27111 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO FcrRICA. PERMITNO.
APPLICATION/PERMIT PLUMBING.MECHANICAL
BUILDING DIVISION BUILDING PROJECT IDEN'T'IFICATION 27111
BUILDING ADDRESS: SANITARY NO. APPLICATIONSUBB'MI.TTAALDAU
J'IK Y h�Iq— UNIT# LOTH
OWNERS NAME: � PHONE: CONTRACfO ' NAME LIC NO:
el vet 1 �to8 496 3 N/c coNTROL a
�ARCIBIEC 'Ido GINEER: LIC NO: ADD ❑
CONTACI PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
13LDO ELEU PLUM8 MECH
PERMIT ISSUANCE ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL B IPfION
pwZ Ihereby 700maffirm thatl amliCensNunraiind rifesions Catered
mmmcing with ✓ /
"+s00 Section]008)mf Division Sof the Business end Professions COJe,and my license is in PANELS `
aU full force and effect.
F- ly License Class Li,# UP TO 200 AMPS I HI
m?mData Comractm 201-1000 AMPS IJV
Z8yz ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLOOR AREA 5/SQ.FT.
O Z_p I understand my plans shall be used as public records.
F S2+1-at SIGNS ELECTRICAL
QY�j Licensed Professional
�y'a'Q OWNER-BUILDER DECLARATION SPECIAL CIRCUff/MISC.
XOa V 1 hereby affiem that I nm exempt from the Conracmrs License Law for the
W 3 u FFi following reason.(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST.
F'Ir j which rrquirta a permit as constrvet,alter,improve,demolish,or repairbt�,'zumprior to its issuance,also requires Ne applicant for such permitto file a sigen" POWER DEVICES
ly=QO that heislicensed punvanno"he pmvislmns of the Comnmor's Liccner
9(commencing with Sec"ion?000)ofDivision J of eo Proode) SWIMMING POOL ELECTRICVALUATION
W w nr that he ix exempt IM1crefmm and the basis(or the cgeasr a prion.Ann of 112 OUTLETS 1 I QO
FZa Section 7031.5 by any.,heam fore permit supjerM x manuoacWtpenalty of SWITCHES-FIXTURES
5E m marc shun five hundred dollm.(S500).
MI= ❑ I.asowneroftheproprty,ormyemploymsw' asrhe leco activation, NEW RESIDENTIAL ELECT# _SQ.FT. STORIES t'YPE CONSTRUCTION
y3e—° will do the work.wJlhe svucmrcisnn"imm�deJ or fwed Jnwa,
` ,Bovines
and Rofcssions Cale:The Comnaor's Li«ns d« fo an owner of
puryety whobaiWsorimprove..IM1ereun and wh.,docssuchIforthmughhis
employees,provided th...
co up not" fr,,df.r,alc.If, OCC.GROUPbsever,Ihebuildingor juseomem issom inoneyeidne.theowner- ,�builder will have the burden ofpmvingt a mb Ieforpuryomof
sale.).
❑ Loo.wnernflM propedy.umexclusively cont- In�ensodcone«ursu QTY' PLUMBING PERMIT FEE FLOOD ZONE path
construct the Project(Sec.7044,Business and Professions Codo The C. -"a
Licenw Lawdoes not apply a an ownmofpropedy whobuildsorimproves"hc=.and PERMIT ISSUANCE
whocuntmets for such Projects with a omdmadm(s)licensed fai swam mme Convacud
License Law. ALTER-DRAIN&VENT-WATER(G)
❑ FEE SUMMARY
1 am exempt under Sec. B&P C for IM1is reason BACK FLOW PROTECT.DEVICE OUTSIDE FEES
Owner DataSANITARY Y_N
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR.ROOF.AREA. RECEIPT to
SCHOOLTAX Y N
❑ ers.hereby affmm rharlhaveecmifiwm of nmsem mself-in.vure,ora ccdificae of FIXTIIRFS PER,IRAP RECEIPT#
Workers'Cnmpenmtion Insomniac ora cerified copy thercof(Sec.39011ab C.)which PARK FEC Y N
coven all employee's under this permit. GAS-EA.SYSTEM-1 INC.4 OUTLETS RECEIPT#
Policy p BUILDING DIVISION FEES
Company
❑ Certified!copy is hereby famished. GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Ccmficd copy is Bled with the it,inspection division. GREASEANDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
('ITis section neodnm be conehood ifthe pamtir is for one hundreddoll.(§100) SEWER-SANITARY-STORM EA.200FT,
or less.) ENERGY FEE
I certify that in the pefformen«ofthe work forwhich this permit is issued,Ishan WATER HEATER W/VENT/F,LECTR
me employ any person in any manner so as m become subject In the Workers PAID
Compcnmrionlawsof Califomia. Dam WATER SYSTEM/IItEATING Date Neceiprp
Applicant
z C NOTICE TO APPLICANT:If.after making Nis Comficaeof Eaampriomyou should NEW RESIDENTIAL PLM. SQ.FT.
I'-' ZZ) become subject a the Worker's Compensation provisions of"he Labor Code,you must TOTAL:
forthwith comply with such provisions or this pend"shall be deemed invoked. BUILDING FEE
ped, Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z I hereby affirm that there is a con ometio r lending agency for the performance of
V C) the work for which this pemti"is issued(Sec.3097,Civ.C.) ELECTRIC FEE
Lender'.Name
Q U Landers Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
1 ccdify that I have read this application and sine that the above information is
(r-' W P. correct I agree to comply with all city and county ordinances and state laws relating in PERMIT ISSUANCE MECHANICAL FEE
_ buildingconsmaction,and hereby vuNorice eemaximadves ofthis city roomer upon the
U z aMve-mcminncJ property for inspection purposes. ALTERORADDTOMECH. CONSTRUCHONTAX
(We)agree to save,indemnify anal keep harmless the City of Cupertino against
ishililies,judgmems,costs and expenses which may in any way acerueagaim"said City AIR HANDLING UNIT(TO 10,000 CFM)
con"en5f of the granting mid,poemil.
AIR HANDLING UNIT(OVER 10,000 CFM)
101314?4
ignaturc of Applicant/Contiactor Data EXHAUST HOOD(W/DUCq
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Dae R<ceipl#
Will Jho applicant of froom building«cupam er 9.or and t e haemd,as material
revel,Section
the Cupertino Municipal Code,Chapter 9.12,and the Healthand Safely HEATING UNIT(OVER 108,000 BTU) TOTAL:
Colo,Section 25532(a)?
13 Yes El No VENTILATION FAN(SING LE RFSID)
Will lheapplicamorfummbtildingoecuponmseequipmenlnrdeviceswhichemit BOILER-COMP(3HP OR 1110,000 BTU) IISSSUANCE,DATE
Dhaz"rd" 1 defined by the Bay Arm Air Quality Management BOILER-COMP(OVER 1(18,000 BTU) y- A B
rs tic uv ❑Ycsam n ❑No NEW RESIDENTIAL MECII. SQ,FT
Lhread the hat dons materials requirements under Chapter 6.95 of the QC• ' 5 1994
esh),&Safely Code Seclim,25505,25533 and 25534. 1 undersand that
g does not currently have a amid,that it is my responsibility to notify the
the requirements which must be me"prior to issuance ofa Codifies,ofCI I s vsonsdageat Done TOTAL: ISSUED BY:
OFFIC
{
CiLv of
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408) 777-3228
Fax(408) 777-3333
September 26, 1995
Michael and Iris Ataee
1143 Stafford Drive
Cupertino, CA 95014
Subject: 1143 Stafford Drive, Permit# 27111
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 responsein 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.
I
Sincerely,
City of Cupertino
i
i
Pr'mf@d 011 Reelcletl Pave.