28194 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OF CUPERTINO J. BUILDING-ELECTRICAL PERMIT Na. 28194
APPLICATION/PERMIT PLUMPING-MECHANICAL.
BUILDING DIVISIONINIhDING PRO.IRf.r IDENTIFICATION
BUILDING ADDRESS: u ` SANITARY NO. APPL ATIONSUBMIL'
'TIALDAT
+�/
b
S I>Su N� � ,UNIT# 1.0'1'#
OW F.RS NAME: PONC: CO RACfOR'S NAME.: aLIC NO:
Dmon C G OD NIC COM ROLA
RCHITECT/ENGINEER: LIC NO: ADDRESS:� ^ El
CONTACT: PHONIi: 3
QTY. hLECT'RIC PERMIT' FEE BUILDING PERMIT INFO
ECH
'mm Fol.Lel— y�B 2-77-4,6,4Z) PERMIT ISSUANCE -BQ HLfC'I' PLUMB M-1
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION❑MH DESCRIPTION
Metz 0LD Ihereby 000).1affirm ision 3 ofd a,Business
Bins add rofesions Cner9(commencing with
[^00 See,!..7000).1
and) fices.ision9ofthe Hminess.W Professions Coale.and mylicense isin PANELS
<UF5-. fall force Claseffttt.
F yVy yVj License Clms Lid.If UP T0200 AMPS
Qy Date C.ntmamr 201-1000 AMPS
Z CNZ ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.PLOON AREA E/SQ.PI'.
OZ�G l understand my pl.m,shall be used.,public records.
Fy(_J In
SIGNS 17LECIRICAL.
7U Licensed Professiond
OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
x Oa F- I hereby affirm mm at 1 aexempt from the Comments License Law for the
ts134rn following reason(Section]031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST.
t
which Termites a permit to construct,alcor,improve,demolish,or repair any structure
prior to its issuance,also requires the spheral forsuch permit to file a signed statement POWER DEVICES '
C DOC mthat he is licensed pumuamrto the provisions of the Communes License Law(Chapter
a KILL 9(camereing with Section70(fJol'Diviumn 3ofthe Busires,aProfessions.fessions Ce) I SWIMMING POOL ELEM RIC VALUATION
W .,,but he is exempt therefrom and the basis for dmi leged exemption.Anyvi.Imion of OUTLEfS-SWITCfIfS-IIXTURIS
t l,,¢ Section 7031.5 by any applicant for a permit subjects the applicant a civil penalty of
not more into five hundred dollars(S503).
K p - ❑ I,asownerofthepmpay,nrmyemploymswithwages.stheirsolecompcnsation, NEW RISIDEhIT1ALELECR SQ.FT. STORIES TYPECONS'IRUCTION
will Bothe work,anJ rhe xlructurc ix nntimcndeA mrofferEJ forsule(Sec.]1W4,Business
and Professions Code:The Contrncmrs License Law does not apply to an owner of
prmpeny who buildsorimproves themon,and whodoes such work himselforthrough his
employees,provitled that such imprnvemems.rcnotimendeJ oroffercd forsale.If, OCC,GROUP RES.IIN1'1'S
however,he building orimprovement is sold wit hn neyearofcompletion,theowner-
builder will have the burden of proving 1M1m he]111 not build or improve fur,repose of
soled.
❑ I,axownerofthe property,am excluslvelycmnracting with licensed convenors t. QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
comstrun the project(Sae.7044,Business and Professions Code:)The Contractors
License Lawdms nmtapplym.nowncrofpropeny who builds.,improves thenem,and PERMITISSUANCH
whocommcts(orsuch projects with a contractions)licensed pursuant m the Com addia's
License Law. ALTER-DRAIN&VP,NT-WATER(EA) FI?E SUMMARY
❑ 1 am exempt abler gee. ,B&PC for this rcuson BACK l\4 i'Rw'Is OUGSIDEFEVSV
SANITARY Y N
Owner Date RECEIPT R
ORAINS-FLOOR,ROOF,AREA,COND.
WORKMANCOMPEeme.foNDECLARATION SCHOOL TAX Y N
❑
Workers
reby Compensation adonInsurance
hrance ori cemcofc copy
trmical mcf(Sesure,or std,C.) hich FIXTURES-I'IiR TRAP RECEIPI'p
Workeri Comperosmioainirflou oracenifiedcopy thermf(Su.38IXl,isb C.)which PARK IrHE Y N
covers Ill employee's under this permit GAS-IA.SYSTEM.I INC. I. RECEIPT p
Policy q 4 BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER PLANCI IBCK FEE
❑ Ceniliedcnpyishmthyfurnished.
❑ Cerlilied copyis Nedwith the city inspectiondivision. GREASE/INDUSTRL WASTE INTERCi"I'O GRADING Fl
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE,
COMPENSATION INSURANCE
(This xenon neednot be completed if Ne Permit is far..hundred do][.pi IM) SEWER-SANITARY-STORM EA.201 ENERGY FEE
or less.)
I lanify,that in the peofomoneatfrhe work for which this permit is issued,)shall WATER HEATER W/VENT/HLECTR
not employ any person in any manner so as to became subject to the Wormal AID
Compenxtlonlawsof Culifomia, Dale WATER SYSTHM/I'HEATING 4 Date Reuolpia
Z Applicant I Tr
Z 0 NOTICE'1'O APPLICANT:IL after medin this Curificme of Excm Y
Z g p mude.yxishould
most NEW ftESIDEN IAh PLMB. SQ.F1'. TOTAL:
F !n become subjectaply the Worker's Compensation pfovisionsmfthe Labor Crude. must
a �
forthwith comply with such provisions or this permit shall be deemed avoided. BUILDING FEE
z CONSTRUCTION LENDING AGENCY SEISMIC FEE
1 hereby affirm thin them is a construction lending agency for the performance of
C..) O the work for which this pemrit is issued(Sec.3097,Civ.C.) 'TOTAL: ELECTRIC FEE
Lendees Name O PLUMBING[,'[it,;F Lender's Address QTY. MECHANICAL PERMIT FEE
V 1 certify that 1 have read this application and state that the above information is
Fa cures. )agree mc.reply with ail city end c.umy ordinances and smmlaws relmingm PERMIT ISSUANCE MECHANICAL FEE
y buildingcomtruction,and hereby mdmfimrepresenmlivcs.fthlx city m enter upon the CONSTIt UCTION TA%
U z above mentioned property fm inspection purposes. ALTHRORADDTOMECII.
(We)agree m over,indemnify and keep harmless the City of Cupertino against
liabilitim,jadpotals,costs and expenses which may in any way accrue against said City AIR HANDLING UNIT(TO 10.000 CFM)
e of the'.rein of this permit.
AIR HANDLING UNIT(OVER 10,000 CPM)
'g minof Applicam Commcmr P.tc EXHAUSTII00D(W/DUCp
PAID
HAYARDOUS MATERIALS DISCLOSURE HEA'I'[NO ON]']*(10 100.070 BTU) Dole Receipt#
Will the applicant or fame building occupantstoreor handle turnabouts material
as defined by We Cuperl me Municipal Code,Chapter 9.12,and the)health and Safety HEATING UNIT(OVER IOB000 BTU) TOTAL -
Code,Section 25532(a)7
11 yes ❑No VENTILATION FAN(SINGLE RISID)
BOILER-COMP CHP OR 100,030 BTU) Vk1ANSC&DATE
Will Oeapplicanrorfummhuilding occupant use eyuipmcmordevimswhichemit PF P� 0U 1J
h atom an,cormaninumme
s us defined by the Bay Area Air Quality Managent BOILER-COMP(OVER 1110,000 BTU)
=Net'
❑Ycs ❑No - NEW RESIDENTIAL MECH.—SQ.FT. JUN 19 1995
I have read the haaardous materials requirements under Chapter 6.95 of the n�l i
CalifoSoriano,one Health Come,Secns 25505,25!]3 and 25534. 1 andernead that VI�r Vurt� U
if the building does mol currently have.Ianant,thea is my responsibility to notify the
occepul of the requiremcros which must be met prior m issuance of u Certificate of
Occupancy.
Owner.,authorized agcm Dare TOTAL: ISSUED HY:
OFFICE
1
a JUN18 1935
OlDt3:INPEGTfON:DEPARIT
rr� � CITY .CIF GDPETtTINO.. "
K
• . .
OFFiCE COPY
PLOT PLANS f
CBE Y
AY
1PLANNINC
BA` C CA r.l DEPT,
ri
• BLDG. Dk
f ,
r.
10300 Torte Avenue
• Cupertino,CA 95014
Ci1c rl
Luper illo Building Division
(408)777-3228
(408)777-3333 (fax)
April 23, 1996
Resident
1451 Saratoga-Sunnyvale Road
Cupertino, CA 95014
Re: Expired penhit (copy attached)
Dear Residenf:
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
•
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