26354 (2) AEPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
[BU]ILDING
Y OF CUPERTINO R ILUING-h.LECIRI AL - PERMITNO.
UILDING DIVISION APPLICATION/PERMIT BUILDING
CT IDEN riFIC n C 3 C
RUILUING PR(IJECI'IBFN'1'IFICA'IJON G v J L�
ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
C/`�Ldt�'Vr UNIT( LOTk
AME: PHONE: CONTRACTOR'S NAME: LIC NO:
NUC CONTROLM
GINEER: aT LIC NO: ADDRESS ❑
6r La-v�/� G313 7 �7
CONTACT: PHONE: BUILDING PERMIT INFO
,To.11s 404,+-ry ata aa1s'�v(, I' QTY. ELECTRIC PERMIT FEE
••♦ep33 Aa..! PERMIT ISSUANCE BLDG ELF.QI' PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION pppl.lANCF.S-RESIDENTIAL !3 2— r[y]t� p��yj,
Matz I hereby affirm that l am licensed underprovisions ofCJw mug(m..rvaingwbh LOB DESCRIPTION
00 Section OWO)of Division 3 of the Business and Professions Code,end my Because is in PANELS
aa ❑q❑q full force and effect,
License Class Lice UP T0200AMP5 U D
�ia6a
Dam Cmmacmr 201-IOW AMPS
•^ SQ.FT.FLOOR A EA $/SQ.FT.
'L FOy3 ARCHITECTS DECLARATION OVER 1000 AMPS
0 Z p 1 understand my plans shall be used m public records.
rmkw, SIGNS ELECTRICAL O 0
''{ Liceed Profmsionul
Ly UnsOWNER-BUILDER DECLARATION SPECIAL CIRCUTGMISC.
x4Oa 1 hereby affirm that 1 am exempt from the Common's License Law for the
41 a C)y following reason.(Section 7031.5.Business and Professions Code:Any city rT coumy TEMP.METER OR POLE INST.
A which requves a Factor in crrswct,niter,imPmve.demolish,or repair any structure
>�
poor o its issuance.also reclaim the applicant for such Permit o file a signed statement POWER DEVICES
Wq that he is licemed pursuant to the provisions of the Contractor's License Law(Chapter SWIMMING POOL ELECTRIC
R'Ke� 9(commercing with Second Division 3 of the Business and Professions Code) VALUATION acv^
W,H or that he is axemptherefromandrhe basis for thealleged exemption.Any violation of p
�zQ
Section 7031,5 by airy applicant for a permit subjects the applicam m u civil penalty of OUTLETS-SWITCHES-FIXNRES sgU 6 Ll s
g 0 mmorethen five hundrtd dollars($5W). NEW RESIDENTIAL ELECIR S PT. Z
m ❑ 1,mawnero(the property.ormyemploymswithwagesvtheirsolecompensadon, Q STO IFS TYPEC CONSTRUCTION
LL -, will do the work,snd the structure is not intcndadoraffartd forsale(Sec.]044,Business
end Professions Code:The Contractors License Law does nor apply m m owner of
property who builds or improves thereon,and who does such work hinnselfor through his OCC.GROUP RES,UNI IS
tun employees,pmvidad that such improvements me not intended m of fered for sale.If,
however,the building mimprovemem o sold within one yearofcomplerion,theowner-
gV-TO
builder .will have the burden of,moving that he did not build or improve for f TOTAL:
Prov' g Prov purpose o
sI1 1.as ownerofthe Froprty,smexclusivelycommcting with licensed contractors to QTY. PLUMBING PE FEE FLOOD ZONE APN
m
dnstcr the project(Sce.](144,Business and Professions Code:)no Commences
License law deestam.,lym anosterofproprty whobuildsmimpowastbermn.and PERMIT ISSUANCE ?�
who contracts for such projects with a conerectm(s)licensed pursuant orbe Contractors ALTER-DRAIN&VENT-
LicenseLow. ) r FEESOMMARY
❑ 1 am exempt under Sce. ,B&P C fm this resin BACK FLOW PROTECT.DEVICE OIIT DE
SANITARY Y - N
Owner Dute I RECEIPT g s s
AREA
RAINS-FLOORBOOK F, ,CON -yN
WORKMAN COMPENSATION DECLARATIO DSCHOOL TAX Y N
❑ D RECEIPfp
Worters'Canpermatinluxuriance oracertifadcopy therenf(Sce.3800,labCJwhich FIXTURES-PER TRAP
PARK PEE Y_N
coven all ma kaye2a under this permit. GAS-EA.SYSTEM-I INC.4 OUTI.ID''S RECEIPT e
Policy N BUILDING DIVISION FEES
.. Company GAS-EA.SYSTEM.OVER 4(HA) PLANCHECK FEE L/ a
❑ Certified copy is hereby,furnished
furn .
❑ Certified copy is filed with the city impaction division, GREASFANDUSTRL WASTE INTERCEPTOR GRADING FIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE nO
COMPENSATION INSURANCE
(This section reading be completed ifrhe permit is forum hundred dollars($IW) SEWER-SANITARY-STORM EA.2WFT. ENERGY FEE 6V/n
a r/1
or less.) _ 1
I certify that in the perfomunce ofthe work for which this permit is issued,l shall WATER HEATER W/VENT/LLECIR e
nm employ any person in any meaner so is to become subject to the Workers PAID _ �T
z Compensation Lawsof California. Date WATER SYSTEM/IREATING Data Ll
Applicant
z0 NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEW RESIDENTIAL PCMB. SQ,FT. TOTAL:
r Inbecame subject to he Worker's Compensation provisiomofthe laMr Code,you at BUILDING FEE V [3gV
fa" 5 forthwith comply with such FroOsims m this permit shall be deemed revoked. ,p
7� CONSTRUCTION LENDING AGENCY SEISMIC FEE f61,J
z I hereby affirm that them is a construction lending agency for the purfmmance of
U O the work for which this pamtit is issued(Sac.307.Civ.C.) TOTAL:FjFEE
ELECTRIC FEE -�
0 U Lender's Name
Leader's Address QTY. MECHANICAL PERMIT' PLUMBINGFEE
U 1 certifyNat 1 have rtad Nis application and state Nat Ne above information is MECHANICAL FEE
mcorrect.I agrem comply with all city and county ordinances and slate laws miming to PERMIT ISSUANCEbuilding comwnion,and hereby auNorice representatives ofthis city to enter upon rheU above-mentioned propenpoy for inspection purses. ALTER OR ADD TO MECH. CONSTRUCTION TAX
7 (We)agree to anve,mMmnify and keep hamdms the City of Cuprtino against
limilides,judgmeas,costs and expemeswlech may in any way accrueagaimg said City AIR HANDLING UNIT(TO 10,000 CFM)
in orsequnc (the grating of Nis noir.
O AIR HANDLING UNIT(OVER IBM)CFM)
rgnsmrt of AppllcanVContmwtor I I MAUST HOOD(W/DUCT) PAID ✓ L�pIF
_
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 1013.000 BTU) Date Rceciptp
Will the applicant or future building occupant etre or handle hazardous material J HEATING UNIT(OVER I W,0p0 BTU) TOTAL: 9 e
m defined by the Copartner Municipal Cole.Chapter 9.12,and the Health and Safety
Cede, tr
Seeti❑Yes 25532(a)?
Y" / VENTMTION FAN(SINGLE RESID) tSD
ISSUANCE DATE
WOl rhe epplicanmrfmurebuildingmcupantuseequipmemmdevicu whichemit BOILER-COMP(313POR 101.000 RTU) � � 4 pat
mzard,Gus air conminams as dented by the Bay Arts Air Quality Management BOILER-COMP(OVER I WB00 BTU) PJ
titin?
❑Yea - ❑No NEW RESIDENTIAL MECH. SQ.FT.
SEP 3 0 1994
1 have mindthe horeNous materials rcyue
iremms under Chapter 6.95 of the
California I lealth k Safety Code,Sections 23305,25573 and 25534.I understand chat
itihe building does not currently have a tensor,that it is my responsibility to notify the CII I yr wrctlI HqU
it oceupent of the requirements which must be met prior m issuance of a Ccnificate of
Occupancy.
Owncrmautho.. egem Date TOTAL: S.OD ISSUEDB `�• JCL
OFFICE
ptip-eithio
10300 Torre Avenue
Cupertino,CA 95014
ol,
Building Division
(408)777-3333 (fax)
February 10, 1996
Resident 2
10055 Crescent Road
Cupertino, CA 95014
Re: 10055 Crescent Road Permit#26354, addition
Dear Permit Holder:
Our records show that the referenced permit has not been finaled by a City building
inspector. A permit is 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, 95014, Attn: Building
4 Department.
1
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 date of receipt of this letter. If we do not hear from
you, the City of Cupertino Building Department will have no recourse but to resolve your
permit as expired and discard the records.
Thank you for your assistance.
CITY OF CUPERTINO
Prime)on Recycled Paper