27800 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO III II.DING-BL.UI ICAL PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 27800
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUHMFITN.DATE
- ' 358 Se� Ll lac) UNIT# LOT# 1���
OW��t�ERSNAME' PH I TRACfOR/'�NAMIi: LIC NO: NIC CONT—RO`L#
R�h1(�� �lx CQ -I olK.�9US O!J 7�fS�IS
A RCHITECT'IENGI NCER: LIC NO: ADD ESS: 11 Itg�,,II��LL
1UZJ�k YQ 1rc�-s
CONT'ACI': PHONE: BUILDING PERMIT INFO
QTY. ELECTRICPERMIT FEE
LDC G PLUMB MECII
PERMIT ISSUANCE X ❑ 11
LICENSEDCON I censedRACfORSOECIARATION APPLIANCCS-RESIDENTIAL, n a�Gg p4 S'CrnR�I'IOR b'^-
Dyy Thereby affirm that I licensed uACTOR'SDE DECLARATION
(commrncingwith df 1TK I LTO f n+'uae
LVOOh=. Section 700l Division 3 of Ne Business and Prefessiom Code,and my license is in PANELS
UC) I
1� full force and effect. UP T0200AMPS ws
IQ,zw License Class Lie.p
m Q'y Date Contractor 201-UNIT AMPS
1-y ARCH]T'fiCrS DECLARATION SQ. rl'.FLOOR ARCA $/SQ,Irl'.
co 1 understand my plans shall he used as public rcamE. OVER 1 Whl AMPS
mz F 0 O SIGNS ELECTRICAL
I-wenswi Pof ...I
ww< OWNER-BUILDER DECLARATION SPECIAL CIRCUrT/MISC.
OyU 1 hereby effml Nat I am exempt from the Crooner's License law for the
30.y followirItoasnn.(Section 7031.5,Business and Profes,kna,Cade:Any city.,roomy TEMP.METER OR POLE INST.
cS�� which requires a permit inconsonant,alter,improve,demolis r repair any structure
Y+� prior t0 its issuance,also requires the applicant forsuch nt9 Ceasignedstalemem POWER DEVICES
p0 that he is licensed pursuant to the Provisions murap.e. se Law(Chapter
K0� 9(commencing with Section 70W on30ftbe Business.dProfessions Cade) SWIMMING POOL ELECTRIC VALUATION
yl_y onhatheisexemp th or andthe basis far heallegcd excmp on.Anyviolmiono( TOUTLErS-SWITCHES-FIXTURES w.
E• Q Semion]03L5bymr applicant for.pemtit subjects the uppliw m.civil penahy of
I more than five bu idred dollars($5110).
p NEW RESIDHN'FIALELEC'I'R _SQ.111. STORIES TYPE CONS]'RUCTION
ym ❑ Laework.andt roperturcisyemtendedorofwedfor th (Sea,7rsolec ,Btrsiren,
willdo the work,undN swnure is oat intendedoroffered torso (SecJf144,Business
and Prefexsimp CMe: aCOnttncois Wce se s not pply to on owner of
pr.penywhobuildsorind o slherta mdw �' in work irreforthroughhls
nentployees,previded a uch' a •nmimende roffendforsale.lf, OCC.GROUP RES.UNTIS
however.the building or l v itldnoneyeur mpletion,The owner- TO
huilder will have the bur gthaihe did am hori rove for purpose of
.I.J; I fir' ,
❑ Lasowneroflhepropet . exclusively meting with Operated contractors QTY-. - PLUMBING PERMIT FEE FLOOD ZONE APN
corexame the Pojem(St]OW,Business Professions Code:)The Conaractors
Licenselawdoesnotap yminowner. penywhobuildsmimpmveathereon.and PERMIT'ISSUANCE
who contracts
aetsforaueh Or jeuawilhl ml el.n(s)liansed pursuant lathe Contmcl0r's ALTER-DRAIN&VENT-WA'TER(EA) f
I,ic� se FEESUMMARY,
rJ
❑nI am exempt under tt B&P C for Ihis reason BACK FLOW PROTECT.DEVICE .1 TEE
SANITARY Y N
(honer Dale RECr:IPT#
DRAINS-FLOOR,ROOF,AREA,COND.
WORKMAN a certiEcau,of COMPENSATION DECLARATION SCHOOL TAX Y N -
C] Ihereby affimr Nntlhave
ntrane moranieconscmerawf(insure,0,Lab Cficmeof rgXTURES-1'ER TRAP RECEIPT'#
Wnrkem'Cnmpenxmion lnsumnec 0rooeni0ed copy lhercof($ec.3gW,Lab C)whlch P PARK NEB YN_
covers.11 employee's under this permit. GAS-EA.SYSTHM-I INCA OUTLETS. REC'HIPI'#
Policy# BUILDING DIVI. S
Company GAS-G.SYSTEM-OVER 4(FA) CHECK FEE
❑ Certified copy is hereby famished.
❑ CenifiW copy is Bled with the city inspection division. GRGSEBNDUSTRL WASTE INTERCEPTOR GRADING FEB
CERTIFICATE OF'EXEMPTION FROM WORKERS' CREASE'IRAP / SO :S FEE
COMPENSATION INSURANCE
(This section need not Is,completed if the permit is far one hundred dollars Pi OR) SEWER-SANITARY-STORM EA.200FT. P YFEB
or less.)
I ttrtifylhat in the rformance ofthe worIt(rwhich Nie pemlitisismed,lshall WATER HEATER W/VENr/CLECFR
not employ any pars any manner so t t ct o the Workers PAID_
e'
Cnmpensalon Law glifxo ia.,4LIe WATER SYSTIiMUREATING Dule Receipt#
Z
0 NOTICE TOAP�NT:If,after making this Cenilicne of Exemption,you should NEW RESIDENTIAL PLMIL SQ.ff. 'T TAL:
o fn become subject o the Workers Compensation previsions of the Labor Cade,you must
forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE
1 Q CONSTRUCTION LENDING AGENCY SEISMIC FEB `
1 hereay.ffrm tbm here is.construction lending agency for the perfomumce of
O TOTAL: ELECTRIC FEE
the work for which this permit is iswcA(Sec.303],Civ.CJ
Lender's Name PLUMBING FEE
U Icndeh Address QTY. MECHANICAL PERMIT FEE
I certify that I have read this city
an application and store That an above information is MECHANICAL ITE
a correct.lagrce nr comply with all city.nd county ordinances and store laws,apongo PERMIT ISSUANCE
LO buildiattrAmlruation, nd hereby nnlhorize reproecmaives of thio cirywemer upon the CONSTRUCT ION TAX
) 7. uhwc-mentioned pr any for inspection purposes. ALTER OR ADD TO MECfI.
(We)agree t. ave, de d ke harmless Nc City.f Cupenin.against
Hiddlities,jud a s,coses sm Aex
/Xsea
/(__Ormi'manywayac eagain said City AIR HANDLING UNIT(TO 10,000CFM)
c e c the 6mnti 6 u.
AIR HANDLING UNIT(OVER 10,0110 CFM)
S mature ofA plicanl/C.nlranor hale EXHAUST I IOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt Of
Will the applicant or future building occupant store or handle hvardous malarial HEATING UNIT(OVER 100,(X0 BTU) TOTAL:
as defined by the Cepenin.Municipal Cod,Chapter 9.12,and the Health and Safety
Gale,Section 2.5532(.)7
❑Yes 13 N. VENTILATION PAN(SINGLE RESID)
BOILER-COMP OIIP OR IM,000 BTU) ISSUANCE DATE
Williheepplicatvorfutumbuilding0 cupantuseequip=ntordevlceswhichemil P B
�wallom air camaminanu u defined by the Bay Area Air Quality Management BOILER-COMP(OVER 1(10,0(0 BTU) a`G
D nrict^
❑Yee ❑No NEW RESIDENTIAL MECH. SQ.Fr.
I have read the hazardous materials requirements under Chapter 6.95 of The /s AR 14 199
California I heath&Safely Cale,Sections 25505.25533 and 25534. 1 understand that CG/
if the building does not currently have a tenant that it is my responsibility o notify NeY LIl' VVrI,
occupant of the requirements which must be met prior o issuance of a Cer ifcam of
fkcuPancy.
Owner or amb.rirnd agent Date TOTAL: ISSUED BY:
OFFICE
i
_. city of
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
19358 Sakura Way
Cupertino, CA 95014
Subject: 19358 Sakura Way, Permit# 27800 - Interior Remodel
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 `
I
_J
Printed on Recycled Paper
POST THIS CARD NEAR FRONT OF BUILDING
QTY OF CUPERTINO PERMITNO. __$O
PR
BUILDIAG DIVISION - BUILDINGOJECFIDENTIFICATION
BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMITTAL DAi
.�WNERS NAME: -PHONE: CONTRACTOR'S NAME: _LIC NO:-,
". '_ 1 1 •.1:' .' _. ti.� - I `_ \'N/C/ CONTROL
RCIIITCCT/ENGINEER: LIC NO: ADDRESS:� \V$q
'BUILDING PERMIT INTO?!^-.i 4kP-
INSPECTIONS DATE INSPEC. INSPECTION RECORD
MECH
FOUNDATION/PIERS/H.D.S. NOTE: ALL GRADING AND DRAINAGE
;K 1:1B ❑
UFER GROUND SHALL BE INSTALLED TO COMPLY WITH »IDB DESCRIP IO
THE APPROVED PLANS AND CITY OF ;
PAD/SET BACK-CERT CUPERTINO STANDARDS.
GARAGE SLABS/PREGUNITE -
POUR NOCONCRETE UNTIL ABOVE HAS BEEN SIGNED INSPECTION SPECIAL INSPECTION DATE INSP.
UNDERGROUND/SLAB REQUIRED ❑
PLUMBING
ELECTRICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS
INSULATION /
PLACE NO SUBFLOOR UNTIL ABOVE HAS R&ATfGNED
ROOF SHEATH/DIAPHRAM
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
r ELECTRICAL/POOL BOND
e
FRAMING/STAIRS/E.EGRESS
INSULATION/VENTILATION
COVER'NO WORK UNTR:ABO' .. BBEN" �Dj
EXTERIOR SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR f
EXTERIOR LATH/W-SCREEN
SHOWER LATH
NO TAPE OR PLASTER'UN11L-ABOVE HAS BEEN SIGNED:
SCRATCH COAT
SEWERIWATER
TEMPORARY APPROVALS "�»Fc`rijA;�,"'"'*� '
BUILDING
ELECTRICAL
GAS
GAS TEST
GRADE
FIRE APPROVED FOR OCCUPANCY El
HANDICAP TO ARRANGE INSPECTION "'u' CE DATE
ELECTRICAL/ENERGYCALL AFTERNOONS(12:30 PM-4:00 PM) ?_ CJ .
/ 252-4505 MONDAY TO FRIDAY 24 HOURS P A I D
PLUMBING/ENERGY BEFORE REQUIRED INSPECTION. JOB AD-
,DRESS AND PERMIT#ARE NEEDED WHEN �p q
MECHANICAL/ENERGYPHONING. MAR 14 1995
BUILDING/ENERGY ATTENTION CONTRACTORS:
ELECTRICAL FINAL TEST 7NO PERSON(S)SHALL PERFORM WORK ON CI I Y 'Jr "urrri i vio
THIS JOB SITE WITHOUT WORKER'S
OCCUPANCY OF BUILDING IS NOT PERMITTED CONIFENSATION I S RA CE.
UNTIL BUILDING FINAL IS SIGNED BY BUILDING IMPORTANT!
;INSPECTOR.---'r .'' .. PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION!! ISSUED BY:
_APPLICANT'S POSTING COPY