S 1913APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY ON CUPERTINO RDH -DING -ELECTRICAL
BUILDING DIVISION A1111LICATIONIPERMIT I'IN(;IRING MECHANICAL
' 15I]ILDINO I'ROJISCT IDEN'1'Ipl('A'HON'
PE rr No
1913
BUILDING ADDRESS
470e7v^11
SANITARY NO.
APPLICATION SUBMI'I'I'AL DATE
'7..Y4j-961
(1W'NER' NAMG: PHO NIi:
CON'rRACErRSNAMH LIC NO:
NIC
❑
CON 'IROLp
RCHITECOENGINEEKR: LIC No:
ADDRESS:
`\,WACr: PHONE:
yam{
❑ Consuhant Fias Paid by Applicant (Initial)
BUILDING PERMIT INFO
BLDG ELECT PLUME)MIiCH
I '
❑ ❑ W ❑
LICENSED CONTRACTOR'S DECLARATIONr'
1 heresy ufftrm that I am licensed under pmviaions of Chvpter 9 (nnnmeneing
QTY ELECTRIC I'ERh1IT ` FEIi
_
]OR DESCRIPTION
FFRMIT ISSUANCE
widiSc,ion 9110(1)of Divi,in 03nfthc Huriinensand P le .... r. Codgandlny l ic'ense in
In folI force and O ilia.
RESIDENTIAL:
C FI'DWI. CKI'ICIIIiN kI'.M000L
APPLIANCES -RESIDENI'1A[.
Licence Class Lion
Date Contactor
[I ADDITION C PLUMBING RH.PIPE
CMUI.TI-UNrr CS'IRUCTURA[
MODIPICATI(IN
ARCHITECTS DECLARATION
1 undennmd my plulls xhall he uswl us puaie rmnnls
PANELS
'
UP 10200AMPS
El INTERIOR El CHIMNEY REPAIR
IMPROVEMENT` []SWIMMING TOOLS
Licensed Profib,A wl
201-10X0AMPS
OWNER -BUILDER .a Ox'sa'a?I DECLARATION
I hemhy afrmn 1h:n I am xempt from the Cnnlacmrs Licenser Luw babe
fnllnwing calm. (Serino 7031.5. Basin... and Professions Code: Any city nr county
C BATA REMODEUREPAIR CDEMOLFFIO.N'
- -
C 011 IER
�4+ rJ7�/G �•r�.�
OVER IgOAMPS
SIGNS ELECTRICAL
which requires a permit to construct. alter, improve, demolish or action any structure
SPECIALCIRCUI'1'LNIS
,rill t it, 1.o, ventures he a,lacm,f hpe ll 11 :'g d.Pmmcnt
dro Ic,oc icoas,d1 ' t lo diclonvokiono.fithe C t t Law (Chaplet 9
let ancircia,isithS,cli ....7000).&D .. ..... a 3oI(1a, Ra,mr,land Pontes„uCode) (it
rEMI'. METER OR� .:INS'I'.
•COM ER�i4 IAL
that he is exempt therefor and the basis for the alleged exemption. Any violation of
C NEW BLDG/ADDITION C DEMOLITION
Section 7031.5 by any applicant for a permit subjeav the applicant m a civil penalty of
o” I Ince than five handesi dollars ($511111.
Lasnevorof the pm,pertly,ori,mi imendeswuffereeans'thcinnle 94.ntion,
lh Boner
will dolhewons iachm's
1'OWIi -
_S1" I I'll( I 'C'
❑TENANT El TOO]) SERVICE
OWERIMPROHh11iNT
❑ (I'I'IIER
Caand
The �un
Licerso Law dos not apply. o an
and Professions Cafe: The Landow Law gas no apply e, uo nsvncr
'1. TCHE. I. " ES
over then'
property who builds m improves thereon, and who does such work himself or,hm
his awn owevera,, building That such Lnpmvwnena aro not imcnded a red t
sell, If. however, the building orimprnvcnamis snlA within one ycor
RE ?N L �? J'R SQ FT
SQ.IT. I1110R ARCA
$ISQ. Irl.
mer -builder will havethe nuMenofpmvingthat hedidnot NO 0 e -
1ww ofmlc).,
M I, as owner nI the pn,paty, aa, mclnsively col oon,li , wish li it u emI,
Oil IOTA I.:
`
m,owt Lha project (Sac. 91144, Brion—, sad Prnlessimts Cl le ar, Li
i, .-
a
IM1... ,QTY.
PLUM1iBING PCRMIT' 'FEL?
asehwdiesnmapplytoaluwneroTropcnywhobuildsorimp
M1n contracts for such projects with a conowtoda)licensed Punua Ito Contra
I.icensc Law.
I ume.1111"lundcr Fee. ,B&PC In '. nolo
,
- --
PERMIT ISSUANCE
35--1-
Owner _ Date
WORKERSCOMPENSATION DECLARATION
ALI ER - DRAIN & VENT- WATER EPA)
'ALUATION
O U
HACK FLOW PkCfECr. DEVICE
1 "".1" ulBmn nndar panalty of ,,,ary ane rf da fallowing dcaluatin,ts'.
DRAINS- FLOOR, ROOF,, AREA. CON 1) .
I have an I wi Elmnitiin a ClaifcaneoIConsent osciff-morelar Waders C(,mpen-
tion, as provided for by Section 3'11X1 of the Labor Cale, for the performance afac
S'rOlilliS
TYPECUNS'I'NUCI'ION
N.
work for which this pernil is issued.
FIXTURES - PER [RAP
C 1 have and will maintain Worker's Compensotiun Insurance, its required by Section
39110 ofthe Labor Gere, fortire Psi-mrnance of We work for which this peril is issued
OAS - ILA, SYS'I EM-1INC. 4LITTLE IN
OCC.OROUP
APN
My Workers Compensation Insurance camel and Policy number are:
Carder: Policy No.:
GAS- EA. SYSTEM OVER 41FA)fr= IR g7 rth p
CERTIFICATE OF EXEMPTION FROM WORKERS'
GDMPIiNSA'I'IDN INSl11tANCH
1 '
GREASPIINDUS'I'RL WASTE INTERCI IOR �1,�r 1,1 I J
BUILDING DIVISION 17EliS
(Thinscutionnecd nal hecomplered it the pend, E for one hundred Anllan($1 W)
orless.)
GREASETRAP l 1
' I'
-
NCIiF.CK IFC
--
1 artily that in hcperformancenf the work fur which this permit is issued, l shall
nntnnplmyauypromnannymunner>ousmbceomcxuplcuuo the Worker., Comba,�
-
SIiWI?R-SANI'I'AItY-S'I ORM CA. 2fN1 <7. �(yU
ENERGY FCIi
WA I 17 HEA I'IiS W/V I?N'I'ICLECTR
nation Laws of California. Dare
Applicant 1
GRADING THE
NCIICE TO APPLICANT: IL atter nuking this Cenificam of Iixemplion, yon should
hsome nuh, t h, In, Workers Catnpcnamian pmvlxinns of me Lnbnr Cole, run must
WATER SYS'l HMTREA'1'ING
SOBS FEE
forthwith comply withsuch provisions or this permit shall he deemed revoked.
WATER SERVICE
CONSTRUCTION LENDING AGENCY
I huchyaforn but man, isoconstruction leafing agency for the trboureace of
PAID
NEW RESIDENTIAL PLMB. SQ, FII
Dne Receipt#
the walk Inc which Ink permit is isnot beer. YOU, Clv. C,)
Leader, Name
-
TGI'AI:
'Lenders Address
TOTAL: S Steffi
BUILDING FEE
1 certify that I have read this application and ,mac Nat he above intornmion is
,oirvo. agncmcou,1y with all oily and loony 1111minecsaal sae hill milling h'
building cnng arcdon, and bmcby mut afize reEnswritmivec nl this city m enhur upon the
QTY. MECHANICAL PERMrr, Ff?I? t
S17ISMIC FIZI7
TERMI'r ISSUANCE
ELECTRIC FEE
above-mentioned property far inspection purposes.
nave, indemnity and keep harder, the City of Cnpcnino against
(We) agree m rd
ALTER OR At)[) TO MUCH.
PLUMBING. FEE
S��J
liabilities, lodgments,cults unit expcn,cs which tray in any way amntengain,Ouid City
in c t."b nee orlhe gnarling of tbinpumdt.
glli IlANIILING UNIT fIY110.INNI ❑FAD
MECHANICAL lTG
APPLICANT '.'fAND$ AND WILL COMPLY WE III ALL NON -POINT
SOURCE EGULAT ULAT INS.
�
' .0.
/ ` -1
AIR HANDLING UNIT(OVER 10,0(X1 CFM)
CONSTRUCTION'IAX
Sipourneof AA/ir,lli I/Contol Urate l/
HAZARDOUS MATERIALS DISCLOSURE
EXHAUS'1'I1001)(W/UUC'I)
HOUSING MITIGATION FEL?
HEATING UNIT (TO IIN1,000 BTU s
Will the applicant or future building occupant sore or handle hazardous material
1s defn,ed by the Cupertina Municipal Code, Chapter 9.12,and the Head, i I Safety
Cade, Section 25532(u)P
'[:GATING UNIT' IOV(?It HOELB
❑Yes FIN.
VENTILATION FAN (SINGE IL 1 - .D i IDIV
PAID
-
Dnc Rccelpl #
BOILER- COMP(3HP OR fly),()()() HOU
Will doe apphictat ur future holding occupant use cplipmer, onlevisea which
hurardn is airesmlamtinams 0-16.W by ere Ray Ara Air Qudhy Mmatgemal
nal?
❑Yes LJ No
TOME,
I{OILER- COMI'IOVER IINLIIW BTU)
AIR CONDITIONER
quirt p
I huveead the hueanlaus natuiads requirements under Choler 6950 the Cull-
ISSUANCE DATE
NFW RESIDENTIAL- MECIL SQ. FI'.
food. Iledlh & Safel1y Code, Stations 25505, 25533 and 25534 I understand Ihot it t_he
nuilding na dvmdy have human, thin a I'my asponeibllhya amifythc occutas
none pllm are is wM1ichiaan,a Eur orto,i#s ,ace otoeen�ntaancr.
_Y/�_•-�/lam
ISSUED ]I .
TOTAL:
neon raw zed ugem 1 aleOp
OFFICE
f
0
10300 Torre Avenue
R Cupertino, CA 95014
CITY OF
CUPERTINO Building Division
(408)117-3228
(408) 777-3333 (fax)
October 28, 1999
Homeowner
21905 Regnart Road
Cupertino, CA 95014
SUBJECT: Permit # S 1913
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 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.
•
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 younassi stance. - - —
Sincerely,
CITY OF CUPERTINO
1
Christy Akatiff, Administrative Clerk
Pnnfee on Recycled Paper