28258APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
NG -ELECTRICAL
CITY'OF CUPERTINOBUIL PLUM"
APPLICATION/PERMIT PLUMBING -MECHANICAL.
BUILDjNG DIVISION BUILDING PROJECT IDENTIFICATION
- PERMIT Na. ^ � ^
L L 58
BUILDINGADDRRESS: w I '6
[.J\1' A_.I` UN' # L L �TX a%�iZ-
SANITARY NO,
APPLICXATITIONSUBMUTAAALs DATE
L� 'J
N[R NAMP. PHONE:
8X16 Se 6
CTOR'S AMB:
c a�2s !J
N/C
❑O
CONt'ROL#
ARCHITECT/ENGINEER: I.IC NO:
ADDRESS: /V �✓ Z
CONTACT: PHONE:CeJI
Q ELECTTR C MIT PEE
BGILDINO PERMIT INPO
�pLDG E PLUMB MECH
PERMIT ISSUANCE 0.
LICENSED CONTRACTOR ade,roSi.,rf DECLARATION
that I amllces underi my mmencing with
1h7000).f
s ofns
APPLIANCES - RESIDENTIAL
JOBD RIPTION
Di
Section ]000) of Division 3.f the Business end Professions Cade, and my license is in
Ba tufa Come,9 add
pe and effect.
T
PANELSfull
License Closs LIeX
UP T02W AMPS
\_•`ice
Date Contractor
201 - IOW AMPS
ARCHITECTS DECLARATION
I understand my plans shall be used as public records.
SQ. FT. FLOOR AREA
$/SQ. PT.
OVER IWO AMPS
SIGNS ELECTRICAL.
Licensed Professional
SPECIAL CIRCUIT/MISC.
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
TEMP. METER OR POLE INST.
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance,ilmnal fires theapiumaot forsuch permit to file a signed statement
that he is licensed pursuant to the provisions of the Comments Licerue Law (Chapter
9(ommencing with Section 7000) of Division 3 of the Business and Professions Cade)
or that hers exempt herefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
POWER DEVICES ,
SWIMMING POOL ELECTRIC
VALUATION
�� —�
UTLEfS-SWITCHES-FI ES ��
not more than five hundred dollars ($500).
NEW RESIDENTIAL ELE _SQ.FT.
❑ I,asownerofthepropmy,ormyemployeeswitbwagesastheirsolecompensmlon,
will do the work, and the structure is not intended or offered for sale (Sec 7044, Business
STORIES I TYPE CONST RUCTION
and Professions code: The Companies License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
FLOOD ZONE
RES. UNITS
APN
con employees, provided thatsuch improvementsurenot itnendedoroffered forsale. If,)I.
however, the buildingor improvement is sold within one yearofcompletion, theowner-
builder will have the burden of proving that he did not build or improve for purpose of
,❑ I, as ownerofthe prom progeny, sexclusively contracting with lieensedeontractan to
copra the proles ($o,. 9044, Business and Professions Cede:) The Con esctods
oftOCC.GROUP
• O
QTY. PLUMBING P yl • :sri;
License Lawdoes not apply to an ownerofpmpenywhobuildsorimprovesthe n, and
PERMIT ISSUANCE
who contracts for such projects with a conductorial licensed pursuant loth, Contractors
License Law.
ALTER - DRAIN & VENT - WATER (EA)
PEE SUMMARY
❑, 1 nm exempt under Sx. , B & P C for this reason
Owner Date
BACK FLOW PROTECT. DEVICE
DRAINS- FLOOR, ROOF, AREA, COND.
OIITSID E S
SANITARY Y N
RECEIPT#
WORKMAN COMPENSATION DECLARATION
❑ er;'Co affintion Insave a urance
ortificmeofeonsemmakf(Sesnre,Ora , LabCfi am ofwhich
Workers' Compeneeti0nlnsuranae.I,. ed copy thereof (Sec.3g00, Lab CJ which
olicy all employee's under this permit
Policy #
SCHOOL TAX N
IF R EIPPX
PARK FEE Y N
EIPT N
LD ISION FEES
PLANCHECK
{/
pIXTURFS-PER TRAP
GAS - EA. SYSTEM -1 INC. 4 OUTLETS
Company
GAS - EA, SYSTEM-OVER4(EA)
ElCeniped copy ie hereby famished.
❑ Certifed copy is filed with the city inspection division.
GREASE/INDUSIRL WASTE INTERCEPTOR
GRAD[ FE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCEGREASETRAP
SOILS FEE
SEWER - SANITARY - STORM EA. 200FT.
E GY HE
(This sectiouneed not be completed ifthe permit is for one hundreddollars($IN)
or less.)
WATER HEATER W/VENT/ELECfR
Irenify thrum lheperfombace orthe workforwhich thispermitis issued, I shall
not employ any person in any manner so as m become subject to the Workers'
Compensation Lawsof Califomia. Dam
Applicant
WATER SYSTEMITREATING
PA
Do Receipt#
NOTICETO APPLICANT: It, after making this Certificate of Exemption, you should
become subject to the Workers Compeneadon provisions ofthe Labor Code, you must
NEW RESIDENTIAL PLMB. SQ. FT.
-
TOTAL:
BUILDING 4E el �X
forthwithcomplywithsuchpmvisionsorthispermitshallbedecared revoked.
CONSTRUCTION LENDING AGENCY
1 hereby -farm that there is a construction lending agency for the performance of
SEISMIC Ff r2tL 160
FEE
the work for which this permit is issued (Sec. 3097, Civ. CJELECTR
Lenders Name
Lenders Address
QTY: MECHANICAL PERMIT PEE
it
PLUMB GME /
1 certify that 1 have reed this application and aorta that the above information is
PERdITISSUANCE
25
MECHA CAL FEE
cored I agree to comply with all city and county ordinances and state laws relating to
buildingconstmotion, and hereby authorize repnnentat[ves of'E's city mentor upon the
above-mentioned property far inspection proposes.
ALTER OR ADD TO MECH.
CONSTR ION TAX
(We) agree to save, indemnify and keep harmless the City of Cupertino against
lailditiea,jad ts,costem nseswhlchmaymanywri accrues ainsI se id City
AIR HANDLING UNIT (TO 10,000 CFM)
in cnnsence a the gran' the L
AIR HANDLING UNIT (OVER 10,000 CFM)
,RIgnamre of ApplicanUCompemr `rite
EXHAUST IIr]OD (W/)UCT)
PAID
HEAPING UNIT (TO IN," BTU)
HAZARDOUS MATERIALS DISCLOSURE
Da ecciptX
Will the applicant or future building occupant stare or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
T
HEATING UNIT (OVER 1 W,OW BTU)
Code, Section 25532(a)]
❑ Yes ❑ No
VENTILATION FAN (SINGLE RESIM
Will the ecommitmr is as defined by theAir Quality es
vNous air contaminants as defined by the Bey Area Air Quality Management
Area
imA,t]
�$I Q DATE -
A 1
BOILER- COME LIHP OR IW,OW BTU)
BOILER - COMP OVER 100,000 BTU
( )
❑ Yes ❑ No
1
NEW RESIDENTIAL MECH. SQ. FT.
1 have rend the hazardous materials requirements under Chapter 6.95 of the
California }f Ito&Safety Code, Sections 25505, 25533 and 25534. 1 understand that
if the building does not cilmly have a tenant, that it is my responsibility to notify Ne
v
occupant of the mi,flocar is which mus[ be met prior m issuance of a Certificate of
Occupancy. t!
ISSUED BY:
Owner or euthorinti 'eno Date
OFFIOt
ti t
of
10300 Torre Avenue
Cupertino, CA 95014
Cupertino Building Division
1 (408)777-3228
(408) 777-3333 (fax)
s
February 10, 1996
Resident
10555 S. De Anza Blvd, Suite 115
Cupertino, CA 95014
Re: 10555 S. De Anza Blvd.#115, Permit #28258, Tenant Improvement
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 Torre Avenue, Cupertino, 95014, Attn: 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 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
i
Pr, nted on Pecycled Paper
THS
OF
PLUMBING
VENTS
WEM
it 1YfA21
ELECTRICAL
GAS
I7Q�IKCS�.-:: C
GAS TEST
GRADE
FIRE
HANDICAP
ELECTRICAUENERGY
FINALTHST
28258
NOTE: ALL GRADING AND DRAINAGE
SHALL BE INSTALLED TO COMPLY WITH Aon tmio
THE APPROVED PLANS AND CITY OP
CUPERTINO STANDARDS. t
ems+ e
INSPECTION SPECIAL INSPECTION I DATE I mp
APPROVED FOR OCCUPANCY N / \ l,W
BEFORE N. JOB AD.
DRESS AND PERMIT # ARE NEEDED WHEN
PHONING.
ATTENTION CONTRACTORS:
NO PERSON(S) SHAM. PERFORM WORK ON
THIS JOB SITE WITHOUT WORKER'S
NO IS NOT. PERMry`=. COMPENSATION INSURANCE
t3S12}NlftfBYB, INCI CHROME SE
PLEASE READ REVERSE 3ll)E BEFORE