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27767 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY CITY EADDR�S PESION IJUILIJINU ELECT RICA I PERMrrNo. APPLICATION/PERMIT PLUMBING BUILDINGIVISION BUILDING PROJECT IDEN'TIFIG\PION 27767 BUILDING : —/ Ifs/2 SANITARY NO. APPLICATIONSUBMITIAL DATE ZO 000 .L"' UNIT# LOT# 01OWNERS PHONE: CONTR CI'Oft'S NAME: LIC NO: I N/C CONTROL# 21 2Or✓G�u✓SIA!LATI o/� RCill'IECI'/fiNGINEER: LIC NO: ADDRESS. n s � O C ❑ f CON'I'ACI': PHONE: /Y o BUILDING PERMIT INFO QTY. ELECTRIC PERMIT FEE BG ELECT PLUMB MECH PERMIT ISSUANCE 11 El El LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL nwz Iherebyuffinn that l an licensed tinderprovixionsolChepmr9(currunendngwiN JOB DESCRIPTION W00 Section 7000)of Division 3 of she Business and Professions Code,and my license is in PANELS 5 V F full force and effect. `. F<„ZW License ClassLic.It UPTO200AMPS ,<0- Date n Commer 201-1000 AMPS F yZ ARCHITECTS DECLARATION SQ.FT.FLOOR AREA $/SQ.FF. ZO ZO 4 O 1 understand my plans shall be used as public records. OVER 1000 AMPS F-rnF j SIGNS ELECTRICAL Licensed Professional �yf�< OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. KOaU 1 hereby all).that I an exempt from the Contrucmr's License Law for the - W3Wiq following rcasoo.(Scction 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST. "0; which regmires a permit to construct,alter,improve,demolish,or repair any structure c, 'or to its issuance,also requires applicant for such Permit file a signed alatement POWER DEVICES pas 9uire pp permi 6n ,,<C)< shot be is licensed pursuant m she provisions of the Comraaur's License Law(Chapter ao o<& 9(conartarcin6 with Section70DO)af Division 3 of the Business and Professions Code) SWIMMING POOL ELEC71YC VALUATION u' or that he is exempt therefrom and the basis for the alleged exam t An violation of W_v. P B pian.Any OUTLETS-SWITCHES URES FZa Section 703 L5 by hmy undred dollars($500). subjects the applicannoacivil penalty of w more than foe hundred dollars($500). NEW RESID LECIR _SQ.FT. K F_o (31,azownermftheproperty,ormyemployecs wide wagesntheirsolecompenatioq STORIES TYPECONSTRUCTION i3°O rill dothe work.and the sbuctureis not intendedoroffered Intrude(Sm.904a,Business and Professions Code:The Conomrors License law does not apply to an owner of propenywhotwidsorimproves thereon,and who does such work himselforthrough hisOCC.GROUP RES.UNITS owitemployees,provided Nuratich improvements ar ovemene not imendcdorofferedforsale.If, however,Ne building or improvemem is sold within on<yeurofcompletion,the owner- TOTAL: rudder will have the burden of proving that he did not build or improve for purpose of nJ. ❑ I,a rnnnepmpeny,a x<wsivetycnmmmm6 wnhlmeoxd<nno-acmram QTY. PLUMBING PE =EE F1,00n zooms ArN 1!mslmw the project(Se,70M,Busines and Professions Code) fire Contractor's iovnx Law Anes nort,dyto anowmerofpmpacoy who bards or improv<s thereon,and PERMIT ISSUANCE J whocnnlrans for such projects with termramer(s)licensed pursuant to the Contractors AL'T'ER DRAIN&VENT-WATER(EA) FEE SUMMARY License l.aw. ❑ I am exempt under See. ,B&P C for Nis reason BACK FLOW PROTECT.DEVICE OUTSIDE FEES SANITARY Y N Owner Date DRAINS-FLOOR.ROOF,AREA,COND. RECEIPTp WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN ❑ Thereby aRrm thalM1avearertificase of conxnuo self-insure,ora neificate of FlXNRCS-PER TRAP RECEIP 4 Workers'Compensation lnsumnce or a certified copy themoffSec.3800.Lab C.)which PARK FEE Y N covers ell employee's under this Permit. GAS-EA.SYSTEM-1 INC.4 Ol ETS RF.CF.IPfp Policy#", - BUILDING DIVISION FEES Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE ❑ Cenificd copy is hereby famished. ❑ Certified copy is filed with the city inspmam division, GREASILINDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION MOM WORKERS' GREASE TRAP - SOILS FEE COMPENSATION INSURANCE (This section need not be completed ifthe pemrii is for one hundred dollars($]W) SHOVER-SANITARY-STORM EA.200F1'. ENERGY FEE mless.) I ceni(y that in the performance ofthe work for which this Permit is issued,I shall WATER HEATER W/VENT/ELECTR not employ any person in any matter so as N become subject to the Workers' PAID Compensatinalawsof Calificum. Dam WATER SY.STEM/TREATING Date Receipt# z Applicant Z2 NOTICE TOAPPLICANT:If.a(ter making this Cenifieate of Exemption,you should NEW RESIDENTIAL FLAB. SQ.FT. TOTAL: N become subject to the Worker's Compensation provision of she Lehr Code,you must - forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE fit .r CONSTRUCTION LENDING AGENCY SEISMIC FEE z 1 he, affirm that there is a construction lending agency for the performance of U O the work for which this permit is issued(Sec.3099,Cls.C.) TOTAL: ELECTRIC FEE Lnmdcr,Name QF Lendor's Address QTY. MECHANICAL PERMIT FEE PLUMBING F17H U I certify that I have read this application and smte that the above information is MECHANICAL FEE>" W correct.lxgremo comply with all cityanJ county orJinancea and tram lawsrclating so PERMIT ISSUANCE f^ huildingconstruOdor,and herebyrood rise repreunlativesof Nis city wenlmuponlbe CONSTRUCTION'TAX U2 above-armaiuned property for inspection Purposes. ALTER OR ADDTO MECH. (We)agree m save,indemnify and keep hatmless the City of Cupertino against Iiabilities,judgmenls,costs and expenses which may in any way accrue against said City A IR HANDLING UNIT CFO 10,000 CFM) in transmittance of the granting of this permit. /O J_ AIR HANDLING UNIT(OVER 10.0110 CFM) Signature of AppHearm(Commustar �f J Dare EM IAUST HOOD(W/DUC ) PAID HAZARDOUS MATERIALS DISCLOSURE IIGTING UNIT(TO 100.000 BTU) Date Recti# Will the applicant or furore building meupam store or handle hamrdon material TO asdnfimed by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100,000 BT U7 Code,$elision 25532(a)R ❑Yes 11 No V17NI'TIATION FAN(SINGLE REBID) UOIL17R-COMP(3HP OR 10(1,000 BTU) ISSUe CIG DATE Will tai apommotners as defined by the Bay equipmentQ ality Mwhichemit ��aaC .D,mvnm air amtaminams az defined hY the Bay Area Air Quality Mana6emenr BOILIiR.COMP(OVER I W,OpD BTU) ss District^ ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.I.T. �p 1 have read the Trainman,materials requirements under Chapter 6.95 of the \,#Z s JQ�``� ad:Health&Safety Code,Sections 25505,3533 and 25534.I understand that �` Q V if the building does not currently have a moans,that it is my responsibility to notify the 0 occupant of the mluiremenrs which must be met prior to issuance of a Certificate of C\ Occupancy. s Owner,,wahoriaed agent Date TOTAL ISSUED BY:�r OFFIC Cupertino 10300 Torre Avenue Cupertino,CA 95014 Building Division (408)777-3228 Fax(408)777-3333 November 29, 1995 Resident 10250 Lockwood Drive Cupertino, CA 95014 Subject: 10250 Lockwood Drive, Permit# 27767 - Skylights (2) 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. �J Sincerely, City of Cupertino - 14 –q— l i - Printed on Fec-,clea Paver