28197 APICANT�TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BIL I :-ELECTRICAL PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION 28197
BUILDING ADDRE2: SANITARY NO, APPLMATIONSUBMGTALDATE
V v LOT# a►/ or q
OW S /it CO ftA DR'S NAME: LIC NO: N-'�- 6�]
MYaa *FEEBU
CONTROL,
ARCHITECT/ENG EER: LIC NO: ADDRESS:coNTncr: PHONE' QTY. ELECTRIC PERMIT ILDING PERMIT INFO
ELECT PLUMB MEl ECH
PERMIT ISSUANCE ,o11 LItmaI.lccmmd. CI'OR'SD s.fClm TION pppLIANCES-RESIDENTIAL RIPf1ON
Myy IM1ertby eflimICENSE liCONT AUfOR i,DE Lf RAT] 9(commencing with
POO❑ Section]000)of Division 3 of the Business and Profession,Code,and my license is in PANELS '
t;- full fomemd effect.
<Z License Class Lie.a UPT02WAMM
y=y Date Contractor 201-1000 AMPS
ZM. ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLOOR ARG ESQ.Fr.
OZ—'p I understand myplans that[b meal as public..Ms.
(-an W SIGNS ELECTRICAL
q]d
Licensed Professional
hz< OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
0e4'Op�,F 1 hereby affirm that 1 am eacmpt from the Connector's License Law for the �) O
W 3
tieori imm PO
following reason.(Section]031.5,Business and ProfnsCode:Any city or county TEMP.METER OR LE MST. /���
R:Oj
y which requires a permitto construct,alter,improve,demolish•or repair any structure
>•� `tp
prior w its isseanoc,.N.requires the applicant for such pemti0o filansigned smtement POWER DEVICES
'p D O rhes he is licensed pur,uenno the provisions of the Comncmis License Law(Chapter
0.0.�rp 9(rommennng with Section](100)ol Division3nf the Business and Professions Code) SWIMMING POOL ELECTRIC ww VALUATION -
t:Ko mction7 that he 31.55 anyap rommdthe Permfonheascgedexemption.Any violation of 1.111M-SWITCHES-FIXTURES
C�} Section?to LSbya u applicant dcntfm apermit subjects the applicant toecivil pemlry of
sS< not more then five hundred dallwe(5500).
SCO NF.W RESIDENTIAL ELECTR _SQ.PT.
yCC m ❑ Lnsowne,and dic peny,msnot maoyceswfthwegesnsalei(Sec.Tom.Business STORIES TYPE CONSTRUCTION
3— will dvahewons Code: soComisnce License Law doesed not apply 9004.Business
and Professions Code:The Can[remar's nd who Law uch not apply w an owner of
propoweertywyess,dsorimpnove,themprove who daessuch wonkhimulfd[for ghhis OCC.GROUP RES.UNITS
wnemplogresilding rimerthat vemeuch npis&old wsaw not intendedmpletired the owner-
builder
uwevwill ave begaden of proem is sold within one yew of completion•the se,of
will have the burden of proving that he did nm build or improve for puywu of
ole).
❑ I,asownernlrhepropc0,L4. usiticas and Foment...
rnvacwr,to QTY. PLUMBING PERMIT E FLOOD LONE APN
onswct the Inject(Sec.to an
Business and Pwholutons orimp•@c Contractors
License oomprwdfar such
upplytn with Hcnofpwperty whobed par antolethacwt,end PERMIT ISSUANCE
whacmtmns fa such projects withacomrncmds)0censcd pussumttothe Convectors
License Law. ALTER-DRAIN&VENT-WATER(G) ais FEE SUMMARY
❑ 1 wn exempt under Sec. ,B&P C for this reason 1
BACK MOW PROTECT.DEVICE
A YN
Owner Date DRAINS-FLOOR.ROOF,AREA,COND. RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N
❑ Ihemby affiah thnslhrveecenihcew of consennoself-insure.mecenifiwte of FIXTURES-PER TRAP RECEIPT#
•Workers Compensation Insurance or aeenifiedeopy thereef(Sec.3800.Lab C)which PARK FEE Y N
covers all employee's under this permit. GAS-F.A.SYSTEM-1 INC. OUIL S RFCEIPT#
policy If BUILDING DIVISION fffrES
Company GAS-EA.SYSTEM-OVER 4(G) PLANCHECK FEE
❑ Cenificdcopyisherebyfumished.
�i ❑ Certified copy is filed with the city inspection division. GREASFONDUSMI-WASTEINTERCEPf GRADING FEE
r CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
F COMPENSATION INSURANCE
(This section need not be completed ifthe permit is forom hundreddollare(5100) SEWER-SANITARY-STORM EA.20(AFT. ENERGY FEE
or less)
I certify that in the perfomnnce of the work for which this pnnat is issued.I shall WATER HEATER W/VENT/ELECIR
nee employ my prime in my manner so as to become subject to the Workcti PAID
Compenselionlnwsof Celifomia. Dote WATER SYSTHMfME,VFING Date Receipt
Q z Applicant
z 0 NOTICE TO APPLICANT:Maher making this Cerificateof Esemptiom ymmmld NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
licemombjectto the Workers Compensation prolkimsnfthe Labor Cale.you..at
HK, forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE �a
0. ❑ CONSTRUCTION LENDING AGENCY SEISMIC FEE
1 hereby affirm that there is a conviction lending agency for the performance of
U O TOTAL: ELECTRIC FEE
the work fm which Nis permit is issued(Sec.3019),Civ.C) �.►
Lender's Name
0 U Lender',Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
U 1 really that I have read this npplicmion and state that the above information is
7" a carrect.]agree to comply with all city and county ordinances and state laws minting to PERMIT ISSUANCE MECHANICAL FEE
building construction,and hereby authonim repmacntatives ofthi,city worse,upon the CONSTRUCTION TAX
U Z above-rncmioned property for inspection puryosas. ALTER OR ADD TO MECIi.
(We)agree to,ave,indemnify and kap harmless the City of Cupertino against
liubilities,judgmcm,mabimd expenses which may nary wayramom inst said City AIR HANDLING UNIT G 010.000 CFM)
in consequence m the granting of this permit.
WI MR HANDLING UNIT(OVER 10,000 CFM)
Signatures,
fApplicant/Contrecwr pate EXHAUST HOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IM,"BTU) Data 0.cecipt#
Will the applicant in future building occupant store or handle hmardous material HEATING UNIT(OVER 100,000 BTU) TOTAL:
es defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(x)?
El Yrs ❑No VENTILATION FAN(SINGLE RFSID)
BOILER-COMP(3HPOR 100,000 BTU) 5 ANCE DATE
Will weepplicantorfmurcbuildingoccupnn[uscequipmemmdevicca whicbcmit eQ[Q�I/x���
aaudnm air onnmminants as dented by the Bay Area Air Cattily Management BOILER-COMP(OVER 100,0110 BTU) JUL O 1VVV
ismer?
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.Fr.
1 have teed the ha andins mrdamd.requirements under Ch rpm,6.95 of the CfIY Ut UUrtH HNO
call,
Health&Safety Code,Sections 25505,25533 and 25534. 1 understand that
If
the huilding docs ons currently have a meant,that it ie my rexponsibiliry to notify the
occupant of the reyairemem,which must M mn poor m issuance of a Ceaifcate of
Occupancy.
Owner or authadxd aImt Date TOTAL: ISSUED BY:
OFFICE
0- citv
of 10300 Torre Avenue
• Cupertino,CA 95014
Cupertuio Building Division
(408)777-3228
(408)777-3333 (fax)
February 10, 1996
Resident
20357 Clifden Way
Cupertino, CA 95014
Re: 20357 Clifden Way, Permit#28197, Enclosed Patio
Dear Permit Holder:
Our records show that the referenced permit has not been finaled by a City building
inspector. A permit is 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, 95014, Attn: Building
Department.
If your permit has not been fmaled, 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 date of receipt of this letter. If we do not hear from
you, the City of Cupertino Building Department will have no recourse but to resolve your
permit as expired and discard the records.
Thank you for your assistance.
CITY OF CUPERTINO
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