27706% APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -
(CITY OF CUPERTINO APPLICATION/PERMIT
BUILDING DIVISION r—
LICENSED CONTRACTOR'S DECLARATION
Ihereby affirm that l am licensed under provisionsofChapter9(commencing with
Section 9DD0) of Twisian 3 of the Rosiness and professions Cade. and on, license is in
full Ibme and sffi
Licenx Claes Lis.0
Date Contract(
ARCHITECTS DECLARATION
I undenland my plans shall be used as public records. -
Liccroscd Profession.?
OWNER -BUILDER DECLARATION
I hereby ailuro Btal I am r.coua lman the Cnntmelor'a License [.me for the
following reason. (Sean.. 0031.5, Business end Professions Cede: Any city or ..my
which reguiKa a permit to en ... met, tiller, Improve, demolish, a, repair any efracture,
prim to its issuance, also requires the applicant for such cermit to file a signed statement
that he is llce.sed pun and to the pen of the C.mrumm's License Law (Chapter
9 (asmmenciog with Section ]BBB) of Division 3 mthe Basle''' aced Professions Code)
orthat he is exempt herefrom and the basis for the alleged exemption. Any violation of
Section 7031 5 by any applicant for a permit subjects the applicant o a civil penalty.(
opt unite than rise hundred dollars 4500.
ELECTRIC PFRMIT I FIFE
PERMIT ISSUANCE
APPLIANCES - RESIDENTIAL
PANELS
UI' TO 200 AMPS
SIGNS ELECTRICAL
SPECIAL CIRCUIT/MISC.
THMP. METER OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETS -SWITCHES -FIXTURES
NEW RESIDIiN'UAL ELECT SQ. ET.
d3w
isIdo the work. and the structure is not intended or offered for sale(See91X4. Business
OUISIDEFEM—
II Professions Cede: The Contractors License law does not apply to an owner of
Y N
RE,CEIPTa
properly wbobu'Jdsorimpmves flu m .rand who does such work himselforthrough his
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timarpl.,ec WIbul such impmvememsurc mrintended nmffered (..tile. If,
RECEIPT' q
TOTAL:
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howeveq IM1e builJing orimpruvemenl i'salt within nneywofcompinion, Ihe.wner-
builder will have the burden of proving that he did not build m improve for purpose of
QTY. PLUMBING PERMIT FEE
BUILDING DIVISION FEES
sale.).
❑ I. as owncrofthe property, an exclusively Contrcting with he ... edcmnrucmrsto
consumer the project (Sec. 7844, Business and Professions Cei The Centrazmr's
License lavedo,mol apply ton owner ofpropeny who builds of improves thereon, and
PERMIT ISSUANCE -
SOILS FEE
whocontraclsforsuchprojeclswithacontmcaman 'cover purmantto the Contractor's
License Low.
AI T'IiR-DRAIN&VENT-WATER CA)-
❑ 1 am exempt under sec. , B & P C for mis mason
BACK FLOW PROTECT'. DEVICE
Data
Owner Dat
DRAINS - MOOR, ROOF, AREA, GOND.
WORKMAN COMPENSATION DECLARATION
❑ Iherehy affirm shell hove ecenifieale of arose.... sel GinsuK,oracenificateal
Workers' Compensation Insumnce or o certified copy thereof (Sea 3800, Leh C.) which
FIXTURES - PER TRAP
GAS - EA. SYSTEM -I INC. 4 OUTLETS
orsall employee's under this permit.
Policy w
Company
GAS - EA. SYSTEM -OVER 4(EA)
❑ Cenifiesl copy is hereby famished. -
GREASEBNDUSTTU. WASTE. INTERCEPTOR
❑ Certified copy is riled with the city inspection division.
CERTIFICATE OF EXEMPTION PROM WORKERS'
GBIASE TRAP -
COMPENSATION INSURANCE
SEWER - SANITARY - STORM EA. 20IFT.
(This section need not be completed iflhe permit is become hundred dollaK(S)0(0
or less)
WATER HEAT17RW /ELECTR
'
I ceNly that in the larfortmove of the work for which this permit is Issued, I shall
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ZO
not employ any person in any manner so as to become subject to the Workers
Compcnwnion Lawsof California. Date
Applicant
NOT ICG'1'O APPLICANT: If, afternntking this Certificate.(EnunPd.n, you ehoulA
WATER SYSTEMniIppI
NEW RESIDEN 1 SQ. FT.
h,come subject o the Worker's Compensation provisions of the Labor Cede, you must
.mss
forthwith comply with such provWrous or this permit shall be deemed revoked.
W 2
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I--' ,t
U7
CONSTRUCTION LENDING AGENCY
I hereby affirm near them is a construction lending agency for the Performance of
Ne work for which his permit is issued! (Sec. 3097, Civ. C.)
LembaCs Name
r'
QTY. MHCHANICAL PERMIT PEE
I.and,f's Address
I cerlily that 1 lin- maul (his +gsdielt ion and state thin the above information is
contest. Iagrec mcomply with all elyand county ordlaance.and state laws relatingm
building construction, and hereby authorize representatives ofthis city mems upon the
above-mentioned progeny for inspection purposes.
PERMIT ISSUANCE
ALTP.R OR ADD TO MECIL
a
(We) ages, tosave, odannify unit keep harmless the City of Cuperth+o against
-
liabililies,judgments, costs and expenses which rosy inan way cengl net¢ iJCity
AIR HANDLING UNIT(TO 10,000 CFM)
mug tceoflhe gmntingofibispermit, �
AIR HANDLING UNIT (OVER 10,000 CFM)
IxHAUS'I'l1pOD (W/UIICT)
SII e[ of Applicanl/Cunlrnetmr Data
HEATING UNIT (TO EST" BTU) '
HALARDOUS MATERIALS DISCLOSURE
ill the applicant or future building occupant slots or handle hazardous material
m defined by the Cupertino Municipal Code, Chapter 9.12, and the Health end Safely
IIIiATING UNIT (OVER 100,1100 B'FrE
VENTILATION FAN (SINGLE RESID)
Cede, Section 25532(a)?
❑ Yes ❑ No
BOILER-COMP(3HP OR 100,000 BTU)
Will ffica licanl or Rome huildin•occumnl mac lordeviceswhich emir
PP 6 1 quipmcn
BOILER - CHIMP(OVER 1W,OD0 BTU)
hmardous vie comaminums as defined by the Boy Are. Air Quality Management
District?
❑ Yes ❑ No
NEW RESIDENTIAL MECIL Is is '11. 11
1 have read the hazardous materials requirements under Chapter 6.95 of the
1
California Health & Safety Code. Sections 25505, 25533 and 255M. I understand that
if the building does not cumently have a tenant, that it is my responsibility to notify the
mupanl .f the rearm ...... col, which can't Is, ntl poor to I ommar of a C,nim.ce of
Orcupency.
Owner orawh.nzed agent Dam
T T I.:
OFFICE
27706
SANT�RY O. AI'I'LICA'HON SUBMITTAL DATE
Z -
NIC CONT'ROLa
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
❑ ❑ ❑
^^ JOB DISCRIPT'ION
SQ. FT. MOOR AREA "Q. ET.
BUILDING FRG
SEISMIC FEE
ELGCTRIC PER
PLUMBING pi
MECHANICAL FEE
CONSTRUCTION TAX
PAID
Dae
PAID
01994
Y uh (,Ur'CH I //yU
ISSUED BY:
FEE SUMMARY
OUISIDEFEM—
SANITARY
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RE,CEIPTa
SCHOOLTAX
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RECEIPT' q
PARK THE
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RE.CF.IPIF 0
BUILDING DIVISION FEES
PLANCHRCK FEE.
GRADING PHE
SOILS FEE
ENERGY FEE
PAID
Data
Receiptp
BUILDING FRG
SEISMIC FEE
ELGCTRIC PER
PLUMBING pi
MECHANICAL FEE
CONSTRUCTION TAX
PAID
Dae
PAID
01994
Y uh (,Ur'CH I //yU
ISSUED BY:
;f 14 • Ivf �
Cupeithio
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 26, 1995
Kullman
10331 Stokes Avenue,
Cupertino, CA 95014
Subject: 10331 Stokes Avenue, Permit # 27706
Dear Sir,.
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
E
P'w"'d Un F.ec;^.9ed P.lner