28751 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES_-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL . . PERMITNO.
BUILDING DIVISION - APPLICATIONIPERMITPLUMBING-MECHANICAL 28751
BUIIAING PROJECT IDENTIFICATION
Si.
{By1Dyl,1yhrjl�ERS/ryp iLL D �a� p r/�If��I P(//�/ SANITARY NO. APPLICATION SUBMITTAL DATI
E C
II Ile-1.0 1�fQ✓1� �1�01/ ,. PIIDN_ax7{eu' kWAiti+ 1 •U�S I�1'IS(�O
N/C CONTROL N
ARCHITECT/ENGINEER: LIC NO: ADDRESS' 'r ❑
I0"10P6h)1-10AVr-F £
- CONTACT. - PHONE: BUILDING PERMIT INFO
••od /a Ick n b
L1115--3-6--71
Di o ❑ Consultant Feas Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSED CONTRAC'IUIi'S DECLANA'fION, QTY ELECTRIC PERMIT FEE
I hereby aBirm Thal Iran licensed under provisions of Chapter 9(cmnmencing JOB DESCRIPTION
'MWZ with Section')ODD of DlvisioOmfthe Immossand Professions Code.amdmy licenseis RESIDENTIAL-
O O PERMIT ISSUANCE
z�FU in Poli force andeffen ❑SFDWL e ❑KITCHEN REMODEL
�Qy Uatemc Class Conmmmr 'APPLIANCES-RESIDENTIAL. - ❑ADDITION ❑PLUMBING RE-PIPE
F ARCHITECTS DECLARATION PANELS ❑MULTLUNIT ❑STRUCTURAL.
Z O n z 1 understand at,plans shall be used as public records MODIFICATION
oz— 1 UPT'0200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR
[r.� Llceawd Prof sional •'�� 2111-IIIOOAMPg - IMPROVEMENTS '
P6c
OWNER-BUILDER DECLARp'fIt1N s pygµ1000 AMPS ❑BATH REMODEL/REPAIR 0 DEMOLITION
Q L hereby affirm that 1 am exempt from the Canftacer'a License Lvw for the
x�Op,U following afte .(Section7031.5.Busian"and Profeminm Code:Any city or countySIGNS ELECTRICAL
❑OTHER
RI C F which requires a permit to construct.alter,improve,demolish,or repair any,structure _
Pill,to it,I'llancO.do,requires the apPlicam Eamelh pnina
nr filesi,mcd,merman SPECIAL CRCUIT/MISC.
a� that heislicenseJpursuammtbePnrvisiomnftheConraertsLicemcLw(ChaPter9
00 (commencing with Section 7")of Division3ofthe Boniness and Professions Code)or TEMP.METER OR POLE INST COMMERCIAL'
c C that he is exempt therefrom mW the basis far the alleged exemption.Any violation of ❑NEW BLDG/ADDRION ❑DEMOLITION
ie m gectinn 7031.5 by any applicant for a peit subjects the applicant to a civil penalty of POWER DEVICES ..
{{tA1
mrm []TENANT ❑FOODSERVICE
F�6not Immo than Ever t h pimps dollaa($eth).
I,as owner m norm -Io res with wa es a9 their sole cont ensntion, SWIMMING POOL ELECfkIC IMPROVEMENT
0 ❑ t act YemP Y g P
will dothework;end the he Concis sots Licensoroffixtal wdos of apply
wilt,of ❑OTHIiR
and Professions ld,.The improve,
thereof,
License Law dies nm apply m an owner of 'OUTLETS-SWITCHES-F1%TL
CCC property who M1u w.or improves thereon:and who Jces such work himself of thoughdfor
his own however,
th p ilding that such improvements me nos Ynlanded or rRaal far a NEW RESIDENTIAL ELECT'
owneLhowe,will bbuilthe hu tan fp vin(itat he
aneild or improve
_ SQ.FT.FLOOR AREA LSQ.FT.
ownerhuilder will have the burden of proving that he did na build w improve for part- '
pose of soled. '
Q 1,as owner of 0th progeny,ant excla6vely mmiaming with licensed contractors m TOTAL: ]
enilmrucube projem(Sec.7N4.Busimera and Professions Cale:)The Calmmmor's L y g
cause,Law does not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FEE W
who contract forsuch pmjens with a comracmr(s)licensed pursuant m the ContmrmA e�
License Lew' PERMIT ISSUANCE
❑ I ten eaempt under Sea - ,B'&P C for this reason
7 ncr Oaxe ALTER-DRAIN&VENT-WATER(6A)
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE `h
I hereby affirm under penalty of perjury one of the following declarations:
❑ IhaveandwillntuinnairaCenilicateof Crnsenrloself-insure for Worker's Compen- DRAINS-FLOOR,ROOP.ARPA,CONUC' h '�
smirn,as provided for by Section III of the Lvbm Cale,far she perfnamnce of the v.a• a U LL STORIES TYPECONSTRUCTION
wn -for which this permit is issued. FIXTURES AP-PER TR ✓
I have and will nminain Wodels Compensation Marmara,as regained by Section
39( the Labor Code,for the perfomousecorihe work for which shin Penni,is issoal, GAS-EA.SYSTHNU I INC.4(IUTLL IS OCG GROUP APN
( My in is Cot •nsa'nn ns,mmce artier and Policyypebet$a{ o�p GAS-EA.SYSTEM-OVER4(EA)
Cartier: TY 1'nEcy No.:UU 77 D0 !—
CERTIFICATEOFEX PITON FROM WORKERS'
COMPENSATION INSURANCE GREASEINDUSTRL WASTii INTERCEPTOR
. (Thissectinnneed nm be completed lftho imrnit lL,Ea rte hdndreddollprs($I00) -`„ -, ,BUII,.DINO' IVIS
or loss.) GREASE TRAP PLANCfIECK P
Icerifythat intleeperformencc ofth kfmwhich this permit is iaued.l shall SEWER-SANITARY-STORM EA.200 FT.
not employ any person in any manner s rower onto subject,o the Workers'Compen- ENERGY FE
2, sasinn Lows of Culifomia.Date
' O APPlican, WATER HEATER WNENT/ISLF.CTR GRADING
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should WATER SYSTEM/TREATING
a � become,object m the Worker's Compnsolion provisions of the labor Cale,you as, SOILS FE'
W forthwith comply wilhwch provisions or this permit shall be decreed nevalml WATER SERVICE
Q
CONSI 1CTI0NLISNDlNGAGENCY' NEW RESIDEMI'IAL PLMB. SQ,PT. PAID
V O k far
rwhich fm that there lssued(Seeconstruction0 lending agency for the performance of D to Receiptp
.-t the work for which this permit is issued(Sec.JIt9],Civ.C.)
� 1"t Lenders Name n pL:
LUiI Ilndcr's Address - - r - TOTAL:
1 certify that I have read this application and state that the above informntian is BUILDING PEE
cool I agree m comply with all city and county ordinances and smc laws claxing to QTY. MECHANICAL PERMIT FEE
U building caneruction,and hereby atthunre representatives ofthis city center upon the SEISMIC ME
aboscomationed Property for inspection purposes. PERMIT ISSUANCE
(We)agree to.cave,indemnify and keep harmless,he City of Cupertino against ELECTRIC FE
liahilinies,judgments,costs and expenses which may in any way accrue against said City PETER OR ADD TO MECH.
in consequence of the granting of this permit PLUMBING E .
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO'POINT AIR HANDLING UNIT(I'O IO.IXX)CFM)
SOU .Lr REGULATION / MECHANIC FEF.
AIR HANDLING UNIT 111,000 CPM) CONSTRUCT NT
Sig mreof APpiicmmContractor Dole EXHAUST HOOD(WMUCD HOUSING MITIGATIO EE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or home building mcapam store or handle hammous material HEATING UNIT(TO 100,0!1()BTU) y
as deined by the Cuperino Municipal Cale,Chapter 9.12,and site Heath and Safety '
Cale,Section 255120C air HEATING UNIT(OVER 100,000 BTU)
❑Yes ON. `.+ ��.
• VENTILATION PAN(SINGLE RESID) PAID' Dose Reccip N
Will the applicant or future huilding(secnpinn use equipment or devices which' BOILER OR'IfM1.I11N)BTO
mit hamrdous air commilinun_b m defined by the Bay Area Air Quality Management T AL:
ON,Oleates' • BOILER-COMP(OVER IW,11 BTU)
Q Yes ❑Nu
L have read the terminus outenals re marmial,under Cha ter 6.95 of me Cali.. AIR CONDITIONER `
q P t ISSUANCE DATEN.
facia g does&Safety Cade.Sabana 255at itis 33 and]5534.1 t understand that if the NEW RF.SIDLM'IAL MECH. SQ.Ff.
budding iii rw¢,which have ametPior oismyresponsibilitymft,ofythe orepent
of the raluiremcnm which muss be met Prior issuan¢of v Ccniftcam of Qcvpancy.
Owner or amounted agent - Date - TOTAL: ISSUED BY:
OFFICE
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10300 Torre Avenue
Cupertino, CA 95014
Cita' of
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
May 23, 1996
Business located at:
10443 Bandley Dr.
Cupertino, CA 95014
Re: Expired permit, (28751 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
opermit 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
O
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