26975 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO ' '- "' PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 26975
N^ ^�a
BUILDING DIVISION BUILDING PROJECT'IDENTIFICATION L F6 `V/ /
IILDING ADDRESS ��'� � SANITARY NO. APPLICATION SUBMITTAL DAG
O
(l NIiR AMD: PHONE' aa CONTRACI'OR'SN E: IC NO'.
�i�"rJ mrC CONTROLM
kRCHITECT/ENGINEER: LIC NO: ADDRESS: ❑
CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE . ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
nwzI hereby fGrm that l am licensed under p (commencing JOB DESCRI N
woo ya pm Professions
Che le,and
mmenens N
FOOF. fall Section 7000)of Division 3nf the Business and Prokuions Code,end my license is in PANELS
y-ZF Licemceandeffect. /1 .��
o, [),Is ¢Class Contract
UP TO 200 AMPS (\(!_1�G%
m7y Da¢ DECTS or OVER I AMPS
Z FO v`ms Z' AHhall be CTS DECLARATION OVER IOOOAMPS SQ.M.FLOOR AREA g/SQ.FT,
O Z 1 understand my plans shall h used m public rtcoNs.
F.yF J SIGNS ELECTRICAL
Q xas< Cloned professional�r+ 6 OWNER-BUILDER from
m DECLARATION ON SPECIAL CIRCUIT/MISC.
KO c. I hereby n,(Se that I um cxcmpt from Nc Contractor's e:Any Lew for the
3O" following reason.(Section](13L5,Bminees and Professions Cuda Any city or county TEMP.METE OR POLE INST.
which regairea a permirro consrmct,alter,improve,demolish,or.,an any structure
prior to its issuance,also requires the arplicant for such permit ms file a signed statement POWER DEVICES
W25<0 Thal he is licensed pro,door to the provisions of the Contractors License Law(Chapter
aaxotas 9(commencing with Section70ai Division 3 of do Business and Prefcasions Code) SWIMMING POOL ELECTRIC VALUATION
W_rn or that he is esempl Ncrefrom and the basis for Neallcged caemption.Anyviolafinnnf
1—ZQ Section 703 IS by any applicant for a permit subjects the applicant to a civil penalty of OUTLETS-SWITCHES-FI%TURES
n rotation,than five hundred dollars($5WA
TCm n❑ l,asownentfthe t NEW RESIDENTIALELECIR _SQ.FT.
proper y,ormycmployees withwageseslhirulecompcnsation, STORIES TYPE CONSTRUCTION
y;. will do the work,and the swclure is not intended proffered forsalelSec.]Oe4,11miness
and Professions Code:*Me Cmttmi License Law does not apply to an owner of
property who builds orimproves darmort whodoessuchwork hinuelfor through his
own employees,provided that suchimprovementeare not intendedmoffend fort e.If, OCC.GROUP RES.UNITS
however,the building or improvement is sold within one yearofemmpletion,the owner- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
[I 1 TY, PLUMBING PERMIT
❑ Las the famfth(Sm.74,1, usinesvelycorofessio withde:) he Conactorse Q FEE FLOOD ZONE qpN
License the project(Sec.mann,Business and Professions Code:)The Conton.and
License Lawdoa not apply t nownaof to0s)whobuildsorimproves Nercugand PERMIT ISSUANCE
wbocse Law, orxuch projects with a<onlracmrts)licensed pursumun the Canvndnr's ALTER-DRAIN&VENT-WATER FA
License Lew. (' ) FEE SUMMARY
❑ I am cxcmpt under$c. ,B&P C for this reason BACK FLOW PROTECT.DEVICE V1'SIDE FLIES
SANITARY Y N
Owner Dem DRAINS-FLOORROOPAR h.COND. RECEIP it
EN
WORKMAN COMPSAT , ,
ION DECLARATION . SCHOOLTAX Y N
C3Ihereby affirm theilhaveacenificam of comm malt-insure,arattnifcate of FIXTURES-PER TRAP REC1i1PPp
Workers'Comprnsatinn Insurance orucenifieJ copy thereof(Sec.3800,Lab C.)which PARK FEE Y, EI
' N
t coven all employer's under this permit, GAS-EA.SYSTEM-I INC.4 OUTLETS RE' PTa
Polity If BUILDING DIVISION FEES
pany
[I CarriEW copy is hereby furnished. GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE 1
❑ M
❑ CenifiW ropy is filed with the city inspection division GREASfgNDUSTRI.WASTE INTERCEPTOR
GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE
COMPENSATION INSURANCE
('This section need nosh completed ifthe permit is famit,hundred dollars(SIM) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
orless.)
I certify that in the performance ofthe work for which this permit is issued,I shall WATER HEATER W/VEJT/ELECTR
not employ any Person in any rammer so n to become wbiecl m the Workers'
PAID
O z Compensation lows of Culifomn. Dam WATER SYSTEMI/IREATING Date Receipt p.
nprbeam
z 0 NOTICE TO APPLICANT:If,after making this Cmiicale of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TO'fA6.
1-^ a become subject to the Workerab
Worker's Compensation provisions of the Lor Cade.you must
a > forthwith comply with such provranns order permit shall h deemed revoked. BUILDING FEE
0. (� CONSTRUCTION LENDING AGENCYS17ISMIC FEE
Uz I hcmby afr,.Natlhem is a consmuction lcnding agency for the performance of
O the work for which this permit is issued(See309],Civ.C.) ELECTRIC FEE
Leaders Name
0 U Leine s Address QTY.EM
CAL PERMIT FEE PLUMBING FEE
I certify Out I have read this application and state that the move information isMECHANICAL FEE
W c rata. I agree,to comply with all city and roomy communities and state laws miming to
ubuildiagconstruction, dhembyauNomcmpreunmdvesofthiscitytoentauMnlhc
U z uMrvwmcno yfor'aspeclion purposes. ECII. CONSTRUCTION TA%
e .gr t s ,indemnify and keepharmlessthe City of Cu in a last jmd t is mtsandexpenseswhilla loan ayacc a inat sal iy (TO 10.000 CFM)in cisas quer t runtingnl'IhisAIR HANDLI (OVER 10.0110 CFM)
Signal f licam/Conimnor D� a EXHAUST HOOD(W/DUCq
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(10100,000 BTU) Do¢ Receipt#
Will Ne applicant m fame building occupant smrc m handle h caurdoas material
as defined by the Caperton Municipal Code,Chapter 9.12,and the Ilealth and Safety I HEATING UNIT(OVER 1 W,"BTU) TO L:
Cede,Section 25532(a)p
❑Yes 13 No VENTILATION I-AN(SINGLE RFSID)
WilIIM1ea licantorfmurcbuildingoccu am use BOILER-COMP(3HPOR 100,000 BTU)) ISSUANCE DATE
Pp p equipmenmrdevices whichemit
,gazardousaniel? air contaminants az defined by the Bay Area Air Quality,Management BOILER-GDMP(QVEH IW,tX10 BTU)
D
❑Ycs ❑No NEW RESIDENTIAL MECH.—SQ. I JKY �/�
L7I have mad the haeari materials rcgNrements under Chapter b.95 of the
Califomia Health&Safety Code.Sections 25505.25533 and 25534. I understand Out - V
ifthe building does not rurally have a tenant.that it is my na,mosibility to notify the //r. r . 19g.
of the requirements which most h met pnor m issuance of a Cacti of
Occupancy. bre...
Owner ca mmon>W.gent Dale TOTAL: ISSUED BY:
OFFICE
Ci U, of
Cupertiuio
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408) 777-3333
September 20, 1995
Charles Hanson
7617 Elderwood Court
Cupertino, CA 95014
Subject: 7617 Elderwood Court, Permit# 26975
Dear Mr. Hanson,
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 it's '
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. At
Sincerely,
City of Cupertino