26416 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO RI 11-7ons-it 1,m.TRI.A L PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMPING-MECHANICAL n� /I �C
BUILDING PROJECT IDEN"rIF4 oICAIION L
UALDING1ADDDRESS: //-p �].y.�r - SANITARY NO. AIRLICATION SUBMITTAL DATE
R
OWNERS NAME: PHONE UNTRACI'OR'S NAME: LIC NO:
/-�1O
M /7 I NIC CONTROL IY
IE(7/EN LIC NO: DRBSS: /
COMACf: PHONE: BUILDING PERMIT INFO
Q'I'Y. 13tiCC'I71IC PERMIT FEE a BLDG ELECT PLUMB :eH
PERMITISSUANCE
I.I FNSFDCONI'RACI'OR'SDF.CI,ARATION APPLIANCI!S-ItISIDI!NfIAL JOB RI PION
00
ciwz Iherebyafft lthallamlicenadunderpmvisionsofCapteO(commencingwith - /
u1S-liom9000)of Division 3 ofthe Business and Professions Code,andmy license is in PANELS _
+
11--''61l force enJ eRc
4ZW .icensc Close Lic.p_--� UPT0200AMPS
y 6 d Commnor 201-I O(p AMPS
ZOy ARCIIITIiCC5 U8CIAkA'PION-ti—M;IT 1p Q OVER 1003 AMPS SQ.PI'.IlOOft ARfiA S/SQ.PI'.
OZ-O IunJenlanJ my plans sh�llh used as public remNs. I I "'f yP �O a^�
G'M SIGNS ELECTRICAL O.l •�2
q E j Licensed Professional
La�6 OWNER-escom from
the Con TION SPECIAL CIRCUIT/MISC. we s0
1 hereby arum that 1 am encmpl from Ihe Commcmrs License Law fordo (,-/Oo O
W 3LLpfa foll.wi demolish.
Co de:Any[in orcounly TEMI'.MCI'LR OR PULE INST. _�77
F-t3�; which requires a permit re moeat er alter,improve,dm rmitt or repair any structure'
E Y� trash its iesocedsc unatt Th the,kino fin"ach Copermiuo file.signed Law(Chapter POWER DEVICES _
W,ad ¢Oz that he is Planes]pursuunnnthe pnrvlainrm of the Cnntracm/s License Law(Chuptcr
W
aLL 9(commencing with Section 7100)of0ivision J ofthe Busineasand Professions Code) SWIMMING POOL VALUATION
LL-,� or Phut he is exmnpnhemfmm anJ the burix for the alleged cxcmPtion.Any vinlmiun of - ®O�
Y Section 7031.5 by applicant t b t Thea I' noaeivil y ( ITI'LBTg-S E. 1 !S .�
F Z 6 y any aPP ican Penni sit jec s pp¢an pen ry n
�y not moa than five hundred Jnllum($5R8}
Cts ❑ I.asownernftheprol ny,ormyemploymswithwage ,hciraolccompemanim, NEW RESIDPN'1'1 .P 'f SQ.IT. 'T'OkIBS TYI'Ii CON59'kUC110N
i3.. will dnthework,and lheslmelu.eis not imendell oroffcred foraale(Sec.7044,Business
and Professions Cade:Ile Contractor's License Law does not apply to an owner of
prnpcny who builds or improves there m.and whodees such work hlmsclforthrmgh bis
employces,provided that such impmam vementanot imendedoroffered forsale.If, OCC.GROUP RES.UNITS
h wwcc thebuilA'mgor improvement is sold withinone yearnfearmiltion,theowner- f
builder will have The burden of proving That he did not build or improve for purpose of
sat
❑ I,asowncrofthepmpeny.amexclusivelycontractingwithlicmn dcontmctonm QIY. PLUMBING PERMIT PCE 19,OOD ZONE APN
emrstruct the Project(Sec.7044.Business end Professions Cai'Ihe Contractor's —
License Law does not apply toanownerol'pmpeny who builds or improves Thereon,and PERMIT ISSUANCE.
who contracts for such projects with acontractom)licensed pursuant no the Cnmmdors
License Law. ALTER-DRAT &VENT-WATER(BAT FRE SUMMARY
❑ I em exempt under Sec. .B&P C for Tnis reason BACK FLOW P C P CF UT' IDB
SANITARY V_N
Owner Dam RECEIPI'ft '
DRAINS-r.00 .A,GOND.
WORKMAN COMPENSATION DIiCLAItATION SCHOOLT'AX Y N
-I Ihemby affirm thmlhave acmificem mfconaem to self-iruure.mn anificem of FIXTURES-PF. 'R RECEIITk
skcra'Cnmpereation bram e,or a certified copy lhrehub
eof(See.3800, C.)which PARK FEE VN
users all employee's under this permit. GAS-EA.SYSTEM-II UTL kl!CEflyl'q
Policy W BUILDING DIVISION FEES
Company GAS-EA.SYSTEM OVER4 ) PLANCHUCK FEE L'
'❑ Cenilicdcopylsherchyfumishcd. SiS�a
❑ Cenifed copy is filed with the city inspection division. GRFASPIINDUSTRL WAST13 INTERCEPTOR y� GRADING FEE
CERTIFICATE QP EXEMPTION FROM WORKERSGREASETRAP SOILS FEE
COMPENSATION INSURANCE
('this section need am becomplcted iflhe orm,is foronehundred dollars($100) SEWER-SANITARY-STORM EA.20017. ENI!RGY FFL
m leas.)
I certify That in 1,m performance ofthe work forwhich lhispernil isissued,I shall WAI ER HEATER W/VEN117ELECIR C
not employ any person in any mama so as to he me s b'ect;the Worker' PAID J 1��y �J 6 -dr
Crommoullnal.awp IG:� Dem WA'I'ERSYS'1'EMMI16TING' Dmo Receipt# v 7T
Q z APPlivmt -
Z O NOTICE TO APP'JCANT:If.after making this Certificate offixe Jom (st'lo id NEWRESIDEN'TIALPLMIU SQ.Fr. TOTAL:
�+ become subjectmike Worker's Compcnvtion provisions ofthe LelrCode.you mustAr
7 forthwith comply with such provisions or this permit shall he deemed revoked. BUILDIV,
IF
' 0
a'Q CONSTRUCTION LENDING AGENCY SI CH Q
z 1 hereby affirm than there is a construction lending agency for the performance of o0
U O The work Pim which Phis permit : ITSec.M9'1,Civ.C.) ELF.. IC FEE
PLeadce,Name ���iasler PLUMBING FI 3
LemWrs Address Q'I'Y. MF,CHANICAL PERMIT FEC
V I certify that 1 have read This application and state That the above information is
corral. Ingres.lit conmply with all oiry cool county oNinunces anJ slate laws rcl;ning to PERMIT ISSUANCE MECHANICA E
E" building construction,and herebyamhodae repmseanitives of this city iu rnmr upon The CONSTHUCTI
V Z above-mentioned property for inspection purposes. LTTAXI!R OR ADD TO MECI I, 2 ��
(We)spree To save,indemnify and keep harmless The City of Cupenim against
limalities,judgments.costs and expenses which nmy in any way accrue against said City AIR IIANDLING UNIT(TO 10,000 CFM)
in consequence or taming of This percent,
AIR IIANDLING UNIT(OVER 10,(p0 CFM)
j Signumrenf pp cut tiactor ane ^ EXHAUST HOOD(W/DUCq
PAID
AZARDOIIS MATERIALS DISCLOSURE HEAPING UNIT(TO 10f1,0008'1ID Date Raciplp
Will We app cum or Tumors building occupant store or handle hazardous material
,edintmed by the Cupenimo Municipal Cale,Chapter 9.12,andihe Health and Safety HHATING UNIT(OVER I00,000 BTU) TTAL:
Code,Seeman 25532(x)'( VGNTILA'I']ON PAN(SINGLE RESID)
❑Yes ❑No
tl011.BR-ER100,000BLU) „1 IISSUAN .DA
Will Theapplicam m miurebuildingnecupant u¢e,doment ordeviceswhich emir P A I
euNoair amwminanta as defined by Ihe Bay Arca Air Quality Mmagement BOILER-COMP(OVER 1110,000 BTU)
deft AUG 1
-� Cl Yee ❑No NEW R[SIDF.MI'IAh MECH.—SQ.FT. - D
mla l lhove octalIhe husoolmus materials requirements under Chapter 6.95 of the U 19gq
Caffoealth&Safety Code,Sections 25505.25533 and 25534. 1 understand than la /�+
if the butding dons not currently have a tcnanLJhat in is my responsibility To notify the
Ur L'(/p
cupanl of the mqummu as which must be mel prior to issuance of a Cenificam of thluvo
Occupancy.
Owneror awnnrred ager Date U' ISSUED IIY:
OFFICE
-
'cit,• of
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
21952 Regnart Road
Cupertino, CA 95014
Subject: 21952 Regnart Road, Permit# 26416 - Addition
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
Printed on PecKwd Paper