28607 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO ' I BUILDING—ELECTRICAL PERMIT NO,,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECBANICAL 2 8 6 O�"
BUILDING PROJECT'IDENTIFICATION
BUILDINGADDRE.4S: _ - _ SANITARY NO. APPLICATION SUBMITTAL DATE
OWNER' NA PITON . CO Ii IOItS ME:' LICN
t.` N/C - CONTROL
AR( IITECI'/E GLNEER: - LIC NO:- t AD R SS: - ❑
CONTACT: - - , - PHONE: BUILDING PERMIT INFO
• '/ - "'u ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELE 't PLUMB MECH
LICENSED CONTRACTORS DECLARATION QTY. ELECTRIC PERMIT NEIi f
1 hereby affirm that
l' licensed n m p s of Chapter 9 mormie tr ng "' JOB DESCRIPTION
with Seaton 9000)nfD"' ] Dh BusinessmanY fissions Code, Jnylicense is - - RESIDENTIAL:
�� full force soda PERMITISSUANCE q t
�Uu1F —e r—'/ ❑SFDWL ❑KITCHEN RF-PIP.I.
U Lsens y card APPLIANCES—RESIDENTIAL. []ADDITION "PLUMBING RE-PIPE.
in L Dote Cont t
CHITECTS TION ❑MULThUNIT []STRUCTURALF7tpa PANELS
ZOv�`j 1 dersr i ry � se antic �orde " ' „a ' , r MODIFICATION 1,
p7,F t- UP1'0200AMPS ❑INIPRIOR El CHIMNEY REPAIR
�.� Lim. to
nd - 20I-I1100AMPS .IMPROVEMENTrG� OWNERBUILDER DECLARATION
fK1hfirm that I am exempt from the Contrecm Ltoense Law for the OVER N XIMAMPS El BATH REMODE PAIR DEMOLITION
3 6 U followingSection 1031.5.Business and professions Code Any city or county SIGNS ELIiCGtICAL "❑OTHER
LL which requires a permit to construct,alon,,impmve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such Permit o file a signedxtaaotent SPECIAL CIRCUIT/MISC.
} that he is licensed pursuant to the provisions(fine Contractors License law(Ch;pter9 - COMMERCIAL:
C OQ (commencing with Section70XoofDivision3afdw Rosiness and Professions Code)or TEMP:METER OR POLE INST. _ '
that he is exempt tberefmm and the basis for the alleged exemption Any,violmam of _ 0 NEW BLDG/ADDITION DI:MOIATI0 -J
W Section 9031.5 by any applicant fora permit object,the applicant too civil pamlty of POWER DEVICES
^m ❑TENANT FOOD SERVICE
not more than live hundred dollars(5500). IMPROVEMENT
6
1,as owner of the propeny,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC
will do the work.and the structure is not intended orolicrcd for sale(Set.704,4.]business ❑OTHER
and Professions Cale:the Contractor's License Law does not apply to an owner of OUTLETS—SWITCHES—FIXTURES
propeny who builds or improves Nereon,and who does such we*himself or through
his own employees,provided that such improvements are not intended or offered for. NEW RESIDENTIAL ELECTR SQ Fr.
sale.If,however,the building'or improvement is sold within one year ofeampletion,the - l SQ FT.FLOOR AREA VSQ.ET.
nwner-huilder will have the burdennf proving that he did not build or improve lir put- _ " - -P A
now of Bald). - D bJ'
TOTAL:
I,as owner of the pmm pvrty,aexclusively contracting with licensed corbactocs to
p gz� _
c(nnruct the project(sec.7044,Business and Profession Code)The Contractors Li-
opvr• 1995 ,
ase law does not apply to an owner of preny who builds or improves diction,and QTY,PLUMBING P17RNIIT FEL SEP ^1
who contracts for such projects with a,iontractnKs)licensed pursuant o the Contractors ,A
License La.' PERMIT ISSUANCE + CIT�a�T / U1-
El 1amexempt tinder Sec. - ,B&PCfurthisreason WiJEHFIN
Owner Die
ALTER DRAIN&VEN9 WATER(EA) t` -'VALUATION
- '
• WORKERS COMPENSATION DECLARATION BACK I OW PROTECT DUICE
hearth,.0finan Wer penalty ofp, y f th fill g J t . 1 f s
I]Ih ve andw llma ntu.aCenifcum ofC itlf'nsu f W krs Compen= `' DRAINS FLOOR,ROOF,ARCA N O STORIES TYI'I?CONSTRUCTION
sotto( as Provided for by Section 37W of the Lam,Cale,for the performance of the -
work fir,which this Manitisissued. - IIXTURIS—PER TRAP
❑1 have and will maintain Worker's Compensation Insurance,as required by Section •'
37M of the labor Code.for perforemnce of the work for which this Permit is issued. GAS—IiA.SYSTEM-I INC.4 OUTLETS
M Worker's Compensation Insurance artier and Policy number are: OCC.GROUP. APN
My pcnau : GAS—IiA.SYSTEM-OVEN 4(EA)
Coria: - Policy Nn: f
CIiRfII IC MPEXEMPTION PROM WORKERS'
' COMI'ENSATION INSURANCE' GREASI'IINDIISTRL WASTIi INT131tC1iITOR '} •
Glaiseecthinroud not hccompleted ifthcpemtit k immulamdredd(Ilam(S100) BUILDING DIVISION FEES -
mle9sJ ORHASETRAP PLANCHECK FEE ,
Iceriify that into.performance nfNe wad fnrwhichth11Permit isissued,Ishali SEWL'It—SANITARY—STORM PA.200 FT.
nm employ any peDon in tiny manner so as t.banme euM1jcdt m the Workers Cmnpen- ENERGY FEE '
,Z
motion sof Calif.mia.Date WATER HEATER WNCNTdiLECTR
70 O Applicant - ' GRADING PEE
G . NOTICE TO APPLICANT If,am,making this Certificate of Exemption you should WATEk SYSTF.M/fREATING 'r )f
a become subject to the W k Compensation pe s ti pm s n. f the Labor Cede,ym must SOILS FHH
^ {✓a foahwth comply wohruhp_viiom rthi, thull by deemed revoked.' WAII'k SLItV10E,
Q r
CONhem is acONLi NDINCAGENCY NEW H&51DF:NTIAL PCMB. SQ.FT. PAID
G ^
that
U O l hereby which me,cootI�sacontru lion Civ.agency f(rthe perfnmmnw of 'Osie
{]n I- the work far which this lxrmit is issued(Sec.JW),Civ.CJ
(] LemJers Namie TGTA .
U IanJer'i Address " TOTAL
' 1 c unity that 1 have d this pelican n anal-sale that he bo e harormilim is BUILDING REE.
�. h corre t I agree to comply with all ty and ty fi nouns d t t Inf go QTY. MECHANICAL PERMIT PEE
U y
buildingconstruction,ti JI ly th rite repmwonatic,ofty' y'm eanmra,tmthe SEISMICFT
above-mentioned propeny I inspection Purposes; _ ' a PERMIT ISSUANCE
(We)agree to one,indemnify and keep handles,.the City of CuPerim(against' LLEC'1'R1C
liabilities,judgmems,roatsandexpenses which in any way acerae again City ALTER OR ADD MECH.
e of the gmming of this pe" PW MBING
t PPLV ANT UNDERSTANDS A WIL 'OMPLY WITH ALL NON-MINT AIR HANDLING UNIT(TO 10,003 CPM) _
SOUR GULATIONS. MECHANICAL FEF.
E
AIR HANDLING UNIT(OVER 10,000 CPM) CONS'1'RUC1'ION TA
Smreof P ctn/ ommanr Un® EXHAUS'f1100D(W/DUCT) HOUSING MITIGAT
HAZARDOUS MATERIALS'DISCLOSURE ,
Willtheupplicam nr fuwre building occupant store or handle hueuohm,noedal HEATING UNIT(M 100,000 BTU)
as defnc l by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 1'532m)R ' HEATING UNIT(OVER 1(X1,000 RTU)
E3 yes t ❑Nn. VENTILATION FAN(SINGLE RISID) PAID
Will the applicant(it furore building occupant use equipment or devices which Date-. Receipt
emit notation,air corromonon,a,definul by the Bny Area Air QWID Management' BOILER-COMP IMP OR 100.000 BTU) '
O'T L
Dletrel. 'BOILER—COMP(OVER 100,00 BOF)
❑Yes Cl No
"
I havemedthe ha,mli smaterials rcgdimmems under Chaptert,95 of Ne-Cali- AIk CONDITIONER ISSUANCE DATE
forms,Health&Safety Castle.Sections 25505,25533 and 25534.1 undmmnJ that d the ' NEW RESIDENTIAL MECH. SQ.FT.
building does not currently have a tenant,thio it is my tcspomibility to notify the occupant '
of be requirements which mus be met prion.issuance(!,Certificate of Occupnncy. �.\.
Owner or authorized agent -Dote . T ISSUED BV �{/�� \•f
t 'OFFICE
--"--�City Oi
Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
20171 Suison Drive
Cupertino, CA 95014
Subject: 20171 Suison Drive, Permit# 28122 - Bathroom Remodel
Dear Resident,
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 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.
Sincerely,
City of Cupertino
Printed on Pecvciad Paper