S1432 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CaY.OF CUPERTINO BUILDING.-ELECTRICAL PEgyl`�IT NO. 1432
BUILDING DIVISION APPLICATIONq'ERMIT PLUMBING-MECHANICAL
BUILIHNG PROJECT IDENI'1F'ICA'1'IUN
HIJILDINGADUHFSS: SAN[LARYAf APPLICANON SUBMITTAL DATE
OWNER'SNAME: PHONE: CONI ACT(J S?IAMk LIC NO:
N/C CON1'HOI.ro
CHITECI'II NGINEER. LIC NO: AD �yS,V O CLr ❑
J�ado
kill,
RF I
CONTACT: ` �(I P ONE: BUIL-UINC PERMIT'INFO
/�(/ ❑ Consultant Fees Paid by Applicant(Initial) -IH' IiLEC11 PLUMH MECH
El�I ❑ ❑
LI LNSI U CONI RACI OR UI CI AR IION Q'ry ELECTRIC PERMIT 'FEE
I here by anmNtl r i d e fcrpt )(. e g JOB DESCRIPTION
DIAL with Section 7004B.1'Dustier 3of the Bus rlmEss'an.Cade,anJmylice cis RESIDENTIAL:
W O PERMIT ISSUANCE
F-B mfull
Oirce las elf tel Li, �p ❑SFD\VL ❑KI'1'CHF:N RCb10DIi1.
Y U F License Class—(.�Lic.#
<—U APPLIANCCS-RISIUENTIAL ❑ADDITION 0PLUb1BING RE-PIPE
rnaact
'*am "a ARRCCIlFrrCGSDECLARAFION ❑MUCH-UNIT ❑STRUCTURAL
Z I end ersland my plans shall lse rood a,ubli.aeonh PANELS MODIFICNHON
OZ�O LETO 2IXIAMPS ❑INTERIOR El CHIMNEY REPAIR
F L4t:Wt Licensed Professional 201-1000AMPS IMPROVEMENT [-]SWIMMINGPOOLS
Z.1
f- -BUILDER DFCLARXIION HATH REMODEVREPAIR ❑DEM ITI FOVER IOAMPS
iW casL I for he hylit p
OTHER
F yO F following g rc : (Section](1JI 5 B d Professions C de A y ty aunty SIGNS ELECTRICAL. ••••������ �X p� �'•�
y h 4 e I t :t Ltp J list, p st: cwrcIt#'e ,—
prior to itsalso requiresIll,.elf if - I1coulne file ni,ed,uncomet S PECIAL CI RCU I I'IM ISC.
that he is I censedpursuant isthe provikirms Ofthe Contractor s LuOtome 1 (Center,9
�C[�� fcommenetng wnh Semm�](1fX1)nl l)vzion 3nf the Nus rte and Pr l ::' ns Ctde)nr 'TEMP METER OR POLE INST. COMMERCIAL:
a a c C that he is exempt therefrom and the bail for the alleged exemption.Any violation of C3 NEW BLDGIADDITION ❑DEMOLITION
�=tw
Section 7031.5 by any applicant for ap:mit subjects the applicant to a civil penalty of POWER DF.VICRS ❑ITNANT ❑1001)SERVICE
nrn marc than live hundred dollars(8500). IMPROVF,MI:N'L'
Z� ❑ asoo
I, owncr if be propcny,ariymrtployccs withwegc.as their.cole cmnponsation, SWIMMING POOL ELECTRIC
p. will dothe wrk,and the simncm knotlnanded ...bees far sale(Sc,7044.Business ❑0'IHP.R
W3 m and Professions Calle:The Continuants Liceme Law does not apply w an owncr of TT
OUTLETS-SWICHES-FIXl1RES
lL
ppcny who holds or improves thereon,and wdoes s such walk himich or through
ugh /
his awn employees,provided that such improvements am not intenNd or oReted far NEN'RESIDENTIAL ELECfR SQ PT.
sale.ILbova,,r,thebaddingorimpocermat i.ssold within one year ofcompletion.the .1T. ' RAREA $/SQ.FT.
marser-hailder will have the harden of povmg Thar he did nut build or intpnrve for puts /f
pose ofsalc.l. '-]
L as owner of Nm
e propcny,am exclusively contracting with licensed conlracrs to 'IPO IPA L, G
consumer the project(Sec.704.Business and Protestant,coact the contractors Li-
cence Law Joss nm applyman owner of propcny who huilJs orimprovez thereon.and QTY. PLUMBING PERMIT FEE
who contracts for such projects with a commemr s)licensed praaanua the Contrectofs n
License Law. PERMIT ISSUANCE D
❑I in cannpi under Sec. .B&P C for this camn
His,,cal
hereby a:maintaner Penley of rCrmmnt ml elf-iollowingg Workcations: DRAINS I)FIAON VIiN'I'-WA'lliltlliA) ,.y\
Own,, DION - LIAR 2 fr L `
jury one if the
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE
ROOF,AREA,COND. ST 1 Tl'PE CONSTRUCT ION
Lanon,as provided for by Section 3700 of the Labor Calla fin the peri mance of he 1 1 17-9H 45v u t t I N
work for which he pemth is mucd. FIXTURES-P I
❑ 1 loo,,; I will mninatin Wn kers Compensation holonmce,ns reydned by Sediun
3700 of the Labor Cade,for the perfofmaneeof the work for which this Fermi,is ned, GAS-EA.SYS 1-Illi( t 1 'F OCC GROUP APN
M Work f, cubo Msumnc artier and Polio GAS-EA.SYS \'E (Egl
Carrier: !�f��- s. PnEcy No.. h
C RTIFIC OMPE SATION'IINN FRO. WORKERS' GRE\SFIINDUS'TRL WASTIi IN'l1iHCIiP10H
COMPENSATION INSURANCE il11LUING DIVISION FIDS
TInki,ectionnuAnm bcumgticiN iftbc pcmtit lx for ane bundmA JolLvs f51 W) GRHASETRAP
or lees.) I'LANCIILCK I ?li
le<nilythal inthepeflimmenceofthewnrkliewhlch this permit is'jotted,[,hall SEWER-SANITARY-S"FORM EA.21X1 F1'.
not employ any Person in any mne
anr so as to become subject to the Workers'Camr-peLNIiRGY F .
ZZ all..Laws of Califamia.Date WATER HEAT ER W/VENT/ELCCTR GRADIN jE
Applicant
NOTICE TO APPLICANT 1L alter making this Cer ilicaro of Exemption,you should WATER SYS'I EMO REATING
SOILS FET
F I desitxnbjectnt the worker's Cal envisions titheald Al you must
Lrzthwitb comply with such provisions or this panni,shall he JeemeA rcvukaJ. WATLR SERVICE
CONSA Q
� z OEM there
iso cIONLENDINGAGENCY NEW RESIDENT'IALPLh1P. SQ.FI'. LAID ,tc Rccciptp
U O Thereby affirm Nauherc isattmmmnion,coring agency for pcdnmanec of
U. FPI the work for which Nis lamit is issued(See 31000.Civ.CJ
Lend N TOL'
TOTAL:
U Leader,AJI
I Ty doe I h' 'I thN appl -t d ric'Fe'Fertile h torou.n oa is
111111 NO 113P. ,-
Ei N momcf I a,mi,at comply e[ Il city and comay d' once d:late In,,Milng nt QT'Y. MECHANICAL PERMIT FEE SEISMIC FEE
U building construction.and hereby authorize representatives of this city to enter upon the
abate-mentioned property for inspection Purposes. PIiHMiI'ISSUANCE Ii1.ECl'RIC FEE
(Wn)agree to save,indemnify and keep harmless,he City of Cupertino against
liabilities,Imlgments,costs and expenses which mdy in,my way accuse against said City ALTER OR A DO TO MECH. PLUMBING FBP
tire a of,he griming of l his it,.
'PLIC,.e t UNDERSTANDS ILL C MPLY WITH ALL NON-POINT' AIR HANDLING UNIT(TO IIIIXIq CFM) MI CHANICAI.i'Tt
SOURCE RE(. I NS.
AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTION'I X
Sig AApplic J omarlam EXHAUST IRKA)(W/DUCT) HOUSING MITIGAT ON FEE
A%ARD JS MATER LS DISCLOSURE
Will thea camorlinum hnllJingn cupanLaorc or bundle o,anus lnmammal HEATING UNI'I(TO 100,000 BTU)
as rental by the Cupertino Munioipal Cod Chapter 1)12.and Nc Ilmd,h trod Sidel,
Cada Station 255320)4 HEATING UNIT(OVER IdifrXX)1{'1'U)
❑Ye, 0N VENTILATIONPAN(SINGLBRESID)
nc Recti N
W II the upplicum or fuutm vildia,occupant use equipmem nr devices which
BOILER-COME(}I{POR ItXI.(NN111TU)
Tit hmanloun air contaminants ac dunned by the Nay Arca Air Quality Monagm"nn I OI'Ah
fti,ndo? BOILER-C'OME(OVER 100 ye IF
I-]Yr, [:1 No
(have teal the hazvdons rwmrials requiremcros anter Chapter 6.l5 of Ne Cali- AIR CONDI'I IONER ISSUA CE DATE
train Health&Safe,y Qde.Sections 25505.25533 and 25531.1 understand Nat if Ne NEW RESIDENTIAL MLCH. SQ,P.
building does nm currently have u tarot.Nat it is my msparssibility ut notify the occupant
of the mquimnted,wbicb must be"tet Prior m u"uninsc of a Ceniticme"I'(car pancy.
Uw'nm or authinued agent Date TOTAL: ISSUED BY:
OFFICE
®p 10300 Torre Avenue
Cupertino, CA 95014
Citef,
o
Cupertino Building Division
Cupertino -721-78
(408) 777-3333 (fax)
February 9, 1999
Homeowner
20167 Las Ondas Wy
Cupertino, CA 95014
SUBJECT: Permit #S1432
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 pen-nit 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 catmot
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
l
F- - J
Christy Akatiff, Administrative Clerk
•
Pnn:e4'on Recvclea PaDo,