27894 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO B 11.01 G-LLLUJ'RI A, PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL, O N
4
BUILDING PROJEC'TIDEVITICATION o
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
UNIT LOT#
OWNERS AME: PHONE: CONTRACT :S NAME: LIC NO:
'e 1\112 Ir 6
�� C NdC CONTROL#
� Agor
A CHIT EC1713NGINEI1R: LIC NO: A D ESS:
L5 rl '
CONTACT: PHONE:
QTY. ELECTRIC PERMIT FEC BUILDING PERMIT INFO
BLDG ELECT PLU MUCH
PERMIT ISSUANCE ktl 0 El
LICENSEDCONTRACTOR'Sionsof RATION APPLIANCES-RESIDENTIAL JOB DEECRIFf10N
pyZ Ihemby affirm that I CENSE CONTunder p R'SDE DECLARATION
with 1L1`MyaBD C I
PIOE Section7")eHDivision 3 of the Business and Professions Code,end my license is in PANELS
VV Liccrtsc less Lic.# HP T0200 AMPS
LnQi Date Committee 201.1000 AMPS
AF.y� ARCHITECTS DECLARATION SQ.FT.FLOOR AREA $/SQ.PT.
OZ-0
O w 3 I understand m shall be used as public records. OVER 1000 AMPS
Z T- ypanes n
F y F J SIGNS ELECTRICAL
Q,Y�J Licensed Professional
L y�a'Q OWNS -BUILDS ECLARATION SPECIAL CIRCUTDMISC.
°C)wu 1 hereby afford that 1 xempt the Coronations License Law far the
013 a y following reason.(Section]031. B i ev d Pmfeyytt66 Cada.Any city or county TEMP.METER OR ISLE INST.
which yuiruapermi r roost emalish,or repair any structure
�f priort t pplicm f s t to file a signed statement POWER DEVICES
G p that he ear Pu tor the ions t e con fir's License Law(Charter
tiac 9(co ith Section TA viddis the usinessand Professions Cade) SWIMMING POOL ELECTRIC VALUATION
y_,y or that he rc1.5 tauh e nnV iaforrbealleged excmant to civil
of OUTLETS-SWITCHES-FIXTURES �'SC�0
yO Section] .1.5 by ony pp nrfm$50T.oxubjects rM1e applicant acivil penalty of l�
t mom t a five hurt Ilurs($500).
,Ym r❑ las re wages asthcirsolecompenadon. NEW RFSIDENTIAI.ELECfR _SQ.FT. STORIES TYPECONSTRUCTION
g322 will do the work,and the armature is not inectdedoraffimed forsale(Sm.7044,Business
and Professions Cole:The Contractors Lic7se Law does not apply to an owner of
pmpenywhobuildsorimpmvesrheman,and'whodmssuchworkl iforthroughhis OCC.GROUP RES.UNITS
ownemployees,Provided thafsuch improvemenmam not imendedoroffered forsake.If.
however,the building orimprovemcnt is sold within one yearafcompketion,the owner- TOTAL:
boiler will have rhe harden of pro""that he did not build or improve for purpose of
❑ I,mowner of the property,umexclusiv<ly, contracting with licensed convenors to Qom' PLUMBING PERMIT FEE FLOOD ZONE pPN
arnbuct the project(Sec.70,14,Business and Profusions Code:)The Contractors
License l.uwdoesnmappkymanownerofpmpeny wh.lmilds orimponestherwn,and PERMIT ISSUANCE �.
who contracts forsuch projects with acceleration)licensed pursuant to dm Contractors ALTER-DRAW&VENT-WATER(EA)
License Law. FEE SUMMARY
❑ 1 oro exempt under Sec. B&P C far chis resson BACK ROW PROTECT.DEVICE VT.IDIS ES
SANITARY Y N
• Owner Data RECF.IPI'#
IO
DRAINS-MOOR,ROOF,AREA,COND.
WORKMAN COMPENSATION DECLARATN SCHOOL TAX Y_N
❑ Ihemby rffinn that lhave acertificate of conxm ro self-insure,ornc<nif¢am of RECEIPT#
Fl%TURES-PER TRAP
Workm Crmpensationlnur1vuc¢peeo�n�Ic.<nified copy thereof(Sec.J800.Lab CJ which PARK FEE V N
ove " '� /(// GAS-EA.SYSTEM-1 INC.4OUTLETS BUILDINGDVISION FRES
rs nllem art '
raficy#
Company `:-"i GAS-EA.SYSTEM-OVER 4(EA) PIANCHECK PEE
❑ Certified copy is hereby famished.
❑ Cenificl copy is filed with the city inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section need not be completed ifthe permit is furore hundreddollars($100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or less.)
I certify that in the performancen'the work far which this permit is issued,l shall WATER HEATER WIVFNTIELECfR
not employ any person in any manner so as in become subject to the Workers' PAID
Z Compensmior Lawaof Califomia. Data WATER SYSTEM/@EATING Dam RaIf
applicant
7O 0 NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should NEWRESOENTIALPLMB. SQ.FT. TOTAL:
t1— f/] become subject to the Worker's Compensation provisions of the Labor Code,you must
�-' forthwith comply with such pmvismas or this permit shall be deemed revoked. ftzsrr BUILDING FEE
Da D CONSTRUCTION LENDING AGENCY SEISMIC FEE
z Ihereby offirm that here is a conanumion lending agency for the performance of TO ELECTRIC FEE _a
O the work for which in,permit is issued(Sm.3097,Civ.CJ
r.t Lenders Nome PLUMBING FEE
O U Lender's Address QTY. MECHANICAL PERMIT FEE
1 certify that 1 have read this application and state that the about information is
bonen.lagree ta complyand herby Horidamnsmanisnenandatam lows upongm PCRMII'ISSUANCE MECHANICAL FFiG
U Z abovengennswctiomand hercbyuuction p rpreanutivesof thiacitymrn¢r upon the CONSTRUCTION TAX
V above-mentioned property for inspection and Purposes. ALTER OR ADD TO MECH.
(We)agree m save,indemnify and kap harmless the City of Cupertino against
liebilitieapensee whicj(iney many way accrue egoirts�eaid Cit' AIR HANDLING UNIT(TO 10,0(NI CFM) �w
the gtvrti of
this pet '(( KL.,!//
AIR HANDLING UNIT(OVER 10,000 CFM)
Sig
at..of Ifam EXHAUST HOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.000 BTU) Data Raeiptp
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(OVER 100,IKp BI U) TOTAL:
as defined by the Cuper iia Municipal Cal,Chapter 9.12,and the Health and Safety
Code,Section M532(a)]
❑Yea ❑No VENTILATION FAN(SINGLE RESIT)
Will rheapplicomorfuwm buildingoecupent uuequipmrntordevica whichemBOILER.C6MP(3HPOR HM"BTU) IUir ANQE TE
(J�
d
hazardous air conmmidems as defined by the Bay Arca Air Quality Management BOILER-COMP(OVER IN1,WOBTU)
District?
❑Yes 0 N NEW RESIDENTIAL MECH. SQ.FT. q Q� al �8 199
1 have read the haznrdr a m.nmuda requircmems under Chapter 6.95 of the
California Health&Safety Cede,Sections 25505,25533 and 25534.1 understand that Ur L'Vr
if the building does not currently have a tenant,that it is my responsibility to notify the
oecupam of the requir meats which must he met prior to issuance of a Certificate of
Occupancy.
Owner m mahorizcd agent Data TOTAL: ISSUED BY;
OFFIC
''city of -
Cuperthio
10300 Torte Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
10280 Vicksburg Drive Ll
Cupertino, CA 95014 4 -
Attn: Rental Office
Subject: 10280 Vicksburg Drive, Permit# 27894 - Shower Enclosure
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 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 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
•
Pdn(od an Recycled Paper ,