29038 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING ELECTRICAL PERMIT NO,
.BUILDING Ii1VISION APPIACATION/PERMITPLUMBING-MECHANICAL. 29038 9 0 3 8
BUILDING PROJECT IDENTIFICATION v
BUILDINGADDRFSS: 'SANITARY NO. APPLICATION SUBMITTAL DATE.
201v 4-44 Div S li,.
Q+R VCE, r A��VE:1/7 4- CONTRACTOR'S NAME:UrLo_t� LICNO�7
VQ 1 `[7 NIC CONTROL p
RCHITECT/ENGINEER: LIC NO: - ADDRESS ❑-
' 6 � � Q4STv� t� �t3fi l
CONTACT: PHONE:P - BUILDING PERMIT INFO
+ •' ❑,Consultant Fees Paid by Applicant(Initial) BLDG. I LEC T PLUMB 'MECH
El
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE -
1 hereby ars that 1 licensed under provisions ores pt 9(commencing JOB DESCRIPTION
FSD0Z a n Secton 7000)uf Di 30 Rhe Basin rad I sainn:C l td rylicc se.is RESIDENTIAL:
O full force and effeu q PERMIT ISSUANCE
QUU License Clas Liep 64142 � ❑SFDWL [I KITCHEN REMODEL
F-ZWDas JQ• Contra ;�[J/] CCAPPLIANCES-RESIDENTIAL ❑ADDITION [I PLUMBING RE-PIPE
bn< ' ARCHITECTS DECLARATION ❑MULTI-UNIT ❑S'TRUCIl1RAL
Z0�` 1 understand my plans.shall be used as public records PANELS s MODIFICATION
OZ-0 UPT0200AMPS. � El INTERIOR C1 CHIMNEY REPAIR
G W Licensed Professioml 201-1000AMPS IMPROVEMENT
OWNER-BUILDER DECLARATION OVER 1000AMPS BATH REMODEUREPAIR [I DEMOLI'I']ON
E 6 El hereby affirm that I aro exempt from the Contractor's License Lnw for the
K36U following reason.(Section 7031.5,Business and Professions Cate:Any city or county SIGNS ELECTRICAL ❑OTHER
W LL h¢ which requires a Permit to construct,alter,improve,demolish,or repair any structuresa
'F'4'O.] priori t also q thef such permit fl signed statement SPECIAL CIRCUIT/MISC,
y
apothat he licensedp tt Ih p : fth C uu.L 1 (Chapier9 COMMERCIAL'
(commencing with Sects 7000)of Division ofine Business and Professions Code)or TEMBMETER OR POLE INST.,
C.a c C that he n exempt therefrom and the basis for Ne alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
4• Section703 L5 by any applicant for a permit subject the applicant to a civil Penalty of POWF,R DEVICES
�y ❑TENANT El FOOD SERVICE.
^Z y moisture than five t h props ty las y Still), compensation, IMPkOVEMENT -
.x=Q ❑ Lothe as wor .the propeny,mmyemntendedwithered fosthei(Sec. 044,Binsa SWIMMING POOL ELECTRIC
(.., will do the work.and the swComer not intended muttered Illy
Business ❑OTHER
1�-m and Professions Cade:The Conuaanr's License taw Jnes not apply ro an oxner of OUTLETS-SWRCHES-FIXTURES 4
a3 pmcenY vho builds p thereon, d who doessuch asnrkhimself or through
hie^ n i pl ye: p ided Il him such' p c are our-intended mi,firwal fur NEW RESIDENTIAL ELECI'R SQ FC
le,if,however,be building p net is sold within oneyou of completion,the Q
e builder will have the burden of that he did not build r for S .FT. �QR ARE( - Cj $/SQ.FT.
own Proving improve par,
,]reasut� e
❑ 1, fthe proceny.are exclusively contracting with licensed contractorsm
construct he p ject(Sec 70,44 Business v d P f ns Costa)The Cmumaromr,Li- �7
se Low does not apply t owner of progeny h builds o p e:thereon,and QTY.r"��� PL B T FEE CL[k.�.
who contracts for such promecn with a commcmrfs)licensed pursuanuo the Conaamors 'I//
License Law, 40
PERMIT ISSUANCE
❑ I:un exempt under Sec. ,B&PCfor Nis remon
Owner Date ALTER-DRAIN&VENT-WATER(EA) VALUATION
WORKER'S COMPENSATION DECLARATION 13ACK FLOW PROTECT.DEVICE
1 hereby affirm under penalty of perjury one of the following declarations.
•❑ I hrceend will maintain.Ccnifcmeof Consent mselbimun for Worker's C^mpen- DRAINS-FLOOR.ROOF,A A,GOND. STORIES TYPECONSTRUCTION
section,as provided for by Section 37W of are Labor Code,for are Performance of the
work for which this pcmut is i.aticrL - FIXTURES-PER
ED 1 have and will maintain Worker's Compern,mino Insurance,as required by Section
3700of the tabu Code,for he pro rnwareol the work for which this permit k omed. GAS-EA.SYST IN 1 1 - DEC.GROUP APN
My W'orker's CIN...tio r Insurance came and Policy number art:
Cartier: Policy No.: GAS-EA.SYSTEM-OVER 4(
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANC17 GREASFJINDUSTRL WASTE INT ITR R '
BUILDING DIVISION FEES
' (Thuxectiun neednuth completodifthepermit aforonehundsJdollars(SI(pl GREASETRAP.
or less.) - PLANCHECK FEE
I cenify that in the Performance of Ne work for which this permit is issued.],shall SfEWER-SANITARY-STD E
ria enspiny any persnnin my man sousmbeeofytc suhjcn mile Workerx'Cotnpem (ENERGY FEE
X sntiun Luwa of)/ om
U: WATER HEATER WNENT/ELE R
Z0 Applicata �Qeji t- 1 As'4 i�� GRADING REF.
z q NOTICE TO APPLICANT f,a tar making Nis Cc�sac of Excm"'an.you should WATER SYSTEMRREATING
F' become sobject o the Workers Crnnpe xrou n pmviaions mf the Labor Code,you must SOILS FEE
. �
forthwith comply with such pmvlxinac or this permit sM1^Il be deemed revoked. WATER SERVICE '
a0
CONSTRUCTION LENDING AGENCY NEW RF_SIUENTIAL('LMB. SQ.FE PAID
U O Dae - Receipt p
I hereby affirm that them is a constmdion lending agency for the performance of
the work for which this Permit is issued(See,3097,Civ.C.) '
Its (~ Leader's Name - - TOTAL:
'O UIsnders Address TOTAL:
r y 1 rectify that 1 have read this application and state that the above information is BUILDING FE-13
nFi Zi correct.I agree to comply with all city and county entrances and state laws relating to QTY. MECHANICAL PERMIT - FEE .
U Z broldingcamwrdim,and hereby authorize npnamou,vesof do,61,In vuri, poo he SEISMIC FEE
above-mentioned progeny for inspection purposes. PERMIT ISSUANCE
(We)agree to save,indemnify and keep Fantasia the City of Cupertino agaimt ELECTRIC REE
Habilitice.judgmems.costs and expenses which may in any way accmc against said City ALTER OR ADD TO MIiCIL
in consequence of the granting or this permit. PLUMBING PEE
APPLICANT UNDERSTANDS AND WILL.•COMPLY WI HALLNONOINT AIR HANDLING UNIT(TO 10.000 CFM) MECHANICAL FEE
SOU E EGULATI NS. �.
AIR HANDLING UNIT(OVER 1401X1 CFM) CONSTRUCTION TAX
Signature of Applican Commcmr Dart EXI AUST)100D(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOS RE
Will Ne applicant or future building occupant store or handle ha mous comenal HEATING UNIT(TO 100.010 BTU)
as defined by the Caper ism Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(x)/•' HE INC,UNI'i'(OVIER 100,000 BIG)
[-1 Yes ❑No VENTHATION FAN(SINGLE RISID) PAID Date Receipt It
Will the applicant or future building'.,upon,use equipm,m or devices which
As
emit hanndous air contahtinnmsas defined by the Bay Ane Au QualityManagement BOILER-COMP(VERRW.t1WgBBTU)
lDistrict? BOILER
'
❑Yes C]NoKL
AIR CONDITIONER
I have read the havaus mls
dnateriarequirements under Chaptar 6.95 of Ne Cali- ISSUANCE DATE
forms Hc.hb&Safnry Cud,,Sections 25505.25533 and 25534.I understand that it lot NEW RESIDENTIAL MECH. SQ.FT.
building does not currently have a tenant,thin it is my responsibility to notify the occupant —
ofthe requirements which most be mapdonr issuaneeofa Cenificasof Occupancy.
OwneroramthorPaal agent 'Dme T01'AL'. ISSUEDBY: y�--_'V•�
OFFICE
10300 Torre Avenue
l•
of Cupertino,CA 95014
Cite
Cupertiuzo Building Division
(408)777-3228
(408)777-3333 (fax)
April 23, 1996
<7Ic- ,
Resident
Cupertino,
Las CA 9 Way
Cupertino, CA 95014
Re: Expired permit(copy attached)
Dear Resident:
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
•
Peeled on Recycled Paper
1� VV`JI IMID UAMV neAn rnvmI yr OVILV11Yv /; (".7c . /764� J VW '
CITY OF CUPERTINO PERMIT No. L^ oA 3781/�
BUILDING DIVISION
!r+T+:N`-+3Y PU LOIN6 PPOIECt IOEM'IPICATION'Y=4!F_�"tl::
BUILDINOADURESS: SANOARY NO. APPLICATION SUBMITTAL DATE
IRS P:: 7 11(]NE:� 7 CONTRACIOR'SNI [: LIC NO: °
' ;: 7/ ✓�[L t 5� � L 1.t( 1 L J IV 1 2 NIC CONPROLe
:CHITEC IENGINF.F.R: LIC NO: jDJtF1SS:
%//'f 4 `1./%/J//�/i /!/!`// 1(l / L ❑
Izr}•I`'a i "I Y5.Ii�A.+exIYW" +Iry� dtJ yi Apd4� ' ''R'+'y° d- Ey '>cM+(r14Axii�iB II:bINO, BRh11T.1NP0 M1 :
I II'Vj's"'7in�N�'�EC170NS' bAT� iNSPBC: ❑ Consultant Fees Paid by Applicant(Initial) BLDG E PLUMB MCC"
XJ
El �. ❑ ❑
FOUNDATION/PIERS/H.D.S. INSPECTION RECORD -
JOB DESCRIPTION
UFER GROUND NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL
PAD/SETBACK-CERT SHALL BE INSTALLED TO COMPLY WITH ❑SFDWL O KITCHEN REMODEL
THE APPROVED PLANS AND CITY OF DADDITION ❑PLUMBING RE-PIPE
GARAGE SLABS/PREGUNITE Cuo GaTIlJLLfTAN n A 12n c DMULTI-UNIT [)STRUCTURAL
MODIFICATION
pl!OUR NO,CONCRBTH UNtIEABdVH,HAS.gP.EN�IGNHD I Td ARRANGE INSPECTION! , F I I 4' D INTERIOR UCHIMNEY REPAIR
- _. y '
UNDERGROUND/SLAB - CALL AFTERNOONS(I OUFM:d3 PM)(�,,`ff IMPROVEMENT
ill-kil MONbAV TD FidbAY zd NGURS ' ' D RATH REMODEI/REPAIR D DEMOLITION
PLUMBING IHRFORRRHQII,IREdIN§PECI'1011.'IOIl�, •JI '• DOTHER I
ELECTRICAL !ADDRESS ANb PERMITU ARE N(:EDBD WFIRFJ
)NfN C�POORFLOORUNTILABOVHFIAS,IIBENSIdNBti hFFONINO' i' ").°4a,r+hY.lhi?.yL7h� i'T`$IR C.i(
COMMERCIA
s PLUMBING HF 1F.IvIIUIv I-Gn1Rai,FilFlu: ❑NEW BLDGIADDITION DDEMOLITION
MECHANICAL NO PERSON(S)SHALL PERFORM WORK ON UMPROVEMP:NT [)FOODSERVICE
THIS JOB SITE WITHOUT BEING IN COM- DITHER
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION
FRAMINGVENTS' '. INSURANCE REQUIREMENTS.
INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑
DATE INSP. '
°
PLACE NO,SUJI RA8 BEEN.SIONBb
ROOF SHEATH/DIAPHRAM
PLUMBING
TUBS&SIIOWER PAN i
MECHANICAL
RAMI I __ -- --
FRAMING/STAIRS/E.EGRESS
INSULATIONNENTILAIION
1-14
COVBR NO wdRK.UN'FiUnBbVB HAS BBEN§ICNBb� 3
EXTERIAL SHEARMOLD DOWN fe, '
INTERIOR SHEARMOLD DOWN r !
SHEETWROCK/SHEEIROCK SHEAR
EXTERIOR LATH/W-SCREED
SHOWER LATH
1 NO TAPE OR PLASTBR UNTHIABOVP HAS BEEN SIGNED
SCRATCH COAT
SEWER/WATER
-TEMPORARY APPROVALS 1 x.x+�( ;• A�.k Ix. .,hl:t
OCCUPANCY
ELECTRICAL
i
GAS N
.GAS TEST NOY -I
995
GRADE 1
FIRE i
HANDICAP
ELECTRICAL
PLUMBING
ECHANICAL
ENERGY CERTIFICATE OF OCCUPANCY ❑
VISUAL FINAL ONLY
BUILDING IMPORTANT: ISSUANCEDATE
sSS' l PLEASE READ REVERSE SIDE BEFORE )•
�IG� CALLING FOR FINAL INSPECTION!!
NxfI �t ISSUED BY:
APPLICANT'S POSTING COPY ____