30907 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -
CITY OF CUPERTINO - ., •. BUILDING-ELECTRICAL, ',• PERMIT NO, O O
BUILDING DIVISION APPLICATION/I'ERMIT 'PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION '
BUILDING ADDRESS: .� SANITARY NO. APPLICATION SUBMI'FI'AL DATT
OW 'SNAME: PHONE: CONT CIDR'SNAh • LIC NO:
S NIC CONTROL.p
XRCHITE /ENGIN.ER: LIC MO. AD ES: .❑
qjo II
ONFACr: 1, PHON13: - - BUILDING PERMIT INTO
I _I I'n'/ �❑' Consultant Fees Paid by Applicant(Initial) BLDO ELECT' PLUMB MECH
1 /WI)FO IC( ❑ •.t75 ❑ pl•
LICENSED.Recover]
QTY. ELECTRIC PERM IT FEE �W W
(hereby affirm that l sen licensed under provision,of Chapter 9(commencing JOB DESCRIPTION
®oz with Seen 17Wn)of Dlvlstor3ofthe Buxinessund Prafcasinns Codc,ami license is RENIDENTIAI:
k O full force and elle /� 1'EItMIT ISSUANCE
��F m, —OLQ 7-I O.�I - - ❑SFDWI. ❑KITCHEN REMODEL
UU to Tulle Clava Lieg
yQa Dam Commc ctolasAPPLIANCES-HES I DEN'FIALift ❑ADDITION - El PLUMBING RE-PIPE
ARCHITIiCTS DF.CIARA'I'ION PANELS
tLOm -' ❑MUL'ITUNIT C1 STRUCTURAL.
z0ie'Z I understand my plarr,hall he used se siblicmcords MODIIrICATION
Ozt UPTO200AMNS _
�r?,I".W Licensed Professional ❑IMPROOR ❑CHIMNEY REPAIR
20J.1000AMPS IMPROVI3MEN'F .
96 OWNER-BUILDER DECLARATION OVFRl000AMPS . ❑BATH REMODEUREPAIR El DEMOLITION
aJ,�-{ I hereby affirm Thal 1 am exempt from the Comou nre,License Law fonhe
�d"6U following fewer.(Section 7031.5,Business and Profusions Code;Any city or county
I�v�Iy�OyY Ew¢J" ' SIGNSELEmucAL HER
tt I I ❑ p J I' p Ysnucmrc XOT
which"cousin p
Ono I it uance ht q thef .ochre 's signed.tamment SPECIAL CIRCI/T/MISC.
that he licensed v h p s ITh C I I Lis I� (Chapter9 '
- nneei—Ej;5;:�
W�LIpO (commencing with Section]IXp)of Division 3 of the Business and Professions CWe)or TEMR METER OR POLE INST. ' COMMERCIAL:
my oa that he Is exempt Therefrom and the basis far life alleged exemption.Any violation of
x^N Section 7031.5 by any applicant bra permit subjects the applicant to a civil penalty or POWER DEVICES ❑NEW RLDGIADDITION ❑O13MOLITION
LV mime then Ove hrndrcd dollars S50fh. ' ❑TENANT. ❑FOOD SERVICE
^ q ❑Las owner of the pmp<ny,or my employees with wages os Neir sole mmpcnwTinn. SWIMMING POOL ELECTRIC IMPROVEMENT
will Jolh,se k,imd nhcatntatore is not intra:delonotfenal Instill,(See 70fL If an,, ❑OTHER
W and Professions Code:The Contractors License Law does not apply to an owner ofOUfLETS-SWITCHES-FIXTURES
memory who builds or improves meocon,and who Anes such work him,ch a,Through
his own employccs,pnwidcd Nm such improvemetns are am intended 6r offered for NEW RESIDENLIAL ELECT R Q FT."
sale,If.however the linkingor impmsol
roveentlsd w 1frinrne yeerof conedetian,the SQ.PF.FLOORARPA SISQ.PT.
ownenbuilder will have the burden of proving that he did not build or imprme for per- -
'no of,,dod,
M h as owner of the purport ,ant exclusively mowed.,with licensed contractors to Tf>
common the project(See.71W4,Business and 1'mfusions Code:)The Come nors Li-
uLaw does not apply toanowner offuturity who builds or improves thereon,and Q'TV. U 31� NEIi
who contract for such pr jects with a conoaenny,licensed pursuant to tha Commctor's Is
License Law.
❑I am esempl under Sec. B k P C fonhis reason '
Owner
AL r �I IN& 'AT13R(13A) VALUATION
orae
WOIIKF:k'S COMPENSATION DIiC1.AItA'1'IDN 4 •t
t ACK W PItOTE .DEV
I hereby amrtn under penahy r(perjury one of the following tied
f, I have nM will W:,,od m a Cenlhamnl1711,mon xelGlnsure l..Werke 'Imp I, �A S- OR.ROOF,AREA,COND, STORIES 'fYPP,CONS'TRUCTION
as provided for by Section 3700 of the labor CMe,for the Piedmont of
CConfim"Inch lhia permit is i.tsuat. XT'URIiS-PIiR TRAP
have and will mainmin Workers Cmpirr airn]asunlnce,us required by S
l lofthe Labor Code for The perfnrmnuce of Om wink fill which This permit is its n GAS-BA.SYSTEM-1 INC.4 OUTLETS OCC GROUP APN
My Worker'. mensainn mmormoo carier and
Policy
Carrier; GAS Policy No.: GAS-EA.SYSTEM-OVER 4(EA)
CE FICAT E Oil EXEMPTION FROM WORKERS' GREASFIINDUSTRI.WASTE INTERCEPTOR•
COMPENSATION INSURANCE,'.' BUILDING DIVISION FEES
(This uedrn mad mol tecrmpleted iftha parotitis ur;ne hundml doliers(S ERT,
or less.) GREASE'IRAP PLANCHECK PER '
I certify that in they normnecidthe work for whichlbispendt is Issued.],hall SEWGk-SANITARY-STORA11iA.2fN1 FF.
mol employ any person in any manner so ua m become subject to the Workers'Compen- ENERGY FEE
Z ration laws of California.Date
O WATER IIHATER WNFNT/13LEC1'ft
yO ApplicNOTIem - GRADING FF.E
boomne subject
Ionic
War :e,after ranking thin Cllionsmc of 13,empdon,you should WATER SYSTENJITRCATING
a ; forme subjat m the Workers Compensation provisions of the rte dr Code,you muu' SOILS FEE
forthwith n,mply with such rroviaions onhis permit shall MJevned revokal. WATER 513RVICP a -
Qs
CONSI'RUCI'ION LENDING AGENCY. .: NEW RESIDEN'T'IAL('LMB. SQ.FT, PAID
U O Ibereby affirm that there is econewetinn lendi......ey for poommunceof Date k at
I,. N the work fm which this racoon Is issued(Sec.3007,Cls C.)
OLenders Name TAL
U Lenders Address TOTAL
f'�., a 1 ccnify that I have read this application and Atom Lha the above information is BUILDING.MHA 9 1 s "
L h coned.I agree m rontply with uIl city:uW aunty nnlinvnces amt Aram hws rclnthtg no QTY. MECHANICAL PFRMFF FEE 111
U buildingmnstruction.undherchyauthorixc representatives of this city tocmerupnn the SEISMIC FEE
aMve-mentioned property for inspection Purposes. PERMIT ISSUANCE e
(We)agree to save,indemnify and keep hamdess the City of Coleman against L7 ELBA 1UG' H1 '
liabilities.judgmentsgrantand ft his eswhich mayinany way raceme ngainsTraidCity ACI'T:R OR ADD TO MECH.
in gnnsequence of theegranting of this rennin. PLUMBING FIiE '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Alit HANDLING UNI"I'(TO IB,000 CPM) , 1 u r t ak ! 1T
SOURCE REGULATIONS. MECHANICAI�IH ) 30
-, AIR HANDLING UNIT(OVER I0,000 CFM) CDNSTItHCI'IGN'1'AX
Signumre of Applicant/Cmemsemr - Dam EXHAUSTHOOD(W/DUCT) HOUSING MITIGATION FEE
- HAYARDOUS MATERIALS DISCLOSURE
Will the vpplicmii nrfmurt huilding ocatpum store nr handle baiurdom material HEATINGUNIT(TOIWPII(IBTII)
as
refine)by the Cupertino Muhicipnl CMe,Charmr 9,12,and tlm Hallh'und S:J'cty
_ CMq Section 25532(u)P a�' HEATING UNIT IW,000 ITTU) -
❑Yes �No
- r
•ttt VENTILATION FAN(SINGLERPSID) PAID
- - Date Reccipta
Willthe it co minot imutum huilding by he
Aso cyuiir Quality
Madaraorrand. BOILER-COMP(3HP OR 100.000 BTU)
I hazaNnus air cnnmminanta as def red by the Bey Area Air Quality Managemem cOO
•�tTricf! " ''// - .. TOTAL.
L❑Yes �Nn BOILIiR-COMP(OVER ITq,00011TU)read the has eramria]sra,droments under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
&Safety CnJe,Sections 25505,25533 Tmd 255]4.I undemmA Ihm If theNF.W RESIDENTIAL MEC((. SQ.Pf.at unemly haveamnanlthat it is my respottihiliry to orallthe rs;cuanf,air
twhich moa be menyp[m/yn�fn Ceni�fcaeEopf(u -tom t, ;\�A •'''J'`
Owner e"�ngeni 66//ares! '"I ,`e•�]D:ee TOTAL: V ISSUED BY:
OFFICE .
,• ®'` 10300 Torre Avenue
Cupertino, CA 95014
City of
Cupertino Building Division
(408)777-3333 (fax)
March 5, 1999
Property Owner
22340 Regnart Road
Cupertino, CA 95014
SUBJECT: Permit# 30907
Dear Property Owner:
We have been going through our files in the Building Department, and contacting those
people with permits remaining "open".
• According to our inspection records, this 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 your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
Printed on Recycled Paper