27457 - -----------
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO .DINU-LLLC I RTCAI, PERMIT NO.
APPLICATION/PERMIT PLUMBING MECHANICAL 27457
BUILDING DIVISION BUILDING PROJECT'IDENTIFICATION
BUILDING ADDRESS: - SANITARY NO. APPLICATION SUBMITTAL.DATE
10yy Loc. LC✓JOV t-• Cf,,PMAIA.3 UNIT# LOTH 1f�
OWNERS NAME: PHONE: CONTRACTOR'S NAME: LIC NO: -
1 /� N/C CONTROL#
2 SL r �.n tM�_ V23�3ro
RCHIECIENGINEER: LIC NO: ADDRESS: ❑
;L-o)_ FredwL S nit n+
CONTACT. PHONE:
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
�06 Z PERMIT ISSUANCE El
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
OKZ Ir,rebyzffirm drat l am licensed triaderpmvisionsofOmpder9(commencing with JOB DESCRIPTION
WOO Section 7")of Division 3 of the Business and Professions Code,and my license is in PANELS
K V F lull fume and effecyx '/` T g��i f-r-{
<7ui License lass IS Lic.# 3 UP TO]Ir,AMPS I ` l �,���11` kew6'6)
y<y Dude })^SS Contractor 201.1000 AMPS l sr` `^•L
F,ziZ ARCHITECT'S DECLARATIONSQ.pT.FLUOR AREA g/SQ.FT.
Z O y I understand m d II be used as public records. OVER 1000 AMPS
OZ�n unypunssh a
SIGNS ELECTRICAL
Licensed Professional
p�a'< OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC.
d CWU I hereby affirm that I am exempt from the Contractor's License law for the
W 3 tL y following reason.(Section 7031.5,Business and Professions Cade:Any cry or cowry, TEMP.METER OR POLE INST.
F-k0< which reyuires a Immat to construct,alter,imp rove,demolish.or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement POWER DEVICES
�rtop that he is licensed pursuant to the provisions of the Contractors License'Law(Chapter
a
2L SWIMMING 9(commencing with Section]000)of Division 3 ofthe Business and Professions Cade) SWIMMING POOL ELECTRIC VALUATION,..,
m_w or that he is exempttherefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES FlXTURFS �0
F Z Y Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of t�V
< nm more than five hundred dollars(SSW). NEW RESIDENTIAL ELECfkSQ.FT.
c&F- C3I.asownerofthepmpcny.ormyemployceswithwagesmtheirsolecompensation, STORIES TYPF.CONSTRUC ION
p.r3- willdn the work,and lM1e structure Isom intended proffered forsale(S«JD44,Business
and Professions Code; Die Contractor's License Law docs not apply to oa owner of
property whobuildsor improves thereon,and whodoes such workhimsufonhroughhis OCO GROUP RES,UNITS
own employees,providedthat such improvcmentsamactinteaded oroffered forsale.If, �^
however,the building or improvement is sold within one yearofcompleuon,theowner- TOTAL:
builder will have the burden of proving that he did not build or improve for puryose of
sale.).
❑ Lasowner of the propenri arnendusivdymntraming with licensed cesnvacronto QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
consumer the project(Sec.7044,Business and Professions Code.:)The Contractor's
License Law cher, atapply to anownerufprnpnny whiNnildtmimpfovesthereon,and PERMIT ISSUANCE -OO
who contracts for such projects with a contmemeh)licensed pursuant o the Contractor's pf:fF.R-DRAINIG
('iN'1'-WATER
License Law. ' ) FEE SUMMARY
❑ 1 am exempt under Ss. .B&PC for this reason BACK FLO �OILCT.DEVICE TSIDE FEES
SANITARY Y N
Owner Date RECETPTp
DRAINS RAREA.COND.
WORKMAN COMPENSATION DECLARATION SCIIUOLTA% Y N
❑ Thereby affirm lhetlhave ac,mificete of cans«nn self-inaure,macenificamof nX'HIRES-PERTRA O OL RECEIPI'N
Workers ComMnsation Insurance or avertified copy lhemol'Ser.39W,Lab C.)which PARK FEE Y N
covers all employee's under this permit GAS-EA.SYSTEM-ILNC.4 UTLET$ RECEIPT#
Policy# BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVE (EA ` PLANCHECK FEE
❑ CerdGed copy is hereby furnished
❑ Certified copy is Bled with the city inspection division. GREASFONJDUSTRL RCE R GRADING FEE
r CERTIPICATEOFEXEMPTION FROM WORKERS' GREASE TRAP \ v\ SOILS FEE
COMPENSATION INSURANCE
('ITissection need nm h,completed if the Permit is lesion,hundred dollars($I W) SEWER-SANITARY-STORM ' WP' ENHRGY FEE
orlcaa:k
I cenify that in the performana offer work for which tris permit is issued,l shall WATER HEATER W/VENTRiLECTR
not employ any .on in any manner so as or become subject to the Workers PAID
Z Compensation Lavaof Califca ia. Date WATER SYSTEM(TREATING s r Date Receipt
Applicant
0 NOTICE TO APPLICANT:If,after making this Certifiese of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
become subject to the Worker's Compensation provisions of the Labor Code,you most
� > forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE V 0
SEISMIC FEE �q
0. Q
CONSthere is
AGENCY I sy
Uz T hereby affirm tatermil is a conssued(See 3[ending agency C.) for the Performance of TOTAL: ELECTRIC FEE D
O the work for which this permit is issued(S«.J09],Civ.CJ
Lender's Name 'A- �
Leader FE
Address QTY. MECIIANICAL PERMIT FEE PLUMBING E -0 J f/
V I certify that I have toed this application and slam that Ne obove information is MECHANICAL ME correct.lagreeto comply with all city and county ordinances and atom laws mitiingmn PERMITISSUANCE
building construction,and hereby authorize representatives clans city to enter upon the
(� Z ubnve-mentioned n forums tion ALTER OR ADD TO MECIL CONSTRUCTION TAX
props y pec purposes.
(We)agree r save.Indemnify and keep harmless Ire Oily of Cupertino against
liabilities.judgrnmt,amsandexperues which may interry way accrue against said City AIR HANDLING UNIT('1010.000 CFM)
n conacquence of the granting of this permit.
q�/ / AIR HANDLING UNIT(OVER 10,000 CFM)
S',Xumo fApplicunUCnmrarmr Dare EXILNUST I IOOD(W/DUCT) PAID
IIAZARDOUS MATERIALS DISCLOSURE HEATING UNIT ITO I00dX)0 BTU) —Date Receipt#
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety HEATING UNIT(OVER IW,0W BTU) TO IA L: I7
Code,Section 25532(u)? VENTILATION FAN(SINGLE RESID)
11 Yes C3 No g�ISYl s�AI LW0e�
.0WBTU) Ir DATE
Will the applicant prfaoccupantre building occupant ue
sem quipmeordcices BOILER-COMP(3HPOR IW
which emit Y Yt 1
h dous air conmeninaras as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU)
Dunicl? JAN 241995
❑Yes ❑No NIiW RESIDENTIAL.MF:CII. g0.1T.
1 have read the hazardous materials mcluiremems under Chapter 6.95 of the
California Health&Safety code,Seetians 25505,15533 and 25534, l anderatand drat CII Y Ur tUr[HI INU
if the building docs not currently have a tewm,that it is my responsibility to notify the
span of the reyuimmenls winch must be and prior to issuance of a Cenificate of
Occupancy.
Owner or authorized agent Doc '1'O'1'AL: ISSUED BY:
OFFICE
Citx of
Ce1tll10
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax (408)777-3333
November 29, 1995
Resident
10444 Lockwood Drive
Cupertino, CA 95014
Subject: 10444 Lockwood Drive, Permit.# 27457 - Kitchen and Bathroom Repair
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 I
Pointed on Recycled Paper