27978 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO BUILDING-ELEM RIAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING PROJECT IDFNTIFICAT'ION
BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMITTALDATE
iO3,11 E4lt,�cRE�1' lNo
UNIT N LOT#
OWNERS FMB: I PHONE CONTRACT R'S NAME: ^� LIC NO: NIC CONTROL#
QV `"null yn Cl.aaW96 l6cl—I
RCHITECTIENGINEER: LIC NO: ADDRESS: S q`1j�e Q� ❑
ONTACF: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
B ELECT PLUMB MECH
PERMIT ISSUANCE E] ❑ ❑
LICENSEDCONTRACI'OR'SDECof CliV ON APPLIANCES-RESIDENTIAL JOB DESCRIPTION
pyZ IherebyaffirLICENSE liCONTRACTORv DECLARATION
q(cormnencing with ,�s•'V`,J/�nr�
POO❑ Section 7")of Division 3 ruffle Business and Prefessions Cod,and my license is in PANELS
C d Gfull force and effect.
F Z' License Class Lie.# UP TO 200AMPS OT
m=yDate Convector 201-["AMPS
ZOr z ARCHITECTS DECLARATION OVER IOW AMPS S FT.FLOOR EA f Q.ff.O Z—O 1 onderamnd my plans shall 4 used v public retards.
4 t� SIGNS ELECTRICAL
Licensed PmfessionA
0OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
6 VF 1 hereby affirm that 1 am exempt from the Commenes License Law for mc,
W 3 m¢ following reason,(Section 7031.5,Business and professions Cade:Any city or county TEMP.MEILR OR POLE INST. '
E'yJ which requires a permit to consumer,ager,improve,demolish,m m*r my structure
F J+5 p6 1.its issumce,almrequire.,mit pliant fmsuch Permit Nee simadatarcmeid POWER DEVICES
CQp Char he iz licensed pursuemmthe provisions of N<Contracuo/a License Lew(Chapter
d4o� 9(commencing with Section 7000)u(Division3 of Ne Business and professions Code) SWIMMMGPOOLELECTRIC �VALUATION
ly�y or that he is exemptthercfromend the basis for Nealleged exemption.My violation of OUTLETS-SWRCHES-FI%TURES
hZQ Section 7031.5 by any...licantfor.permit subjects Ne applicant a civil penalty of
F� not marc than rive hundred dollars(SSW). NEW RESIDENTIAL ELECTR _SQ.FT.
❑ othe wok opthestmeum,syemployeeswiNwed forsNe(Sceecampeusinev, STRIPS TYPF.CONSTRUCTION
d3— will damisims ands:TheCreisnmis License Law does or
to.Business
and Profcsxions Cale:The Convenor's License Lew dans nm apply to an owner of
property who builds orimprovesthemon,andwhodcessuch work himselforthroughhia
own employees,provided Nuuuch impmvementsamnot inteodedorafferedfersele.If. OCO GROUP RES.UNITS
however,the building or improvement is sold within one yearid ecmpletion,the owner-
builderwillhavetheburdenof rovin that he did not build or int for f TOTAL:
P g Prove purpose o
sale.)' QTY. PLUMBING PERMIT FEE FLOODZONE AIN
❑ I,er the prject(Sm.eny,amexinsivelyconvessio with licemedemvemorsm
consumer the project(Sec.]044,Business and Professions Ca1nJ The Contractor's d
Licee Luwdocsnm apply man with acofpmpeny whosed pursuant
toveathereon,end PERMIT ISSUANCE
whecse Law. orsuch projects wiNncomrmtogs7licerued pursuanuothe Contmaols ALTER-DRAIN&VENT-WAMR(EA) FEESUMMARY
License Law.
❑ I am exempt mtlm Sec. ,B&P C Motor reason OUTSIDEFEM
BACK FLOW PROTECT.DEVICE SANITARY YN
Owner Data DRAINS-FLOOR,ROOF,AREA.COND. RECEIPT
WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑ Ih<rcby a(fum,harl haveaceni0cate of mnamto pelf-inure,areanificem of FIXTURES-PER TRAP RECEIPT#
Workers'Companmtion lmurancema modified copy thereof(See3800,Lab C.)which PARK FEE Y N
coven all anployee's under Nis permit. GAS-EA.SYSTEM-I INC.4 OUTLETS RECEIPT#
Policy# _ BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK PER
❑ Cenifted ropy is hereby famished.
❑ Cmified copy is Rletl wit'the city inspection division. GRFASE/INDUSTRL WASTE,INTERCEPTOR GRADING FEE
a
CERTIFICATE OF EXEMPTION WORKERS' GREASETRAP SOILS FEE
COMPENSATION INS NCE
or less.)
remionneed uk completed ifthe nisfaroaehu reddollars(f100) SEWER-SANITARY-STORM EA.2WFT. ENERGY FEE
Icenify Natin NeperformmmofN orkforwhic "i all WATER HEATER WNENT/ELECI'R
not employ any person in mY mann as m bane ms b t in tssu PAID
Z Compensation"we of Celifomia. m w r WATER SYSTEM/BEATING Data Receipt
Applicant
z 0 NOTICE TO APPLICANT:If, er making Nis Cenifi t E am o yoush Id NEW RESIDENTIAL PLMB. SQ.FT. T TAL:
ry bscomembjecu to the WorkersC penserion o the �Code,you est
L , forthwith comply withsuch provis ns or Nis ps vist II bed revoked. BUILDING FEE
Dr Q CONSTRUCT NLEN G CY SEISMIC FEE
D Z I hereby affirm that there Is a con ction lending ency for Ne perfor meof
U Ne work for which,his pentru is issued ce.300],Civ.C) TOTAL: ELECTRIC FEE
Lenders Name PLUMBING FEE
0 F tender.Address QTY. MECHANICAL PERMIT FEE
LUL.1 I certify that I have reed this RM icat n and state Not the above i orm cion is MECHANICAL FEE
enrrtn.(agree mcomply with all Ciry atMc ryaNinmca andam4l erelaungm PERMIT ISSUANCE.
F'' U) building construction,and hereby amhodze rc enNtivesofthischyt macruponthe CONSTRUCTION TAX
U Z above-mentioned property for inspection pu es. ALTER OR ADD TO MECH.
(We)agree to save,indemnify and keep less the City of uparino against
liabilities.judgments,costs and expenses which in anywayace eagainstsaid Ciry AIR HANDLING UNIT(TO 10,000 CFM)
in mseg tate oft granting of this permit.
sLcp7`-s— AIR HANDLING UNIT(OVER IO,OgI CFM)
nature of Applicant,Contractor 1'D—a!¢— EXHAUST HOOD DYMUCT) PAIN
1 IAZARDOUSMATERIALSDISCLOSURE HEATING UNIT(TO 100,000 BTU) Data Receipt#
Will by,he icammfmarebiptilCacupanrsrorem and theHealthanmadm HEATING UNIT(OVER 100,000 BTU)
us defined ion 25 Cupeninn Municipal Cade,Chapter 9.12,and the HwIN and Safety
Code. - ,ion 255T2(ap VE TION FAN(SINGLE RFSID)
—- - ❑Yes ❑No
BOILER-COMP(3HP OR 100,000 BTU) ISSUANCE DATE
Will Ne applicnmmerfumre buildingacupmruse<quipmenrordevices whichemit AID
=dam air connotations;as defined by the Bay Area Air Quality Management BOILER-COMP(OVER IM."BTU) P A I
DisRimY
❑Yes ❑No _ NEW RESIDENTIAL MECH.—SQ.FT. MAY
ffnn11 QY 0
I have read the hacadous himmuls requirements under Chapter 6.95 of Ne p1,f
California Health ealth&Safety Code,Sections 25505,25533 and 25534.I understand Nar ##''##
if the building does not currently have a tenant,that it is my responsibility to notify the �' `]L
Eoccupiedoccupiedof the requbemcros which most be met prior to announce of a Certificate of /`F LUP
Owner or emhodzeJ ,at Data TOTAL: ISSUED BY:
OFFICE f
Cils of
C-apertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 29, 1995
Resident
10211 Hillcrest Road
Cupertino, CA 95014
Subject: 10211 Hillcrest Road, Permit# 27978 - Skylight
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
la4,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, 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 of this 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
Panted on Recycled Paper