26547 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO NLN-"I'MYRICA• PERMIT NO,
APPLICATION/PERMIT PLUMBING-MECHANICAL C C /1 7
BUILDING DIVISION BUILDING PROJECTIDENTIFICATION U 5`F 1
BUILDING AAD'-DRREESSSS: SANITARYNO. APPLI ATITION/SSUBMI'ITALDATE
14NAME lO .P 'UNITp LOT# �� .I.r��
OWNER
JZ//$$NAME: /f .,I ��ONN/E: CONTRACTOR'S NAM LIC NO: 111 /
` .oA L�/�/a'� .1_<az� �S rS �F87 Z N/C CONTROLp
�KCIIII %/ENGINEER: LICNO: ADDRESS:p /J
a b/V OI .r(0.i�C .Dlfstl�
CONTACT: AAPHONE.
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
PERMIT ISSUANCE BLDG X P UMB ME❑CH
LICENSED CONTRACTOR'S DECLARATION APPLIANCES/RESIDENTIAL
OyZ Ihembywifrmthst lam licenudunderpmvisions of❑tap¢r9(commrncing with LOB DESCRIPTION
u100 Section 7")of Division 3 of the Business and Professions Cade,and my license is in PANELS
FF-W I- full force and ef[ent
F
Liuu. Liccns Lic.lr y87�92 1 UPT02WAMP5 ��
m<0. Date Contmrta �� 201-1000 AMPS ` ` `
FyZ ARCI CTS DECLARATION OORAREA
ZOtn— OVER TWO AMPS
OZ—O lundcrstand}y.pt `1 ublic taords.
SIGNS ELECTRICAL U
licensed Professtytrdl OWNIEILDER DECLARATION SPECIAL CIRCUTDMISC.
KO W U 1 hereby affirm that and exempt from the Contractors Lateran,taw for she
W 3 m y following reason.(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST. 1.`!
which requires a permit to construct,alter,improve,demolish,or repair any structure
X111 prionoin issuance,also requires the applicant for such permit to statement POWER DEVICES
�,Y Q p that he is littrtsed pursuanno the provisiotu of Ne Contractor's License Law(Chapter
0.0.4 9(commencing with Sation]WO)of Divisiun3ofthe Busness and Pmfessior¢Code) SWIMMING POOL ELECTRIC VALUATION
,L, or that he is exempt therefrom and the toxic for the allcgedexemptinn.Anyvialmlonof
FZY Section]031.5 by any applicant fora permit Subjectstheopplicanno a civil penalty of IITLETS SWITCH FIXTURES
yQ not more than five hundred dollars($500). O ��
F� ❑ I,mownemfthcpropeny,ormyemployeeswiihwagesastheirwlecompensadon, NEW RESR50ALELECTIR _SQ.FT. STOW TYPE CONS"IRUCIION
y3_c will do the work,and the someone is not intended or offered for sale(Sec. Business
and Professions Code:The Commerce's License law does not apply to an owner of
property who builds or improves themon,andwhodoessuchwork himselforthrough his OCC GROUP RFS.UNITS
honemployees,pmvidedthat such improvcmcntsamunt incendedcroffered forsale.IL
wever,the building(it improvement is sold within one yearofcompletion,thematic, ly 14TA/
builder will have the burden of proving rho he did not build orimprove for puryou of
Sala')' QTY. PL 6 G T FEE Fl. ZONE APN
❑ I,usownerofihepropeny.antexclusivelycontructingwithlicensedcontrazmrsm
construct the project(Sec.7(44,Business and Professions Code:)The Contractor's /J
hicenu Lawdcesnot applym an ownerofpropcny whobuildsorimproves N<reon,vtd PERMIT ISSUAN E�
who contracts forsuch projects with acomractor(s)licensed pursuant to the Contractor's gLTER-DRAIN&VFN R(EA
License Law. ) FEE SUMMARY
❑ 1 am exempt under Sec. ,B&P C for this mason BACK FLOW PROTECT.DE IC
OUTSIDEFEES
SANITARY Y N
Owner Date RECEIPT#_
DRAINS-FlOOR.ROOF,AREA. ONU.
WORKMAN COMPENSATION DECLARATION $CHWLTAX N
❑ Thereby affirm thetlhaveattnificam of conunuo self-insure,oracenifcam of FIXTURES-PER TRAP R CEI p
Workeri Compnmtionosuranccoracenifiedcopy Nercof(Se<JBW,Lab C.lwhich PARK FEE N
covers al l employee's under this pemtit GAS-F.A.S YSTEM.I INC.4 OUTLETSRECF T9
Polcy# /c _BjUVDNti D ISIONFI?HS
Company GAS-EA.SYSTEM OVER 4(EA) PIANCHECK O
❑ Certified copy is hereby famished.
❑ Certified copy is filed with the city inspection division. GREASE/INDUSTRI.WASTE INTERCEPTOR GRAD i
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOIL
COMPENSATION INSURANCE 1
(This section need active completed ifthepermir is fur one hundred dollars($IW) SEWER-SANITARY-STORM HA.200PT. ENERGY
or les.)
I certify that in beperformance of he work for which this permit is issued,l shell WATER HEATER W/VENTELECTR
not employ any Person in any manner 2>?2vr`YY bb�r��� a 'abject to the Workers' PAID
Compensatiu s alit Dam 6 WATER SYSTEMORE,TING Dale Rci,,
0Z Applicant
0 NOIICET PPra:CA a making this CeriGeam of Exemption,you should NEWRESIDENTIALPLMB. SQ.FT. At..
F' :1) hecnmesubject o the rs Compensation provisions of the Labor Code,you must BUILDING FE 'y
> frrhodh comply with such provisions m this permit shall be deemed revoked.
aQ CONSTRUCTION LENDING AGENCY SEISMIC F E
z 1 hereby affimr thm there ix a consvuetion lending agency for the performance of IiLE IC
U O the work for which this Itemdt is issued(Sec.3W],Civ.CJ
Lcndde Name
OF Lenders Address QTY. MECHANICAL PERMIT FEE 1 , G FEE
U 1 ecrtify that 1 have read this application and state that the above infnnnation is MC ANICA :E
TCW
c acct lagrce mc�m�ly with ell city and county ordinances and state laws relating to PERMI'1'ISSUANCE
F" �t building canstmnion.and wn,byautbodre represcnutivesofrhis city m cnterupen the
U z above-mentioned pmpeny for inspection purposes. ALTER OR ADO TO MECII. �� CONSTRU ION TAX
(We)agree us rove,indemmly keep harmlces the City of Cupenino against
liabilities.judgmem com,anJ ex swhich may in any waywcrve agaimt svd City AIR HANDLING UNIT(J'O 10.W0 CFM)
to scyuc o t 8 ting o pemrit.
// AIR HANDLING UNIT(OVER 10.000 CFM)
Q�p—
Si a Applicant mu an, EXHAUST HOOD(W/UUCT) PAID
41AZAR 'IiRIALS DISCLOSURE
HEATING UNIT(TO 100.100.000, U BTU) Date Receipt If
Will tM1c applicant or Tulare building rc<upant score orhandle hamNnus mamrinl HEATING UNIT(DYER 100.001)BTU) TOTAL:
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cod,Section 0Yes 25532(v)R 2-N, ENTILATION FAN(SINGLE RF,SID)
ISSUANCE DATE
Will the applicamorfmurebuildingoccupantuuequipmentordeviceswhichemit BOILER-COMP(JIIP OR IW.(pO BTU)
Jous air cnmzminams,as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 1041 BTU)
Jp
40 ' ❑Yea Lei No NEW RESIDENTIAL MECH. SQ.FT.
I have read the hemrdoux materials requirements under Chapter 6.95 of the //r '20X99
California l health&Safety Code,Sections 25505.25 533and 25534. I understand thatrac
if the buildi 11Rss tly M1ave anon,.mat it is my responsibility m notify Ne
OC7pa f the reyui whi ust be met prior 10 issuance of a Cenificate of
y �P —pIrl
Owner or oath red agent Date ISSUED BY
OFFICE
f
4�1
t i tx of
Cupertino
10300 Torre Avenue
a - Cupertino, CA 95014
Building Division
(408)777-3228
Fax (408)777-3333
September 20, 1995
Sheena Chang
10586 Larry Way
Cupertino, CA 95014
Subject: 10586 Larry Way, Permit# 26547
• Dear Ms. Chang,
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
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