26559 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY PENMIT NG.
D".BB� MECHANICAL
IA, 2§ 559
CITY ON CUPERTINO
PLUMBING.-MF.0 TRIC AL
BUILDING DIVISION APPLICATION/PERMIT 1i1111.)ING PROJECT IDKN I'11'11;A II tors
SANII'ARYNO. APPLICATION SUBMITTAL DATE
BUILDING ADDRESS:
1002 A/ W A UNIT# LOT#
OWNERS NAME PHONE: CONTRACTOR'SNAME: LIC NO: N/C CONTROL#
Sn u Ca p S� 271 r� /n7fJ TsFff �ff�l Co. CIO
y ENO: ADDRESS:RCHIrECT/ENGINI ❑
GIr wt� 6co4r vHurxtc cad-
' } r EI GEsRt li 4z b-T` z PEEILDINC PERMIT INFO
CONTACT: PHONE ICPERM
t:x Al-.,, a 3 BLDG ELECT PLUMB MI3CH
PERMIT ISSUANCE ❑ ;2� ❑ ❑
LICENSED CONTRACTORS DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPr1ON
QWz I oomeortimtlhm lam li.modunderpmom.ns afChapmr 9(cnmmencing with
WOO Section 7W)of Division 3 or the Business and Professions Code,and my license is in PANELS
y^V full fmce and effect. •I Sg 5'1 UP TO 200 AMPS
GG License ME In Lie# e.e �I
boQ v Date Cnmranor An O&W, zol-1000 AMPS
F,J ARCHlTECCSDECLARA'r10N SQ.FT.FLOOR AREA SISQ.Ff.
OVEtt 1000 AMP$
z0 Z Eo co W 1 undemm�d my plans shall be used us public rtcmds.
SIGNS ELECTRICAL
9 Licensed Professional
'a OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
cLO y V I hereby affirm that 1 am exempt from the Conmerses License Law for the
3H TEMP.METER OR POLE(NST.
a following renson.(Section 7031.5.Business and Professions Code;Any city or aunty
whichrequires ape.am consumer,ulmr,improve,demolish,or repair any swetare POWER DEVICES
WaE prior to I.i....ulsomccires to applicant for such pemduo flee signal statemem
5❑ that he is licensed purmma m the pnividme,Of the Contractors License Low(Chapter SWIMMING POOL ELECTRIC VALUATION
ti e� 9(cemmencing with Sectio 7000)of Division 3ofthe Business and Pmfde)cseions Co
W_, or that he is exempt therefrom and the basis for the alleged exemption.Anyviolation of GIITLET$-SWD'CHES-FIXTURES
aSection 7031.5 by ny nppbutal for o permit subjects the applicant to a civil Penalty of
al more than five hundred dollars($500) NEWRESIDENTIALELECIR _SQ.FT. STORMS INPF.CONSTIUCDON
y'FL' ❑ Lho carmalthesomeoe is.ml pinyeeswhhwegesaatIOUnle c04,Buanon,
Moo
will do the work,und the someone isnot intended nroffereJ forsaie(Ss.]044,Business /
and Professions Code:The Contractor's License Law dues not apply to an owner of
proporywho mildsorinpaw.aNereon.and whodroa .ch work himselfmthroughhisOCC.GROUP NES.UNITS
to�it noployces,provided that such impowements me erns intended or offered for sale.If,
however,the building or improvement is sold withmone yearo(completion,the owner- TOTAL:
budder will have the burden ofprovmg that he did not la Id Or improve for Purpose f - _
Wo.). QTY.3;nr. -, .pLUMBINC(PE z� mn' 'PEE IIOODZONE APN
❑ Latowner ofthe property,amexclusively convecting with licensed contractors to t - ¢J^
dnstrem the project(Sec.7W.Business and Professions CNet The Con regimes a PERMIT ISSUANCE
Licence Law dies ma.pply to as mwmr nfpmpeny who huilds or improves(hereon,and
whocomracts forsuch projects with acamractuds)licensed pursuant to the Contractors ALTER-GRAIN&VENT-W FEE SUMMARY
License Law.
E] 1 um exempt under Sec. .H&P C for this reason O :IDI:;S
BACK FLOW PNOTECf. EV SANITARY Y_N
RECEIPT p
Owner Date DRAINS-FLOOR,ROOF,ARP.A ND.
WORKMAN COMPENSATION DP.CIANATION SCHOOLTAX V N
t❑ I hereby affnm that l have a certificate oremesentto self-insure,ora certificate of FIXTURES-PER TRAP RECEIPT 11
kWmkai Compensation Internment.certified copythomof(Sec,3800,Lab C.)which PARK FEE Y N
NDIVI ION
"covers.il employyeps undenhis permit GAS-PA.SYSTEM-I INC.40UTLETS � BUILDING DIVISION PERS
"Policy# cZZ[�3G Y
Com nEI3 ye GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK F
Certified copy b hereby famished.
❑ CenifudcopyisfIMd ith Necityinspectiondivisin. GREASEBNDUSTRL WASTE INTERCEPT OR GRADING FEE
QERTIFICATE OF EKEMMON FROM WORKERS' GRFASE'TRAp SOILS ME
COMPENSATION INSURANCE
(T'hissection needaothecomplaed dram permit is foronchundred dollns(5100) SEWER-SANITARY-STORM FA.200 Fr. ENERGY IEE
or less.)
I certify that in the performmee of the work for which this Permit is issued,l shall WATER HEATER W/VI:NTtELEC1k
not employ any perm, in any manner so as to become subject m the Workers' PAID
Cempensutinalawsul'Celifomia. Dam WATER SYSTEMORA WrINO [)ate Rmcipt#
0 z Applicant
z C NOTICE TO APPLICANT:IL after making this Cerificam of Exemption,you should NEW RESIDENTIAL PLMIL SQ.PT. TOTAL:
Fry become subject m the Workers Compensation previsions of the labor Code,you must BUILDING IEE
W fforthwithiwith comply with r
such provisions or this pemit shell N ddecedecedentmrevoked.
7
[� CONSTRUCTION LENDING AGENCY SEISMIC 113E
11 I hereby an that them is a construction lending agency for the perfonnnce of
V z ffrTOTAL: ELECTRIC FEE
the wmrk far which this permil is issued(Sec.3097,Co.C.U. 6
Lenders Name '^ PLUMBING E
0 F Leudcrs Address QTY± r r MECHANICAL PERMIT FEE
FE
0 U 1 cenily that 1 have mad this upplication and stem that the above information is .we` "" " - MECHANICAL FET:
W correct.l agree to comply withal]city and county oninnces nJ scale laws relating to PERMIT ISSUANCE
building com muction,ndherthy aethoriurtptescnmtivn of this city to emerupon the CONSTRUCTION TAX
L) z above-mentioned property for inspection purposes. ALTER OR ADD TO MEC H.
Wo)agree to save,indemnify and keep handless the City of Cuper]n against
liabilities,judgments,rests ndexpenscxwNch may in any wayocerowtumm1mid City AIR HANDLING UNIT IT'010,000 CFM)
in umseomarc of the granting of this Permit.
AIR HANDLING UNIT(OVER((1,000 CFM)
Signature or Applicant/Contractor Date EXHAUST HOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE.
HEATING UNIT(TO l00,000 BTU) Plane Receipt#
Will the the CuumoroMunicipal Codecupnismrcor huddle Hualtousmatfety HEATING UNH(OVER 100,000 BTU) TOTAL:
u Jcfincd by the Cupcnino Municipal Code,Chapter 9.12,nil the Heahh nil Safety
Calc.Section 25532(n)1 VENTILATION 17AN(SINGLE RISID)
❑Yes 19 No ISSUANCE DATE
BOILER-COMP(3HP OR 1 W,WO BTU)
Will lhenppli'art
arfummhuildingmcupam use equipmem ordevices which emit O gt
hazallous nit conmminnts as defined by the Bey Arca Air Quality Mnagement BOILER-COMP(OVER IW,000 BTU) D
R nP
❑Yes IF No - NEW RESIDENTIAL MECII. SQ.PT.
I have read the hazardous materials requirements oder Chapter,6.95 of the JUN 141994
C.I'd'nmia Health&S.fot vie Scnions 25505,25533 and 25534.1 undentand that
if the building does n at have a mount.that it is my resPunsibility,Inanity the
occupant efth,re 11T hien mein met poor m issuance of a Cenircale Of
CI Y Vf V r Ctt I uvU
Qaip;mmy. / 6`ry—�
Ownerdzcdag I Dam TOTAL: ISSUED
or o
OFFICE
r
C.11;A' f11
cupei tino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 26, 1995
1003 Saich Way
Cupertino, CA 95014
Subject: 1003 Saich Way, Permit# 26559
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, V' -
City of Cupertino
P,in'eJ an Rocvc!vo Pnrer