0864 (2) CITY 01' CUI1F.[1,T'1NO INSUCTIOt! RECORD (Office Copy)
0864 _ 10614 Lonna Lane _
PEPdII'r tI0. SANITARY DIST. No. LOT id0. ADDRh:SS
'S Plumbing Ken Dorst
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
BuI]dintt Date Insp.
Electrical Power PoLe
I'Lumhing — — Underground
Mechanical P.ou ;h Wiring _
T'cmp. Cas/IRlcct. Fla] s
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign [lotors
Grounding
[fisc. Temp. Power
Other
FINAL. INSPECTIONS Not Approved
Date Insp.
"S PLUMBING
Electric Date Insp.
Plumbing Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rou h
Grading b Rough Complete
FireDe Solar Rough
F
Fire De t. Water & Insulation
Health De t. !4a in Drain
BUiIdin RS Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
['ad Certification MECHANICAL
Foundation Date Insp.
Pre—Gunite Underfloor S.M.
Slab—Membrane Ducts & Insulation _
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & ]food
Tiedowns One flour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
lial.ls—Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Wallboards Int/Ext .
Firewalls
Other
Not Approved
f
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -'USE BALL POINT PEN O
/
V-4�"BUI LDING PROJECT I DENTI FICATI ON RV IT NUMBER'
B�,UD,HO - APPLICATION & PERMIT' 08(; /�
AooHEss J / U u 4
/ Ld "LN BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'$ f! PLAN CHECK VALIDATION
NAZI/ p
OTV. ELECTRIC PERMIT FEE
awts HONE
NAME
CONTRACTORS OUTLETS-SWITCHES-RECEP _ 5.00/1.00
UC,NO. LIGHTING FIXTURES 5.00/1.00
DDRESCrOns
As PPLIANCES-RESIDENTIAL 4.00 - -
ODREs
PHONE PANELS ' 5.00 DATE OF APPLICATION
ARRCHITECi'. SIGNS 6.Dtl PLAN CHECK FEE .P.C.NO.
ENGINEER
uc.NO. SIGNS TRANS. 3.00
ADDRESS5.00ENG SPECIAL CIRCUIT - 5,Q0 PERMIT VALIDATION
ZIP rrEMP.METER OR POLE INS. 15.00
ADDRESS rs - MOTORS SEE FEE SCH.
ADDRESS -
SERVICE CHANGET 10.00 /7 ,
w o o� LICENSED CONTRACTORS DECLARATION I�N �/r /
a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N w (commencing with Section 7000)of Division 3 of the Business and
u g I• BLDG. ELECT. PLG. MECH.
F N i Professions CoJu,and my license is in full force and effect AJIG J ❑ ❑ ❑
o i m W License Class Lic.Number
11101
Date Contractor
P, x f - - BUILDING PERMIT
c'a OWNER-BUILDER DECLARATION
a o a o - ` - INFORMATION
X ; y I hereby affirm that I am exempt from lbc Contractor's License MISC.- EFER TO ORD
H Ii o a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00 VALUATION $/FT.
fw0P Code:Any city or county which requires a permit to construct,alter,
IF < Dimprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO, ELEC.
wD M requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
$m he is licensed pursuant to the provisions of the Contractors License
z <
Law(Chapter 9(commencing with Section 7000)of Division 3 of the -
i D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
at H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; by any applicant for a permit subjects the applicant toucivilpenalty ALTER-DRAIN& VENT-WATER (EA.) q.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.'-DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure rs not
intended or offered for sale (Sec. 7044, Business anti Professions DRAINS-FLOOR,ROOF;AREA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner of _
property,who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself re through his own employees:provided that such improve-
ments
buildi e-
himself a throuot gh
or emplo ee sal rovided that s thebuildingGAS-EA.SVSTEM e.I INC.40UTLETS 4.00
or improvement is sold within one year of completion, the owner. GAS-EASYSTEM-OVER 4 (EA.) 100 BUILDING USE
builder will have the burden of proving that h . . .
e did not build or int- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ . ❑ El 1:1 1:1❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec..7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. -5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law dols not apply -
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for such projects with contractors)licensed pennant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 " TRACT NO. PARCEL NO.
❑ lam ex e pt under. ,B.&P.C.for this WATER HEATER W/VENT 4.00
\I rexso
7� Dateowner
s- Lyv-r_T WATER SYSTEM 4.00 ACC.DATE ACC,FILE NO.
WORK F.RS'COMPENSATION DECLARATION- WATER TREATING EQUIP. 4.00
I hereby affirm that 1 have a certificate of consent to sal Ginsure, �� ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,LAC.).
Policy No. Company
0 ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified Copy is Filed with the city inspection division. MISC.- REFER TO ORD.
O .Applicant - Y ❑ N Y ❑ N❑
~ r2 PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
. CERTIIICATIi OF EXEMPTION FROM WORKERS
LU COMPENSATION INSURANCE: PLG.CONTR. LIC.NO. PLG. /i/CJ-O Y❑ N❑ Y ❑ q❑
IL O (This section need notbe completed if the permit is for one TOTAL T
0 Z hundred dollars(SI00)or less.)
U O 1 certify that iarbe performance of the work for which this per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY
'LL r mit is issued,I shall not employ any person In any intoner do as t0
U become subject to the Workers'Compensation Laws of California.
0 i Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} N NOTICE TO.APPLICANT:.If,after making this Certificate of Ex.
? Cmption,you should become subject to the Workers'Compensation APPLIANCE - 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with 'FEE
G such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. - -- MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
Lender's Address H EATI NG UN IT(OVER 100,000 B.T.U.17.50 ELECTRIC -
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 /� DO
information is correct I agree to comply with all city and county PLUMBING
-� ordinances and state laws relating to building construction. and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 4.00
h hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,o00BTU)SEEFEESCH. MECHANICAL
abovrmemiora d property for inspection purposes.
h (We) agree to save. Indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
May in any way accrue�q,mill said City in consequence of the
grant
in f his permll:J l MECH.CONT. LIC.NO. MECH. TOTAL .
��11/ TOTAL
Signlure of Applicant/Contractor Dxte -
OFFICE COPY ,
t
• Cit4 of Cuvertino
10300 Torre Ave
(408) 252-4505
Ext: 228,229
2-25-83
Ken Dorst
10614 Lonna Lane
Cupertino, Ca, 95014
Dear Sir,
After reviewing our files, we find that permit no. 0864
• issued on 8-17-81 f6r Plumbing
has exceeded the maximum alloted time of 180 days since:
11 1.) Permit was issued.
2.) Last called inspection.
Options for renewal are listed under Sect. 303(d) 1979 Uniform
Building Code. (enclosed)
In order to close our files, your cooperation would be appreciated.
CITYOFCUPERTINO
John Busto,
Building Official
JB:jj
Ruth Dorst
10614 LONNA LANE CUPERTINO,CALIFORNIA 95014
March 1, 1983
City of Cupertino
Building Department
10300 Torre Avenue
Cupertino, CA 95014
Dear Sir,
As instructed in our conversation of February 28, I am writing
this letter to confirm that our sewer connection was installed to
code standards. The inspector possibly forgot to sign the permit
upon leaving our home. I do remember, though, his instructions to
"Cover it up." which would not have been given if he felt that out
sewer line was incomplete or incorrectly installed.
Thank you for your swift and understanding cooperation in this
matter. It was certainly appreciated.
Sincerely,
�lY/`��
• Ruth L. Dorst
permit #. .0864
MAR ,3 1983
OLDG.CITY OF ICUPERTINOMENT,