27947 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
at Cht OF CUPERTINO HGnAINU-RECC'IRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL 27947
BUILDING 1'RDJECTIDEN7'IF'ICATION
BUILDING ADDRESS:j' - - SANITARYNO. APPI.ICATIONSURNIMALDATE
1 a�-
�4rLeY UNIT# LOT# 2
OR NAM : PHONE: CONTRACTOR'S NAME: LIC NO: N/C 7 CONTROL
OL p
RCIII'IECT/ENGINEERY LIC NO: a ADDRESS: 0
/d TAve. a, o
DIN ACI': If ION B:.ly3-y'7�� "* " � .a,u TSw
BUILDING PERMIT INFO
QTY: �I;'. F "�2-�'MECTRIOPERMIT FEE
BLDG ELECT PLUMB E i
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL 10tl DESCRIPTION
p
-0
.z, I hereby affirm that l amlicensed underpmvisiamofChapmr9(commencingwith
µI0W01= Section 7")of Division 3 of the Business and Professions Code.and my license is in PANELS
d'V k 1 11 force and off t. ��
FZ Vjy License Class `f^� I.ic.M � UPT0200AMPS
,<o, Date /_• .taa, Contractor 201-1000 AMPS
zC) za ARCIIITECPSDECLARATION OVER IOW AMPS SQ.FT.FLOOR AREA ! VSQ.FT.
07 C) l understand my plans shall homedns public rccand..'
gFroFW SIGNS ELECTRICAL'
�_J Licensed Professional
5 Was< OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
aWSOyF I hereby affirm that 1 am exempt from the Convectors License law for the
u13m following reason.(Section 7031.5.Business and Pmfeasioits Code:Any city se....nty
O TEMP.METER OR POLE MST.
J0 which requires a pi to croquet,titer,improve,demolish,,,,repair any svd
uuro
:RYA prior in its Mature,arso requires the applicant for such permitta Ne a signed statement POWER DEVICES
that he is licensed pursuant to the provisions of the Convector's License Law(Chapter
aa�C 9(commencing with Section 7100)of Division 3 m.he Businsei Professions Cade SWIMMING PoOL ELECTRIC
ov, ( 6wi ) VALUATION
Sectio 7031. b,zon,mpt rcfmced fthe perbecentorcte tsthicJexemption.Aiviny lommy of OUTLETS-SWITCH;.;-"''RES
not
oMore
thaniv mundredicantfnr$500).txuhjecutheapPlicum toecivilpenaltyof
KKCo ❑ Lvuwnerofthepmpeny,ormyemploy«swiNwagesestheirsolecompenserion, NEW RLSIDENTUL ELECfR .Ff. STORIES TYPE CONSTRUCf10N
y3� will do the work,and thestructure is not in¢ndedoroffaal forsale(Sec.7044,Business
and Professions Code:The Commences License Law does not apply m an owner of
properly who builds,,,improves thereon,and who doe,such work himselfor through hie -
ownemployms,pmvidedthaistshimprovemen"=notintendedoreffemdformle.If.
OCG GROUP RFS.UNITS
however,the buildingor improvemcm is sold within oneyearof completion,the owner. /
builderwill have Ne burden of that bedidnot build orim TOTAL: L .
proving prove rat puryose of
sale.). 93
❑ I,as owncrofihepmpeny.amexclusively contracting with liecroadcomunctors m QTY' PLUMBING PERMIT FI?I: FLOOD ZONE pPN
vnsvuct the project(Sec.7044,Business and Professions Code:)The Contractor's
License Luw dcesnot apptym an ownerofpropeny whnbuilJsorimprovesthereon,and PERMIT ISSUANCE
who convects for such projects with a convanor(s)licensed pursuantco the Commences
License Law. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
❑ 1 ant exempt under Sec. ,B&PC for this ream. BACK FLOW PROTECT.DEVICE OUTSIDE TEES
SANITARY Y N__ ~
Owner DateGRAINS.FLOOR,ROOF,AREA,COND. RECEIPTM
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y_N
1 hereby affirm tum 1 have o cmificam of consent m ulf-inmre,or a cenifcate of RECEI FI'Y
FIXTURES-PER TRAP
'arken'Compensation lmumnceortrcenifiodccpy thrnrof(Sec.3B00,Lob CJ which PARK FEE YN
ovmallemployce's under this pe t. RECEIPTN
.a/ r p— GAS-EA.gYSTEM-I INQ 4011TLETS
Pulicyp ALV✓�•G,{-,dL- —�r1J0-/ !an � BUILDING DIVISION PEES
Company _�6 Ld G gTI4 GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Cedifiedropyisherebymnothed.
❑ Codified copy is fited with the city inspection division. OREAS 18NDUSTRI.WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section need notbe completed lithe Permit is for one hundred dollurs($10B SEWER-SANITARY-STORM EA,200FT. ENERGY ME
or less.)
I certify that in Ne performance of Ne work for which this permit is ismed,l shall WATER HEATER W/VENT/ELECIR
not employ any pension in troy mesmer so as to become subject m the Widen' PAID
ZCampensuour Laws of California. Dem WATF.RSYSTEM/TREATING Date Receipt
Applicant
zO C) NOTICE TO APPLICANT.If.after making this Certificate oTBxemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
t—t p) become subject to the Workers Compensation provisions efface Labor Code,you must
CYi forthwith comply with such proviuinns or this fours shall be,deemed revoked BUILDING FEE
(�
CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that them is a construction lending agency for fie performance of
U O the work for which this pemri t'is bound(Sar.3097,Co.C.) TOTAL: Ii1.HCTRIC IEE
Lenders Name ae
O F Leneaders Address - QTY. MECHANICAL PERMITFL1' PLUMBING FEF.
U I.I dor that 1 have read this application and stem rhes the above awsre ding is MECHANICAL FEIi
correct lngreemcomply with all ciryand counryemativ xofthiand stat ne enter
rupin the PERMIT ISSUANCI;
bnildingamcured on,mtd for by ourifficuran manned.
ivuof this city mrnmr upon the CONSTRUCTION TAX
(� z shove(We).,me pmpertyfor inspersion peep hose ALTER OR ADD TO MECH.
(We)s6rce n nuvq indemnify expo sod keep harmless the City of Cupertino id City _
incoisequenc mend,cosuand of this permit. moyinany weyeccme again.svd City AIR HANDLING UNIT LTO Il1,0W CFM)
consequence of the gmntin6 of this permit.
AIR HANDLING UNIT(OVER I0,000 CFM)
Silicon.of Applictudah7 mutter Dato HNHAUSJI U GG(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNITOO 100,000 BTU) Date Receipt g
Will the applicant or future building occurred store or handle himudous material HEATING UNIT(OVER 100,"BTU) TOTAL:
as defined by the Cupeni..Municip d Code,Chapin,9.12,and the 11.11h and Safety
Cade,Taction 25532(a)7
❑255yes 11 No VENTILATION FAN(SINGLE REBID) q�
BOILER-COMP(311P OR 100,0(X1 BTU) P aEiSUANCE DATE
Will theapplicantedfutum buildingavcupant useequipmem ordevices whichemit v1 ( U
Zirho?s air contaminants m defined by the Bay Arca Air Qualify Management
BOILER-COMP(OVER IoO.WOBTU) _
aM
13EI5Yes No NEW RESIDENTIAL MECIi, SQ.IT. DEAR 1O(II��^
I have mad the hazardous S.ti.als requirements ander Cheerer 6.95 nd the ,7a7C (7���1
if lifamilding dh&Safety Codq have
a ns eem,that
it is ayd responsibility
l uy it)pond Nm VI- (e(�
if the building da.nm currently have a tenant,Nat it is my reaptsmibiliry m notify the r L'n I IIS J
cupof the rcquimmenu which must he met prior m isswnce of a Certificam of
Occupancon cy.
)wner oramhodred aganr Dme TOTAL: O ISSUED BY:
OFFICE
i
1 10300 Torre Avenue
Cupertino,CA 95014
PC, of
Cup ertul o Building Division
1 (408)777-3228
(408)777-3333 (fax)
June 18, 1997
Homeowner
21427 Krzich PI
Cupertino, CA 95014
SUBJECT Permit#27947
Dear Homeowner:
We have been going through our files in the Building Department, and contacting those
people with permits remaining "open.
According to our inspection records,the subject permit has-not had a final inspection.
Many times an inspector will sign the permit in the field, but overlook reporting all of the
information to the clerical staff for input into the computer. If this is the situation and
your permit card shows the final sign-off, would you please contact us so we may
complete our computer records?If the permit is not signed off, please call to schedule an
inspection for final closure of the permit.
Because of the large volume of paperwork within the building department, we cannot
separately monitor the progress of each permit. We ask that you give this notification
your immediate attention. If we do not hear from you within ten (10) working days, we
will dispose of the file and remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
Printed on Recvcleo River