S 0719 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CIT-9 OF CNPERTINO BUILDING-DLEC"l IUCAI- PERhfr 1'NO.
BUILDING DIVISION APPLICATIONIPRRMI'r PLIIYII3ING-M1tI'.CHANIFIC S 0719
' IIUILDING 1'RO.IEC'f IDF.NTINICATION lJ
SANITARY NO, APPLICATION SUBMITIAI DATI
BUILDING ADDRESS:
e)3Ba • n ia�g-97
O R'S AME: PHONC: CONTRACfOR'SN LIC NO: - NIC CON I ROLir
W6w,1w- e ,1-01 3 v
CHI'1'1?CTIENGINHER: LIC NO: ADDIt I' S: ❑
Lt
CONTACT. PHONE: BUILDING PERMIT INFO
( ❑ Consultant Fees Paid by Applicant(Initial) HI TDO ELECT PLUMm 11iiI I
53�oG1 ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE JOB DESCRIPTION
hamhy affirm that 1 am licensed under Provisions of Chapter 9(Commencing
oZ th Sation7m17 ofDivision3ofthe Foxiness and l'mfeasions Code.amf my licence is
YERMI'1'ISSUANCE RESIDENTIAL'
F W� 'm full force and effect. ElSFDWh [I KITCHEN REMODEL
�UUU 1"icense Class LiaM APPLIANCES—RESIDENTIAL ❑ADDI'T'ION RrmtBRING RIi-PIPF"
Zly Dam ract
Contor
Hst ARCHITECT'S DECLARATION PANELS
❑MUI.I'I-UNIT ❑STkUCTURAI.
MODIFICATION
, dermad my plans nhJI be used e,public recnrd+
CZ-C ❑P T02110 AMPS ❑IMPROVE ❑S CHIMNEY Rl OOL
1,," l Licensed Professional 201-1qa AMPS IMPROVIiMCN'1' SWIMMING 1'001.$
9y OWNER-9UILDIiR DECLARATION OVER IND)AMPS [I BATH REMODELfREPAIR El DEMOLITION
C' I hereby ohnin that I um exempt from the Contractor's License Law for the
2 U following reason.(Section 7031.5.Business and Professions Codd Any city or county SIGNS ELECTS OTIILR
OI"' which requires a permit to construct,alter,improve,demolish,or repair any structure
mm pnmm its jasuanae,msomgmmv men,boam forsuch permi,to f0eaxlgnnd smtement SPECIAL CIRICJ6111
mut he is licensed pursuant o the provisions efmc Contractor's I.ccnce Luw(Chupmr9 COMMPRCIAI:
�typ� (commencing with Section of Division 3 ofthe 9tninecxund Professions Cartel Or TLMI'.MITERO '0 .T. v,�
6 ey that he is exempt therefrom end,he basis for me alleged exemption.Any violation of _ El NEW BLDGIADDITION ❑DEMOLITION
^N Section 7031.5 by any applicant for a pemnim subject, he applicant to a civil penalty of POWER DEVICES []TENANT ❑FOOD SERVICE
not.,an than five hundred dollars($500). IMPROVEMENT
=Q 0I,as...trafma propeny,omy employee,wilh wagon as their sole compensation, SWIMMING POOL ELECTRIC
F will do the wmk,and the structure is not intended or offered for sale(See70,14,Business ❑DTHLR
Raj[ and Professions Code',The Commoner's License Law doe,nm apply to nn owner of OUTLET'S—SWITCHES—FIXTURES
TRE propeny who builds or imprmes 0nerenn,and who does such work himmlf or through
his an employees,provided that such improvements are not intendnl 0,r nnered for NF:W HIi.SIDF;NTIA1.ELEC'1'R 11'.
vale.If.however,the building or improvement is sold within
one
year of cntnplmion.the 1?A $ISQ.FT
er-huildo,will hove the hmdon of pricing mat ho did nal holdor improve for per- CEI D
prseofaule.).
❑I,as owner of the propeny.am exclusively contracting with licensed conmacnea,n) 1'OT
construct the project(Sec.70H4,Business and Pmfes,ions Cuum:) e Cn
nmmnr's Li- 1 FI?8 s7DEC 0 8 199
t ce Law deeso m
napply an owner of TL
property who builds or improves thereon,aol QTY. .7
who contracts for such projects with a could cra(s)licensed pursuant o the Contractors
License I.aw. PERI . NCE Q BY:
EJ Into exempt under Seo. .B&P C for Ibis reason
A E A A)
F-
Owner Dote
WORKER'S COMPENSATION DECLARATION BAC O k .DIi ICE
I hereby albou under penalty of perjury one of the following declarations:
'I hove and will muimain nCcniMam of Comennn self-itI in attar, S—FL( R P,AREA,CONK STORIES 7Y1'Ii CONS'1'RIICTIO
anion,as provided for by Section 3700of the Labor Cohn fnr the perfo a a O
work fnr which this permit is issued. FI RES PER TRAP
❑ 1 have and will maintain Workers Connpensation Inmmncc,as r red by So Minn y
37M afthelsbon CndefarImpermommnce oftha work forwhah this nitcd. — :A.SYS'I'liM-I INC.4 OUTLETSOCC.GROUP AI'N
My Wed Com suntan 'u ace -Uryand o no are: GAS—I?A.SYSTFM-OVER 4(EA)
Cartier: licy No.:
CIi"T :OF F.XI!h 'TION FNO ORKIiRS' GREASIIINWSTNL WAS'flilMfl?RCI?PfUlt
COMPENSATION INSURANCE BUILDING DIVISION FEES
Mix section need not he completed ifthe pemtil is for one hundreddollart Ila) GREASETRAP
m le".) PLANCIif:CK lgili
I ceinlymna.tinperfonnanceofthework for whillada,permit is Issued,111w11 SEWER—SANI'T'ARY—S'I'ORM EA.200 FT.
not employ any tienan in any manner so as to become subject to the Workers'Compcn- ENERGY PEE
(Z, nation lows of Cul immia.Data WATER HBATER WIVEN'IA LEC R.
Z2 Applicant I GRADING FEE
kt) NOTICE TO APPLICAN'E 11;after making this Ccnificam of Eeempion,you should WATER SYSTENI TREATING SOILS Il?E
F become subject It,the Workers Compensation provisions of the Labor Cole,you must
forthwith comply with such pnrvisionxor this pemnim shall be decimal revoked. WATI!R SERVICE
Q
UO CONSTRUCTIONisacLENDING AGENCY NEW RLSIDEN'I'IAI.PLMD. SQ.Irl'. PAID
I herffi
eby arm thatrt lheis construction lending agency for rfnrma
the peunof —Dam Rccei
U 2 the work fur which this permit is Issued(Sec.3097,Civ.C.)
V Lendeea Nome TO
4' L:
0 U Landers Addat TOI'A : C
{{rr W 1 cenify that I have mad this application and shorn that the above information is BUILDING FEE
;Ist/4 correct.1 agate to rntnply with all airy and county oNinunaa and sem Iowa calming m Q'fY. MECHANICAL PERMIT FEE SEISMIC FEE
U Z buildingamstruedomand hcrebyamhorizerepresunmusex aphis rimy mcmaupnn the
above mentioned propeny for inspection purposes. PERMIT ISSUANCE
(We)agra to save,indemnify and keep hannlass the City of Cupertino against ELF.CIRIC FEE p
liabilities,judgments,costs and expenses which may in any way accme agai aslsald Cary ALT ER OR ADD TO MECI I, PLUMBING FF,Ii ZZ
p
in consequence of the granting of thi4AND �
mit
APPLICANT UNDERSTAN OMPLY WITH AL1.NON-POINTAIR HANDLING UNITG70 HUg10CFM) MECHANICAL IEE
SOURCAPPLIC NT UL IONAIRIIANDI.INGUNIT(OVERIn,dia)CPM) CONSIRUCPION'IAX
Signam lit: and cData EXHAUST HOOD(W/DUCp HOUSING MITIGATION PIE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicatnor future buildingnccutiant some 0,r handle hnsanloamntarlal HUA'I'ING UNIT(I0104),000 BTU)
us defined by the Cupertino Municipal Code,Chapter 9.12,and me llaahh and Sammy
Crude,Section 25532(a)7 HEATING ON]F(OVER 100.00(l BTU)
❑Yes El No PAID
VEN ILAT10NFANISINGI"E RESID) Date Imceipt#
Will the applicant or future building rc upant use equipment or devices which
- ^t haeardous uircontmninonts as defined by he Bay Amo Air Quality Management BOILER—COMP(3HP OR I00JM011TU) /
TOTAL: /
Taint? BOILER—COMI`(OVER 1I0,0wili'ti)
❑Vias ❑Nn
I have read the hazardous materials requirements under Chapple,6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE:
(omit,Health&Safety Calc.Sections 25505,25533 cad 25534,1 undersand thin if the NEW R17SID1'"N'I'IAL MIiCIL SQ.PI'.
Wilding does not eurmn ly have a tenant.that it is my responsibility to notify the(section, L��
of the requiretants which must M met prior to issuance of a Certificate of Occupancy.
Owner or aumomaa agent Date TOAL ISSUED BY:
OFFICE
10300 Torre Avenue
Cupertino, CA 95014
City of
Cuperthio Building Division
(408)777-3333 (fax)
February 4, 1999
Homeowner
10382 Scenic Cr
Cupertino, CA 95014
SUBJECT: Permit#S0719
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
Roofed on Recyclea Paper