28890 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USESALL POINT'PEN ONLY '
. CITY.OIF UPERTINO BUILDING..RI.ECTRICAI. PERMITNO. � O
BUILDING DIVISION APPI.ICATION/PERMI'r PLUMBING-MECUANICAL
BUILDING PROJECT'TDENTIF'ICA'1'ION
BUILDING ADDRESS: „
SANITARY NO. APPLICATION SUH 'I'fALDATE
D S0/
OWN ;S NANUL - PHON!: CONTRACTOR'S N/1 H, LIC NO "
O OG NIC CONTROL
t ARC ITE GINEER: .LIC NO: SS: ll ❑
CONTACT: BUILDING PERMIT INFO
Sofl/E/IN ❑ Consultant Fact;Paid by Applicant(Initial) H DO ELECT' PLUM MECH
( ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT PEE t
1 hereby affirm that 1 licensed and,,pro ions of Chapter 9(commecemg JOB DESCR PTIO
woOZO with Section 701B of Division 3 ofth It sin a d Professions Code, n o'hatme is PERMIT ISSUANCE RESIDENTIAL'
I-W P m full force end e' ❑SFDWL ❑KITCHEN REMODEL
Out License I a lap ir APPLIANCES-RUSIDFNTIAL i 'CIADDITION " ,F1 PLUMPING RE-PIPE
rF�0. ❑me TS t
p:=w
ARCHITECTS DLCLARA ON ❑MULTI-UNIT,' ,[]STRUCTURAL
Z 1 understand m I PANELS
Z O y plans shall he used as public records MODIFICATION
OZ— UPT0200AMPS '
F�.B7Lq Licensed Professional - ❑INTERIOR 0-CHIMNEY REPAIR
���dc ml 10RAMPS IMPROVEMENT OWNER-BUILDER tfrDECLARATION OVER INXIAMPS _ ❑BATHREMODEUREPAIR ❑DEMOLITION
pp,, 6 I hereby ff th t t rcpt t the C tr t /. I' La f rh�
pg3LI- followng w: S t ](1315 B, " ' dP f Club:A y ty ty SIGNS FiLECIRICAL + ❑[]THBR
WO which req Paulus t tmt ft p demolish.(it rep y structure •'
prior to itsrues I. requiresBe applicantl hpenmO fl g of martmal SPECIAL CINCUII'/MISC.. s
I�^�jtvy�Y thmh 1'exedp en theP : fth Cnwa ll L (Ch pt )
IyCQp (commencing with Sectio 7")(if Division 3 ofthe Business and Professions Cod)or 'TEMP.METER OR POLE INST. COMMERCIAL: .,.
6 ty o thio he is exempt therefrom and the basis for the alleged exemption,Any violation of
Section 7031.5h an a Iicaat forpermit - El NEW BLDG/ADDITION ❑DEMOLITION
Y Y PP . bj t the t < Ipe alry f POWER DEVICES
I„ y not more than five hunJrcdJ 11 ($50 ). _ � ❑TIiNANT ❑FOOD SERVICE +
❑ Las owner al the� O rn h ' Ynmyc. wages d Pecp .rt , SWIMMING POOL ELECTRIC, IMPROVE-
MENT
willdntnewoek utdat du1F d 1.1.1clehec.744 usmexs 001'Hit ad Profesrons Code: Ue Conmemr,License
.,
Law`does not apply to an owner of OUTLF,TS-SWITCHES-FIKTURHS
.a 3— Praperir-wnn hnddx tar improves thercmn,arta wnn area tarn wrrk nimaelr nr mroagn•
s his own employees,provided that such improvements arc not intended or offered for NEW RESIDENTIAL ELECIR SQ Ff.
ma.If.however.the building or improvement is sold within one yearofcompletion,the SQ.FT CLO it AR asl ID, '$/SQ.IT.
owner-builder will have the burden of proving that he did not build or improve for par. Y" /j '
pati mf ode 7
[I,as owner of the proper.,an.1hoket,iturus,ion,wih Peened com.(o 'r. :x -TOTAL: •
construct the project(See 70Ti 116siness and Prolesvors C dc)The Contractors j-
cause
C^ O ��
e Law olives not apply to of property who b IJ,Or improves thereon nil Q'PY. PB MBIN ?RMIT DEC 9
wh contracts fonuch prof t rth a amtm t rt
licensed punuam m the Contiecror s n r�, '
clam<xe t oder Sec. 1 ,n alpCforthrsreason PERMI3ISS)IANCE clic U(- (euMEHr.I
<sA ALTER-DRAIN&VENT WX[UR RA) Il l•
Owner Il t VALUATION
♦♦ ORKFRS C INSAXION DLCLARAI ION v BACK FLOW I'ROTF.CT DEVICH `m
av
• I herebvafbrm unJ pe hyol'p j ry ftl f II w ,declaration:: '
.�Ihavc and Ilmmma a Certfcti, fC n.emt selft : f,W krCuntn DRAINS-FLOOR.ROE AREA.CON . STORIES - TYPECONS'I'RUCTION
non;as provided for by Section 37x1 of the Labor Code,for the performance of the _
work for which his permit is issued. FIXTURES-PER
I have and will wainarin Worker's Compensation Insurance acquired!by Section
3700 mfthLion I,f th d rtnance Ol thew rk for' t hth pe t suet. GAS-EA.SYSTEM INC 40U .f OCC GROUP AIN
My W rk rs p t I res a ca t and l y t Ftl C ,
Came � GAS IA SYSIEMTOVFR (IA _
CINI'IFICA OFH EMP,ION FROM WORKERS -
MPENSATION INSURANCE - GREASE/NDUSTRLWASTE INTERCEPTOR
(Thisscid Onne of odcompleteJ tithe perm tis fur one hundred dollars($1 W) BUILDING I3IVISION FEES
' or less) - r,. GREASE TRAP
I certify chat in the pert aac fthe kf h m
which pert' d 1 hall PLANCHLCK FEE
rm
nm employ any N mom y(an act hesubjectO the N k C SEWER SANITARY-STORM EA.200 FT. ENE -
HE
,Z, Baton Laws J'mo e Ix-n - - GRADIYFFE r
0 Pp ���jJ � - WATER HEATER W/VENT/FI.HCTR '
O n Tic m
Z .., - " GRnulrvf FEr.-- r
y NOTICE IPI ANT If ft k b th s Cem ficrat o npefTh� or�you should, - t
/ WATER SYSIumnREATING
hewn bj AE
Worker's C pen. f m pmvrs ons of the L Thor Code,you must - SOILS FEE
forthwith comp ith such provisions or this permit shall be deemed revoked. WATER SI:NVICI!
yD
� Z CONSTRUCTION LENDING AGENCY - NEW RESIDENTIALPLMB. SQ.FE. PAID '
• V O Thereby affirm that there is a combumion lending agency for the performance of - Date Rclis
4. F the v kforwhichthispermitls ils.ed(Sw,3(191,Civ.C,I '
U I.¢ndee's Namef01'AW
'I
{S1 Lenders Address - - TOTAL:
I cenif that 1 have mad this application
G y end state thio the salve Information is - BUILDING PEC
Z comr0lagreemromply withall Cry and nmm,cmrtiancesuOJ statclaws
me,tfaingm QTY MECHANICALPERMIT FEE
V z building conswctinn,and hereby amhnrim representatives of this city mercer upon the SEISMIC PEE .
ubnve-ma mioned progeny for impaction purposes. I
PERMIT ISSUANCE.
(We)agree to save,indemnify and keep harmless the Ciryof Cupertino'against ELECTRIC FEE
liabllitics,judgmtms,costs and expenses which may in any wary xccmengainstssid City ALTERORADDTOMECH,
nnsequml n the gmntingo"I"perntit. PLUMPING FEE
' APPLICA DCRSTANDS AND WI LL COMPLY•WITH-ALL NON-POINT 'AIR HANDLING UNIT(TO 10,000CFM) -
SOURC ULATI MECHANICAL.TLE
6 AIRHANDI.INCUNIT(OVERIO,Up CFMI CONSRUCTIONTAX
.tgmam o ¢ammcOmmno Ole EXHAUST HOOD IW/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE „
it coa applimmt or future building mcnipant stare or bundle livarmous nwtoriol HEATING U NI'rdTQ 1IX1AXI RTI!)
as defined by the Cape tin0 Munkgedt Cm1a,Chapter a12,and ilia Health and Salary -� _ - '
Code,Station 25532m)'1 d I, � HEATING UNIT(OVER 100,0!10 HTU) T
E]Yen ❑No ,
VENTILATION PAN(SINGI.E RESOD) PAID
WII Nee !team nr fuwre builJin xa Dam Receipt q
pP 6t eBay Area
Air Quality
Management
BOILER-COMP3HPOR 100,00011TU
mit boric'? oat air conuminants"as defineA by the Bay Area Air Quality Management f )
lisWc@ _ . -TOl'AL:
❑Yes ❑Nn. - BOILER-COMP(OVER 1011000 13 rt])
i
I have rear, a hazorduus materials requirement,under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUAN
fomio Health cry Code Sections 25505.25533 and 25534.1 understand that if the NEW RESODEMIALMECH. SQ.FT.
buildmgdre curg,hu,t
vee tenant,0mt it ismyresportsibiliiymnotifythemccupem '
.film anti whe faCerimotoroath rite joefe - 't TOTAL: a.. ISSUHU By: '
OFFICE
owit,
10300 Torre Avenue
Cupertino, CA 95014
of
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
September 25, 1996
Nannette Fontes
21079 Red Fir Court
Cupertino, California 95014
SUBJECT Waterheater, Permit#28890
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
•
Pnnlea or,Recvcle0 P•ioer