26455 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CIT'i'OP CUPERTINO RDIEIHNO-RI'ELTRT�. PERMITNO.
` TION/PERMIT PInl
BUILDING DIVISION APPLICABUILDING PROJECT'IDENT1I'l;AON 26455 6pCJ
BUILDING ADDRESS:0 SANITARY NO. APPLICATION SUBMITTAL DATE 30 �� *+�/1 UNIT# LOTH
t4yK5 NAME PHONE: CONTRACTOR'S NAME: LIC NO: 111...
f// -^, I 4 NIC CONTROLp
A CH TECTIENGINEER: LIC NO: ADDRESS ❑
CONTACT PHONE: f ')184`.5. u
�Nfy//��`/ QI� BL'EGPRICPBRMIT:t 4'. - 'FEE - BUILDING PERMIT'INFO
IDS 3-31-C PERMIT ISSUANCE f gray V��� y BLQG ELECT PLUMB ME❑CH
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL NSW JOB DESCRIPTION
cmz Ihereby affirm that l am licameJumderprovision.M Chapter 9(commercing with
�00 Section 7")of Division 3 of the Business and Professions Code,nM my license is in PANELS
y d'� full forty and effect.
GNZu1 License Class Lic.# UPT0200AMPS
=y Date Co..", r 201-I"AMPS `
Z Os"ir'Z-" ARCHITECTS DECLARATION OVER 1000 AMPS SQ.IT.FLOOR AREA $/SQ.FT.
O Z—Q 1 understand my plans shall he used us path.records.
r�I:!� SIGNS ELECTRICAL
Q n� Licensed Professional
5'g�6 OWNER-BUILDER DECLARATION SPECIALCIRCUTT/MISC.
0.x OP-F 1 batch,uffimt than I um exempt from the Contractors License Law for the
tv131s�m¢ following reason.(Section 7031.5,Business and Professions Code:Any city m county TEMP.METER OR POUR INST.
Oy o which requires a Permit to construct,that.Improve,demolish,or repair any srumano
�Y7 prior its issuance,also requires the applicant for such Permit to file asigned statements POWER DEVICES
�p thtn he is licenecd Pursuanuotbc provisions of the Contractors license Law(Cheerer SWIMMING POOL ELECTRIC
P'Xaley .,.no,
he is ingwit theinirrion d,hd Endsion3ofthe Businesrphi Professions Cad e) VALUATION
y)Z, orthn h7031.5 by any applicant
nt for a
the Permitnnhe aseged exemµt to My l violationety of
ZG not Section vu undredicamrs($50rmit subjects the applicant toecivil penalty of OUTLETS-SWITCHES-FIXTURES
not mom than rmfhmmrcddouarmyem).
O I,asowneroDhe yemp y g µ NEW RPSIDENTIAL ELECfR _SQ.FT.
ap ❑ protr cY•nrm en edorefera a aratta(Se.cam nssiness S'1'O PS 'TYPE CONSTRUCTION
3=e will Bothe wons and e:no tummetin'not sL is a se Lae dos not apply to ant owner of
and Professions Cale:The Contractor s License Law does not apply to an owner of
propery whobuildsorimproves thereon,and whodces such work himselfonhrough his OCC.GROUPRF;S.UNITS
own emploYces,prate ided that s tach`repro vemenks arc not i m ended or offcrtd for sale.If,
however,the building or improvement is sold within one yearofcompledon.the owner L:
builder will have the burden of proving that he did not build or improve for purpose of
sole.). ... f
❑ I,aeawnerofthepropeny,amexclusivelyconwctingwithlicensedcont ionto QTY. ''PLUMBING PERMIT ' PEE• FLOOU ZONE ANN
construct the pmjmt(Sec.1044,Business and Professions Cade)The Conu¢tor'a PERMIT ISSUANCE -
License Law does not apply mon ownernf pmpeny who builds or improves therenn,and
whocomractsforsuch projects with acommou(s)licensed pursuant m the Coundemes ALTER Be VPNT-WATER HE PEE SUMMARY
Licenx Law. - f >
❑ I am exempt under Sec. B&P C for this reason BACK FLOW PROTHCU DEVICE OUTSIDE
I.E.
S ITARY YN
Owner Das �csDRAINS-FLOOR.ROOF,AREA,CON RECEIFI•N
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ I hnchyuffirm that l have acenificate ofcomem nsself-insure,oracenificate of FlXTURES-PF.R TRAP RE .IPfp
Workera Compeaeation Insurance or acertilieJ copy thereul'(Sm.3800,Lah CJ which PARK FEP. Y N
covers,all employee's under this permit. GAS-EA.SYSTEM-1 INC.4OUTLETS UII''Ip
Pol cy p VISION FEES
Company GAS-EA.SYSTEM-OVE 4TA) CPIANCHECKI
❑ Certified copy is hereby furnished.
❑ Crnifed copy is filed with the city inspection division. GREASF/INDU L ASTEINTERCEPI'OR CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAPCOMPENSATION INSURANCE
(ibis seaim mealnm be completed late permit is forms,handfulCmllara($100) SEWER-SA Y-S 200FT.or less.)
I certify that in the performance ofthe work for which this Permit is issued,I shall WATERIIIATERW/VENT/EL R
not employ any person in any manner ao as to Ixcame s----- m Ne Workers'z ACPpmlpenmtionlawsofCalifornia. Date WATER SYSTEM[MEA G NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should NEW RESIDENTIAL PL Q.ET.became subject to the WorkCs Cumpe wisman provisiosofile labor Code,you must
; fonM1with comply with mch provisions or this permit shall be deemed rcvakM.CONSTRUCTION LENDING AGENCY
z 1 herehy affirm that them is a construction lending agency for the performance of
U C) the work for which this Permit is issued(Sec.3(97,Civ.C.) TOTAL: ELECTRIC FE
Isndma Nam,
OF Lenders Address QTy.i ; F MECHANICAL-PERMIT- 'FEE, PLUMBING PG
U I candy that 1 have read this application and state that the above information 1 1, 41
a.mea.l to cam 1 Ih all cit ❑count n elawa rclnot m PERMIT ISSUANCE MECHANICAL -E
egrte pywi yon ym g
� &,eatu,undherebyamhmnze rep mtivmsofthiscit mercer uponthe CONSTRUCI'IO TAX
U z ropertyforimpenionp ALTER OR ADD TO MUCH.save,i emnify an cepM1vmesathePtys cost.andxPense. ich may in any way ervee ���(///ffyyy AIR HANDLING UNIT(TO 10,000 CFM)
the,ra arm obis it. ((/
L I ' w ( L IR HpNULING UNIT(OVER 10,00 CPM7
Signature ml ApPlicant(Contmomr G/a� Date IT
I{OOD(W/UU"q
PAID
HAZARDOUSMATERIALSDISCLOSURE EATING UNIT(TO 100,000 BTI1) Gua Receipt
Will rh epplicum or fumm building accupanumrc or handle hazallous mmenal
os deflned by the Cupertino Municipal C,d,,Chaprcr9.12,and rhe H.Ith and Safety HEATING UNIT(OVER 100,000 BTU) TOT
Code,Section 255321n)Y
13Yes )CN. VENTILATION FAN(SINGLE REMO)
❑
Will thcappllcum orfumrchuildingoccupum use equipmemnnlevices whichemir
BOILER-COMP(3HP OR 100,010 BTU) ISSUA ATEO
hazardous air contaminants as defined by the Bay Arca Air Quality Management BOILER-COMP(OVER 100,0110 BTU) 'JUL
•
District? 1994
El Yes 0N NUW RESIDENTIAL.MCCH. SQ.FT.
1 have read the hazardous matenals requirements under Chapar 6.95 of the y'/Y I
California health&Safety Cold,Sections 25505,25533 and25534.1undennandthat wrth NQ
z ifthe building does not currently have a tenant,that it is my responsibility to notify the -
cupem of the requirements which must be met prior to issuance of a Certificate of
Occupancy.
Owner ammthm,eA.gem Ome TOTAL: ISSUED BY:
OFFICE
MAY 2 6 1995
'
Gabriele Rico
22630 San duan Rd.., Cupertino, Cil 95014
7ef. #408/253-3758
May 8, 1995
Mr. Robert S: Cowan
Director of Community Development
City of Cupertinn
10300 Torre Avenue
Cupertino, CA 95014-3255
REF: Permit # 26455
Dear Mr. Cowan:
This is to inform you that 50% of the work for this permit has been completed
and has passed inspection. Due to the heavy rainfall on a hillside with heavy
run-off, we stopped work on the second wall. It will start again soon. Please
• extend this permit for another six months, rain permitting!
Please call me at ove number if you have any questions.
(/Cordialll ',
Q,U l I t ( C�
Gabriel L. Rico
"Ci(.V of
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
22630 San Juan Road
Cupertino, CA 95014
Subject: 22630 San Juan Road, Permit#26455 - Retaining Wall
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 our permit shows that the final inspection has been completed
P Y
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 ( '
• ` J
Printed on Pecvcled Paper