27628 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CI'T'Y OF CUPERTINO BUILDING-LLECTR[CAL PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL n O
BUILDING DIVISION BUILDING PROJECT'IDEN'TIF'ICATION L o
BUILDING ADDRESS:6 •, /,. SANITARY NO. APPLICATIONSUUBBMITTT:
'ALDAT/V er ✓ rl UNIT N LOT#
O S AMF PH NE: CONTRACTOR'S NAME: LIC NO:
/�, .I A (r r lid w ! �a NBC CONTROL#
Ctll' 4 F (NEER: e`✓ CNO: ADDRESS: l !
�Gs Q / (.fin
IA-
CONTACT PHONE:
QTY. ELECTRIC PERMIT FEF. BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE 171 ❑ ❑ El
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL l� IUB DESCRIPTION
I hereby offirm that l am licensed under provisions of Chmi(commencing with
QC
E full force teff ofDh, 3 of Nc Business and Professions Cade,and my liccnm is in ppryEM �� ��
FZW Liccnx s. Lic.# UP T021X1AMPS
m srci.y Dam Contactor 201-RA)AMPS
ZOr`r Z ARCfIITECTS DECLARATION SQ.FT.FLOOR AREA S/SQ.FT,
O Z_n I undersand my plans shall he used as public records. OV 1000 AMPS
�yFYI
MINS ELECTRICAL
<,2,,j Licensed Professional
cezwV OWNER-BUILDER DECLARATION S .CIAL CIRCUITIMISC.
Ola. I hereby affirm dal I am exempt from be Contraclmr's License Law for the
to 3'+V,ir roilowingreresam(Section 7031.5,Business arW Professions Code:Any city or loamy T MP.METER OR POLE INST.
01 which requires a permit to conswet,alter.improve,demolish,or repair any structure
K�QS prior to its issuance,ahorequires the applicant forxuch pe.iuo fileeslgnedaatemeot WERD VICES
d,K O that he is licensed pursuant to the provisions of the Contacmr's Lcam Law(Chapter
a XOLL 9(commencing with Section7")ofDivision3 ofthe Business and Professions Cod[) WIMA�1 VALUATION
ty_y Smithal 7031.5 by uhclefmmnt for
berPerrot subjeal ctsdedaxemant to Aivilja ally of OUTLETS ITCHES-FIXTURFS 1Q �w
F Z¢ not more
than by my hundred
doll rs($50rtnit subjects Ne applicant n civil penalty of ` w
ESO not more than five hundmG dollar(5500).
=F� ❑ LusowncenUhepmpeny,Dray employeeswithwages as theinalecompcnsaarm, NEW RESIDP.NTIAI,ELECTR _SQ.FT. STORIES T'YPECONSTRUCTION
x322 will do the work,and the structure is not intemedoroffered formic(Sec.0044.Business
and Professions Code:The Contactors License law does not apply to an owner of
progeny who buildsoT improves thereogand whodoes such work M1imselforthrough his
employ«s.providcd tsuchimpmvemenu=notintendedoroffeledfwsale.If, OCC.GROUP RES.UNI'T'S
however,the baildingor improvement is wld within one year ofe mplelion,theowner- TOTAL
will have the burden of proving that he did not build or improve for purpose of
ale.).
❑ I.asowneroflhepmpeny,amexclusivelycontmetingwithlicensedcontactorsm QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
mdmal the project(Sec.9044,Business and Professions Code:)'Me Contractor's
License Lowdoes not applyto anownerofprogeny whobuildsorimproves thereon.and PERMITISSUANCE
whoccei fm such projects with acontrecoma)licensed pursuant o the Contraction's gL'ftiR-DRAIN A FIiE SUMMARY
License Low. )
❑ I em exempt ander S«. ,e&P C for this aamn BACK FLOW PR CI'DEVICE OUTSIDE FEES
SANITARY YN
Owner • Date m DRAINS-FLOOR.RO .7 RECEIPTp
WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN_
❑ I hereby affirthat l have a cenificaeofcanxnf to xlGinsure.ora ceniffcateof FIXTURES-PIiRT RECF.IPI'p
Workcrs'Compcnxmion lnsuana or acetified copy thereof(S<c.3gW.Lab CJ which PARK FEE Y N
covers all employee's undoudtis permit. GAS-FA.SYSTEM_'
INC.40UTLEI'S REC 1 #
PolityN BUILDING DI SION FEES
Company GAS-EA.SYSTEM-OVER4(EA) PLANCHECK FEE f t
❑ Certified copy is hereby famished.
❑ Cmifid copy is fled with the city inspection Division. GREASFpNDUSTRL wipGRADING FEE
CTRTIFICATE OF EXEMPTION FROM WORKERS' GRE,SETRAP CPAID
E
COMPENSATION INSURANCE,
(TTls section need not IN completed ifthe permit is for one hundred dollars(SER) SEWER-SANITARY-STORM EA.21X117. FE
orless.)
I certify that in the perforrnance ofthc work for which this pe6it is issues.)shall WATER HEATER WIVENUDELECTR
nm employ any person in any Income,ao as to become subject m the Woke"
Z Compmsaion Lawsof California. Date I WATERSYSTEMITRFATING Raeipfp
Applicant
Z 0 NOTICE T'O APPLICANT:IGuftcr making this Cenificam of Exemption,ywo.,muld NEW RESIDENT IAL PLM. SQ.ET. TOTAL:
1-^ LO hecmme subject the Worker's Compemmmon Provisions of the Labor Code,you muss
� fonowith comply with such provisions or this permit shall be deemed revoked. G IEE
d !� CONSTRUCTION LENDING AGENCY FEE /r
Z I hereby affirm that is a corvuction lending agency for the performance of
L) O the work far which this permit is issued(Sec.3097,Civ.C.) TOTAL: C FI E
tenders Name
U.
U Lender's Address QTY, MECHANICAL PERMIT FEE PLUMBING 'E
1 lenity that I have lead this ri,micmion and state thm the Arwo information is
�" u^ coral Iagree mcomply with all city and county oNinances and seta laws rtlatingm PERMIT ISSUANCE MECHANIC LFEE
building conswetion,and hereby authorize mpmxnlatives ofthis city toemer upon the
V z above-mentioned progeny for inspection purposes. ALTER OR ADD TO MGCH. ON TAX
(We)agree a save,indemnify and keep harmless the City of Cupertino against
liabilities.judgmems,casts andexpenxs <h may in any way accme against aid City AIR HANDLING UNIT(TO HkM CFM)
in consequence of the granting of f
/I Ile
It /,�L./ AIR HANDLING UNIT(OVER I0,000 CFM)
Stgnaam or AwNtan7Gatrector Dam EXHAUST HOOD(W/)UCT)
HAZARDOUS MATERIAIBDISCLOSURE HEATING UNIT(TO IOB4O00 BTU) Uat Receipt#Will the the Criam or infurore hupalC de,Chant smrc or handle hHea lthae materialas Cde,Secio the32(a)?no Municipal CWe,Chapter 9.12,and the Health and Safety IIFATING UNIT(OVER IW,IXNI BTU) TOTAL:
Code,Section 255J2(a)?
❑Yes 11 No VENTILATION FAN(SINGLEftESID)
BOILER-COMP UHP OR 100,000 BTU IS ANCE DATE
Will theapplicanf or fmurebuilding«cupanmucquipmenmrdevices whichemit )
• Dlsvllas do+e air conmminans u defined by the Bey Area Air Quality Management 901LER-COMP(OVER 100,000 BTU) p
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.EL PAID
D
I M1avc,cad the hazardous matenals aStAmmems under Chapter 6.95 of the %iq1 8
Culifomia I leallh&Safety Cade.S«tions 25505,25533 and 25534.1 understand flat 190r
if The builJing d«s n"I curemly M1avc a¢rent,IM1af iI is my mspamihilify I"nmify Ne SIT
occupant of the requirements which"lust he met pilar to issuance of a Certificate of
Occupancy.
Dwncnn aulhortmd agcnl Dalc TOTAL: ISSUED BY:
OFFICE
0- C1t.X of
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995;
Resident
22672 Silver Oaks Lane
Cupertino, CA 95014
Subject: 22672 Silver Oaks Lane, Permit#27628 - Deck/Stairs
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 fmaled,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
�w
P=ad on Recycled River
Ocav,
10300 Torre Avenue
Cupertino,CA 95014
of,
Cupertirio Building Division
(408)777-3228
(408)777-3333 (fax)
April 23, 1996
Resident
22672 Silver Oaks Lane
Cupertino,CA 95014
Re: Expired permit(copy attached)
Dear Resident:
According to our records,the referenced permit has not 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(408) 777-3228, so we may
arrange to extend your permit and schedule a final inspection.
The City of Cupertino requires a response within ten(10)working days from the date of receipt of this
letter. If we do not hear from you within this time,the building department will have no other recourse but
to resolve your permit as expired and discard the records.
Thank you for your cooperation,
Building Department Staff, City of Cupertino
•
Printed on Recycled Paper