27324APPLICANT TO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY
CITY OFCUPERTINO BUILDING - LL Ecrl
PLUMBING - ME'
BUILDING DIVISION APPLICATION/PERMIT IWL)INGPROICCI'DDKNGIFICA TDN
PERMIT NO.
27324 73n4
HIIILDING ADDRESS : .�(I {�y s�
fJ�-i/t.i CJ�a'I' {— 1 UNIT LOT
SANITARY NO.
APPLICATION SUBMITTAL DATE
11'7 Y1
l l
OW I?RS NAME: ZONE:
s'xGil ea
CO ACI'OR'SN LIC NO:
�4
NIC
❑
CONTROLX
PRCIII'IEC'YIENGINEER: LIC NO:
ADURCg�_♦ /)�n.� _/f 0 I
CONTACT: PHONE:
QTY. ELECTRIC PERMIT PLtC
IiIC
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE.
� ❑
LICENSED CONTRACTOR'S DECLARATION
I hemhy affirm that I am licensed under provisions of Chapter 9 (commencing with
APPLIANCES -RESIDENTIAL
JOB DESCRI ION
PANELSfall
Section 0008 of Division din the Business and Profeesiom Code, and my license is in
effect.
nseelnd
License Clues Lic.#
License
UPTO200AMPS
Date Contract nr
R S
201 - 1000 AMPS
ARCHITECTS DECLA RATION
I under+tend my plans shall be used as public records.
OVER WMAMPS
SQ. FT, FLOOR AREA
M. PT.
SIGNS ELECTRICAL.
Lleun>ul Pmlcnvional
OWNER -BUILD ER DECLARATION
SPECIAL CIRCUIT/MISC,
hereby affirm that 1 an exempt from the Contractor's License Law for the
TEMP. METER OR I'OLC INST.
Co de: Any city., wunty
followwhichiequireoaermit
which requires permit re alter. improve, demolish,
toco3L9.Basite.iunitve, demolish, repair any mmaum
issuance, quires the fi
permitsLieaseLaA statement
priolnslcensedpursuant
POWER DEVICES
of The Co
to the provisions
thin n Ia ncinsed pursuant m the provisions of the Contractors License Lew ns Corte)
9(ronmmncing with Section ]BW)of Division Jof the Business mW Professions Cade)
SWIMMING POOL ELECTRIC
VALUATION
or that he is exempt demount and the basis for thealleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects he .,he., I. is civil penalty of
OIITLETg-SWITCIIPS-FIXTURE
nos more than five hundred dollars($5110).
❑ haxnwncrnRhe Progeny,ormyemploYm wiNwagesesnhei...lecompcnsutum,
NCW RLSIDENTI I. ECI'R SQ. FT.
STORIES
'fYl'F:CONS'TRUCTION
will do the work, and the tummre isnot mended mrolfered Easels (Sec. 7144, Business
and Professions Code: The Cman cmr's License Low fires not apply tu an owner of
prolerly who huildxorimproves themon.and whodtes such work himselforlamigh his
own employees, provided that such i mpruvemcnd ore not intended or offered fm sole. It.
OCC. GROUP
RES. UNITS
,TOTAL:
however, the building or improvement is sold within one yearofcompleslon, sheowner.
hander will have the burden of proving that he did not build or improve for purpose of
QTY. PLUMBING PERMIT FEE
le.).
❑ I,usownerofthepmo y,amexclusivelyeontmetingwithlicensedconUacmrsto
Iq.00D ZONE
APN
construct the project (Sec. 7044, Business it Professions Code) The Cminecmr's
improves thereoand
License Law doesnm apply tounownerofpropeny who builds m n.
p1iRMIT ISSUANCE
who amrtmc0 for such projats with a connectors) licensed partum to the Contmtoes
License Law.
I ALTER - DRAIN & VENT. WATER EO
FEE SUMMARY
❑ I am exempt under Sec. , B & P C for this mason
BACK FLOW PROTECT. DEVICE
OUTSIDE FEES
SANITARY Y N
RECHIITp
9ivner Date
WORKMAN COMPENSATION DECLARATION
�] ors'Compeasm thmlhave aceni0cam of consent yflnnsel Ninsure, nroccrtincmo nl
lnsuranccoracenili<ylpopy thereof (S<c. 3800, Lub CJ which
nes.1 Compare',
DRAINS -PLOOR.ROOP,ARP.A, CONT.
SCHOOL TAX YN
REClilfl'#
FIXTURES - PER TRAP
PARK IT!E Y N
ti
rs ill cmplo ee's undenhis s.
Y Penne
Policy a
OAS - CA.SYSTEM-I INC 40U'I'LETS
RECTUMa
BUILDING DIVISION FP.PS
IVISI
Company
GAS - EA. SYSTEM -OVER 4IRA)
PLANCHECK FEE
❑ Cenitiedcopyishrmbyfum,aI..
GREASEIINDUSTRL WASTE INTERCEPTOR
GRADING FEE
❑ Certified copy is filed with the city inspectiondiddion.
CERTIFICATE OF EXEMPTION FROM WORKERS'
GREASETRAP
SOILS ME
COMPENSATION INSURANCE
SEWER - SANITARY - STORM F.A. 20017.
ENERGY PEE
This section need not w completed ifihe permit is for one hundred dollars (f1Bud
or less)
WATB ER W/VENT/ELECTR
I ccrtifythat in the performamceof the work for which this permit is issued, l shall
so
not employ any Person in any m its to become subject to the Warkcoi
PAID
Cnmpwtsurlon Lnws of Celifomin. Date
ATP.R. EMITXHATING
Date Receipt#
Applicant
NUI ICE'I O APPLICANT: If, after making this Certificate of Exemption, you should
:W RESIDENTIAL PLMp. SQ. FT.
TOTAL:
become maccno the Worker's Compensation pmvisiom of Ne Labor Cale, you moil
fon ovith comply with such provisions or this permit shall he deemed revoked.
BUILDING FEE
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby offimr thuthem is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 301 Civ. C.)
A
ELECTRIC FEE
lender's Name
Lettuce, Address
QTY. MECHANICAL PERMIT PER
PLUMBING FEE
1 cenify that I have read his application and ,are then the above information is
correct. l agree no comply with all city and county ordinances and state laws relming to
PERMIT ISSUANCE.
MECHANICAL FEE
buildinlconstruction, and hereby authorize represennevesofthis city to enter upon the
ovcntioned property for imperil. purposes.
ahmm
ALTER OR ADD TO MSCI I.
CON59'RUCION TAX
I Ws) agree m save, indemnify uJ ef�tnrnuwa nM1c Ciry of Cupenino against
Iiahit ies,juit r cox os¢andexpe swh' hinny' anyway accrue against said City
AIR HANDLING UNIT IT010,000 CPM)
'nG coylt:nrIt gruritingo is n. >^�L
g1RHANDLING UNIT(OVER 10,000CFM)
tgoltureof Applmama Data/
EXHAUST HOOD(W/DUCn
PAID
HEATING UNIT(TO 100,000 BTU)
HAZARDOUS MATERIALS DISCLOSURE
Date Receipt p
Will the applicant or future building occupant store or handle hazardous rwmrial
as defined by the Cupenino Municipal Cale, Chapter 9.12, and the Health and Safely
HEATING UNIT (OVER 100,000 PTU)
Crile, Section 25532(u)?
ElYes 11 No
❑
VENTB.ATION PAN (SINGLE RISID)
Will the npplium orfinurebnilJingoeeupum oseequlpmenn nrdevimswhiclicaun
ISSUAN DA'1
h
BOILER COMPOUPOR 100,0110 BTU)
L�a`t,urdous air contaminants as ddined by the Buy Arca Air Quality Management
m
IIIicfl ❑Yes ❑ No
A
pOILER - COMP (OVER 100,f#q BTU)
pp
is
ry
® O
NCW RCSIOENTIAL MF.CII. SQ. FT.
1 have mod the hazvdous matenals requirements under Chapter 6.95 of the
C�/. V sF
California Health & Safety Code, Sections 25505, 25533 and 8534. 1 ursta
ndend flat
Hthe building does not currently have a tenant, that it is my responsibility to nmify the
cuput of the requirements which must be met poor to issuance of a Ceriricme of
Occupancy.
•I
ISSUED BY:
Owner nr uuthoozed agent Date
TOTAL:
OFFICE
M
Cupertiuio
September 26, 1995
Vince Merkhofer
21932 Woodbury Drive
Cupertino, CA 95014
M
Subject: 21932 Woddbury Drive, Permit # 27324
Dear Mr. Merkhofer
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
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
Printed or? Pocycloo P;ipor