27236PY OF CUPERTINO APPLICATION/PERMIT
BUILDING DIVISION
t .1 L-ez 9 /
LICENSED CONTRACTOR'S DECLARATION
OCZ Thereby affirm that I 3 idthe wd Business and
]sines icas Coler9 (commencing yii.is in
th
5100 Section 70(10) of Oivision3 of rte Business and Professions Cade, end mylicenseis in
�full farce and effect.
b ZW License Clvs Lie.#
6y Date Cromer r
ZDyz ARCHITECTS DCCLARVHON
O Z o, G 1 understand my plans shut] be used as public records.
�n W�.a
Q Q Licen,d Professional
55 OWNER -BUILDER from
m the CmaTION
6X,OaU 1 hereby affirm nm 1 am exempt from Inc Conione, Ca Liven, law for the
tll3Wy billowing reason. Section 7031.5, Business and l'mfessions Cade: Any oily or county
ci, which requircs a moit tu construct, vl,q improve, demolish, or repair anystructure
W �� prior to i is issuance, also requires the applicant for such permino rile vsigned smmment
y 0 p Ihel be is licensed puuuvm mine provisionsof the Cma some. License Law (Chapter
d4o� 9(commencing with Section 7l(111) of Division 3 ofthe Business and Professions Code)
ty r?y or that he is exempt herefrom and the bssi¢ for the alleged exemption. Any violation of
Senian]0315 by any applicant for. permit subjectslheappluter,oa civil pemillyof
G
not marc than Eve hundred donors (11500).
❑ T,nsownerofthepmperty,ormyemployeeswlthwagesustMirsolecompensation,
WF�
will dothcwons ands The Cinastructure mmti. License
La doad (mule (See y1.an owner
ss
of
and Professions Cade: The Conlmcmis License Lew does not apply to an owner of
property whobssiIdsorimprovethereon,and whodoessuchworkraroseered through his
honeer. theu,pmvidednatuehlmpisry entsarene earref doroffeml tarsale. owner.
howeer will ave t e burden of omen g thatsola didn oae year ofcomplve for t urpusobuilderwill have the burden of proving that he did not build or improve for puepo., of
sole.). O
T I,osownerafihepmp ny,amexclusivclycont tingwiihlicenudconi a iorslo
,¢tact the project (Sec. 9044, Businessand ProfeWons Cort The Conuactofs
License law does not apply to u owner of property who builds or improves thereon and
whn contracts foramen projects with a coronations) licensed pursuant to the Contractor's
License Law. -
❑ 1 am exempt under Sec. , B & P C for thisVolost
Owner Date
WORKMAN COMPENSATION DECLARATION
❑ I herebynffrm that l haveucenificamnfco anon self-insum,maceniftcu of
Worken'Compensvtioaim tan maceniri do ythereof(Sm,38W,Leb . 'c
Policall empinyec'x under Ibis pasmit.
Policy q
Company
❑ Ceniftedeopy is hereby ramisned.
❑ Cenified copy is filed with the city inspection division.
CERTIFICATE OF EXEMPHON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the pemtil is for one hundred dollars ($101))
or leu.)
1 certify that in thcermormace of the work for which this parmi is issued, l shall
not employ any person in any manner so in to be nate g� t o Workers'
O 7. Compensation La!::; lifo . ate a �d sZ§
O Applicnm 4/-"
NOTICETO AP ICANT:If.after making this Cenificam of Exemption. you should
assume subjectto the Workers Compensation provisions of the lab, Code, you must
�> forthwith comply win such provisions or this permit ¢halt be deemed revoked.
4 (] CONSTRUCTION LENDING AGENCY
VZ 1 heruhy affirm not There is a Construction leading agency for the perfomentt of
O
the work for which this permit is issued(Sec. 3097. Ci, C.)
IL Lcndet's Name
O Lenders Address
W 1 sanity IM1at I have mail this upplicaion and ¢tate that the above infnrmminn is
nett. lags ro comply tui@all city uJcoumy aNinanca uJ cumlaws relering to
F" building cnnsuuction, and hereby authorize representatives of this city to enter upon the
U Z move -mentioned property for inspection purposes.
(We) agree to save, indemmfy and keep harmless the City of Cn nano again¢
liabilities,judgments, costs and expenses which may m any way accrue agmn
in consequence of the granting of this permit.
—�2-le //aa/9
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Cnde. Chapter 9.12, and the Health and Safety
Code, Section 25532LI?
❑ Yes ❑ No
Will
he applicant or future building occupant use equipmem or devices which emit
mom air commminam u defined by the Bay Area Air Quality Management
r;�rict?
❑ Yes ❑ No
1 have read the hauNous materials requirements under Chapter 6.95 of the
California I Icahn K Safety Code, Sections 2550.25533 and 25534. I understand that
if the building does not currently have a tenant, that it is my responsibility to notify the
Ontpmn of the requirements which most be, mel prior to issuance of a Ceni ficale of
ccupancy.
Owner or authorized agent Data
PLUMBING -
ELECTRIC PERMIT
PERMITISSUANCE
APPLIANCES -RESIDENTIAL
PANELS
UP TO 200 AMPS
OVER 1000 AMPS
SIGNS ELECTRICAL
SPECIAL CIRCUD'/MISC.
TEMP. METER OR POLE INST.
POWER DEVICES
SWIMMING POOL. ELECTRIC
OUTLETS - SWITCHES - FIXTURES
NEWRESIDENTIALEM?CIR _SQ.FI'.
1
TOTAL:
PLUMBING PERMIT
PERMITISSUANCE
ALTER - DRAT VENT- WATER(RA)
BACK toP5RTECT.D VICE
DR*I - FI.00R, ROOF, A N
GAS .S J1IFM) INC. 40UTLE'rS
GA. Y. EM_OVF.R 4(EA)
GREASFJINDUST'RL WASTE INTERCEPTOR
GREASE TRAP
SEWER - SANITARY - SI ORM HA. 200Ff.
WATER IIEATIiR W/VENWELECTR
WATER SYSTEMnREATING
NEW RESIDP.NTIAL PLMIL SQ. FT.
TOTAL:
MECHANICAL PERMIT
PERMIT ISSUANCE
CI RORADDTOMECIL
.AIR HANDLING UNIT (T0 10,000 C
AIR Rsi NDLIHG UNIT p8lis IU,000
MEATI NIT OVER IOL" BTU)
VFNTIL ONF N(SINGLE RESID)
!II.ER-COMP 311P DR IOO,IX%1 BT'U)
BOILER - COMP (OVI?R I W.OW BTU)
NEW RESIDENTIAL MECII. SQ. FI'.
TOTAL:
-r-" 27236
SANITARY NO. APPLICATIONSUBMITI'ALDATE
b
N/CC N'IROLg
❑ 7s`F3
FEE BUILDING PERMIT INFO
BLDG eyecr� PLUMB ML'�cll
JOB DESCRIPTION
SQ. FT. FLOOR AREA S/SQ. FT.
6g67 ]
VALUATION /
Vcaaaaa�
STORIES TYPLCONSTRUCfION
OCC. GROUP RES, UNITS
e?r Oe
FEE FLOOD ZONE APN
FEE SUMMARY
SI S
SANITARY YN
RECEIPT M
SCHOOLTAX Y N_
NO
rr�
BUILDING DIVISION
PLANCHECK FEE 2N
GRADINGFEE 1\
SOILS FE `.
ENERGY FEE.
PAID JiL +A+ /i
Date ReceiplM
BUILDING MT
SEISMIC FET?
ELECTRIC FEE
PLUMBING FEE
MECHANICAL HE
CONSTRUC ION TAX
PAID
Data
JAN 201995
Cil( I IJ I" vurr%I IINV
rV
December 4, 1995
Resident
19900 Price Avenue
Cupertino, CA 95014
-1; -cb
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax (408) 777-3333
Subject: 19900 Price Avenue, Permit # 27236 - Single Family Dwelling
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
11