27013BUILDING DIVISION APPLICATION/PERMIT
G_
FyatLL x53-0618
LICENSED CONTRACTOR'S DECLARATION
O C 2. I hereby affirm that lam licensed under provisions ofChaprer 9(commencing with
ts100 Section 7") of Division 3 of the Business and Professions Code, and my license is in
CF full force it cfrect.
.<a. License Cl ass Cour
m<y Date Convector
Z FO oo ARCHITECTS DECLARATION
CZ -0 1 imdcrmand my plans shall be used as public records.
FtilW
Licemcd Professional
�Y0;6 OWNER -BUILDER DECLARATION
5n' O y V 1 hereby affirm that I em exempt from the Convectors License Law for the
u1Ih following ices a poen to 9031.5, Business and Professions Cade: Any city orcounre
fJ y which requires n permit to construct, vheq improve, demolish, ore. sir any structure
the,
he ibuensed pursomqui ca the pr visio softhe Co penNt mLiease Lo ammment
u1 nq�0 Tharheis licensedpursuennotheprovisiareof the Convector's License Low (Chapter
ade4. 9 (commencing with Scnion]000)he Division 3ohhe Business and .An, Professions Code)
yt_y option 7031.5 by any applicant
the permit
sbeasegedexemant to civilpnsiily of
t3Y Section than bye undredieantfmapermit subjects the applicant toecivil perWtyof
0 n0 1. as own fivehundredity. or yeml
ul oL0 ❑ LssowneroDh<propcny.ormyemployeeswith wages astheirsolecompetueuoa,
o. will do the work, and the structure is not intended or offered for Rate (Sec. 9044, Business
and Professions Cale: The Contracures License Law don not apply to an owner of
property who builds or improves Overton. and who does such wohhimselforthrough his
cmployeas, prov ideddrot soch imme
pmvenu aroma intended tampered fonale. If.
huwever,Ne building or improvement is sold within ane yearofcompletion, the owner.
builder will have the burden of proving that he did not build or improve fm purpose of
sale.).
❑ I. se owner of the Pmpeny, amexclusively conducting with licensed contractors to
construct the Project (Sec. 90a . Business end Professions Cale:) The Contmcmrs
License Law does not apply to an owner of propcny who builds or improves thereon, and
who contracts for such projects with a cost ector(e) licensed pursuant m the Contractors
License Law.
❑ 1 am exempt under Sec. , B & P C fm this reason
Owner at
WORKMAN COMPENSATION DEC RATI
❑ Ihembyaffireathetlhave ecmificam of consen oself-innate,rnificoteof
Warkerd C'nonametionlmursnce moceBB
nifiedcop in vd(Sec. 3I�b C.)which
covers all employ.,a under this permit'01 /
Policy p
Cenifled Copy is
notes, 1 LJg� w ��/ }
Icenif than in the �`{ v�ceo for whit th trs is shell
not employ any person any rmn n so s bjas m Workers'
O ,Z, Applicant...,....._• _• __ _. _� �..�
z 0 NOTICE TO APPLICANT: L otter making this Cenificme of xemption, you should
p] become subject to lbs Work�B CompmseRon pro vis o eCompenseRon pm vis a "labor Code-youmurt
forthwith comply with such visions a the pemdt oro be deemed revoked.
GI.1 CONST Cf10N GAGENCY
z 1 hereby affirm Nal them is ns on lending agency for the performance of
O the work for which this permit Is issued (Sec. 3099. Civ. C.)
I, Landes Name
Lenders Address
V I certify that I have teed this application and slate that the above information is
correct. I agree to comply with all city and county ordinalmes and state laws relating to
building construction. and hereby authorize representatives ofthis city to enter upon the
V 7 above-mentioned pmpeny for inspection purposes.
(We) agree t Tuve, indSmnify and k«pjd eAs the City of Cupertino against
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant m future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the IIcahh and Safety
Cede, Section 25532(a)'l
❑ Yes ❑ No
Will the constitutions
M defined by thentuse equipment Quality
Management
hozmJous tar contaminants ss defined by the Bey Area Air Qunliry Management
District?
❑ Yes ❑ No
I have read the hazardous musboos requirements under Chapter 6.95 of the
Califaniv Health & Safety Code, Sections V505,25533 and 25534. 1 understand that
if the building does not currently have a tenant, that it is my responsibility to notify the
occupant of the requiremems which must be met prior to issuance of a Certificate of
Occupancy.
Owner or amhnriud agent Date
PLUMBING - MECHANICAL.
N
PERMIT ISSUANCE
APPLIANCES - RESIDENTIAL
PANELS
UP TO 200 AMPS
OVER 1000 AMPS
SIGNS ELECTRICAL
SPECIAL CIRCUIT/MISC.
TEMP. METER OR POLE INST.
POWER DEVICES
SWIMMING POOL PT ECIRIC
OUTLETS - SWITCHES - FIXTURES
NEWRFSIDEN`FIALELECIR _SQ.FT.
TOTAL:
PLUMBING PERMIT
PERMIT ISSUANCE
ALTER - DRAIN & VENT - WATER (EA)
BACK FLOW PROTECT. DEVICE
DRAINS- FLOOR, ROOF, AREA, GOND.
FIXTURES - PER TRAP `
GAS - EA. SYSTEM.] INC. 4 OUTLETS
GAS - FA. SYSTEM -OVER 4 (EA)
GREASFJINDUSTRL WASTE INTERCEPTOR
GREASETRAP
SEWER -SANITARY -STORM EA. 200FT.
WATER HEATER WIVENT(ELECTR
WATER SYSTEM/IREATING
NEW RESIDENTIAL. PLMIL SQ. FT.
MECHANICAL PERMIT
PERMIT ISSUANCE
ALTER OR ADD TO MECH.
AIR HANDLING UNIT (TO IB,Om CFM)
AIR HANDLING UNIT (OVER 10,000 CFM)
EXHAUST HOOD(W/DUCO -
HEATING UNIT (TO Im,OIX) BTU)
HEATING UNIT (OVER 100,080 BTI!)
VENTILATION FAN (SINGLE RESID)
BOILER- COMP CHP OR 100,000 BTU)
BOILER - COMP(OVER Iq-. f0'BU4
NEW RESIDENTIAL MECH, SQ. FT.
27013
SANITARYNO. APPLICATIONSUBMDT'ALDATE
—� — 45
NIC CONRtOLp
/`-tel ❑
FEE BUILDING PERMIT INFO
L ELECT UMB MECH
10 I�N�
rI —assh—l-c
FEE
FLOOD ZONE
FEE SUMMARY
6lJT_§J_DffVffEr_
SANITARY
Y N
RECEIPTp
SCHOOLTAX
Y N
RECEIPTp
PARK FEE
Y N
RECEIPT#_
BUILDING DIVISION MI
PLANCHECK FEE
GRADING FEE
SOILS FEE
ENERGY FEE
PAID
Dam
Rweipt4
FEE
BUILDING FEE
SEISMIC FEE
ELECTRIC FEE
PLUMBING FEE
MECHANICAL ME
CONSTRUCTIONTAX
PAID
Dare
P W I D
APR - 5,1-q
•
Cupertino
November 28, 1995
Resident
10285 .Colby Avenue
Cupertino, CA 95014
•Opv �
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
Subject: 10285 Colby Avenue, Permit # 27013 - Repiep and Tub Tile
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 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 ofthis 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
Pnnre:i on Recycled Paper