with a conuenorts)Iiensed pnrsomuo the Conuecmr s
ALTER-DRAIN&VFlgT-WATER TEA) 't "�.:we` ;;^.',FEE SUMMARY
Liana law. _
❑ I am exempt under Sec. ,B&P C for this rtesonSI S
BACK FLOW PROTECT.DEVICE SANITARY Y_N
Than Date RECEIPT N
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF,AREA,COMB. SCHOOL TAX YIN
❑ I hereby affirm that l have acenifiute bloomer,to self-insum,ora mnilcamof FIXTURES-PER TRAP RECEIPT#
[#Workers Compensation Insurance me matifiedcopy thereof(Sec.39W,Lab C)which PARK FEE Y N
Come.Vl emp�l�o%v«��'xpu t this perp it GAS-EA.SYSTEM.11NC.4 OUTLETS �� RECF.IF'Tp
Poli cyY Y'�I '� BUILDING DIVISION FEES
Company • s '[(/'. f L / 6 a GAS-EA.SYSTEM-OVER PLANCHECK FEE
[I Certified Up,is here,famished.had. 4 B
�] Certified copy is tied with the city inspection division. GREASFFJINDUSTRL WASTE INTERCEPTOR GRADING PEE
CERTIFICATE OF EXEMPTION MOM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE �•
(This sectionn«d not becom,lned ifthe permit is frrone hundred dollars lSl W) SEWER-SANTTARY-STORM EA.201 ENERGYME
or less.)
I anify that in the performance of the work forwhich this permit is ismad•I shell WATER HEATER W/VENT/ELECTR
not employ any person in any mamas m es to become subj«t to the Workers PAID
Compcnsationlawsof Celifomia. Date WATER SYSTEM/1REATING Date Receipt#
Z A,dicarrdt
NOTICE TO APPLICANT.If,after making this Ccnifiate of Eacmption,you should NEW RESIDENTIAL PCMB. SQ.FT. TOTAL:
bacteria subject o the Worker's Compensation provisions of the labor Code.you must
forthwith comply with such provisions or this pemddeemedBUILDING FEEtshall be marked. �•
(] CONSTRUCTION LENDING AGENCY SEISMIC FEE
I Z thereby affirm that these is a concoction lending agency for the performance of
1 O the monk for which this permit is issue(f5«.1(NJ,Civ.C.1 T ELECTRIC FEE �-
LendersName r.a: l,y:;:,jp.':•. 'r .s ". ! ;corn w/.. PLUMBING PEE
V Lander's Address QTY, `Y�,(.-kMECHANICAL P_ERMIT.,�'.-• ' ; FEE,.
I certify that I have read alis appliarion and mtc this the strove informed.is r
corn. lagrcc.comply with ell city and county ordinances and nee laws rtleting to PERMIT ISSUANCE ..I • MECIIANICALFEE
building cstruction,and hereby solitaire representatives ofthis city mercer upon the CONSTRUCTION TAX
r Z alwvementioned properly for inspection purposes. ALTER OR ADD TO MECH.
(We)ogre to save,indemnify and keep harmless the Cary oI Cupertino againe
liabilities.judgmcnn.cosesand expenses which may in any way accmragaanat mid City AIR HANDLING UNIT ITO I0.000 CFAO
in Consequence of the Framing ofsrs 't.
• �Vlaru /afX , AIR I IANDLING UNIT(OVER I O"CFM)
Signature of ApplicmJConto Yj 1(� I`� Date EXHAUST HOOD(W/DUCg)
PAID
a HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT(TO 100,0110 BTU) Dam Recnt,N
Will the the Curet ti forum building oc,Cam store or hurdle hHeoldous material
to,C d<finrd by the Cupeninn Municipal CMe,Chapter 9.12,reel the lieehh and Safety HEATING UNIT(OVER I W.OW BTU) TOTAL,
Co,e.Section 35R(a)? VENTILATION FAN(SINGLE BESIDE
11 yes ❑No
ISSUANCE DATE
WilHhea licmtnrfuwrcbuildang«spam over tai BOILER-COMPI,illl'Ok 1W,IXq BTU)
pp q pment unlit c Management
haurict? air eonuminmrs es def ncd by rte Bay Ana Air Quality Management BOILER-COMP(OVFR IOO,WO BTU)
District?
❑Yes Cl No NEW RESIDENTIAL MECH. SQ.FT.
I have read the haoodous materials requirements under Chapter 6.95 of the
California health&Safety Code.Sections 25505,25533 and 25534. T understand that ^�
if the building doe,nm currently have a tenant.that at is my responsibility m nrnify the r
Occupant of the requirements which mml he met prior toissuane,of a Cenificee of
Orrup'n".
Owner or authorized agent Date TO it ISSUED BI':
oft=ricE � ..r