27751 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO -lf-vin'
rRICA. PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION BUILDING PROJECIADENFIP'ICA'1'[ON 1 7 7 C, '1
1 v 1.
HUILDING ADDRESg: SANITARY NO, APPLICATION SU BMITTAL DATE
flil UNIT LOT#
OWNEF$N MF. ION
: PIE CONTRAC�UR'S NA ME: LIC NO: N/C CONPROLp
ri
Q
ARCHF!"ECT/P.NGINEER: LIC NO: ADDRESS ❑
CONTACT: 11IIONc QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
LD ELECT PLUMB MECH
PERMIT ISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
O m 2 I hereby affirm that 1 am licensed underprovisions ofainnea9(commencing with ION
Fi00 Section 9000)of Division 3 of the Business and Professions Cade,and my license is in PANELS
full farce and effect. \ W\J
inU UP T02fM)AMP$ l Tl
^C,W License Claw Coon
QLL D'atc Commnm 201-1000 AMPS
F-,,z ARCHITECT'S DECLARATION SQ.Fr.MOOR AREA $/SQ.FT.
Z OI_n— 1 understand my plans shall be used os public records. OVER IIXp AMPS
OiF�
SIGNS ELECTRICAL
Licensed Professional
KKg ot< OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
KOp. I bereby oil!....that I nm canon limn the Communes Licence taw for the
W 3 LL y¢ following reason.(Section 7031.5,Business and Professions Cade:Any city m county TEMP.METER OR POLE INST.
f�'u-0J which requires a permit to construct,alter,improve,demolish.or repair any structure
f,n}S primm its issuance,elan requims theapplicanl for such permit m flea signedsusament POWER DEVICES
Of,M<0 z Nw he is licenxd pursuanuo Ne provisions of the ontmemra License law(Chapter SWIMMING POOL ELECTRIC
LL6oW 9(cammencing with Section 9000)of Divixion 3 of Businessandfirm stoma ) VALUATION
onhm M1c is exempt Ncrcfrom and the Wi tirb all cdexcmptl to. 11not OUTLETS-SWITCHES-MIXTURES
WaQ Sccti me
vawundredidollars pe is ti wpplicom to 11 of
nmaru than frvu hundred dollars SUU), NEW RESIDENTIAL ELECTR SQ,FT.
F�
not
I,asowncrofbepropenY.or Y pl wire eswthole comp aeon, 59'ORII3 TYPE CONSTRUCTION
a3— willdolhework,an News n ed ff for (Sca.]0� .Business
and Rafessions C e ors Li w,d n apply to an owner of
pmpenywhob'da m es erton,en M10 ssu wmkhimselforrtuoughhia
con employees r -Id wsuchimprov< n notimendedorofPomdforsale.If. OCC GROUP RES.UNITS
however,the building 'mprovememissold ithin one yew o(completion.the owner. TOTAL:
builder will have the btn of proving that he did not build Or improve for purpose Of
e
❑ Las ownendthe property,amexdusivdy, convening with licensed conwmorsm QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
cnnsvuct the projca(Set.9146.Business cod Pmfcssims Code)The Commem",,
Liceau taw does not epplymanrwneradwopeny,whobtildsorimprovee marcor,and PERMIT ISSUANCE
whoccommis forauch pmjmm with amntmemr(s)licensed pursuanuothe Contractors
License law. AUfER-DRAIN At VENT-WATER(EA) FEE SUMMARY
❑ 1 ran exntgn under Sec. ,B&PC for this reconBACK FLOW PROTECT'.DEVICETSIDE FE
SANITARY YN
Owner Dan DRAINS-MOOR,ROOF,AREA,COND. RECEIPI'a
WORKMAN COMPENSATION DECLARATION SCHOOLTAX r; Y N
❑ I hereby affirm mat l have a cenificem mcounent tovelf insum.ore certificate of MIXTURES-PER TRAP RECEIPTa
Workers'COmpenction lnsumncanr acenified copy bereaf(Sec.3g00,Lab C.)which PARK FEE Y N
coversall employees under this permitGAS-EA.SYSTEM-I INCA OUTLET'S RECEIPT M
Policy M BUILDING DIVISION ITES
Company GAS-EA.SYSTEM-OVER 4(IiA) PLANCHECK Ff712
❑ CerliGeJ copy is fereby fumi,had.
❑ CenifieJ copy is flW with Ne city inspection division. GRIASILINDUSTRI.WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' ORBASE TRAP SOILS FEE
COMPENSATION INSURANCE
(This sectionnced not bccomplwed ifbe permit is Fmccre hundred do11ars(5100) SEWER-SANITARY-STORM EA.20017. ENERGY FEE
or less.)
I certify that In the performarmeof the work for which This permit is issued,I loll WATER HEATER WNEWIpLECTR
not employ any perven in any manner so c to become subject to the Workers PAID
Compcnsatianlawsaf Califomia. Dole WATERSYSTEM/IREATING Date Rece, p
Q z Applicant
z0 NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should NEW RESIDENTIAL PCMB. SQ.IT. TOTAL:
p .N-h become subject m the Workers Compensation provisions of be labor Code,you must
BUILDING FEE
> fsMwiN comply with such provisions orchis permit shall be deemed invoked. `#
S Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
z I hereby affirm that there is a construction lending agency for The performanc of TOTAL: ELECTRIC
U p the work for which this p 99,emtit is issued(See.30Civ.C.)
Lender's Name PLU N
u' F lender's Address QTY. MECHANICALPERMIT FEE
U I cent that I have read This application and state that the above information is MECHANICAL FZE
covcct.I agme to comply with all city and county ordinances and sum laws relating to PERMIT ISSUANCE
F" buildingeon.aructimn,and hereby unbridle representatives ofthis city center upon the CONSTRUCTION AX
UuMrvcmentimard property for impectiun puryoaes. ALTER OR ADD TO MSCI I.
(We)agme m save,indemnify it keep harmless the City of Cupendon agwnsl
liabilities.judgments.costs and expenses which may inany way women City AIR HANDLING UNIT(TO TO."CFM)
in sequence of the grmang of this permit.
ATNG UNIT(OVER 10,000 CFM)
Signet of Date EXHAUST HOOD(W/DUC) PAID
L HAZARDOUS MAI'HRIALS D CLOSURIi HEATING UNIT(TO 100,000 BTU) Dote Receipt#
Will the applicant or fmure building Occupant store or handle hrmadous material HEATING UNIT(OVER 100,000 BTU) TOTAL:
as defined by the Cupertino Municipal Cade.Chapter 9.12,and the Hut th cod Safety
Code,Section 2553240? VENTILATION FAN(SINGLE RESID)
❑Yes ❑No
Will the upplir morfumrc builJingoccupantuscequipmenmrdeviceswhichemit
BOILER-COMP(311P OR 100.04)0 BTU) I$ ti4 TE
Noes air contaminants ns deft ed by the Bay Arm Air Quality Management BOILL'R-COMP(OVER 100,M)BTU)
n I ❑Yet ❑No NEW RESIDENTIAL MECH. SQ.IT. FEB 21199,
I have mad the hasardous materials dequicments under Chapter 6.95 of the CI1Y ut-
curEN I 1-3
California Health&Safety Code,Sections 25505.25533 and 25534.I understand that
if the building does not currently have a tenant,that it is my responsibility to notify the
occupant of(lie requirements which oats,he met prior to issuance of Ceni runic of
Occupancy.
Owner or anthomed agcm Date TOTAL: ISSUED BY -- 1
OFFICE
Octlyof
Gtipeitino
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 29, 1995
Resident
10501 Madera Drive
Cupertino, CA 95014
5a
Subject: 10 Madera Drive, Permit# 27751 - Skylights (2)
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, �2—��✓
City of Cupertino
i
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