27356 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO 1 M.'soi-MhUr l PERMIT'NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING DIVISION - BUILDING PRO$CT IDENTIFICATION
BUILDII1NGG ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DA'I'.
(is I ST'A R O viUNIT p LOT#
O NEK$NAM. PNONE: TRACT'OR'S NAME: LIC NO: L•�l
c.A 2O L MA.ft ?S3 97 Y �2 Lt 'TTSA fZ to (0$'3 Cry Nrc CONTROL#
1 KCHITLC1JlNGINLLR: LIC NO: DRESS: ,
ZII t3 titre SAxMA. It Z. ❑
'ONTACP: PHONE: QTY. ELECTRIC PERMIT PEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE ' ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
MC7 thereby offimra 1 am licenxdunder promn
s ofau,no,9(commencing with
WOO Section 7000)of Division Sof the Bminesa and Pmfcasiona Code,andnry license is in PANELS
TecW r- full force and effect.
QrLW License Class Lic.# UP TO NIB AMPS as
mQy Dae Commemr 201.IOW AMPS • -
7FOy= ARCHITECTS DECLARATION OVER I"AMPS SQ.FT.MOOR 7,REA $/SQ.FT.
1 derswnA my plan .holt be usetl as public recoNs.
QNF� LittnxJ ��� SIGNS ELECTRICAL
r CWQ OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC.
E:C)WU 1 hereby affirm that 1 am exempt from me Commences License Law for the
W3Wy following reaser.(Sectiort 7031,5,Businesaand Professions Code:Any citymcounty TEMP.METER OR POLE INST.
F'a which requires a permit to concoct,alter.improve,demolish,or repair any structure
prior Polio....... ookone,trus the applicam forsuchpemrim file.signed smmmem POWER DEVICES
that hers licensed pursuantto the provision of me Contractors License Law(Chapter
daoyy 9(commencing with Section 7")of Division 3 of the Business and Professions Cade) SWIMMING POOL ELECTRIC
k rn T VALUATION
W—Iq or(list he is exempt herefrom and Ne basis for the alleged exemption.Any violation of _•
1_7¢ Section 7031.5 by avy.ppliom,for.permit subjects iheapplicam ma civil penalty of OUTLETS-SWTTCHFS-FlXTURFS
�S� nm mors than five hundred dollars($500). NEW RFSIDEN IALELECfR _SQ.FT.
X1"'0 ❑ I,asowncrofthepropeny,ormyemployceswithwng us eirsolccompensation, STORIES TYPECONSTRUCIOP
y3°. will domework,.nde: heContractor
oteisnotim kende Law
apply
to an Business
and urty whiona Cale:The Contractor's License Law does not hams lf an owner of
propertywthobuildsorimprovesthereon,and whorl«notchwork himselfed mosi e.bis
own employees,provided mm such impmvcmentsarc not intendedoroffemd forsale.If, OCC GROUP EIIN
lowever.the building Lir improvement is sold within one yearofcompleu TOTAL:
builder will have the burden of proving that he did not build as imp efor purposeof
mlc.).
❑ L n carrot me pooped ,amexclusivcly contracting wit temsedcommmorsm QTY. PLUM ING PERMIT FEE FLOODZONE
n dmei the prject(Sec.7(A4,Business and Professions ale:)'nc Contractor. a
License Lawdersnot apply mamownerofpropenywho buildso impmveamercomand MIT ISSUANC
who contruasforsuch projects with a commotion)licensed purs anlmmc Conweme, rR- R & FNT-WATER EA
License law. ( ) FEE SUMMARY
❑ I am exempt under Sec ,B PC
for this C ) M.DEVICE EE SUM FEES
SANITARY YN
Owner Ua AI OR, OF,ARTA,GOND. RECFi PT#
WORKMAN COMPENSATION DLCLARA ON SCHOOLTAX Y
❑ Thereby affirm that lhave acenifi<ate of commto xlf-in re.macromateof PER TRA RECFIpT#
nrkers Compensation lnsumnee erecenificd copy mawf(Se.JNW,Ln .)whim PARK PEE Y N
covers all employee's under this Ferriv GAS-FA.SYSTEM-I IN 4OUTI_ S RECEI r#
Company BUILDI IV ION FEES
❑
El CsFEF. 0
niBM copy is hereby famished. GA -EA M-OVER4(L PLANCHECK `
❑ Conflict]copy is Cited with the city inpecdou division. DUSTRLW EINTERCEPTOR GRADING
CERTIFICATE,OF EXEMPTION FROM WORKERS' ASETRAP SOIL
COMPENSATIONINSURANCE
(lbisannionneednmbemardictedifthe permit is fmnnchundmddollars I f' EWER SAN ARY-STORMEA.200Fr. T;ryER ,
or less.)
I cenify mat in the perfonnanu ofthe work for which this permit is issued,l 1 WATER TER WryF.NT/ELECDt
not employ any person in any manner so as to become subject Inc the Works
Compenanou Lawsof Califoma. Date WATE SYSTE PAID
M/fREATING Date Receipt#
Applicant 0 NOTICE TO APPLICANT:If,am,making this Ccnificam of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT.
E'^ c') become subject to the Worker's Compensation provisions of the labor Cede.you must TOTAL-
forthwith forthwith comply with such provisions or this permit shall be deemed revoked. BUIL NO FEE
per, Q CONSTRUCTION LENDING AGENCY SE] IC FEE
ZD z I thereby of Fran that mere is a coostraclum Radiogram,for ped orm uce of
U O me work for which this Action is issued(See301 Civ.C.) TOTAL: E ECIRICFEE
finders Name
D.
U Lender's Address QTY. MECHANICAL PERMIT FEE LUMBING FEE
1 cenify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances andsmte Iowa minting to PERMIT ISSUANCE MECHANICAL FEE
F' buildingcontrvction,andherebyaamodi mprexnmiivesofmiscitytoemteruponme
(..1 z abuve•mentiened property for inspection Purposes. ALTER OR ADD TO MECH. CONSTRUCTION TAX
(We)agree to save,indemnify and keep bamless the City of Cupertino against
linbilitics,judgmcnts,cots and expenses which may in any way acrneugaina said City AIR HANDLING UNIT(TO IO,Ig0 CFM7
in amacquence of one granting of this permit.
a Of S NR HANDLING UNIT(OVER H%W CFM)
7S1p.t.- 1,A'.'pp,h'-�cant/ on mcmr Dam EXHAUST HOOD(W/DUCTIrnlD
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IW,000 BTU) Receipt#
licam or future building occupantsnore or handle haus material
upertino Municipal CWe,chapter 9.12,and the Health and Safety ABATING UNIT(OVER 100,000 BTU) T TAL:
32(a)7 0 N VENTILATION FAN(SINGLE RESID)
Will meapplicanlorfumm buildingescupam useequipmem ordevices whichemlt BOILER-COMP QHP OR IW,OW BTU) ISSUA EDA
ramrdom air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER I W,000 BTU) 9 {
oricp
❑Yes ❑No NEW RESIDENTIAL MECH.—SQ,Ff.
I have mad the haraMmas materials requirements under Chapter 6.95 of the FEB 7 1995
C.lifomin Health&Safety Code,Sections 25505.25533 and 25534. 1 understand mat
if the building does not cumemly have a tenant,that it is my responsibility to notify the
(occupanter me requirements which most x met vdmr ro issuance of a cenifieare ter
Denture,t OF WHEI
amhonm �
y.
Owner or dagent Dae TOTAL: ISSUED BY:
OFFICE
Itv of,
Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408) 777-3228
Fax(408)777-3333
December 4, 1995
Resident
1147 Stafford Drive
Cupertino, CA 95014 .
Subject:1147 Stafford Drive, Permit# 27356 - Deck/Windows
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
calling (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
•
P.amea on Recycled Paper