B 0275 APPLICANTTO FILL IN INFORMATION WITHIN REDr LINES•USE BALL POINT PEN ONLY
CITYC CUCUPC'RTINO BUILDING-ELECTRICAL PERMITNO.Wo L A
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL 5,0001
BUILDING PROJECT IDENTIFICATION
75
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
ao kuppC it P/acs verve) C'in moi
OWNER'S NAME: �A .'/d /rO NTRACT R' F.: nafin N/C CON'1'ItOL#
ARCHITECTIENGINP.F.R: G LIC NO: ^
: AD1435� U / ! �/
ONTACT /�,f/qN m /I/llT ➢UIIAING PERMIT INFO
Consultant Fees Paid by Applicant(Initial) BLDG F.LECT PLUMB MECH
❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATIONELECTRICPERMiT FEE
I herehy otlina that I..lwar,ad under proti.dmi,of Chapter 9(commci
enng QTS'' JOB DESCRIPTION
OCz with Sermon 9txro)o[Dlvision 3oDna easiness and Profeasrobs de, yliceneois RESIDENTIAL:
WW O PERMIT ISSUANCE
H(y fidl farce and ([ a�a7 ❑SFDWL ❑KITCHEN REMODEL
aUU� Ia'censc Class QZ� �a# APPLIANCES—RESIDENTIAL [-]ADDITION EJ PLUMBING RE-PIPE
F W Date Contractor
h<a' ARCHITECTS DECLARAL ❑MUCI'1-UNIT ❑STRUCTURAL
F de lindau,nod ra,dans shall bo usednspubli,ow its PANELS MODIFICATION
Q�,4O . UP'T02M AMPS El INTERIOR El CHIMNEY REPAIR
F"W licensed Professional 201-1000AMPS IMPROVEMF.N"i' ❑SWIMMING POOLS
aBi
Zi OWNER-BUILDER DECLARATION OVER IWIIAMPS ❑BATA REMODEUREPAIR El DEMOLITION tv]�a I hereby erm that I am axemmr
pl from the Cmarae 's License Law for the
iqriyy O y U following ration.(Section 90315,Businessman!Prnfesaions Cade:Any city nr nearly SIGNS ELECTRICAL ❑OTHER n
r++'�E,y which strums a permit h,amvmum,aper,Improve,demolish,or repair any.vtr annue ^ r /
F�Od pnormital5sureve also requires thceppllenm for such PennllmfileasighW stmemenl SPECIAL CIRCUITIMISC. COCO RCI
�{,�."'I that he ithennaed Section
700(E praviainnsnr the Business
License Law(C ode) 9
a6O (cat he I,
(commencingwithSectirapanB of basis for
oftheeged rasa and Professions Any
lotion r TEMP.METER OR POLP.INST. MMF
that he is exempt therefrom and the basis for the alleged exemption.Any vinlatinn of ❑NEW BLDG/ADDITION ❑FOODDEMOLITION
SERVICE W..m Section 9!131.5 by any applicant fnr a pannh subjects the npplicam m a civil penally of POWER DEVICES
net more than Five la adred dollars(8500). IMPRO❑TENANT El FOOD SERVICE
F z Y OTHERVf:MCNT
x60 ❑ Las owner i,,malmeautuddr Imy,aminoyeeawithwred astheir sole 044,13emion, SWIMMING POOL".
F. ad od work tndr,The int incen,License
wdo For sale(Sec.90an owner of ❑OTHER
3 m and Professions Code:The Conttannr'r Liconao Law does not apply , if owner of WTLETS—S IES—FI% :9
his it who builds or videdves thereon.and who docs such work hurred o[or through
his own employeese provided Ism such improvements art not inter of er aRered'he NEW RB91 N k SQ FT.
mle.If.however,the building or improvement ksold within one year afwmplaion.the SQ.pF�T.FLOOR AREA S/SQ.19'.
Pher-builder will have the burden of putting that he did not build or improve forpnr- A 1,
pose of sale.).
❑I,as owner of the primary,am exclusively contracting with licensed contractors to TOI'AI.:
construct the project(See.9044.Business and Professions Ctde;)The Contractors JUL],I-
cable Law docs not apply to air owner of property who builds c r Improves thereon,end Q `'P ING PERMIT, - PEP. U U
who umYVwtr
Cls for such projects with a nactor(s)licensed pursuantto the Contractor's
License Law. pH ISS H
❑ Iamexempt under See. .B.&PCformisawso 017Y ur uuref111No'
Owner
4,R—DRAIN&VENT'—WATER(EA) VALUATION
Dete
WORKER'S COMPENSATION DECLARATION AC W PR(3TECT.DEVICE
I herebyill mai under penalty teperjuryoneofthefoEnwior dealer r 1.
'I have and will maintain eCen3700 of Con senna pride xure for Wo e.Compcn- DR S—FLOOR,ROOF,AREA,COND. STORIES TYPE CONSTRUCTION
on as provided fnr by Smdon P110 0(the tabor britt,fnr the per once n
ark for which this permit is issued. IXTURES—PER TRAP
141erve Emit will maintain Worker's Compensation Inaumnce,as required b tion
11!the Labor Code.for the performance ofthe work for which this permit iia. GAS—EA.SYSTEM-I INC.40UTLHTS OCC.GROUP APN
My We, �Cppaaxssa�a��tia�nfirs y�ran 99e��r,,��'',,'' I miry num
Grticc�EJQ{{�K.[LL(I,.I71W'C{iLNn:97 0,��.7►6 GAS—EA.SYSTEM-OVER 4(RA)
CERTIFICATE OP EXEMPTI FROM WORKERS' GRIiAS&INDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE - BUILDING DIVISION FEES
(Thisaectinn need oat beeampleted lithe permit is farone hundred dellars($1W) REASP.TRAP
nr less.) Q PLANCHECK FEE
I arnily thm in the performmeeporme work fsawhich this parnit is ted, SEWER—S4 ITARY—STORM EA.201 FT.
net employ any person Er any amoner so as to become subject the Work `Co n ENERGY PEE
Zz satins Laws of Califandir Date WATERUF. ER WNENTMLECTR
O Applicant 1 GRADING FEE
NOTICE TO APPLICANT:If,after making this Certificate of Exemption uetild WATER SYST'HM7REATING SOILS FEE
f••t become a djact to the Worker's Compensmion 110vivions of 0e Labor Coda you must
forthwith comply withauch provisions or this permit shall be deemed revoked. WATER SERVICE
0
� z CONSTe is
construction
ION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FI'. PAID Dam Receipt#
I hereby e[firn that Permit I is v (Sea30 lending agency fonhe puformanw of
U O mo work for which this p�rmhia loomed(sw.389z cm.c.)
LLE 'rt
Lender'a Name
'IDEAL:
WLender's Address - - TOTAL:L.t L1+ IcerOfy Nvtl have read this application and orate that the above information is 13UILUINGFP.H
FE cornet,i agree to comply wllli all city and county ordinances and state laws relating to QTY, ` MECHANICAL PERMIT - FEE
yZ
-V a building amsometion.and hereby audieriza representatives ofthis city to wterapon the SEISMIC FEH
anota-metnimad p,,,,any for inspection purlxrses. PERMIT ISSUANCE
(We)agree.to save,indemnify ad keep hannleas the City of Cnpcoino agahrat ELECTRIC FEE
lisbildea,,judgntnms,costsand expenses which may many way occur agmm,aid Cry ALTER OR ADD TO MECH.
PLUMBING FEE
in consequence of the starting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM)
MECHANICAL FEESOURCE REGULATIONS.
AIR HANDLING UNIT(OVER I0,000 CFM) CONSTRUCTION'1'AX
Slgnamreof Appinqua/Commetor Data EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the...From in future ding occupant stare nr handle hazardous material HEAT ING UNIT(TO 100.000 BTID
as defined by the Caponino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)'t HEATING UNIT(OVER I0TV00 BTU)
❑Yes El No VENTILATION VAN(SINGLE RESID) PAID --
Dom Racal e#
Will the npplicanl or Tamm building occupant nae rquipmem or devices which
It ha.Moua air aomsminams es defineA by the Bay Area Air Quality Management BOILER—COMP(3HP OR IDD.fNkT BTU) 'f0'1'AL:
tv°I0Yex No BOILER—COME(OV ER 100,000 BTU)
Ihave read the hazardous materials requirements tinder Chapter 695 of the Cali- AIR CONDITIONER ISSUANCE DATE
[oris Health&Safety bvk,Sc,,h 21,1111,2151"
55115 25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.FT.
ho I'll snot currently v mor tlandis yrevpnnaihilityro ify eoecbpum
t req it n 'ch of a cr . _
authato Cl( Date TOTAL g ISSUED BY:
OFFICE
Pu�ei�t�fil�io
10300 Torre Avenue
Cupertino, CA 95014
of (408)7.77-3228
Building Division
(408) 777-3333 (fax)
February 9, 1999
Homeowner � �/�� /
Ruppel
up tiro, Cl Place `
Cupertino, CA 95014
SUBJECT: Permit#130275
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, 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
Ponied on Reef cled Paper