28154 APPLICANT},TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
7'QY bF t PERTINO BUILDING-F,IECHA ICA PERMIT NO. 28154
APPLICATION/PERMIT PLUMB INGROJECTFIDENTIFIC
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE,
10900 AVr.
UNIT'# LOT#
WNERS NAME: PHONE: 73T CONTRACTOR'S NAME: LIC NO: N/C COM'ROL#
ARCHI ECT/E G LI0 90C NO: A DRESS: ❑
_ CD ncT: PHONE: BUILDING PERMIT INFO
�A+�/o M�ACi.un�.J 7z s 2®r3 QTY. ELECTRIC PERMIT FEE
BLDG ELECT P MECH
PERMIT ISSUANCE xLICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL IOBD SC 1 1
p0z Thereby affimlhaH 3 ofth B milad,and Psioeldii ode,9(commeaddg is
❑100 Swfaildioreand of Division3 of the Business and Professions Cade,and my license is in PANELS rV ly'G� vWvL�
<Z, Lice
meand effect.
F2ty License Class Lic.# UP T0200 AMPS
yOob Date Conjunct., 201-I"AMPS
ZFOvyi Z..] ARCHITECPS DECLARATION OVER 1000 AMPS SQ' 'FT'
O Z-,G I unJentand my plans shall be used as public records.
F m F W SIGNS ELECTRICAL
6y5:1 Licensed Professional
p�,KaQ' OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
pd 3 W F I hereby affirm'I'm I an exwmpl from the Underwrites License Law for the ae
[U following Owned.(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST.
I'J which requires a permit to construct,alter,improve,demolish,or repair any,conewre
prior 0 its issuance,also requires the applicant for such pe.it o file.signed statement POWER DEVICES
c G p that he is licensed pursuant m the provisions of Ore Contractor's License Law(Chapter
mxce 9(core mencing with Section 7000).f Division 3 ofthe Business and Professions Code) SWIMMING POOL ELECTRIC
KM VALUATION
�_y id,that Section
131.5 by nytefmmandthe basis permit subject,
theJexemption.Anyviolation of
I— M net
than fee
anndledcanlfnruPermit eubjcas the upplicanno,civil penaltyof OUTLETg-gWITCHF.S-FIXTURES
^W not mare than Eva bundred dallare($500).
C m ❑ hasowncmfthe n NEW RESIDENTIAL ELF:CfR SQ.FT.
pmpey,ormyempinded withwegesasthei(Sec.7ampensiness STORIES TYPE CONSTRUCHON
y andwilProdolfession,
and the structureContractors
is Liceese otfered wdoes and a ],no ainv m,of
and Professions Code:The Contr.cmr's Limns,Law dews not apply f m o d hhis
property wyceS,Provided
dsorimphat sucroves h improve who dunssuch work himsened brands.
If,
rovnemr,thees,p building
or i pr suchimprovementsis sold tit teen intended for sale.Il, OCC.GROUP RES.UNITS
however,thebuildingarimprovementiesoldedidnof yearoimproeforMeowner-
bre.). will have the burden of proving dui he did not build or improve for puryose of
ale.).
❑ Las owner0fthepropeny,amexdusivelycontracting with licensed comranors to QTY. PLUMBING PERMIT FEE FLOOD ZONE qPN
constmat the project(Se..7004,Business and Professions Cale:)no Contractors
License Law does not applyto an ownerofleopeny whobuildsorhnpowesthereon,and PERMIT ISSUANCE
who contracts forsuch projects with aeonnommr(s)licensed pursuant the Contractor's
License I'awALWATER(GA)
. TER-DRAIN T- FEE SUMMARY
❑ I am exempt under gee. B&P C for this reason BACK FLOW P O ,CT.DEVICE OUTSIDE FEES
SANITARY Y N
Owner Date DRAINS-FLOsiR REA,COND. CEIPT#
WORKMAN COMPENSATLONDECLARATION SCHOOLTAX N
❑ era Co affirm that Insurance m irendieficate coonscal to pytherof(Sec.380il,Lab C.)which FIXTURES-PERTRAP E #
Workers'CompensationInsurancethis perms certified copy thereof(Sec.3800,Lab CJ which PARK FEE Y N
covers all employee's under this permit. GAS-EA.SYSTEM- I .4 TS EIPT#
Policy# DI DIVISION FEES
Company
❑ Cenifedeopy is herebfamished.y GAS-EA.SYSTEM-O
) PL ECK - E
❑ Cenif,d copy is filed with the city inspection division. GRFASRWSDUSTRLWASTE CEPTOR
OR EE
CERTIFICATE OFEXEMPTION FROMWORKERS' GREASE TRAP SOILS FEE
COMPENSATION INSURANCE
(This section need not be completed ifthe permit is boron,hundred dollars($100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or less.)
I crony that in the performance of the work for which this permit is Issued,l shall WATER I IPAT ER W/VRNT/ELECTR
not employ any person in any manner so as to become subject t.the Workers' PAID
z Compensmionlawsof Califomia. Dam WATER SYSTEMOREATING Date Nscript#
Q O Applicant
NOTICE TO APPLICANT:If,arm,making this Certificate of Exemption,y..should NEW RESIDENTIAL PLMB. SQ,FT. 9'OTAL:
FLI) become subject to the Worker's Compensation provisions of the Labor Code,you must
forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE
ped, Q CONSTRUCTION LENDING AGENCY RELECTRICITIF
MIC FEE
z I hereby affirm that there is a consnuction leading agency for the performance of
U 0 the work for which this permit is issued(Sec,3097,Cis.C.) TLander',Name
0 ULenders Address QTY. MEC 1ANICALPERMIT MBING FEE
c 1 certify that I have read this application and state that the above information isHANICAL FEE
omect.Iugrceto comply with all city and county ordinances and sjate laws alafingro PERMIT ISSUANCEh building construction,andhwrobyauthodz�e ralaswnittimsofthls city to enterupon theZaove-mentioned property for inspection purposes. ALTERORADDTOMECLL STRUCTIONTAX
(We)agree to save,indemnify and keep harmless thin City of Cupertino against
habit judgments,costs and expenseswhich may in any way accrue against said City AIR HANDLING UNIT(TO 10,000 CFM)
innf the this permit.
,z..cnt eoe granting of, AIR HANDLING UNIT(OVER l0,f1(I(1 CFM)
SMnaWrE of APA!//Tot/C adnr Date EXHAUST HOOD(W/DUCO
V PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,00)BTU) Date Receipt#
Will the applicant or future building occupant store or handle hazaMous material HEATING UNIT 100,00089'U
as defined by the Cupertino Municipal Code,Chapter 9.12,and the health and Safety ( ) T 1-
Cale,Section 25532(a)Y
13 Yes ,❑No VENTILATION FAN(SINGLE RESID)
Will Pomxcu
the applicant or rebuildingpnm useequipm BOILER-COMP(311P OR 100,000 BTU) ISSUA EDATE
menrdevices whichemit
'.zardops air contaminants as defined by the Day Arco Air Quality Management BOILER- OMP(OVER 100,000 BTU)
CU�
iatrietP .� e,k 1995
❑Yes 11 No NEW RESIDENTIAL MECH.—SQ.PT.
I have read the hazardous materials requirements under Chapter 5.95 of the
Califomia Health&Safety Cude,Sections 25505,2553]and 25534. I undersjand that UY�`{�11'h
if the building does not cumndm y have 0 word.that it is my responsibility notify the 1� Ur
ocup
cant of the reynimmwhich hich must be met prior m ismanee of a Cenid,we of
Occupancy.
Owner or authorized agent Date TOTAL: ISSUED BY:
OFFICE
. ter
Oc1tv
10300 Torre Avenue
Cupertino, CA 95014
�,f
Ctpertulo Building Division
t (408)777-3228
(408)777-3333 (fax)
January 15, 1996
PG&E
10900 N. Blaney Avenue
Cupertino, California 95014
SUBJECT Permit: #28154
Dear Homeowner:
We have been cleaning out our files in the Building Department, and contacting those
people with permits which have remained"open".
According to our inspection records, the subject permit has never been finaled. Many
times an inspector will sign the permit in the field, but neglect to report all of the
information to the clerical staff for input into the computer. If your records show the
subject permit as finaled, would you please contact us so we may complete our records?
If the permit is not signed off your permit can be reactivated and an inspection could be
scheduled for final closure of the permit
If we do not hear from you within ten(10) working days, we will dispose of the file and
remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
SENT BY:PG&E 1-22-97 13:23 XUPERTINO SVC CENTER 4087773333:# 2/, 2:
AUWARIO ARG 9M �
ra�mo _
.v OW11®t MANS ►MOML• ..A �'- /•'i:3:: _
7 _ j . CVMRK10Kf MAgd MO: •' . „� (..
.CMIRCfiIDiOW®t: IJCMR; ASS/: -i •a�•. %�
INSPECTIONS DATE < IIt�BC
INSPECTION RECORD _
AT[ON/PtFR3/H.D.3. NOTE: ALL GRADING AND DRAINAGE OQ ®�
UPER GROUND SHALL BE INSTALLED TO COMPLY WITH
PADISET BACK-CERT THE APPROVED PLANS AND CITY OF
3/PREGUNTIE
CUPERTINO STANDARDS.
GARAGE 54►8
PopRNOOGtatltL+lEU ABOVEIIASBEBrrS , nvsPeclTON SPECIAL INSPECTION
UNDERGROUND/SLAB IE URED El OAte \ •wu.
PLUMBING �.
ELECTRICAL ^-
DO,NOT LOUR FIAOR.UNIII:'A80VE HAS BEW@®.,
PLUMBING
MECHANICAL .
ELECTRICAL IX— �. •.'` ik
)FRAMING VENTS sFj
INSULATION .,.
r =
3UBFI�ORId!Im VSHASBEEN
e i ROOF SHEA
TH/DTAPHRAM
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
`TECiRICAIJPOOLBOND
AMINC/Sl'AIRS/Ti EGRESS ...,.:,,. . . .`c
INSULA TION .:
- :SI Y'r
L iPRIORSIW-ARMOLSDOWN
INTERIOR SHE&WHOLD DOWN
SHEEIROCK/SHEETROCKSHEAR
PX[ERIOR LATH/W.SCREEN
SHOWER LATH
i4O.TAPE.bk ABf�VB1ItiRBio�T[31GNBy'
SCRATCH COAT
SEWFR/WATF]t .
.ALR
BUILDING
ELECTRICAL
GAS
GAS TEST
GRADE
�tE A ROVED FOR OCCUPANCY p _
HANDICAP TO GE INSPECTION �ssuAtr�uAts.
ELECIRJCA[JFlil�GY CALL AFTERNOONS.(12:30 PM-4e00 PPl1 7 7•�� ,
PLUMBINORNERGY 232PO305 MONDAY TO FRIDAY 24 HOURS ,�/��/ a
�HANICAL/IIiERGY BEFORE REQUDtFD W3PEMON.JOB AD- �f� .�.
DRESS AND P@IMS N ARE NEEDBD WfDAi
PHONING. OCT 4 aro. +
ING/GNERGY y AT m"ON C
' ELECTRICAL FINALTERT Z.a_y
NO PERSON(S)SHALL CT WRORKON •�
x+: am THIS JOB SITE WITHO(JT WORKER'S n V�rCnui�J c
IfCY=pp B
�IDQdt1 F>rUL'L4
:•,�; •.Jile$ BNPORTAAFp �..•
.awe.%st PLEASE READ E BEPORE
REVERSE SID
w° CALLING
_ .