28658 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-IU-ECTRICAL MRMUN0 2 8 6 ^ NN
BUILDING DIVISION APPLICATION/PERMIT PLUMBING MECHANICAL 1 illi 1V� RVQ lXJ
BUILDING PROJECP IDENTIFICATION
BURDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
of "De. �.�.
OWNER:SNMR • PHONE C NTRACI'OR'S NAME: LIC NO:
NIC CONDtOLX
aRLTi1TECT/ENGINT;GR: LIC NO ADDRESS: E
CONTACT: PHONE: �y BUILDING PERMIT INFO
K1 (4C)8)Z55 — 0 Consultam I.Paid by Applicant(Initial) BLDO ELECT PLUMB MFCTi
LICENSED CONTRACIOR'S DECLARATION O �Y ELECTRIC PERMR FEE ❑ ❑
1 hcleby affirm mat l am liarned md,Irov;uom of C m acr 9 p�mnmm,ing JOB DESCRIPTION
D00 with Smlinn)gIDl ofDyisim 3 urine Hummin aM Pmfcuimot Codc.cadm Nato RESIDENTIAL:
{Wr��� full forts and cRxt y PERh1ITISSUANCE (]SFDWL El KITCHEN REMODEL
�Ft E In
U� Liam Cleo Cunh
Dan—Cwtmcrm APPLIANCES-RESIDENTIAL ❑ADDIOON ❑PLUh1BING RE-PIPE
F,>y ARCIUnCPS DEC'IARATION PANELS ❑MULTI-UNIT []STRUCTURAL
z ,ZZ Iundersand.,,I...shell Mmedor public Iaorda ' MODIFICATION
OZ p® UPTO2WAMPS
rs,'a,G J LxsnscJ Ymf,.asuxW TERIOR ❑CHIMNEY REPAIR
OY OWNERINJIIDER DECLARATION 201-IOOOAMPS IMPROVEMENT
C=W 1 h, man eft man 1 am ezempl froom the Cmas Litems law f«do OVER Ipp0ANP5 *O BATH REMODEUREPAIR El DEMOLITION
A. following. ISeaitm 1031.5.Businma wd Prof—ion.Cmk:Any city or county SIGNS ELECTRICAL ❑OTHER
W wMCn un u'mn a Permit to commonc0 dor.i nlaove,demolish,An mlu r any alranme
�LLNO 'ourto no,monucc,ulwrtyuim the tt'licam for such,cmut w Neusigad etaamem SPECIALCIRCUITI
�.
that he ulianaeO putvum to the pmviniooa of da ConlraclMs License law(Chapn9
�O Iconums,rcing wltM1 Samimll ,of Diviaim3ofda Bninxxs ed Rofeaims Code)m Tnl;METER PO INST COMMERCIAL:
a IMI he is
to nnefmm ed tha bationds for ty,e&,d cncmpim.Any violaof
DEMOLITION
Saban]031.5 by any applicvnl fm a pemil sub*h,the applimnt to a civil penalty of POWER DEV ❑NENANT ADDITION ❑FWDSERVI
rot more dom five moodd dollen($501), OTFNANT ❑FOODSERVICE
❑ I.0 owlxr Mth pmpcny.orm IMPROVEMENT
wilyempayrnwilhw,geualc(Sde0,14,B .tine. SWIMMING PWITcd CfRIC
ad son!Jomile wark.Codd:eimnumiocan' oendulor offend Tarsale(Sec.11 H4,Bniicc:c El OTHER
,toand Pmfnlbomto Cotler The Cmu fficru IantJ of Lew does nor appy tom owner M OVIEITS-SWITCI Es ar'
M,nown w110 build,In Impiuvn themm,ami who don such wmk himmlror duorgh
M,owm employee,pmvidd thu such irnpnry ac4d s ere mx intended a o0eid for NEw RPSIDBNTIAL ELECT FT
. .ILhowev wdcbuilding ucknoorcrtcm iawldwidtinartb.00-(ipoo,niory do SQ.FI',MOOR AREA S/SQ.FL '
woer-buihl,will neve the burden of paving Dat M did mN buid m impnwc for[anr-
que
coLnortft orohs,Sw.7Y,am,xclutivelyrumnclingC Iicemudcuntranunto T x�
cowruct the Pgam(Sx.IOW,Bu'ucaa ed Profeaimrs Cdc:l The Cmnrxvur s I.i� pp�a p
Scrota law don not appy to an usurer of p rfy who builds«Improves damccm.sad QTY, PLUMBING PERMIT FEE PPL
�wha onuxufor suchpmjecte wilharnnnxRMa)licensd,uuenm mn the CnnmrocmolS B y
Lowe Law' PERMIT ISSUANCE 1r
❑I am exempt umkr5ec. ,B&P C for this mown
ALTER-DRAIN&VENT-WATER(EA) v ON
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICEI'II
I heRby affirm umki peoby ofper)ury Svc of ds,following dnWndom: YLIr la(J!'tH on",
❑(have ed will mwintaineCcrdfce¢of Conserv molt-Tana for Wuhefx Cnm,cm DRAINS-FLOOR,ROOF,AREA.COND. STORIES *"" TYPECONSTRUCIION
aedoa,u Imtvidod for by Sodd.3100 d do Labor Code,far da,pnfonmmna of ds,
work for which thia,c rout is is.mcd. FIXTURES-PER TRAP ,
❑1 have ad will mountain Wmkds Carrtpeltunm Inti.,an h,uh d by S.sdnn
37W of the Labor Cdc,for dr pufnmancc urns,work for which thin permit is houcd. GAS-EA.SYSTEM-I INC.i OUDETS
(ICC.GROUP AYN
harrier. Cumpemadn
on lowrce carrierand PMicy number art
:
Carrier. IMky No.: OAS-FA.SYSTEM-0VER 0(EA)
CER`DFICATE OFEXEMPTIONI INIRAM WORKERS'
COMPENSATION INSURANCE OREASF/INDUSTRL WASTE INTERCEPTOR
or let)This:lion adtxr be compind iftM pcnnim in!mune huMml dallanGREASE'IRAP
(SIM) BUILDING( ISION
,
1'LANCHECK IF-E
1 unify dw a the any mar ms of oh,work lar which this permit i1 iswd,l shdl
tut employ my perummanY manta sou wbnamc auM1jntlo the Wmken'Cmnpcn- SEN'ER-SANITARY-STORM G.200 FT. ENERGY FEE
,Z tylion Lewvuf Celifumia lAa
O Applcuu WATER HEATER WNENTXLECTR GRADWO
11W I
NOTICE TO APPLICANT:If,afar making Ino Cm6cmc of Eaenapian.you shwld WATER SYSTEM/TREATING
I'•"'a be<vnse subjw to the Worker's Cumpcmidion lrav1s1011t of the lalwr Code,yw must SOILS FEE
fanbwlth amply widtauch lroviniov or Nu Permit shell he deemed revoked. WATER SERVICE
D O
5z CONSTRUC`PONLENDINGAGF�CY
WO, NEW RESIDFNTIAi,PLMB. SQ.Irf. PAID
U 0 IMabyaRirm dwm itis mJS,;an Boiling agency for the pedoirtwcsd ale ReceipX
Un 1M wortfar which thin permit is isud(.5.±%303].Civ.CJ
o �'a N.
TOTAL:
loner's Arfifyt -
I Salify dwa I have scan this applicedm and Sua that the above infmmnlion is BUILDING FEE
(n can.1 ngrtc w comply wim tall city end rounty animists eM sus laws rtledng to QTY MECHANICAL PERMR FEE t
U Z buildingau
mnxte
ion, d hmcrtby rnr ,tcp rmdive ofthitcity local,upm roc SEISMIC FEE
'� eMve-trs,ntiaad pmpcny for in,,ction pap see.
(We)a me to save,irdemnif PERMIT ISSUANCE
B Y and kap hnnnien the City� Cupenitxt ny�ylliBV ELECTRIC FEEin
liabilimiet.jdgrts,ms.mRs taxi eapemes which my in any wvy 4 -
mscqu c of the grunting of thia,cmlin. ��}" ALTERORADDTOMECH. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH TIMIN AIR HANDLING UNIT LTO IO,OXI CFM)
SOIIRf RGGU A ONS. MECHANICAL Fpi
t AIR HANDLING UNIT(OVER 10.000 CFM) CON.STRUCII TAX
rtof ApplicenWormuctm Dene EXHAUSTHDOD(WNUCIITvjt HOUSING MDI TON FEE
HAZARDOUS MATERIALS DISCLOSURE �w
Will the applicant orfumm building acupunm noun,ur handle heanrdoua wuenel HEATING UNfTTDIA CCOLAi) '
'u dcfirW by as,Cup ito Municipal Cade,Chaga 9.13,aid ds,Hollh and Safny
Cdc,ScnRm M532(e)1 HEITING UNIT(OVER IM."BM
❑Yea Fl No - VnENTBATION FAN(SINGLE RESID) PAID
u df rcdd N
WiII the applieanr m m foabuilding tntau cqu ipment m Jhonsrnm
which BOILER-COMP(3"OR SM."BTIJ)
it hn aNws air cmwoiouus eby
dffi Bs,Bay Arro M
Al,Alr Quality Afaimge
UIm ❑Yn E]No uricrt N BOILER-COMP(OVER 100,018)BTU) OTAL
I hevc rod mc, imsar s On,ircmrnu unAn Chiio 69 Ofolc Culi- AIR CONDITIONER ISSUANCE DA '
(ante HcdN&SalelY Code,Smiorts 25505.25533 and 255}1.I u notify hi thu if its,
With,dam rod andyChr rowtavt rot it ism NEW RFSIDENIAI.MECH. SQ.Fr.
g Y ajo ycea.Ceitywm4Occcian,,'
oldie rcquirtns,nu which muu be mn prior w uum c of a CmiRSuc of Ocvslnrcy.
Owmawthav<d organ Dam TOTAL: ISSUED BY:
OFFICE
YARD
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BLDG. INSPECTION DEPARTMENTI
CITY OF CUPERTINO uop YY
Com) z55 - 33�
®�
10300 Torre Avenue
Cupertino, CA 95014
Cupertln.o Building Division
(408)777-3228
(408)777-3333 (fax)
May 23, 1996
Homeowner
867 Femgrove Dr.
Cupertino, CA 95014
Re: Expired permit, (28658 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
•
Pnmrnl oo Pc clod Pvor