31504 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO "". .'BUILDING-ELECTRICAL PERMI T NO
'BUILDING DIVISION APPIACATIONTERMIT PLUMBING-MECHANICAL 31504
•• BUILDING PROJECT IDRNTIFICATION
LDING ADDRISS. SANITARY NO. APPLICATION SUBMITTAL DATE
ACYQ
Ip22,33,5� �t.9Wdut•t ._fr G�/��.�pef"�w�e.,CLQ . 1
WNE/"SN NAME: ��Cirr O NE:(�i�yWL RV1#�IOaNI'S NAMu LIC NO: INIC COM ROL#,
• �—� �
ARC IFEECT(E ORSEER: LIC NO: ADDRESS: ,1 . 1
GNTACT., PHONE: - - - BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG P.LECT PLUMB MIiCH I
LICENSED CONTRACTOR'S DECLARATION - QTY ELECTRIC PERMIT FEE
I hereby affirm that I am license!under provisions of Chapter 9(commencing 70B DESCRIPTIONOaZ wish Sacdcr7U(11Bof Di1idm.3ofdmBusinesxmm Professions Code,andm liceni
00 y ses n WE force and effort. '. PERMIT ISSUANCE RESIDENTIAL:
❑ D ❑KITCHENREMODEL
acZVOLicense Class Lir.# APPLIANCES 'RESIDENTIAL ]ADDITION O PLUMBING RE-PIPE Contrial
r.
AF.C1'S DECLARATION ❑MUI7I-UNIT EJ
RCHIT
H - l PANELS
' Z O n Z 1 understand my plans shall be nwd as public records MODIFICATION
oz--
UPT0 200 AMPS '❑INTERIOR ❑CHIMNEY REPAIR
Liaco. JI fe',..nal ,206111110 AMPS IMPROVEMENT
J
OWNER-BUILDER mDECLARATION OVER JUX)AMPS - ❑BATH REM/
yy 6 I
hereby (Bon that 1 am exempt f the Contractor's L 1 for the
hd 3 a U follo g (Section]OJ LS Bui nes hnJ Pn fess oat C de:A ry Sty m county SIGNS HLECfRICAL - ❑OSYER L
LLLL1l LLO which tial v permit to cnmwe,,Sher,impmve,demolish,or repair any structure
prior to its Issuance,also requires the llpplicam lot such permt to plan signal statement SPECIALCIRCUIT/MISC.
�} that he is licensed pursuant to the provisions of the Contmcmrs License Law(Chapter 9
(commencing with Section'l")of Division 3 of Ne Business and Professions Code)or TEMP.MI:-1'F.R OR POLE REST COMMERCIAL -
1L ry,o td that he is exempt theref can and the basis for the alleged exmnptica Any viol......u( - ❑NEW BLDG/ADDITION 'D DEMOLITION
^n is, Section 7031.5 by any applicant fora permit subjects the applicant Ina civil Penalty of POWER DEVICES
{{....2 r>, not mora than five hundred art lars(s5sp. ❑TENANT ❑FOOD SERVICE
>, a",
as ownaufehe property,ni my anployccswiN wagesustheir snleronrpensmian. SWIMMING IDOL F,LECTRIC IMPROVEMENT
2 will do thework,and Nenmmure is not inteadedmiffertd far sale(Sam.9044.Business []OTHER
and Pm1m,ons Code:'I'Itc Contrseme,License Law Joe,nm apply to an owner of OUTLET'$-SWI'TCE{US-FI%TUBES
L .. property who builds or improves thereon,and who docs such work himself or through - -
his awn Uri...us,provided that such improvements proents are nit intended or offered far NEW RESIDENTIAL ELECTR SQ FT.
sale.If.however,the building or improvement is sold within one year of completion,the SQ.FT.FLOOR AREAE/SQ.FT
owner-builder will have the burden o(proving thin he did not build or improve for put
poso of salol. -
I,as owner of the pmpeny,am exclusively rontracting with licensed com.ears 10 PA �
consumer the project(Seco 9044,Business and Professions Code:)The Contractor's Li- A10 if Q� 1
active Law does not apply to an owner of prolxhem
or,who huildv or improves theon,and QTY, PLUMBING PERMIT. I�9
is
who contracts for such pejeex with a c.meactia )licensed pursuant to the Common /� y
Limixi,Law. �, 1 PERMITISSUANCE C/1y
❑ I.. xempI undtt Sec. &P C far this reason UI- LIJf
ALTER-DRAIN&VENT-WATER IF VALUATIO
Date
RN COME TION DECLARATION BACK PLOW PROTECT.DEVICE - -
therebynflirmunJerpcnvlayafperjuryonetilthe following dmlarutions;
Ihave and will etmimvin aCcrtificam of Cnnscm to self-insure for Workers Compen- DRAINS-FL(OR,ROOF;AREA.COND.
STORIES '1'YPI?CONS'TRUCfION
as provided for by Section 39010 of the Labor Ce,for the pedormance.f the
%rkonfor which this cannot is issued. p1X'TURES-PER TRAP -
1 have and rill maintain Wmkeex Compensation Insurance,as required by Section
3701)of the lahor Code,for the performance of the work for which this permit is issued GAS-IIA.SYSTEM.I INC.4 OUTLETS OCC.GROUP APN
My Worker's Compensation Insurance camel and Policy number are:
Corea Policy No.: GAS-HAS.SYSTEM-OVER 4(EA)
CERTIFICATE OF EX1iMM]ON FROM WORKERS' GRGSI?/INUUSTRL WASTE INTERCEPIY)R's
COMP[NSAHON INSURANCE. HUILI IV MON FTiFS
(This section need but be completed if the permit is for nnchmWred Jdlius($10(d
GREASETRAP
or lwsJ �- JFAL: I'LANCIIF.CKTEE(cenify Natintheperfrmanceofthe work for which this pertnitis issucd.lshall SEWER-SANITARY-STYIRM EA.2(not employ any person in any manner set us 10 Nicosia,subject m the Workers'Conipen- ENERGY FEEr ID
Z wtin Lawsof Culifnmiu.Date
ZApplicant WATER HPTER WIVENTIELECfRGRADING ME
NOTICHTO APPLICAN p IL after making(his Cenificale of Exemption,you should WATER SYSTLM/TREATIG.becameshject m the Workers Compensation prove ions of the Labor Cafe,you nn SOIIS P .hadewith Comply with such provisions or@is pe,mitsshall bu Jeemed revoked. WATER SERVICEdCONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. PAID
V O thereby af0rm thatthem is a construction lending agency fm the Parlirrmnmme off" the work far which Nis permit is issued(Sm.304/,Civ,C.)O ULcrdm,Nume TOTAL:
Dander'sAddressy 1 cenify then 1 hove real Nis applicani.n and nam lit..cite Shave infintwiion is BUILDING FEEV) correct.l agree m comply with all city and county ordinmcesand state laws relmingm Q'pY. MECHANICAL PERMITU 4 building cnnmm�ion,and hereby amhnnce representatives.fthis city acceleration the SF.ISMICFL•E
Marve-mentioned property.for inspection purposes.
(We).,,as to save,ademnify and keep hamJess the City til Cupertino against I'LRMIT155l1ANCF. ELECTRIC Fit.Ii
Iiabilinies,judgmenns,costs and expenses which may in any way aeren against said City ALTER OR ADD TO MECH. PLUMBING PP.E
in consequence or the granting of this permit. -
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,00)CFM)
SOURCE REGULATIONS. MECHANICAL
. - AIR HANDLING UNIT(OVER 10,01YJ CPM7 CONSTRUCTION TA
Signature of Applicam/Conwenr - - Dem. EXHAUST HOOD(W/DUC1) " HOUSING MI'TIGA'TION P:
HAZARDOUS MATERIALS DISCLOSURE '
Will Nenpplicummfuture building occupant nnie or hatidlehastai material HEATING UNIT(TO 10,000 BTU)
vs defined by the Cupertino Municipal Code,Chapter 9.12.and the Heald:and Safety ,
Cele,Section 25532nd? 11 RATING UNIT(OVER 100.000 IT Of
❑Yes [D No - VENTI LATION PAN(SINGLE RES I D) PAID
Date Receipt p
Will the sit co am efuture building by the B use equipment or devices which BOILER-COMP 131 HP OR 100/HIO BTU)
t hazardous air cnmuminums as Jetined by the Huy Arcu Air Quality Munagemena TOTAL.
�tnc Yes No BOILER--COMP(OVER 100,010 BTU) ,
❑ "[] t
I have read the hazardous mammals ¢under Chapter 6.95 of the Cali- AIR CONDITIONER
r5.2553 a p ISSUANCE DATE:
building
gdoes dt Safety Lode,amounts 2l.that 125533 and ns534.1 to
Nat if the NEW RESIDF,N'I'IAL MEC((. SQ,IT, r
of hetigdoesnotcunhichnently veamn,pioroismmorof.sihilitfie notifythetrcupant
' .f the rcquiremans which masa he met prior issuvnco ofu Certifiemeof occupancy, /�7
Ow@rllr amhonzed agent Daae TOTAL: ISSUED BY: IVw�I JV��frs��'•`1����J
OFFICE '
10300 Torre Avenue
_
Cit.%, of, Cupertino,CA 95014
' ipertuzo Quildmn2 Division
(408)777-3228
(408)777-3333 (fax)
June 18, 1997
Homeowner
22335 Regnart Rd.
Cupertino, CA 95014
SUBJECT Permit#31504
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, the subject permit has not had a final inspection.
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 dispose of the file and remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
Primed on Necmed Paver