27053 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO -f'-FI" PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 27053
BUILDING PROJEICI'IDEM]IFICATION
BUILDING ADDRESS: SANITARY NO. APPLI � S[MfITAI.DATIi
1oemn UNIT# LOT If -
_ OWNIiRS NAME: PHONE: COM' I' R'S NAME: ,, LIC NO: N/C COMROLp
ftjN&e' LU(rh'eJ - «a y
ARCI II'1 F.CI'/ENGINEER: LIC NO: ADDRESS: ❑
lL42-0 Pk /3N (_�
CONTACT': PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
LDG PLUT1B ,Nf l
PERMIT ISSUANCE �[�plY I�i.JT
LICENSED COST RACTOR'SDECLARATION , APPLIANCES-RESIDENTIAL , BDE.SCRIWN
O02 Thereby ofrmlbml 3 of flanxdunder
ssand iimficofChapmr9(commendng with '
100 Section 7000)of Di,vision3nf the Business and Pro&ssions Code,and my license is in ppryElS Vc Ik�/T14W`
yL 41 full fomr and ctfcc,''//sr��((
Fye Licenses Clul Lic.p UP T'IM AMPS
'�Qjrail Dae 4 Conductor l'� 201-1000 AMPS gQ.F LOO ARG E/SQ IT.
ZOr"rs? ARCHITECTS DECLARATION OVER 1000 Ah3PS
CZ-0 I understand my plans shall bo used as public records.
F rn F w SIGNS ELECTRICAL
Licensed Professional
x ecQ OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC.
K
XOyU I hereby affmr that I em exempt from the Contractors Licerue Law fee the
W3v-rFi� following reason.(Section 703 L5.Business and Professions Cock:Any city or county TEMP.METER OR POLE
< which requires a permit to consmaa,0mr,improve,demolish,or repair uny swcture
Y prior m its ixman«,alknm then licom Smirch Go Heusi dsmmmeat POWER DEVICES
yuitux pp permit gne
¢O tom he is licensed pursuant to the provisions of the Contractors License Law(Chapter
e'ao sions Code) SWIMMING POOL ELECTRIC
9(commencing with Section 7000)nf Division 3 ofthe Business and Protest VALUATION
w^,Z
or he is exempt herefom and the Wars for alleged esempion.Any violation ofOUTLETS-SWITCHES-FIXTURES
V/nom
F Z Q Section 7031.5 by any applicant for a permit objects the ant pplicanor civil peralty of
c or
t me than five hundred dollars($500).
G2� NEW RESIDENTIAL- SQ. STORIES TYPECONSTRUCTION
71
1LF_p ❑ I.mownerofthepopeny.ormyemploy«swithwagesuthcirsolecompenm4on.
a3e= will do the work,and the strucmm isnot in¢ndedmidfiered formie(S..]044.Business
Ff.
and Pofessiom Code:The Conweror's License Law docs not apply Io an owner of
prolveny who builds or improves Ihemon,and who does such work himself or though his
employees,prevlded that.a¢h impovemerm ve notlnmoded reofferedfrrsole.If.
OCC.GROUP RES.ON]IS
huwcvcr,the building or improvement is sold within one yearofemoplebon,theowner-
builder will have the burden of proving that he did not build or improve for purpose of
ale.)' Y. PLUMBING PERMIT FEE
❑ I.asowner oflhe property,am exclusivelyeadmacontractors QT
cting with licensed contractor
o FLOOD ZONE APN
onamen the project(Sec.1(A4.Business and Professions CoJe)The Contractors
Lic<nx lewd«snolapply roan ow«rofprtryslrty who builds orimpovesthereon.and PERMIT ISSUANCE
whocommcrs for such projects with aconmacrors)Reserved pursuanuothc Conmecmrs ALTER-DRAIN&VENT.WATER(G) FEESUMMARY
License Law.
❑ 1 am exempt under Sm._� .B&P C fm this reamngpCK FLOW PROTECT'.DEVICE SIDE FEES
SANITARY Y N
Owner Dam DRAINS-FLOOR,ROOF,AREA.CCNU. RECEIPT
WORKMAN COMPENSATION DECLARATION SCHOOLTAX �. YN
❑ I hereby affirm that[have it certificate of consent to self-insure,or a cenificam ofpl%'I'UR[3-PER TRAP RECEIPTN
Workem'ComMnsation lnxoranceor a scarfed copy thereof(Site 3800.Lid,C.)which PARK FEE Y N
ars all employee's under this permit. GAS-G.SYSTEM-]INC.4 OUTLETS L RECEIPT p
Policy M BUILDIN4 DIVISION FEES
Company - GAS-G.SYSTEM-OVER4(G) PLANCHECK FEE ,
❑ Certifiedcopyisheubyfumishad.
❑ Certified copy is fled with Ne city inspection division. GREASEINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
('phis section need not be completed ifthe permit is fm onehundred dollars(3100) SEWER-SANITARY-STORM HA.20017. ENERGY ME
or fuss.)
I certify that in the performance oflhe work for which this permit is issued,I shall WATER HEATER W/VEM'/ELECIR
not employ any person in my manner so aSg b.hmlav/subject to the Werken' PAID
Compensation La.0YLfali�tryj�I ,sL L1WATER SYSTEIV RGTING Date Re ptJr
O Z Applicant U�V'a`{t
ZC) NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
f-' y upe
become subject the Workers Camrwtian provisions of the Labor Cade.you most
forthwith comply with such provisions or this permit shall bo dame)revoked. BUILDING Ft
CONSTRUCTION LENDING AGENCY SF.ISMI 6
z1 hereby affirm that them is a construction IrnEL
ding agency for the performance of Ia
U O the work for which this permit is issued(Sea.309],Civ.C.) PEE
I,ender',Name PLU NG FEE
0 F Lender's Address QTY. MECHANICAL PERMIT FEE
U I certify that I have rod this application said state that the above information is MECHANICAL PEE
context.I agree to comply with all city amt county ordinances and state laws relating to PERMIT ISSUANCE5a 10
F' CO buildingconsmuction.andherebyauthodu relosa
mnativofthiscity menterupontha CONSTRUCTION AX
U Z above-mentioned property for inspection purposes. ALTER OR ADD TO MECH.
(We)agrce to save,indemnify and kcep harmless the City of Cupertino against
liabilitics,judgn r, oossin cpusxs which meyinanywriac IItsaid City AIR HANDLING UNIT(TO 10.0011 CFM)
in um
ren oft c',ran' u Ihi,permit.
AIR HANDLING UNIT(OVER R).00(CFM)
Slgnntureot Appl ant/ mwatnr mo EXIIAUST HOOD(W/DUC'C PAID
L! IDOLS MATERIALS DISCLOSURE HEATING UNIT(TO 100,0(10 BTU) n¢ Receipt It
Will theapplican future building consisted stem or handle hoarders material
as def red byline Cu,mr.Mwticipal Code,Chuprer 9.12.and the(health and Safety HEATING UNIT(OVER 100,000 BTU)
Cede.Section 25532bol VEM'ILATION FAN(SINGLE RISID)
❑Yes ❑No
CEDATE
Will rheapplicmtorfmurebuilding«cupantuuegoiMentordeviceswhichemil BOILER-COMP(3HP0R 100.0009'N)
ar-rdoic,air contaminants as defined by the Bay Arca Air Quality Management BOILER-COMP(OVER I W,BX))ITU)
Drofflo?
❑Yes ❑No NEW RESIDENTIAL MECI I. SQ.FT.
I have read the hazardous materials requirements under Chapter 6.95 of the SEP 19
Culifmain Ilealth&Safety Cade.Sections 25505,25533 and 25534.I understand that 1('x
if the building does not currently have a tenant,that it is my responsibility to notify the
receptor of the rcquir meas which must h met prim no issuance of a Certificate of
Occupancy. CII r
v
Owner or amhoriud agent Dam ISSUED
OFFIC
.,..rl Cil:v of
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 20, 1995
Maggie Klugherz
7677 Normany Way
Cupertino, CA 95014
Subject: 7677 Normandy Way, Permit# 27053
Dear Ms.'Kligherz,
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
Primed on Recycled Paper
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`a r7053
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47
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Cia
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
7677 Normandy Way
Cupertino, CA 95014
Subject: 7677 Normandy Way, Permit# 27053 - Kitchen, Bathroom& 2 Windows
Dear Resident,
According to our records the above mentioned permit has never been fmaled 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
calking (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 or:PocYrfeo Psoor