27301APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
6 I R.
CITY OF CUPERTINO
PERMIT NO.
llj NO. ,EC
APPLICATION/PERMIT 1'1.DMHING-MPICHANICAL
27301
BUILDING DIVISION BUILDING PROJEITIDF,h-1'[FICA 'I'ION
BUILDING ADDRESS:
SANITARY NO,
APPLICATION SUBMITTALDAM
UNITp A 3 LOT
OWSNAMI:: nl 1 NG COACTOR'SNAMk CND:
I
V l.0
N/C
CONI'ROLN
-- S 1 ` ` O
K1ia� 1 `t,_ J J
LIC NO: A R SS:
�.ftCHIT1iCT/ENGINEER:
❑
_ E
ConTaCr:! .nOA „^11S`'I PHONE QTY. ELECTRIC PERMIT FEE
LI 'tILTI T t' �/
BUILDING PERMIT INFO
P
HLDG E WMH iCfi
PERMIT ISSUANCE
❑ ❑
LICENSED CON'TRACTOR'S DECLARATION APPLIANCES- RESIDENTIAL
'JOB DESCRIPI'IUN
IherebyaffDi Nall amlicensed Ch (commencingwith
B.si.,i..d Professions; .use, add
Semina ]0(10) n(Divisinn 3.f the Business and Professions Cotle, and my license is in PANELS
P0Z
—
-a
w
awl—f-�.
full foraand cff (.
f1��
U U
F2w
License ass Lie# UP TO 2M AMPS
dl►
,,<e.Da¢
— Conttacmr 201-1000 AMPS
SQ. FT. FLOOR AREA
E/SQ. FT.
FyZ
'L O.��
ARCHITIiNS DE ,A TION OVER ION AMPS
O Z—O
I understand my plans shall be used as public records.
SIGNS ELECTRICAL
yic+�Lice
nwA Rofeasi.nal z�
OWNER -BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
XO a U
i
CO. W
1 hcmby affirm Nm 1 an exempt from the Contractors License law for Ne
w a rFr
�c,_1
following.... (Section 7031.5. Business and Pmfessions Cade: Any city or county TEMP. METER OR POLE INST.
which reunites a permit toc.nsruct, alter, improve, demolish, or repair any structure
KW¢2pd.,
mus osoancc, also onto. Neepplicarn forsuch psrom 1. file. signeddrueneat DEVICES
w K 21O
that he is licensed pumaaat to Ne provisions of Ne Contractors License law (Chapter
VALUATION
o.XPOWER
.114
9(commencing with Section Division 3 ofthe Business and Professions Code) BWIMMING POOL ELECTRIC
w—y
or that he is exempt herefrom and the basis for the alleged exemption. Any violation of
OUTLETS
Section 7031.5 by any applicantfor. permit subjesesde appli...... civilparodyof SWITCHES - FIXTURES
not more Than live M1unArtA Rollers (5500).
M
❑ I.asownerofiheprnpenY.ormyemploymswithwagesmtheirsolecompensation, NEW RESIDENTIALELECfR_SQ. 17.
STORIES
TYPE CONS'BUCTIUN
a3=°
will do the work,andthe structure isnot intendedorofreted fm We (See. Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who buildsor improves thereon, and wlwd.es such work bimselfonhrough his
ownemployms,pmvidedthatswhimpmvement=notinwndcdoroffercdfmade. If,
OCC. GROUP
RES. UNITS
however. the building or improvement is sold within one year ofcomw �.
pletim, theoner- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of W.W
We.). QTY. PLUMBING PERMIT FEE
er ofthexclusively m
❑ Iuct
FLOODZONE
APN
Badness and Professions CWeQ The moor's
(Sve. 7 44, Puffning bere, Coth de) The Ciandreo
the (Saco
et the
License tawdmanot apply to an ownerof pmpcnY whobuild.orimproves lhereon..nd PERMIT I58l1ANCI?
kens oesnol to dyer
who conerams fsrsuch projects with a continen s) licenaedpursuanno Be Comneto's
gL'TF.R-DRAIN&VFM-WATER FA
Licence Law. f )
FEE SUMMARY
❑ I nm acmpt under Sec. , B & P C for this mason BACK FLOW PROTECT. DEVICE,
OUTSIDE FEES
SANITARY YN
RECEIPT#
owner Date DRAINS- R. ROOF, AREA, CON D.
SCHOOLTAX Y N
WORKMAN COMPENSATION DECLARATION
I heubyaffirm But l haven certificate of sonumtoself-iosum,.ra cenificareof FIXTURES P
RIiCEIPI'N
PARK SEE Y N
Wem'Compemfm�in�Jn�,�Ines�urla0nce oracenified<opy thereof (Sec.3800, Lob CJ which
GAS -EA. SY -II 4OUTLETS
ly"'PI
BUILDING DIVRECIISION FEES
PI've"d
y a \11n 11]1
Company Zh6\k GAS - EA. SYS ER4E/d
PLANCHECK EEE
❑ ifed copy is hereby famished.
GRADING PER
edifW copy is filed with the city inspection division. GREASEANDUSTRL W 'INTERCEPTOR
CERTIFICATE Op EXEMPTION FROM WORKERS' GREASETRAP
SOILS FEE
COMPENSATION INSURANCE
ENERGY PER
(This section need not becompleted ifthe permit is for one hundreddollnrs(5100) SEWER - SANITARY -STOI�d
or less.)
I certify that in the performance of the work for which this permit is issued,I shall WATER 11 HA'I ER W/VENTO;
not employ any person in any mariner an a, to became subject to the Workers
PAID
z
Compensation Lawsof Cnliromia. Data WATER SYSTEMORFATING
Applicant
Dme Receipt#
O
zCa%
NOTICE TO APPLICANT: If. after making this Cenifiate of Exemption, you should NEW RESIDENTIAL PLMB. SQ. Irl'.
TOTAL:
become subject t. the Worker's Compensation provisions of Bra Labor Cade, you most
pV]
;
forthwith comply with such Provisions .,,his pernilahe[] be deemed revoked.
BUILDING ITE
SEISMIC FEE
P. r)
CONSTRUCTION LENDING AGENCY
Z) z
e performance of
1 hereby affirm that there is a construction lending agency for Nm
U O
the work for whieh,hi, permit is issued(Seco 3097, Civ. C.) TOTAL:
finders Name
ELECTRIC FEE
PLUMBING FEE
lL
O U
Lenders Address QTY. MECHANICAL PERMIT FEE
I mnlfy the, I have read This and state thin the above ws r is
MECHANICAL FEE
city road county elating
correct. Iagrs mcomply with all city ertd county ordinanceserW some laws miming to PERMIT ISSUANCE
CONSTRUCINON TAX
building construction, and hereby authorim representatives ofthis city beentervsed the
U z
property art inspection ton purposes.
aGwcmcntioneJ t f i ALTER OR ADD TO MECH.
We) agree to indemnify and harmless the City of Cupertino against
ntsave,
es pensesrrit. may inany wey accrue agdnst said City AIR HANDLING UNIT (TO 10,000 CFM)
which
'
incoitiqueneofthecosuand
nmsayuence of the griming of this permit.
AIR HANDLING UNIT (OVER 10,000 CPM)
PAID
Signature of A,,Iecat/Commctor Dam EXHAUST HOOD(W/DUCO
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT (TO 100,030 RTU)
Dam Receipt#
OT
Will the applicant or future building mcupant stow or handle broadens material
as defined by the Cupertino Municipal Cole, Chapter 9.12, end the Ileahh and Safety HEATING UNIT (OVER 100,000 BTU)
yVfs
Code. Section 25532(ay VENTILATION FAN (SINGLE RESIDE
❑ Yes ❑ No
/., '�_
ISSUANCE DATE.
W lithe applirant or fuwre buildingm'cupanmxeyuipment or deviceswhicM1 emit BOILER - COMP (311P OR IITI,UW RTU)
O
znNous air conumina.m as defined by the Bay Area Air Quality Management BOILER -COMP (OVER 100.000 BTU)
-
1#4 y
Disricf!
❑ Yes ❑ No NEW RESIDENTIAL MECH. SQ, FT.
28
C/I 7996
1 have read the hazardous m:derieWrequirements under Chaptet,6.95 of the
i Gr
California Health &Safety Code, gmiom 25503, 25533 and 25534. 1 understand that
if the building does nor currently have a u nand. But it is my msponsjKlity to notify the
ccup the requirements whi t mus hem t r nr to issuance of. of
u
_Cedifcme
1 p
ISSUED BY:
O awhorue .gem / Du TOTAL:
OFFICE
M
10300 Torre Avenue
Cupertino, CA 95014
Cuper tino
Building Division
(408)777-3228
(408) 777-3333 (fax)
January 22, 1996
Homeowner
10090 Pasadena Avenue, A3
Cupertino, California 95014
SUBJECT Permit: #27301
Dear Homeowner:
We have been cleaning out our files in the Building Department, and contacting those
people with permits which have remained "open".
• According to our inspection records, the subject permit has never been finaled. Many
times an inspector will sign the permit in the field, but neglect to report all of the
information to the clerical staff for input into the computer. If your records show the
subject permit as finaled, would you please contact us so we may complete our records?
If the permit is not signed off your permit can be reactivated and an inspection could be
scheduled for final closure of the permit
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
•