27997 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY e4Duu
CITY OF CUPERTINO IsU...TSING-RLECTRTCA1. PERMI'TNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 27997
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BUILDING PROJEUF IDEN'MICATION L r J
RU .DING ADDRESS: SANITARY NO. APPLICATUNSUBMITTALDATF,
r'0 3S rs tie ua , Cin .Jc��a„ CJI} O) C011l'f«
O NERS AME; PHONE: CONTRA OR'S MIME: LIC NO:
A NIC CON'TROL
•
ARC'I I'1'ECf/ENGINEER: LIC N WV ADDRESS: ❑
noftAhstftyLav
CONTACT: PHONE
' QTY, ELECTRIC PERMIT PEE BUILDING PI?R '[NPO
ECT M M
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
emz Therebyaffim"I'd l am liccomdunderprovisiooscr Chapkr9(commencing with )O PSC MON
�00 Section 7")of Division 3 ofthe Business and Profession'Code,and my license is in PANELS
[[GGStz1LF.. full fumeandeffat. �N
F-�V,yUj License Class Lic.p UP TO 200 AMPS
y60- Dole Connow 201.1000 AMPS
ZOyZc- ARCHITECTS DECLARATION OVER IWAMPS SVT.FLOOR AREA $/SQ.FT.
OZ-0 1 understand my plans shall be used to public reamed,. >t]� to
qty '� Licensed Professional N CAL
^�
L��U OWNER-BUILDER DECLARATION ECI C ISG.
Oa I hereby affirm that 1 am exempt from the Contractor's License Law for e
3 a y following reason.(Sudan 7031.5,Business end Professions Code:Any city oreo my TEMP.METER OR PO
I"'V,o which requires a permit to construct,alter,improve,demolish,or repair any structure
5r�}� Prior It,its illanna ,alsvrequires theappliant for such permit to file.signcdstatement POW RDEVIC
v ¢ that he is licensed truant t0 the f the Contractor's Liana Law Cha kr
p0 pu provisions' ( p
P.ca 9(commencing with Section 7IXlfiof Division 3 orthe Business and Professions Code) S L C VALUATION
y' My or h7031.5 by mya applicant
and the baspermits beasegedexemption. civilp relty of UTLETS-SWITCHES-FIXTURES
}Q
Section 7031.5veunyapplicantfmapernit subjects the epplicwuoa civil pcnWy of
� pof ore than Eve hundred Jolles(SSW). NEW RESIDENTIAL ELECTR —SQ,
I;asownarmf(heproperty,ormyemployeeswith wages as theirsolecomprntadon. STORIES 3'YPFi CONSTRUCDON
13 will the work,and the smrdurc is not inlrnded Oroffercd fineale(Sa.7044,Buxinaa
and Professions Co le:'fhe Commerce.License Law doer not apply to on owner of
propertywho builds orimproves lhemon,and whodoe;such workhimselforthroughhis
ownemployms,provi&dthatsuchimprovcmntsmnotiniendedarofferedforWe.If. OCC,GROUPEA
however,the building or improvement is sold within one yearofcompliion,theowner- G A
builder will have the burden of proving that he did not build or improve for purpose of
sole.).
❑ 1,ssowncrollhepropcny,em exclusively contracting with licensed con0mnors to Qom' PI NIN IT IFP. FLOOD ZO E
instruct the project(Sec.7}14,Business and Profession'Code)The Contrarieties PERMIT ISSUANCE
License lawdoes not apply toenownerofpropertywho builds orimproveathereon,and
who contracts mrsuchprree"white enntramr(s)licensed pursuant o tiro Contractor's
I.icenseLuw. NN 7A. ( FEE SUMMARY
❑ I ALTER
am exempt under Sec, a ,B A,P C far this..a BACK FLOWPg6fik. VICE
SANITARY Y N
Owner Date RECF.1 Pl'p
DRAINS- ,ODR.ROOF,A1110,C D.
WORKMAN COMPSENSATIONent to 6RAT10N SCHOOLTAX Y N
❑ eo,'CorlpeI hereby ncnon Insurance
nsuance ecimeed,. therof(Securgor Lab certificate of RECF.IPI'p
FI%3' 35-PP.R TRAP
Workers'Cmployantionler this eorecertified copy lherc0((Sa.3gIXl,Lab C.)which PARK PGB Y N
covers all employee's under this pemdL G - RI'N
BUILDING
DIVISION EA.SYSTEM-1 INC.4 OUTLETS
DIVISI
Policy N ON FEES
ass
CompanyV 4(EA) PLANCHECK FEE 2
❑ Cmifial copy is hereby famished. _ - t
[I Certified copy is filed wish the city in,ectiondisnion. EA ' N RL WASTE INTERCEPT GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GRHASETRAP SOILS FF.F.
COMPENSATION MS URANCE
This section need not be completed ifthe permit is Intent,hundred dollen 100) SEWER-SANITARY-STORM EA.20017. ROYFEE `
or lus.)
I certify that in the performance ofthe work for which this permit is is ,I shall WATFR HEATER W/VF.NT/ELECTR
not employ any person n any manner so as to become subject to a Workers*
Z Compen'ation Laweof Califurds. Date WATER SYSTEM/TREAT1NG D Reecipt0
Applica
Z nt
NOTICE TO APPLICANT:ILefter making this Certificate of Exe prion,yooehould NEW RESIDENTIAL PLMIL SQ.FT. TOTAL„
become subject no she Worker',Comperuation provisions of the rCode,you must
a > rlL
forthwith comply with such provisions or this pemvt shelf revoked, LDIN EP.CONSTRUCTIONLENDING SEISMIC FEEZ I hereby affimt thathere isa construction lendideperforrouncemfELIiCI'kIC FEL'the work for which this Permit is issued(See.30OL Claw
O Lender's Namc
Land Lkl Address QTY. MECHANICAL PERMIT FEL: PLUMBING FEP.
Ic ramify thin 1 have read this a eine that the above infutmadon is MF.CNANICAL FEE
correct.lags kcampiywith Nyoriinmtcoandsatelaw,rclafingm PERMIT ISSUANCEI, buildingeonstmctiogsndhercbyresentativesofthis city m enter upon the CONSTRUCTION TAX
L) Zabove mentioned property for inses. ALTER OR ADDTO MECH.
(We)agree m nave,indemnhamtless the Ciry of Cupertino ageinssIiabiltie.judgm is costsandexhmayinan ex 'd City AIR HANDLING UNIT IT 010,000 CFM)ht en ic core the goof g ofAIR HANDLING UNIT(OVER 10,000 CFM)
Signnm o tic tCnmrnct
Does EXHAUST IIOODfW/DUCI1
PAID
HAZAR USMATERIALS DISCLOSURE HEATING UNrTLTO IW."Irrm Date Revein#
Will the applicant or f re building occupant store or handle hazardous natees)
as defined by the Cupenin unicipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER IW,000 BTU) TOTAL:
Code,Section 25532(o)? VENTILATION FAN(SINGLE RESID) /^
❑Yes No
Will the applicant future building'
ucupmtmeequipmemordevicuwhich cnd0
BOILER-COMP LIMP OR 100,0110 LOU) ISSUANCE;DATE
hazardous air conami ams as defined by the Bay Arca Air Quality Management BOILER-COMP(OVER 100,000 BTU)
f�Dlstrier?
❑Yes ❑No NI?W kESIDGNTIAL MCCI1. SQ.FT. W p
1 have read the hazardous materials requirements under Chapter 6.95 of[be PAID
California HealthA,Safety Code,Sections 25505,25533 and 25534. 1 understand that SPR 27
if the building does not Carmody have a tenons,that it is my responsibility to notify the
occupant of the mquiremems which must he met prim to issuance of a Ci nifiate of
Oce.pancy. s,
Owner or authodeed agent DateTOT 111ISSUED BY: r
OFFICE
,i0eOcit-Vol,
`
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
10357 West Acre
Cupertino, Ca 95014 n
Subject: 10357West Acre , Permit#27997 - Addition
Dear Resident,
According to our records the above mentioned permit has never been f haled 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 Tone 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
Prnttoa on PecValed Poser