27680 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPFR'rINO 9vin"D1,V7�F`.LF.6'IRILAL PERMIT NO. 27680_
NUII,DINO UIVISION APPLICATION/PERMIT PI-UMIi1NG-MECf1ANICAI,
BUILUINC DRUJ F,C'1'IDENTIFICATION
RUIL.DINGADDRISS: M A SANITARY NO. AP�C'FIO SUBMITTAL DATE
7 / 4�CCL UNIT# LOT# SS
OWNERS NAME: - s C'm PIKE:/,� CON CTOR'S NAME',// (IOC Nv:
�• V NIC CON9'ROLp
iC`UEN L iR: LIC NO: A 6S
41
CONTACT: PHONE: QTY. ELECTRIC PERMIT FCC C'• BUILDING PERMITINFO
I(� BLDG ELECT P9 MECH
S3^�p`j PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL.
mwz I hembyaffirm thin l sen luensWundor,morkime,of Chapter 9(commencingwlnh ]OB DESCRIPTION
+100 Section 7")of Division 3 of the Business and Professions Code.and my license is in PANELS `
W full force and effect. t
QjyVj License Class Lie.# UP TO 2W AMPS
F?m Date I ICounts, r 201-I"AMPS
LO NL ARCH TCPS DECLARA1[ON OVER IM)AMPS SQ.FT.FLOOR AREA $/SQ.1'1.
07—m 1 undentand my plans shall be used us public records.
F m F W SIGNS ELECTRICAL
Q,,,$.'.2 Licensed Professional
Eowu
OWNER BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
KOaU I hereby affirm that 1 um exempt from the Committees License Law for the
W3 Ww following reason.(Section 731.5.Business and Professions Code:Any city or county TEMP.METER OR POLE INST.
F,ajOg which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such Permit to file a signed statement POWER DEVICES
p, chat he is licenced pursuant to the pmv,,omnrthe Contractors License Law(Chapter VALUATION
W
E.E. S W IMMI NG POOL ELECTRIC
E.E. 9(commerming with Smion]%p)of Divisum 3 nfthe Business and Professions CMe7
W=w or in.,he is excmpuhe<from and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-
F Z< Section]031.5 by any applicant for a permit subjects the applicant m a civil Penalty of FIXTURES_on not more than five hundred dollars($500), NEWRESIDEMTIALELECB _SQ.FT. STORIES TYPE CONSTRUCTION
ccC3❑ I,asownerofthepmpeny.ormyemployeeswiNwagcsastheirwiecomP mation,
y522 will do Ne work,and the structure is not intended or offered for sale(See.9044,Business
and Professions Code:The Contractor's License law does not apply to an owner of
pri wbobands morpmecs 0eremi and whodae.s such work himself orthrough his
employees.provided that such improvements an,nut imeadedmi,ffered fmsala.If. I OCC.GROUP RES,UNITS
however,the building or improvement is sold within one yevofemomleion,the owner. TOTAL:
builder will have the harden ofproving that be did not build or improve for purpose of
talc.). PLUMBING PERMIT PCE QTY.
ElI,mowner nl the Pmpeny,am exclusivdycnnnacting with licensed con[Remrsto PLOODLONE AI'N
onswet the project(Sec.8144,Business and Professions CWe:)The Contractor's PERMIT ISSUANCE
License Law docs not apply to an owerruf prupeny who builds or Improves thereon,and
who contracts for such projects with a connactor(s)licensed pursuanuo the Contractors
License w. ALTER-DRAIN&VFM-WATER(FA) FEE SUMMARY
La
❑ 1 um exempt under Sec. ,B&P C for this reason I SIDE FEES
BACK FLOW PROTECT.DEVICE
SANITARY Y
Owner Date DRAINS-FLOOR,ROOF,AR EA,GOND, RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
[IIhefebyaffirm that l have a cenifcam ofcon.ant to self-inure,or a certificate ofi�n RECEIPT#
fgXTURPS-PF,R TRAP
r Wmken'Compcnsafion huurancc oraccnificd copy thcreof(Scc.JtlW.Lab CJ which PARK FTE YN
covers ail employee's under this permit. GAS.EA.SYSTEM-]INC.4 OUTLETS BUILDING DIVRDIViISSIOIO
N ME 75
Policy X
Company - GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Cenifedcopyisl rebyfumished.
❑ Cenilied copy is riled with the city inspection division. GREiASFYINDUSTRL WASTE INTERCEPTOR GRADING FTE
CERI'IF.CATE OF EXEMPTION FROM WORKERS' GREASE'FRAP SOILS FEE
COMPENSATION INSURANCE
(This union need not he<omplenad if the permit is for ane M1undrW dollen($I W) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
wIe
I ccoy then i e... in onyarmoe, ,,work for
becomeodjecnilo issued. shall WATER HEATER wN1iNT/IiLEC1R
not employ any Person In any manner t us to become subjm R the Wnrkerti' PAID
Compenwtion laws of California. Dote } WATER SYSTTM/TREATING Ila¢ Recciptp
OZ Applicant NEW RFSIDIiNT1ALPLMB. SQ.M. DO IAL:
z NOTICE TO APPLICANT:If,after Rakingthi,Ceriftcweof Exemption,you should
D,, become subjecnn the Worker's Compensation provisions of the labor Code you..in
� ? forthwith comply with such pmvisim,minis permit shall be domed revoked. BUILDING FEE
GW. Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
7 z I hereby affect that them is a construction lending agency for the performance of
U O the work for wbiehthis perms is ionmr!(See 3197.Co.C.) ELECTRIC LIE
Lender's Name PLUMBING FL'E
l" F Lenders Address QTY. MECIIANICAL PERMIT FEE
0 U I certify that I have read this application candidate that the above information is MECIIANICAL.FEE
>" W correct.l agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE
F— % buildingconstruction.and hereby authrrin representatives ofthis city banter upon the CONSTRUCTION TAX
U z above-mentioned property for inslxe<tion purposes. ALTER OR ADD TO MECII.
(We)agree it,sane in candy and Int City of Cupertino against
Iiibiloies,judgnment,cosc dexpenses h ywayuccrue against wld City AIR HANDLING UNIT(TO 10,IXIO CFM)
r(c wqumu< mg hog of thl. p
AIR HANDLING UNIT(OVER 10,00)CFM)
Sigutumof muc 7 /Date
EXHAUST (W/UUCq PAID
HAZARDOUS MATERIALS DISCLOSURE HHA'TING UNIT LTO 100,100 B'I'U) Date Receipt#
Will the applicant or future building occupant store or handle Inc ardoes material
as defined by the Consent.Municipal Cale,Claim.,9.12,and the Health and Safety HEATING UNIT(OVER 100,0110 BTU)
Cole,Section 25532(a)I VENTILA9'ION FAN(SINGLE RE'STD)
❑Yes ❑No ISSUANCE DATC
Will the applicant or future building«cupantuseequipmenwrdeviceswhich emit BOILER-COMP LIFE OR I00,0011 BTU) pp�� pp
Ahazardous air Conlaminan¢as defined by the Bay Area Air Quality Management BOILER-COMP(EVER UXL000 BTU) p�
Dis let,
❑Yes ❑No NEW RMIDENTIAL MECII. SQ.FT.
1 have reed the hazardous materials requirements under Chapter 6.95 of the FED , 81995
California Health&Safety CIA,Sections 25505,25533 and 25534. I undemou d that
if the building does not currently have a Rican,that it is my responsibility to notify the CITY
occupant of the reNturemems which must be met prim no issuance of u C<nilicme of N1/ f
Occupancy.
O voi amhonmd agent Date TOTAL: ISSUED BY:
OFFICE
&— clix
ol,
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 29, 1995
Resident
10475 Maderia Drive
Cupertino, CA 95014
Subject: 10475 Maderia Drive, Permit# 27680 - Repipe
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,
City of Cupertino (^
:0
Printed on Recycled Paper
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