27668 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO 1 I.D11 Y RF�F.1.EL'fRICAL � PERMRNO.
APPLICATION/PERMIT PLUMBING-MECIIANICAL 27668 C O
BUILDING DIVISION BUILDINGPROJECI'IDENI F'ICAI'IOR r o0
\ BUILDINGADDRISS: SANITARYNO. [PPLICXnCyxSUBmU7ALDATu
�. UNIT# LOT - 1
OWNI3R3 C `�� PHONE: ^ �� CON CTOR'SN s LIC NO:
�♦ NIC CONTROL#
RCI IETECLENGINEFR: LIC NO: AD RES. ❑
9Y tiZ�
ONTACT: __ PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PI UMB MECH
PERMIT ISSUANCE
LI SED CONTRACTORIS DECLARATION APPLIANCES-RESIDENTIAL
❑yy Iherebyaffirm NsOvm licensed underpmvisionsnfChaPrer9(commeneingwith JOB DESCRIMON
+1,00 Senim 7000)of Division 3 of Ilia Business and Professions CWc,and my license is in PANELS
Kod full roue and effect.
FQ-LL License Class Lic.p UP T0200AMPS � -
m<y Date Confession-
201-I000 AMPS
ZOO y'6 ARCHITECTS DECLARATION OVER IIXp AMPS SQ.En FL RAREA $/SQ.FT.
OZFp❑J luntlrrstvul my plans shall be useA as puM1lic reeonls. _
QFcoyA.] Licensed Professional SIGNS ELECTRICAL
5 yv�6 OWNER-BUILDER DECLARATION SPECIAL CIRCUD/MISC.
�5a�4OyF I hereby affirm that I am exempt from the Contractors License Law for the
n1�Om followingmnsnn.(Section 703 1.5.Business and Professions Code:Any city or countyTCMP.MFI ER OR POLI:INST.
rn which requires a permit In construct, her,improve,demolish,or repair any swcmre
WW>� prior to its issuance,son requires the applicant for such Permit o rite a signed stnetnent POWER DEVICES
jEE5�0c that he is licensed pursuant m the provisionsof the Commas,',license Law(Chapter
dKOLL' 9(commencing with Section 7000)of Division Sof Ne Business soul Pmfessium Cade) SWIMMING POOL ELECTRIC VALUATION
or that he is exempt therefrom and the basis for the alleged exemption.Any violiamnof OUTLETS SWITCHES FIXTURES
Section 7031.5 by any applicant for a Permit subjects the applicant m a civil penalty of
O
n more than five hundred dollars($500). NEW RESIDENTIAL ELECIR _SQ.FT.
o ❑ I,nxownernf thcpmpcny,nrmy employees with wugesastheirsole mn'tomme, STORIES 'TYPE CONSTRUCTLON
y 3°_° will amhe wons and e: he Countermen
License
is a se La does of.ppm.to an owner
of
and Professions Cale:The Commdorsadd vibo Law aces not apply to an awaer of
propenywhab,provi improvesthercoqundwhodcesauch work ciedro.elmnbroughhis
own employres,provided@m such impmvcmcntsarenotimendedoroflared 6rsale.If. OCC.GROUP RES.UNITS
however,the building or improvement is sold within one yearefcomplenoo,the owner- -
builder will have the burden of proving that he did act build or improve for purpose of TOTAL:
os
sale J.
❑ Las owner of the pmpeny,smexclusively convecting with licensed contractors to QTY, PLUMBING PERMIT FEE FLOOD ZONE APN
conswct the Project(Sec,7144,Business and Profasian CMed The Craftsman's PERMIT ISSUANCE
License Law does not applytom ownendpropertywhobuddsor improves Hereon,and
' whoconinwsfarsuch projects with a contreua
cions)licensed pursnuthe e Contractor's pL'I'F:R-ORAINffi VPN'p-WATER(EA).
Licenu Law. FEE SUMMARY
E] I'am exempt under Sec. B AsP C for this reason BACK FLOW PRO'I'13CI'.DEVICB
SANITARY YN
st Owner Data DRAINS�Il.00R.ROOK ARIA.COINRECEIPT.!� WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑ Ihertby affirm Natlhave acenificara of<onsennoself-Insure,ararenificate of FIXTURES-PER TRAP RECEIITN
Workers'Compensvtion Insurance or a certified copy thereof(See,380.Lab C.)which PARK FEE Y N
mases all employee's under this pemtit. GAS-EA.SYSTEM-1 IN 40 RECEIPT#
Policy# BUILDING DIVISION FEES
-"' - Co.,." GAS-EA.SYSTEM-GVHR PLANCHECK FEE
❑ Cmifiedcgryi,Inmbyfrrishrd.
❑ Certified copy is fled with the city inspection Division. GRF. pJINDUS'I'RL WA I RCEPfOR GRADING FEE
CERTIFICATE OF MEMPTION FROM WORKERS' G EASETRAP SOILS FEE
COMP17NSATION INSURANCE
To,sectianaed not becompleted if Ne penin is forme hundred dollan($IW) SE ' -SII'A S RM HA.20017. ENERGY FEE
or less.)
Imrfifytha inthe peommunceonhe work for which this permit is named,Imail WATER rATF.R ENT/ELFCTR
not employ any person in any manner co as to become subject to the Wmkeri PAID
z Cnmperomme Lawsof Califamia. Ditto WATER SYS EATING Date Receipt It
Zapplies.,
NOTICE TO APPLICANT:If, CardEcmeof Exemption,you should NEW RESIDENTIAL PLMIT SQ.IT. TOTAL:
y become suhjmfto the Wodea'S Compensation preskimsafthe Labor Code,you must
� + forthwith comply with such provisions or this permit shall be domed revoked. BUILDING FEE
y D
CONSTRUCTION LENDING AGENCY SEISMIC FEE
U z I hereby affirm that hem is a convection lending agency for the performance of 19T ELECTRIC FEE
O
he work for which this parrol is issued(Sm.37,Civ.CJ
Lenders Name
O Lender's Address QTY. MECHANICAL PERMIT FEE PLUMBING ME
1 certify that I have read this application and Stam that the above information is
correct.l agree to comply with all city and county ordinances uttd state laws misting to PERMIT ISSUANCE MECHANICAL ME
huddingcenstruction,and hereby authorize representatives afthis city former upon he CONSTRUC IONTAX
U Z above-memional property for inspection purposes. ALT ER OR ADD TO MECH.
(We)agree to save.uralcromiIi.09 kap harmleD to,City of Cuycnims against
iabilities,j tots,cosre an pe swhic may in any way accrueageinstsaid0ty AIR HANDLING UNIT(TO 10,000CPM)
xi� encyAIR HANDLING UNIT(OVER IO,IXIO CFM)
Si alum of Applicant r ✓�!?5 Data EXHAUST HOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE BEATING UNIT IT01(10,000 BI'U) Date Receipt is
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(OVER 100,(gXI BTU) TOTAL:
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cale,Section 25532(a)?-
Yee ❑No VENTILATION FAN(SINGLE RESID)
/ ❑ �$
BOILER-COMP(3HP OR IOOA0)BTU) S(IANCH DAT17
Willthe.pplicaomrfar..buildin m
gece,aaacespipmeacurdesese whichamit p I
imrdaus air comtmninants us defined by Ne Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU)
District?
❑Ycs ❑No NEW RESIDENHAL MECH. SQ.FT. JAN 41995�'99horrendousL have read the horrendous materials requirements ander Chapter 6.95 of he
brl'yJ s7�J
Culifomia Health&Safety Calc,Sections 25505,25533 and 25534. 1 understand Nat Ur
iftham ami
cal.building dsncunenay have. that it is my resperdbility to rnifythe V Ia
oce.pvm of the reqm
uiremas which must be me, norm issuance of a Certificate of
Occupancy.
Owner or authmized....I Date TOTAL: ISSUBD BY:
OFFICE
r<
C-LIPertll1O
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 29, 1995
Resident
1142 Kentwood Drive
Cupertino, CA 95014
Subject: 1142 Kentwood Drive, Permit# 27668 - Repipe
Dear Resident,
According to our records the above mentioned permit has never been finaled by a
City Building Inspector. A permit is considered to be valid only six months from its
last inspection date. If your permit shows that the final inspection has been completed
please send a copy of the permit, along with this letter to 10300 Torre Avenue,
Cupertino, CA., 95014, Attention Building Department.
If your permit has not been finaled, please contact the Building Department by
callMg (408) 777-3228, so that we may arrange to extend your permit, and schedule a
final inspection.
In an effort to control the number of expired permits, the City of Cupertino
requires a response in ten working days from your day of receipt of this letter. If we do
not hear from you, the City of Cupertino's Building Department will have no
alternative but to resolve your permit as expired and discard the records.
Thank you for your assistance.
Sincerely,
City of Cupertino
J
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