26922 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OFCUPERTINO BUILDING-F'CF.z°PR�' PERMITNO.
BUILDING DIVISION
APPLICATION/PERMIT PLUMIHNG-MECHANICAL ^�/N/1/N
_ BUILDINGPROJEC'I'IDKNEFICA'DON L MVLL
BUILDING ADDRESS: L SANITARY NO. APPLICATION SUBMITTAL DATE:
�O Y • UNIT# 'a LOTH ��
kJFN ;AME: PIIS: CO 3RAC1'OR'SNA t; QLIdCNO: Nrc VVVCONTROLp
C,kAeECI/''GINE(? : LIC NO: ADDRIi �/ ,t ',� 1 ❑
CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLOC Ii ff PLUMB MECH
PERMIT ISSUANCE
LICENSED CONTRACfOR'SDIiCIARATION APPLIANCES-RESIDCNTV.L
owzPoo Iherehy nfFfi Natl 3 offlunsedinss and Professions
Cods.and
(Commencing is in
WWWq Section7000)andefect. on.t of Ne Business and l'mfessions Coln and my license in in PANELS
KUU Licnsfull eeanJ effect. UPT02MAMPS `
Ia,Zu1 License Ciazs Liaq
y=y DaneContracer 201-1000 AMPS
ZOyZ ARCHITECTS DECLARATION OVER IWOAMPS SQ.IT,FLOOR AREA $/SQ,fT.
O Z—❑ I understand my plans shall be used as public records.
f-_-k� SIGNS ELE ICA(.
.'�.�.11 Licensed Prom"i...I
�yTZ'Q OWNER-BUILDER DECLARATION SI'E LCIRCULUMISC.
xdx O,L I hereby affimt that 1 am exempt from the Committees License Low for the
W3ay following reason.(Section]031.5,Businessamd Professions Cade:AnycityorcountyiMP.ME—BI OR POLEINST.
which rcgaire,a permit m construct,aper,improve,demalkh,or repair any stmtture
y°yI'IY� primmimis...nce,a)so...toresthcappficant Onb.oh permit o lileesigned statement FEWER DEVICES
y�jK�O that he is licensed pursuanno the provisions of be Cannot License Law(Chapter
aa�(o�i 9(atmmersomg with Section 7001 Division 3ufthe Business and Professions Code) SWIMMING POOL HLECTRUC, VALUATION
W--gym or that he is exempt therefrom and the basis for the alleged exemption.Any violation of
tzN Section 7031.5 by any applicant for a permit subjects the applicnsn to a ci vi l penalty of OUTLETS-SWITCHES-FI F,S
a0 not more than five hundred dollars MOB. -
KFo ❑do
work,
anheestrucy,ormyemtendedwiNwagesazthe(Sec.7044,Buatien, NEW RFSIDIIJ'TIAI. R SQ, STORIES TYPI?CONSTRUCHON
a3= will Pr the work,ande lie Conture tractor's
License
offiered wdoes not
to an Business
pandro erowholns Code Tho esteee,1keno Low does not apply to an owner of
owncnywyees,provided
that suchercon,andwhodaessuch workendea himselfortbrough his
veneer.theesilding or improvement
prove impmvememsen:ne iearoedaroffemd forthe on r- OCC.CROUP RIS,UNITS
bowever,theaveteorimprovementi Isoldwithinoneuild completion,theowner- TOTAL:
bnilJcr will have tM1c burden of proving that he did not build nr improve for purpose of
sale.).
[ILasowneror0c property,stn exclusivelycomreaing with licensed contractors e Q Y, PLUMBING PE IT FEE FLOOD ZONIi APN
om nsel the project(Sec.704c4,Business and Professions Codo:)The Contraemr's
License Luw Docs not.,dy loan owncrofpropcny who halibut lmpmvcs thrreomund PERMIT ISSUANCE A
whocomracts forsuch projects with acontractor(s)licensed put it the Conars t ALTER-GRAIN&V. -WATER EA) FEESUMMARY
License Law. (
' ❑ I am exempt under Sec. B&P C fm this reason BACK FLOW P 3'ECT,DEVICE. OUT.LUL
SANI'T'ARY Y N
Owner Date DRAINS-E, R,ROOF,AREA,COND. RECFIPr#
WORKMAN COMPENSATION ofco DEC".ta,rIN 'um SCHOOL TAX Y_N
❑ Iherehy affirm thatlhaveeccnifcae of cnnscmeself-insure,or a cenifcateof XT B5-PER TRAP RECFIP 4
Wnrkers'Cumpensution tax umnceorocenifieJ copy Nercof(Sec.38W,Lab C.7 which PARK FEE YN
covers.11'employee's under his Ixnmif GAS-EA.SYSTEM-]INC.4 OUTLETS RI:CEII'T#
Policy#— � BUILDING DIVISION FEES
Company
❑ CenifcA copy is hereby famished. I GAS-FA.SYSTEM-OVER 4(EA) PLANCHECK WE
❑ Certified cpy is filed withthe ay inspection division. GRPASFJINDUSTRL WASTE,IN'I PRCEPI'OR GRA DI NO FEE
J
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP
SOILS FEE
COMPENSATION INSURANCI?
(Thi"velionneed not 6ecompletelifthe pemtitisforonehundreJ dollors($100) SL+WER-SANITARY-STORM EA.200FT. INERGY FEE
or less.)
I certify that in the pen'ormanee of the work for which this psmit is issued,l shall WAT W/VII/ELECTR
not employ any person in any manner so as m become subject m the Workers' PAID
Z Compensationl.twsof Culimpria. Dom ATERSYST /1'RIATING . Date Receipt#
Applicant
� C NOTICE TO APPLICANt':If,afmr making this Cenificamaf Exemption,you should NEWRESIDENTIALPLMB. SQ.FT. TOTAL:
V) become subjecno the Worker's Compensation provisions fthe Lamm Code,you must
forthwith comply with such provisions nr this permit shall be Jeemal revoked. BUILDING FEE
W z CONSTRUCTION LENDING AGENCY SEISMIC FEE
5 I hcohy uffrm that there iso construction lending agency trade perfmari of
te
V O the work for which this pemtit is issued(Sec 309],Civ.C.) 0 ELECTRIC FEE
Ictal Na
0 me
U Lendees Address QTY, MECHANICAL PERMIT FEE PLUMBING FEE
I certify that 1 have read this application and same that the above information is
7^ S correct.I agree to comply with all city and county ordinances and state lows reining mI'IiRMI'T ISSUANCE MECHANICAL FEE
Inildingconnruction, it hereby amhonzerepesen es ofahis city to enter upon the - CONSTRUCTION TAX
U .bovc-meminned proptny for inspettier pu ALTER OR ADD TO MEC#.
(We)agree to save,indemn'fy and p ha asst Ciay of Cupertino egaimt
liuhilities,juAgmene,a sand pen' whic raying nn8uinstseid City AIR HANDLING UNI'TOO IO,000CFM)
in copse genii oft pe
AIR HANDLING UNIT(OVER I0.000 CFM)
gm.m fApplicaam/ am car Daae I EXHAUSTHOOD(W/DUCq
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IWOOO BTU) Dae Receipt
Will the applicant or future building occupant store or handle hazardous material
as defined bythe Cupertino Municipal Cale,Chapter 9.12,and the 11ea0h and Sm y HEATING UNIT(OVER I00,000 BTU) TOTAL:
CMe,Section25532(0)7
0 Yes CI No
VEMILA'I ION FAN(SINGLE RESID)
Will thcapplicnmorl'ante build ingoccup.nmseequipmenmrdevicuwhich anis BOILER-COMP(JHPOR IW,WO BTU) ISSUANCE DATE
haadous it rmaaminams as defined by the Bay Arc.Air Quality Management BOILER-COMP(OVER 100,000 BTU)
'Wrist?
❑Yes ❑No NEW RESIDENTIAL MECH.—SQ.FT. AUG ����
1 have read the hazardm
ous aerc
nads 9uiremrnts under Chapter 6.95 of the 2
California Health&Safety Code,Sections 25505,8533 and 25534. 1 understand that
if the building does not curren0y have a tenant,that it is my responsibility to notify the ( //
occupant of @e rcquiremems which nun be met poor m ismnnce of a Cenifcutc of Ler V Ur'CTI f 11Y(' - J
Occupancy.
Owneror amhoneed agent Dae TOTAL: ISSUED BY:
OFFICE
Cil. t�f
Cupertu7.o
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 26, 1995
Mr. Chen
22409 Saint Andrews Avenue
Cupertino, CA 95014
Subject: 22409 Saint Andrews Avenue, Permit# 26922
Dear Mr. Chen,
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 :,end 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
J
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