27333 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOPLUMB" ;,Ii-ELxcrR PERMITNO'
APPLICATION/PERMIT INC,� T IDENNIFIC 27333
BUI OF C DI ERTII BUILDING PROJECT-M IUHANIFICA'1'1lIN
BUILDING ADDER / SANITARY NO. APPLICATION SUBMITTAL DAIS
UNIT is LOT p
O E SNnCo,
TF:CTIENIC
NGINEr : LIC NO: ADD S:
CONTACT: PHONE - O BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
BLDG ELECT PLUMB ECH
PERMIT ISSUANCE El 11
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
GKZ TOB DESCRIPTION
Ihereby affirm that l am licensed underprovisionsofChapter9(commencing with
.100 Section 7")ofDivision 3 ofthe Business and Profession,Code,and my license is in PANELS
FymF. full haveand effect.
FLW Licenx Class Lic.x OF TO 200 AMPS
m=,d Due Comet., 201-1000 AMPS
F"mZ ARCHITECT'S DECLARATION OVER 1000 AMPS SQ.IT.FLOOR AREA E/SVT-Il
ZO,O ti_ I understand my plans shall h used a+public recants.
SIGNS ELECTRICAL
Licensed Professional
aya< OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. '
0.OyU I hereby of mil that 1 am exempt from the Contractors License Law for the
tXil'+a y¢ fallowing reason.(Sov ion 7031.5,Business and Professions Code:Any oily ur county TEMP.METER OR POLE INST.
t—a 0 J which requires a perl to construct.alter,improve,demolish,ca repair any structure
}F mipriorm its issaava.Ww rcquirs the applinm for such permiuo file.signedamtemem POWER DEVICES
W Q O Thal he is licensed p.,a.,to the provisions of the Contractors License Law(Chapter
❑ SWIMMING POOL ELECTRIC VALUATION
dgoLL 9(umamennng with Section 7000)of Division of the Business and Professions Code)
ly_, or that he is exempt herefrom and the haus for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIXTURES
F Z Q Section 7031.5 by any applicant for a perdle jecu t applicant e a civil perm y of
F 0 not more than Five hundred dollars($500)
NEWRESIDENTIALELECIR _S(yFP. STORIES TYPECONSTRUCI'ION
� m ❑ Laownernfthcproperty,ormyemploye esasthei...lecompensation,
y willdomewmk,millhesl cmremmai Ade n tarsale Sea .Business
and Prnfcaions Codi Th ono d snot It o caner of
property who builds or do th docs su hwo hi Yar Woughhis
ownemployces.provided um not kande cr fc sale.If,
OCC.GROUP RFS.UNITS
M1owcvcr.the builJin r ' mm is sol w ixMe !comp pion,Iheawner- TOTAL:
builder will have the bud e o vingtha I�I d not build or improve for purpose of
sale.). _ QTY. PLUMBING PERMIT FEE
❑ I.asowne,efdtepo eadusivdycontmeting with licenxd convaztors to FLOODZONE APN
construct the project(See 7W,Business and Professions Code:)The Comvactors
License Law docs not apply loan owner ofpnperty whohuilds a improvesthereogand PERMIT ISSUANCE
who contracts forsuch projects with a contractanx)licensed pursuant tmhecomracam"
License Law. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
❑ I um exempt under Sec. .R ffi P C 6r Ihia reawn BACK FLOW PROTECT.DEVICE UTSIUI: :IS
SANITARY Y N
Owner Date DRAINS-FLOOR.ROOF,AREA,CON D. RECEIPTp
WORKMAN COMPENSATION D17CLARATION SCHOOLTAX Y N
❑ Iherebyaffrmthatlhaveaccnifiaeofcommnuomlf-insum,oraccnificateof FIXTURES-PER TRAP RECEIITp
Workers Campenaatiun Irisin.mocerfifiei..py darcaf(Sec.JSBO,Lab C.)which PARK PEI: Y N
rs.Il empbye2s once,this pernit. GAS-EA.SYSTEM-I INC.4 OUTLETS REBUILDING
x
Policy x BUILDING DIVISION FEES
Cmnrymy GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Certified copy is hereby famished.
❑ Certified copy is filed with the city inspection division. GREASIVINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
L. M&VENSATION INSURANCE
(This section need not be completed ifthe permit is porous,hundred&I[=(SIM) SEWER SANITARY-STORM EA.200FT. ENERGY HE
or lexv)
I cenifythat in the performance of the work for which this permit is issued,Ishall WATER HEATER W/VENT/ELECIR
mol empenm
ploy any ny any manso
m me marine, as becosubject to the Workers' PAID
Z
Camped...ionlawsol California. Dale WATER SYSTEMA REA'I'INC Dam Rtteiplx
Applicant
zO NOTICETO APPLICANT:If,after making this Cenifiate of Exemption,you should NEW RESIDENTIAL PLMB, SQ.FT. TOTAL:
= becomembjecl to the Workds Compensation provisions of the Labor Code,you must
� > fnrweim comply withsub prea,mous m this permit shall he deemed revoked. BUILDING TEF.
dQ CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that Nae is a construction lending agency for the performance of
U O the work for which this permit is issued(Sec.3097,Civ.C.) TOTAL: ELECTRIC FEE
Lenders Name PLUMBING FEE
4' F Lenders Address Q'IY. MECHANICALPERMIT FEE
0 U 1 certify that I have read this application and stale that the above information is MECHANICAL FEE
caned I agree to comply with all city and county unbalances and state laws ehling to PERMIT ISSUANCE
building conswction.and hereby authome mpresenmtiveso(thus city to enter upon the CONST'RUCIION'I'AX
U 'z abovenmcnumme,prnpenRnni�fym' urposes. ALTER OR ADD TO MSCI I.
(We) retemsave, mayicodCityliati lies ud delos ahich may in any weyarsae against said Ciry AIR HANDLING UNIT(TO 10,000 CPM)
s ucnce c go11.
AIR HANDLING UNIT(OVER 10,01X1 CFM)
urea Applicam/ ormarea, Dae EXHAUSTf1000(W/DUCT) PAID .
IIA9ARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO I01LWO BTU) Date Receipt#
Will the applicant or future building occupant store or handle hazaeaus material HEATING UNIT(OVER 100,000 BT U) TOTAL:
as delined by he Onlaimno Municipal Code,Chapter 9.12,and the H.Ith and Safety
Cade,Section 25532nd? VEN'TILAT10N FAN(SINGLE RESID)
❑Yes ❑No
ISSUANCE DAT
Will lheapplicant orlhmmhmidingaccupum use equipmentordevices whichernt BOILER-COMPLRAPOR 100.f100BTU)
hvunloos ni,mmnntinarns us refined by Ihc Bay Arca Air Quality Mam.gcment BOILER.COMP(OVER 100,M II
District! (Qy
❑Yes ❑No NEW RESIDENTIAL MECH.—SQ.FT. r /vG
I have read the havrdous materials requirements under Chapter 6.95 of the
Culilimnia llcahh&Safety Code,Sections 25505,25533 and 25534. IunJcrxwnJ that NOV' aS
if the building does not currently have a tenant,that it is my responsibility to ratify the III cif FD
cupam of the requirements which must h met prior to issuance of a Ceniftcale of
Occupancy.
CIII yr vu Ilnu
Owner or nuthorinnl Agent U.le ISSUED PY:
OFFICE
CUN, of
Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 20, 1995
Dick Brown
10601 Madera
Cupertino, CA 95014
Subject 10601 Madera, Permit# 27333
• Dear Mr. Brown,
. 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
•
Printed on Recycled Paper
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