27172 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO II1 UI eU RI AL P17RMIT NO
RUILDING mVISMN APPLICATION/PERMITPLUMBING-MECHANICAL �� 'I IGn
BUILDING PRO1IJECT IDENTIFICATION r
BUILDING ADDRESS: ///����aak 1I�' SANITARY NO. APPLICA'D/Or.N SUBMITTAL DATE
U �Mec� I11V1111+ LOT# /U �pL
OWNS N ME: PHONE, CONTRACI'OR'SNAMF.: LIC NO: l U
/_ Y sis-e A10 NIC CONTkOLp
'lll'1'BCT'A?NGINI?I:R: 2 1C NO: O.r ADDRESS: . �� ❑
e
'ON TAM: PHONE
QTY. ELECTRIC PERMIT IEE BUILDING PERMIT INPO
BLDG ELECT PLUME, MliCH
1-17RMEIISSUANCE 11
LICrt,Tom CONTRACT'OR'S DECLARATION APPLIANCES-RPSIDENTIAL TOB DISCR,/r+�
gUOC Ihmeby ofnn Nctl amlicemsedunr, itvisimtsof..Coda9 dmy la,emg with �✓
+3 00 full Jan,add of Division S of the Business and Professions Code.and my license is in PANELS
stfull tome and effect.
Qz Licem 'I Lic.p UP T02(IfIAMPS
Date Commoon 201-IIXm AMPS \\ S
�[1—NZ. ARCHITECTS DECLARATION OVERIIXm AMPS � Q.FT.FLOOR AREA $/SQ.Ff.
0045 lunde Mand my Plain Il her ed asp lie records.
rLt SIGNS ELECTRICAL
h��dd Licensed to ,.hot
w< OWNER-BUILDER DECLARATION SPECIAL CIRCIATAUSC.
°k10aF I hereby offimt tum I nm exempt from the Conrnctora License Law for the
W3mcw selbowi..aw....(Section 7031.5,Business and Professions Code Any city or county 'TEMP.METER OR POLE,INST.
�O which requires a permit to construct,alter,improve,demolish,or repair any structure
y
Y� thionesscensed ,mamantuires the vintruntfthe Cpemtiuo filLicense
I.. statement POWER DEVICNS _
<O 9(cthe,he fencing with Section oo,the
of Division
the Commctor's mal Pro LaionsCo ter
m 9 with Sation 9000 ) SWIMMING POOL ELECTRIC
e (comat mencing exewt )he Division the
Businesstio.Any vrm Code) VALUATION
'p _y onhohe 3exemptnyapomaad the basis for is thedeacmptt to civil
of OUTLETS-SWITCHES-FIXTURES
F } not
Section hundred
dialloor orapermir subjects the epplicanuoacivil penalty of
rid 226 not am,, rofhe mNnylloTmyem).
❑on the
work.
wihwed f vale(Se. 0,P1,Bsines, NEW RBSIDF.NTIALELIiC'fR IN SQ.Py STORIES TYPI?CONS]'RUCI'ION
a3— will dothewmk,Core:the rThe cture Corisnofmrc.dcde Law loss
apply to
Business
end Prbfesslons Comc'The Contractor',Liccmr Law does not apply m un owner of el
pmpartywhobuildsorimpmvesthereon,andwhrd.c uchwoAhimsclforthroug)ihis
employees,provided Nat such improvements are not intendedoreffered forsals.If, I OCO GROUP RES.UNITS
however,the buildingorlmpnwcmem is sold withinoneycar.f conaderinn,the owner- \ TOTAL:
builder will have the burden of proving thm he did not build or improve 6r purpose of
sale.).
❑ 1,as.wreroftim property,=exclusively c.nuacting with licenaedcontranors m QTY. PLUMBING PERMIT FRE FLOOD%ONE APN
construct the project(Sec.7094,Business and Professions Cale:)The Contractors
is PERMIT ISSUANCE
License Law does not apply man owner mpoi who builds or improver thereon,and
whornmmets lin such projects wiN a contractor(a)licensed punuam wine Contractor's
License law. ALTER BEA) FEE SUMMARY
❑ I i m exempt under Sec. a ,B&P C for this rwson BACK FLOW PROTECT'.DEVICE O DE :ES
SANITARY Y N
Owner Data DRAINS-!LOOKRUDE. RECRIn",
. , , .
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑kcThereby off thmlhave ncenifcete of consentmaelf-Insure,nrn certifcelect RECEIP 's
Waras'Criticism. PIXTURIS-PFR TRAP
prnsatinn lnsrmnce orncertified copy Hereof(Sa.3800,Lob CJ which PARK FEE YN
t rovers all employee's tinder this permit. ai, +.A I I ll' Ers RHCEIPTp
Policy p I BUILDING DIVISION FEES
Company - 'G'A - .SYSTEM-OVER (EA) PfANCHECK FEE
❑ Craniad copy is hereby famished.
❑ Certifind<npy is flW with The city inspection division. GREA$FJINDG$'I'RL AS T EFT GRADING FF.E
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOli's FI!li
COMPENSATION INSURANCE
(This section me ad not be ormpletM ifthe permit is trauma hundred dollars($100) SEWER-SANITARY-STORM EA.200FT, ENERGY FEE
or less.)
I certify that in the Performance ofthe work for which this permit is issued,l shall WATER HEATER W/VI?NT/ELIiCTR
not employ any person in any manner so as to become subject to the Workers' PAID
Compensation Lawsof California. Dote WATER SYSTEMRRFATING Dme Receipt#
Q Z Applicant
Z 0 Not ICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEW RESIDENTIAL PLM, SQ,FT. TOTAL:
.N. become subject to the Worker's Compensation provisions ofthe Labor Code,you must
�i 7 forthwith comply with such pmviaioneor his permitshull be deemed revoked. BUILDING FEE /—
0. CONST RUCTION LENDING AGENCY SEISMIC FEE
VZ Ihereby affirm that Nem is a crosstructionlcnding agency for the performance of TOTAL: ELECTRIC FEE
O
the work(of which this permit is issued(Sec.3099,Civ.CJ
Lender's Name
L,
F Lenders Address QTY. MECHANICAL PERMIT' FEE PLUMBING PEC
U I certify mat I have read his application and.rate that the almve information i.
correct.Ingrec to comply wih all city end county oNinnncee anJ.term lows rdatingm PERMIT ISSUANCE MECHANICAL PER
[F-' building construction.and hereby amhariu representatives ofthis city m enter upon the CONSTRUCTION'TAX
� mhovometnirned property for inspection purposes. ALTER OR ADD TO MECH.
(We agree to save,indemnify and keep harmdess the City of Cupertino against
liabilities.judgments,costs=it expenses which may in any way accrue against said City AIR HANDLING UNIT CFO 10,000 CFM)
in rorwa uemo of the granting of this permitA911 .
AIR HANDLING UNIT(OVER Id.wo CFM)
Slgnmum of Appllenm/Commemr jute EXHAUST HOOD(WMUM
PAID
HAZARDOUS MATERIALS occupy DISCLOSURE
BEATING UNIT(TO 100,003 BTU) Data Receiptk
Will me the Critical..
or future Municipal
ng occupant store 2.handle hazardous material
as defined by the Cupertino Municipal Cale,Chapter 9.12,and the Health and Sofery 1117ATING UNIT(OVER 1100.000 BTU) 'TOTAL:
Code,Section 25532(a)?
El Yes El No VI'ddTRAT10N PAN(SINGLE RFSID)
ISSUANCE DATE
Will me applicant or futurebuilding eccupam use equipmem ordevices which emit
BOILER-COMP(SHP OR 300.000 BTU)
hazardous air conmmn[s inuas dation!by the tlny Arco Air Quality Management BOILER.COMP(OVER IIYJ.INq BTU) -9 -
❑Yes ❑No NEW RESIDENTIAL MECH.—SQ.FI'. ®�
1 have and the hazardous materials requirements under Chapter 6.95 of the T 1 8
California Health&Safety Come,Sections 25505,25533 and 25534. 1 understand that s 10
if Ne building does not cumen0y have a reason,that it is my resgmsibility to amity the
occupant.(the requirements which must be met prior to issuance of o Cenifiatte of
Occupancy.
Owner or amhoriuJ agrnt
Data TOTAL: ISSUED BY:
OFFICE HC�[
� • 4
� q
ny.
City o
upertiuio
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 26, 1995
1110 Steeplechase Lane
Cupertino, CA 95014
Subject: 1110 Steeplechase Lane, Permit# 27172
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
Punteu un Her,VCletl R9ppl
Lawrence L.,Peck
• 1110 Steeplechase Lane
Cupertino Ca. 95014
408-252-0310
October 2, 1995
Building Division
City of Cupertino
10300 Torre Ave.
Cupertino Ca. 95014
Subject: 1110 Steeplechase Lane, Permit# 27172
To whom it may concern:
The contractor we hired did all the rough work on this bathroom remodel and I am now
doing the finish work myself. I am installing floor and wall tile and building in custom
cabinets and vanity myself. Due to a change in employment and other pressing family
matters I have not been able to complete this project as fast as I had hoped.
• Would you please keep this permit open for an additional six months.
Sincerely,
Lawrence L. Peck
•
'city of
4ipertino
10300 Tone Avenue
Cupertino,CA 95014
i
Building Division �.
(408)777-3228
Fax(408)777-3333
i
September 26, 1995
1110 Steeplechase Lane i
Cupertino, CA 95014
Subject: 1110 Steeplechase Lane, Permit# 27172
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