27375 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO IMILHINni-Pit,. RICA PERMITNO.
BUILDING DIVISIONAPPLICATION/PERMIT PLUMBING-MECHANICAL ���� 5
BUILDING PROJECT IDENTIFICATION J
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE:
2233 D �DNITN LOTH 21q _9, o;
OW S _qqON CONTRA 'S NAM LIC NO:
G C5 fi I N/C CONTROL#
RCIHB;CP/EbIGINEHR: LIC NO: ADDRESS: ❑
CONTACT: PHONE: QrY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
� �
BLDG l PLUMB MUCH
PERMIT ISSUANCE �
LICENSED CONT'RACTOR'S DECLARATION APPLIANCES-RESIDENTIAL - JOB DESCRIPTIONa'Z I herebyaffirm that licensedunder,rushaonsofChspter9(commrncingwiN
X00 tipripllo"q,andof Division Sof the Business and Professions Code.and my license is in ppNpyg
yzW License
nse CITws fecT UP TO 2W AMPS OO O a V
Z4I License Class Lic.N
y=y Data Contractor 201-10011 AMPS
ZO,z ARCHITECTS DECLARATION OVER 1800AMPS SQ.FT.FLOOR ARCA E/SQ.FT.
OZ.n 1 understand my plans shall Ie used m public records. _
r.y J SIGNS ELECTRICAL
qQ ,.I Licensed Profexsinnul
Ca < OWNER-BUILDER DECLARATION SPECIAL CIRCIRT/MISC.
�p�(('0 1 hereby affirm that I am exempt fmm But Ci ntraclnr's License law for dme
u13 u.onQ following meson(Section 7031.5,Business and Professions Code:Any city or many, TEMP.METER OR POLE INST.
[❑-fJ�J which rcyuiron petri(mconrmt.deri.improve,dermiali,orrepvirmyshmnne,
SYS prior to its issuancgnNo routines the applicant forsuch permit to file a signed statement POWER DEVICES
y"j aO Thal he is licensed pursuant to the provisions of the Contractor'a License Law(Chapter
d G� 9(commencing with Sorino 700p)of Division 3 of the Business said Pmfessime,Code) SWIMMING POOL ELECTRIC VALUATION
y or thm he is exempnhertfrom end the bvsia for the allegW exemption.Any violation of UTLETS.SWITCHES-FfXTURFS 2
Q
not more loan
Section]03aby anyapplicantforn Permit sobjecu the vpplicmtmecivil permhy of
. Hve hundred dollme(5500). NEW RESIDEN'f1ALELECTR —SQ.PT.
be 22 ❑ odhewoero0hepropeny,orntyempinecro wagesasthei(sole compensiiessSTORIES TYPE CONSTRUCTION
o. will Jomhcwotk,and e:no Couistrad mma'intended Licse La doesed not aMly to an owner
of
and property
who
Code:The Convactota License law Joel not apply lf an owner of
pmpevywheboildsorimmovar suchimon.mdwho Toesswhende himselforNmugh Na - OCC.GROUP RES.UNITS
nempinyebuiprovidedmpr techimprovements in:not(mended moffend forsale.If,
howeventhe blfthe (it improvement ememiesat he within Imildne ofcomoefort rimmax 1' ,
builder,will hove the burden of proving that he did tet build nr improve for purpose of
sale.).
❑ Lmwner project
(Sm.coy,ameacnesis and nuaniions C lis)no Contro orsm Qom' PLUMBING PERMIT FEE FLOOD ZONE APN
construct the project apply
]Brno Baal.eas and Professywhobims Code:)The Cemon,T Told
License Law does rnot upplymmoh a contpropemywhosedporimpmvea themon,mJ PERMI'1'ISSUANCE
whotmnnncta fmsuch lmjccta withacomrmm.(s)Ilcenxd pumumumhc ContrveWr's ALTER-DRAINA,VENT- PA
License l.aw. FEE SUMMARY
❑ I nm exempt amltt Sec. 8&P C far this reawn BACK FLOW PROTECT.DEVICE. SANITARY 0 Y N
Owner Who RECEIPTq
DRAINS-MOOR,ROOF,AREA,GOND.
� - WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ I herchy affinnthat l have acenilicum ofconsenum self-hours,or a certificate of RECEIPT#
PI%TURI?S-PER TRAP
Works'Compensatinnler this eme rmit, fled wpy therm((Sw.3800.Lab C.)which RK FEE Y N
coven ail employcea under this permit. RECEIPT#
FloPalicyM GAS-liA.SYSTEM-1 INC.40UTLETS BUILDING DIVISION FEES
-- Company GAS-FA.SYSTEM OV17R 4 THAT LA 'CK FEE
.❑ Cenitiodcopylshicam,forished.
❑ Cemiliedcopy is filed with the city inspection division. GREASGIINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE-OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE
COMPENSATION INSURANCE
('Phis swoon need not he completed Base permit is for one hundred dollars(SIM) SEWER.SANITARY-STORM EA.2081'1. ENERGY FHP:
or lent
I cenify that in The Performance ofthe work for which this permit is issued.)shall WATER PRATER W/VPNT/ELECTR
not employ any N.in any m as to become subject to the Workers' PAID
Compcnsvtion Lawsof Califoria. Dam eu WATERSYSTEM/TREATING z Applicant Da <iptp
z O NOTICRTO APPLICAM':If,after ranking tl Cardreete of Exemption,you should NEW RESIDENTIAL PLMB. SQ.PT.
8 tents TOTAL:
Ir�-+ > becrnme ith bi comply
the Wuch pro Corns or tionThus
provisions
rrams allheeLahr revoked, most
1TZ > forthwith comply with such provisions or this permit shall bedmmM revoked, BUILD .P
W CONSTRUCTION LENDING AGENCY SEISM '
Z 1 hereby affirm that them is a construction lending agency for the performance of t
L) O the work for which this permit is issued(Sec.3097,Civ.C.) 'TOTAL: ELECBIC ..
Lenders Name'
OF Lender's Address Q'IN. MECHANICALPERMIT FEE PLUMBING FEF
L) 1 cenify that I have mad This application and slam that Ne above information is
�" PW-i correct. l agme to comply with all city and county mdmancea sod state laws relating to PERMIT ISSUANCE MECHANICAL PEE
building construction,and hereby authorize repmeentntives affable city to enter upon the - CONSTRUCTION TAX
V `J above-mentioned Ptolemy for inspection purposes. ALTER OR ADD TO MECH.
F7 (We)ag e,indemnify and keep hmmieas But City of Cupertino against
liabR1tics,ju save,
and expenses which mayin any we rnmevgains[mid City AIR HANDLING UNIT('TO 10,0021 CPM)
in music W the grant( f M' t
—I?— AIR HANDLING UNIT(OVER 10.(X10 CFM)
Sig amm of Apllicant/Cnmracmr Date HX11AUST HOOD(W/DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,00)RTU) Data Receipt#
Will The.,plica.or future building wcopm,stem or handle harmdous material HEATING UNIT(OVLR 1(10,000 BTI))
as defined by the Calemino Municipal Code,Chapter 9.12,and the Ilealth and Safety
Code,Seainn 25532(u)P
11 Yes EI No VENTILATION FAN(SINGLH RFSID)
Will the nPplicamorfuwre buildingmeupanmxequipme....devices whichemi.
BOILER-COMP(3HP OR 100,0310 BTU) ISSUAN DA
�uzardous air contaminants us define)by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU)
ixtriet'/ 1 D
❑Yes 12No I
NEW RESIDENTIAL MGCFl. SQ.FT. P A
1 have mad The hazardous mmmials requiremems under Chapter 6.95 of the
ifthe Thud ingdHealo&nd etycia Cone,
inve a Is25585,t it is mA 25534.1ondcmmd Nat _ FES ^ l0,j
if the bnt of g does and ly have must
he,et prior
r my reuance of ily toa Co (heat the - VY _
occupant of the requirements which must he met prior.o issuance of a CmiOce.e of a
Occupancy. 13
Owner or nuthariud agent Data TOTAL: ISSUED BY: A
OFFICE
4
qa®
CiI.N. Ul
Cupei-thlo
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 29, 1995
Resident
22331 Kendle Street
Cupertino, CA 95014
Subject: 22331 Kendle Street, Permit# 27375 - Door/Light
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 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, n� �J
City of Cupertino x
3 �1 - 5
Primed an Recycled Paper