27354 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO
BUILDING .
- .. RICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PIG-MECHANICAL
BUILDING NG FROPRO27354
JECT'IUENTIFTCATION
OWL
(D/I�NG/yA�IIDRBgg: SANITARY NO. APPLICATIONSUBMITALDATE
`.'� / `I/ • I�r(� Y r• UNIT" LOT" 2 �
OW SAME: PHONE: CONTRACTOR'S NAME: LI
1� 39 -392-' v, C� tru on 627 59 "" `°"H°L"
• RCHITECT/ENGINEEN: LIC NO: AD S:� Qct ~ ❑
CONTACT: PHONE:
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
PERMIT ISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
I hereby aRrm Nat i son licensedundm JOB DESCRIPTION
pKZ Y PmVBunooal Carr and mmccense wish
+10W0 gectim]OW)of Division ofthe Business and Profession Code,end my license is in PANELS
V full tome and effect.
G Licenu Class Lic.p UP T02(IO AMPS
FF. ra Dau Contractor 201.1000 AMPS
ZOv`v'i� ARCHITECTS DECLARATION OVER IIXNIAMPS SQ.FT.FLOOR AREA S/SQ.FT.
Q Z-0 I understand my plans shall be used as public swords.
SIGNS ELECTRICAL
Licensed Professional
c' < OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
OaU I hereby affirm that I an exempt from the Conroctore License Law far the
3WF following
mason,(See..7031.5,Business and Professions Coact:Any city.,county TEMP.METER OR POLE INST,
�41 which mquims a permit to construe,alter.improve,demolish,or repair any structure POWER UI3VICES
Y� paoruiu issuance,elw requires Ne opplicmrfmsuch permit to filcesigned sutement
y�j app that he is IicenW pursuant o the Provisions of Ne Contractus License law(Chl
dKe� 9fcontnrcncing with Secuon]OW)of Divisim3ofthc Businceswd Aofcuims Code) SWIMMING POOL ELECTRIC VALUATION
ty_w marm he is cxcmpuhemfmm andthe breis for da"Ieged exemption.My smituim.1' Otl'1'LEI'S-SWITCHES-Fl%TURFS
kZ¢ Section 7031.5 by any applicant for a Permit subjects Ne applicant a civil penalty of
C� at mouthan roftheve dodrty,an yenipl, NEW RESIDPNTIALELECTR _SQ.FT. STORIES TYPE CONSTRUCTION
IC m❑ I,asnwnemftheproperry,ormycmployceswithwegeantheirsolecompensmion,
S will dothework,and thesweurc is not inualedurofferedforaale(Sm.7W,Business
and Professions Code:The Coamsetoes License Law does not apply to an owner of
property whobuildsmimprovesthereon,andwhodocssuchwmk himselfmthmughhis OCC.GROUP RES. NITS
owmemployms,pmvidtd wsuchimpmvcmmtsmnotimendcdmaffeudforsele.If,
however.the building Or impmvemcm is win within one year ofecmplmion,theawner- TOTAL:
builder will have the burden of proving that he did and build or improve for purpose of
role.).
[1I,as owner.fthe property,am exclusivelyconuacring with licensed contmcura to QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
construct the Project(Sec.7W.Business and Professions Code:)The Contractor's PERMIT ISSUANCE
License Low does not apply m an owner of property who bui las m i mproves Nercon,and
who em out u for such projects with o emtme�or(p liuned puscumUo the Contractor s
Licamem law. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
❑ 1 am exempt under Sm. ,B&P C for this moon BACK FLOW PROTECT,DEVICEOUTSIDE FEES
SANITARY Y N
Owner Data RECEIPT"'
DRAINS-FLOOR,ROOF.AREA,COND.
WORKMAN COM .camofoNDECLARATION SCHOOL TAX Y N
EIThereby affirm that lhave ecenificate of conunuo sel0inmm,mrecertificate of FIXTURES-PER TRAP RECEIPT"
Workers'Compensationlnurenmrmit. fiedcopy thereof(Sec.Jg00,Lab CJ which PARK IEC Y N
rs all employee's undo Nis permit. GAS-PA.SYSTEM-I INC.0 OUTLETg RECEIPT p
Policy p BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Cer if d ropy is hereby furnished.
❑ Certified copy is filem
'mepection division. GREASEANDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFION FROM W KERS' GREASEMAP i SOILS FEE
NSU(Ifid.ction..4d fifth pent t' un dreddollan(5100) SEWER-SANITARY-STORM FA.200FT. ENERGY FEE
thatt pd fyrwhim thapermitisiamed,10mil WATER HEATER W/VENT/ELECIRnot employ r s as became eobject to the Workers' PAID
ZCompcnetion Lnw Co WATER SYSTEM/fRFATING Dau Rtteipp
Applicant
Zz C NOTICE TO APPLIC :I,otter making this Cenificau of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
)r y become subject to the Workers Compensation provisions of the Labor Code,you must
forthwith comply with such provisions m this famous shell be deemed revoked. BUILDING FEE
IL) E CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affimt that them is a construction lending agency for the performance Of
V 0 the work for which this Permit is issued(Sec.3097,Civ.C.) TOTAL: ELEC TUC FEE
Lender's Name
OV
Lenders Address QTY'.' 4 ,.MECHANICAL PERMIT FEE PLUMBING FEE
I cent',that 1 have read this application and state Nat the above information is MECHANICAL FEE
�" 6W. correct.Iegm ucomply with all city and county ordlnnces and sum laws relating to PERMIT ISSUANCE
building comaetion.and hereby aumodu mimvtudves ofthiscity reamer upon she CONSTRUCTION TAX
U 7 above-mensioned property far inspection propel ALTER OR ADD TO MECH.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Ilubilitie udgmmau,costs andexpcnses which may in my way amme against said City AIR HANDLING UNIT(TO 10,01X)CFM)
n t/e ceof the ,cretin of Nis, it.
6 AIR HANDLING UNIT(OV CR 10.000 CFM)
nnA
Srgnmmrof AppmmVConuamor a I Mine EXHAUST HOOD(W/DUC11 PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt"
Will the applicant or(utum building occupant suss or loo all.harard m.material oe
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety HEATING UNIT(OVER IIXI,O(p BTU)
Cade,Section 25532(u)? VENTILATION PAN(SINGLE RCSID) �.
1:1 Yea 11 No
BOILER-COMP(3HP OR 100,000 BTU) ISSUANCEl]AaT►E-
. Will air
uPountar mfuure building by the uy,Men Air Quality
Management
t H'•9
Disarkous air<omaminmu n defined by the Bey Asea Air Quality Mvragemem BOILER-COMP(OVEIt 100,000 BTU) FFA �O
District? V
❑Yes ❑No NEW RESIDENTIAL MECN. SQ.FT.
I have read the honrdous materials reyviremems under Chapter 6.95 of the /�VjC. �19
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that LUN
if the building does not currently have a tenant,that it is my ormonsibiliry u study the L'>
occu Bans of the amuinements which must be met prim to issuance of a Care fate of
Ocmps rcy.
Owner or amhosixd agent Date TOTAL: ISSUED BY:
OFFICE
a,
City of
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 28, 1995
Resident
6693 Clifford Drive
Cupertino, CA 95014
Subject: 6693 Clifford Drive, Permit#27354 - Shower Repair
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
P:mled on Recycled Paper