28762 (2) APPLICQNTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT'PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL - PERMIT NO. 2 8 7^ 2
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL L lYJ( hV L
BUILDING PROJECT IDENTIFICATION
BUILDING DDRESS: � SANITARY NO. APPLICATION SUtlMITTAL DATI
9 2- 6usK, 701 s a g a�t� oC z or Q�2
OWNERS NAME: PHONE: COIRS A E: ( LIC
NO:
N/C CONTROLp
RCHI'IECT2NGINEER: g t1.LCy0: � AD Rp$S: � • � /Y ❑
TO` T R O
CONTACT PHONE: - BUILDING PERMIT INFO
Y, • "� ❑ Consaltant Fees Paid by Applicant(Initial) D ELECTPLUMB MECH
7 17 ❑ ❑ ❑
LICENSED CONTR R'S DECLARATION QTY ELECTRIC PERMIT FEE I hereby affirm that I an licensed aa&,provisions of Chapter 9 mommem,., - JOB DESCRIPTION
Roo wim Sectian]000)of Division Jofthe Business and Profealons Code,and mylicame is
ssa���� in full fame and effect. PERMIT ISSUANCE
Roo
F - [Is W L ❑KITCHEN REMODEL
I-UO Licence Class Comp APPLIANCES-RESIDENTIAL DADDITION� El PLUMBING RE-PIPE
W Q Date Com=nor
t,lARCHITECTS DECLARATION ❑MULTI-UNIT ' ❑STRUCRIRAL
PANELSp8'/_�Z 1 undersand my plans stall be used as public records ODIFIC
M14EY RION
Z.�pp � UPT0200 AMPS El INTERIOR IMNEY REPAIR
C� Licensed Professional 201-10gIn AMPS IMPROVEMENT
C6 fd •aj OWNER-BUILDER DECLARATION OVER IOW AMPS ❑BATH REMODEUREPAIR ODEMOLITION
y K I hereby affirm m
that 1 am exempt from the Comracrs License Law for the
IIx 3 L U following reasay.(Section 7071.5,Business and Professions Cade:Any city or county SIGNS ELECTRICAL []OTHER
ty p which requires a permit to construct.alter,improve,demolish,or repair any structure
poor to its issuance,also requires theapplocam forsuch Noun to file a signed statement SPECIAL CIRCUIT/MISC.
�!(} mat he is licensed pursuunuo the provisions of the Cammcmr's License Law(Chapter 9
pZa�O (commencing with Secua
ELECTRIC
n]OW)af Divisionlof the Business end ProfessionsCode)or TEMP.MLTER IN
OR POLL ST. COMMERCIAL:
a o e mat he it exempt merefmm and mLomas mis for e alleged exemption.Any violation of C3 NEW BLDG/ADDTHON DEMOLITION
^4• Section 7031.5 by any applicant for a permit subjects the applicanto a civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
Ynot more than five hundred dollars(SSW).
Q ❑
1,as owner of the Pmpeny,mmy, employees with wages as their ante compensation. SWIMMING POOL r—�]IMPROVEMENT
will do the soma and the swcutre is net intended reoffered for sale(Ser.70,f4,Basine0 IAOTHER
W and Professions Code:The Contractors License Law does not apply(=w e OUTLHTS-SWITCHES-FlXTURES r
R' .. property who builds or improves demon,and who does suct A
his own employms,provided that such improvements are not intended�'r aR o f I N�W RESIDENTIAL ELECfR SQ ET.
sale.If,however the building or improvement is sold within one yearofrompleaon,the SQ.FT.FLOOR AREA $/SQ.ET.
owne-1 udder will have the burden of proving that he did nm build or improve for par- '
poseofxuln.) - `
E]1,u m owner of the property,aexclusively contracting with licensed mntracmrs m TOTAL:
construct he project(Sm.]DW,Business and Professions Cade:)The Cnmmctors Li-
cense Law does not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FEE A O g�
who contracts for such projects win a mumcnr(s)licensed pursm A uant the Contractors D
License Law. PERMIT ISSUANCE
❑I am exvnptander Sec. ,B&P C for Nis on
Data ALTER-DRAIN&VENT-WATER LEA) p
OwnerWORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE Y VK City ser'
1 hereby affirm under penalty of perjury one oldie following declarations: / (a
❑ and w
_ --
I have will maintain a CenlfiteofCoosennoself-insure for Worker,Crofton. DRAINS-FLOOR OOP,AR ,CON . STORIES ECONSTRUCION
sound,as provided for by Section 37W of the tabor Code.for the performance of the
.,it for which this permit is issued. FlXTURES-PER P
1 have most will maintain Worker's Compensation Insurance,as required by Section
7700of me oboe .for Ne peAormanceofthe work Toros ' ti emit d. GA. . .SYSTEM-1 C. O LTS OCC.GROUP APN
My Worke Co c ration lnsumncecumerand Policy ' - -
Cersier: Policy FROM
� � S-E%. TE )
ERTIPIC O OF COMPENSATION
NFROM WORKERS'
COMPENSATION INSURANCE G A UhXZ WASTE INTERCEPTOR
BUH.DING DIVISION FP.FS
(This section ncednm be completed i(the permit is lorane hundred dollars(EI W) P. SE
PLANCHECK FEE
or less.)
(certify thatimhe Flerfnrmnnce ofrhe work forwhichthispermit is issued.IsAull SEWER-SANITARY-STORM EA.2W FT.
not emDlq%�mY person in 999999ggqIqq{YYYlYY'manner ao as to become subject to the Workers''Compen. ENERGY FL'E
O Z anon InMrbf Calj(omi e WATER HEATER WNENT/ELECTR
ADPlicantVV GRADING FEE ,
VJ NOTICE. PPLICANT:If,after making this ni home of Exemption,gnu should WATER SYSTEM?BEATING
a1� becumest jeer to me Worker's Coo pensation prmisinnx of me Labor Cade,you must SOILS FEE
w ry foMwim comply with such provisions or this permit shall be deemed revoked. WATER SERVICE .
ao
Z CONSTRUCTION is. ONLENDING AGENCY NEW RFSIDENTIALPIMB. SQ.FT. PMD Date Receipt#
L)0 I for w affirm mauhcre is a c d(Sec.30 lending agency for perfomunce of
Da 1-y Newark for which this permit is issue)(Sec.7(197,Civ.CJ
Lender,Address
T AL:
�L) Lenders Address 'TOTAL:
W I terrify mat I have read this application aM doe that the above information is BUILDING FELL
tortcorrect.I agree to comply with all city and county ordinances and state lows relating to QTY, MECHANICAL PERMIT FEE
U building construction.and hereby emasion rcmeaciumnesof this city no emer uponrhe SEISMIC FEE
above-mentioned property for inspection purposes. ` PERMIT ISSUANCE
(We)agree against
to save,indemnify add keep harmless the City of Continue ELECTRIC FEE
liabilities,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADDTO MECH. PLUMBING FEE
in consequence.(,he Branfng'of this per .
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,011)CFM)
ALFEE
CEREGUtas9'I[ONS� /� ea e- MECHANICTIONT
�,ppvv �uJ t/4� /V•16 // AIR HANDLING UNIT(OVER IO,IXXI CPM) CONSTRUCTIONTAX
Sig fApplicantlConvac Date EXHAUST HOOD(W/DUCT). HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hastri material HEATING UNIT LTD IWAOO BTU)
ns defined by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safely
Code,Smmm 25532m)] HEATING UNIT(OVER 100.000 BTU) ,
E]Yes ❑No VENTILATION FAN(SINGLE RESID) PAID
Date Receiplp
Will the applicant or future building occupant use equipment or devices which BOILER-COMP(LHP OR IW,000 BTU(
a=il hazardous are contuminams as defined by the Bay Arca Air Quality Management
District
[]Yes nNo BOILER-COMP(OYER IW,OW BTU) no
I have read the Inauspicious=aerials requirements under Chapter 6.95 of the Cali AIR CONDITIONER ISSUANCE DATE
fomia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH.' SQ.Fr.
building does anteune=ly have a tenant,that it is my msponsibility to notify the exampam
of flee requirements which must be met prior to issuance M a Led Brute of Occup'smy.
Ownermnalbuozed,put Dam TOTAL' ISSUED BY:
OFFICE
• '® 10300 Torre Avenue
CitA OfCupertino, CA 95014
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
May 23, 1996
Homeowner
11092 Clarkston Avenue
Cupertino, CA 95014
Re: Expired permit, (28762 copy attached)
Dear Owner:
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
•
Punted on Recycles PoPer