28350 (2) I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITYOFCUPERTINO •2y8 "a�7 BUIId)ING-ELECTRICAL. PERMIT NO. ^ ^ w O
BUILDING DIVISION APPLICATION/PERMIT PLUM IIINO-MECHANICAL
BUILDING PROJECT IDENTIF'ICA'TION
BUILDING ADDRESS: SANITARY NO. APPLICATI'OYNSUBMIpTTALDATE
" Avil,4 UNIT# LOT#
OWNFRSN E: 111I 1 �'']� PHONE: C [' COM'RACTOR'S NAME: LIC NO;
a `
d k1�lDid— Oiect 7JZ-✓ J N/C CONTROI.p
RCIEITF,CI' � CINFER; I LIC NO: ADDRESS: ❑
CONTACT: PHONE: v BUILDING PERMIT INFO
QTY. LLECIRfC PERMIT FEE
BLDG ELECT PIAMfl MECH
PERMIT ISSUANCE 0 69- El
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL /—�
qyg I herehyaffimn that lam licensedundesprovisions.fChaprsr 9(commencing with LOB DESCRIPTION
ts100S. SdOmr700B.f Division 3afohe Business and Professions Code,and my license is in PANELS JAI
F<Uk3 full to.
and effect
aUt License
classLia.# UP TO 200 AMPS V
yaN Date Contractor 201-I"AMPS
zF0 ARCHITECTS DECLARATION OV17R 1000 AMPS SQ.FT.FLOOR AREA g/SQ.Ff.
2z 1 understand my plans shall be used as public records.
SIGNS ELECTRICAL.
6a"Y,z, Licensed l'ndeaninnnl
p;a'a OWNER-BUILDER DECLARATION SPL'CIAL CIRCUIT'YMISC.
�Yad10yF 1 hereby affirm Nat I am exempt from the Contrnctols License Law for the
F.40r' following reason.(Section 7031.5,Business and Professions Code:Any city rn county TEMP.MET[:R OR POLO INST. 41
p�y m which requires.permit to construct,al¢r,improve,demolish,or repair any suucmre
prion.its imuance,W......ire.theapplicam fmmch permit to fleasigncd statement POWER DEVICES
,onY ohm he is licensed pursuanun the provisions of the Commemra license Lew(Chapter
n. act 9(commencing with Section 7")ofDivision3 ofthe Business and Professions Codd SWIMMING POOL ELECTRIC VALUATION
' '_'a,w or he is exempt therefrom and the busim for the alleged exemption.Any vimati.naf
Section 7031.5 9031.5 by my applicant forape.I,subjects fla.mplicanno.civil penult,of OUTLHTS!SWIT Br- t(OOO . OV
mo more than five hundred dollars(5501).
da ❑ I,asowneroftbeprnlcny,ormyemployeeswithwagesastbcirsolecompe,,..tion, NEWRFSIDEM'IALELF. _gQ.FT. STORIES TYPE CONSTRUCTION
a3— willdo the work,tadthenmum.isnot imeneedmoftered fatsale(Sea.70,L8miness
and Professions Code:The Conductor's License Law does rat apply to an owner of
property wh.hrildsorimpmves Ncrcorn,mdwh,ccessuch.ml,himselforthfoughhls
own employees,providedthat such impmvementaare not intendedmaffcred fortitude.If. OCC. IP RES.UNITS
horwcver,the milmr,mimpomendem is mad within one year of corn,16'n,tha dome- TOTAL:
builds will have the burden of proving that he did not build or improve for purpose of
solo.).
❑ I,anownerofthe property,am exclusively contracting with licensed conductors to QTY. PLUMBING PERMIT FEE FLOOD APN
construct the project(Sec.7044,Business and Professions Cade:)the Contractor's PERMIT ISSUANCE 3z /3
License Law does not apply man nwnerof property who Milds or improves therenm,and
who contracts farsuch pmjects with a contractor(s)licensed pursuanuo the Contractor's
License Law. ALTER-GRAIN&YETI'-WATER(EA) FEES ARY
❑ I em exempt under Sea ,B&P C list this rcu..n BACK FLOW PROTECT.DEVICE O TDF.FEES
SANITARY Y N
Owner Dago DRAINS-FLUOR,ROOP,ARFA,COND. RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑ Thereby affirm that l have a cenificate ofcomem to self-insure,macenificatem' TEXTURES-PER TRAP RECEIPT#
Workers'Compensation hominicamacenifwl copy lhere.f(Sec.3WM.Lab C.)which O PARK FEC Y N
rovers all employee's radar this permit GAS-EA.SYSTEM.I INC.4 OUTLETS RECEIPT#
Policy# BUILDING DIVISION FEES
Company GAS-P.SYSTBM-OVER 4(CA) PLANCHECK FEE
❑ Cenifiedcopyisherchyfumished.
❑ Certified copy is Blnl with the city inspection divi.ion. GREASFJINDUS'1'RL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOBS FEE
COMPENSATION INSURANCE
(This section need not be completed lithe Nuck is forone hundrMdollars(SIM) SEWER-SANITARY-STORM PA.200PT. ENERGY FEE
or loss.)
I cenifythat in the perfonnanceof the..,it for which this permit is issued,l shall WATER FIPATER W/VENT/F.LF.CTR
not employ any person in any munner so m to become subject to the Workers' PAID
z Gumpeasuliom Luwaof Culifomlu. Duro WATER SYSTEM/TRFATING Date Receipt#
Applicant
zQ NOTICE TO APPLICANT:If,after making this Cmificam of F draption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
Cl) become subject to the Worker's Compensation provisions f,he Labor Code,you most
Chi f.nhwim comply with such Provisions or this p.mdt shall be deemed revoked. BUILDING FEE
LII CONSTRUCTION LENDING AGENCY SEISMIC FEE
z 1 hereby afrom that the.is a c..straction lending agency for the performance of C Q
U O the work for which this permit is issued(Sec.3097,Co.C.) TOTAL,: ELECTRIC FEE
Lendels Name Q
O U Lender's Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
1 certify that I have read this application and some that the above information is
correct.1. to comply with all cit and taunt mmances and more laws relating to PERMIT ISSUANCE MECHANICAL FCC
g� and Ya Ya 8
U' Z above
nmentioned tenant hereby uuthmize r,mew.ntmivice of lhinciry meater upon the
ab.vememioned ny for ins o ALTER OR ADD I'O MfiC11. CONSTRUCTION TAX
V z grape ify a n ked,hu.
r.l (We)agreem.ave,indemnifyand hie mayinss theaymcty eagaCo,nstsidor City
in
granting expenses which moyinunywayuccmc against said City AIR HANDLING UNIT('1'01411lX1 CPM)
in<onscquence of the granting of this pcnnio.
AIR HANDLING UNIT(OVER 10,000 CFM) �f
Signature of ApplicanVCommctor Date EXHAUST HOOD(W/DUCT) PAID 8-29'-%— Bg yLS�
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT fT0104WB BTU) Data Receipt#
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Ode,Chapter 9.12,and the Heallh and Safely HEATING UNIT(OVER 1 MOM BTU) TOTAL:/O,7`pp
Cade,Section 25572(a)1
0 Yea 11 No VENTILATION FAN(SINGLE RESID)
Will the applicanrcecsem
lorfumbuildinguupantuequipmeordevices whi<hemBOILER-COMP LIHP OR 100,0(10 BIL) ISSUANCE DATE
it AUGI(�[�[
hwurdam air contaminants as defined by the Bay Area Air Quality Management 25 1x795
Distrito? BOILER. (OVER 1 W,Ufp BTU)
1-1 Yea ❑No NEW RESIDENTIAL MECII. SQ.IT /y
.
I have read the horrendous materials requiremems under Chapter 6.95 of the Cl I Y Vf UUrLt t t....-
Culifnmiu Heahb&Safely Carl.,Sections 25505,25533 end 25534. 1 understand that
Bthe building does not currently have o¢nam,that it is my responsihilky m tonsillitis,
cupant of the requirements which must be met prior to issuance of a Certificate of61)
Occupancy. -.��1III+111
Owner or authurixed agent Data TOTAL: ISSUED BY rDe- /'91-X>k.k.2 CC,
OFFICE
® 31 10300 Torre Avenue
• = Cupertino,CA 95014
Citv. of
Cupertuio Building Division
(408)777-3228
(408)777-3333 (fax)
May 8, 1996
Homeowner J/
22184 Via Camino Ct.
Cupertino, CA 95014
Re: Expired permit, (copy attached)
Dear Owner:
According to our records,the referenced permit has not 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 (408) 777-
3228, so we may arrange to extend your permit and schedule a final inspection.
The City of Cupertino requires a response within ten (10) working days from the date of
receipt of this letter. If we do not hear from you within this time, the building department
will have no other recourse but to resolve your permit as expired and discard the records.
Thank you for your cooperation,
Building Department Staff, City of Cupertino
•
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