28053 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO1 Li UOU" RI AI' PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 28053_
BUILDING DIVISION BUILDING PROJECTIDENTIFICATION
BUILDING ADDRESS: �/µ� a{a.�,{�/�J SANITARY NO, APPLICAI ION SUBMITTAL DA'Di
3 V" a ON v UNITx
OWN Y1dAilli_ PHONE: CO , ^�
� � WI CONTROL#
4RCHITECT/ENGINIrCK LIC NO: ADD SS: _ ❑
!D .S .
CONTACT: PHONE' QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
— I.F. PLUM
PERMIT ISSUANCE
LICENSED CON TRACfOR:S DECLARATIONAPPLIANCES-RESIDENTIAL. _ ,LOB f )
SCJ Iheuhy ufEmn lhatl am liccnxJ sendsrprnvisinns of Chapter9(commencingwith rp7 `�`a
00 Sermon]OOU)of Division 3 of the Rosiness and Professions Code,and my license is in PANELS
full force and effect.
FZjy License Claa. Lic.# UP TO 200 AMPS
rn 5 a- Date Comncmr 201-1000 AMPS SQ.FT.FLOOR AREA $/SQ.Ff.
,FON'Z� ARCIIITIiCI'S DECLARATION OVER BRIO AMPS
O Z_❑ I understand my plans shall be used as public records.
F N F m SIGNS ELECTRICAL.
Q Y j Licensed Professional
OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC. �\
XOaO 1 hereby affiant that I am exempt from the Contractor's License law for the '
��+4m following reason.(Section]031.5,Business and Professions Code:Any city nr county TEMP.METER OR POLE INST.
If which....lyes me-permit m c morcel.alae,improve,demolish,m repair any structure
}2 prior to its issuance,also requires the applicant for.such permitto rile a,signed statement POWER DEVICES \
that he is licensed pursuam to the provisinnc m[the Contmcmis Llsnu Lvw(CM1vpter
^X 9(commencing with Section 7")of Division 3 ofthe Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION
ax or mat he is exem ttherefmm and the basis for the aIle dcxem tun.An I t of ��
to—vs p gc pi yvioaion
F Z� Section 7031.5 er
5 by any applicant for a pmit subjects the applicant to a civil -
4 not more than five hundred dollars($5W). OUTLETS-SWITCHES-FIXTURES
penalty of
� O NEWRESIDF.N'1'IALELECTR _SQ.PT. STORIES\ '1'YPHCONSTRUC'HON
C o ❑ Lvsowneradthepmpuclumi.. loneaded.nerty,ormy employees .fened hasslei(So.rnmpcndars,
will dolhework,nndr: he Canisnot Liceese Law.does not
to an Puniness \ 'V
aro ertywh ors Cale:The Cotnmcme s Little Law does not apply m rt owner of ,
ownenywhob,Pr orimproiesthereon.vements oenotatenmkNmulforthrough his
employees.pmvided thatzuch impmvememsart not imenJedoroffertJ Tarsale.If, OCC GROUP RFS.UNITS
however.the building mimprovemem is sold within one yearofcompletinn,the builder will will have the burden of proving that he did not build or improve for purpose of
role.).
❑ I,as nwnendth,"propeny,am exclusively contracting witb licensed contractors to QTY. PLUMBING PERMIT FGF. FLOOD ZONE APN
construct the Project(Sec.](*b Business and professions Code:)The Contractor's
License Lawdocs notapplym anownerofpropemywho buildsm improvestherton,and PERMIT ISSUANCE,
whoctmtacts(m such projects with aconaoctoms)IiceauN purmantothe Caruacaors ALTER-DRAIN&VENT-WATfeR HEA)License Law. FEESUMMARY
❑ I am exempt under Sec .B&P C Lor this reason OUTSIDE FEES
HACK PLOW 1'ROPECT.DEVICE SANITARY Y N
Owner Date RECEIPT#
WORKMAN COMPENSATION DF.CLARATIQN DRAINS-BOOR,ROOF,AREA.COND. SC1fOOLiA% YN
❑ I hereby affirm that l have a cenifieate ofcomm noxi(-insure,or a cenificam of FIXTURES,PER TRAP f'� RECEIPT#
Workers'Compensation Insurance or a certified copy thereof IS 3800.Lab CJ whicM1 /i PARK FEE Y N
covers all employee's under this permit. GAS-EA.SYSTEM-I INC.4 OUTLERS RECEIPT p
Policy# BUILDING DIVISION FEES
Company GAS-It SYSTE OVER 4(VA) PLANCHECK FEE
❑ Certified copy is hereby furnished.
❑ CeniBed copy is filed with the city ittspatiun division. GREASFIINDUSTRL WASTE INTERCEPTOR GRADING FLE
CERTIFICATE OF EXEMPTION FROM WORKERSGREASETRAP SOILS FEE
COMPENSATION INSURANCE
(Thi.vyaYion neednot he mmplened ifthc penmitin fortune hundfeddallms(5100) SEWER-SANITARY-STORM EA.200IT. ENERGY FEE
or le..)
I ecnifythat in the perfomtanceof the work for which this permit is issued,)shall WATER HEATER W/VEN-UHLECIR
not employ any person in any m as to become subject to the Workers' PAID
Compenwtioulawaof California.manner
so WATER SYSTEMOREATING Date Receipt#
O z Applicant
z O NOTICE TO APPLICANT:If.after maOrt,dis Certificate of Fxemponn,y..should NEW RESIDEN9'IAL PLMB. SQ.FT. TOTAL:
FCI) become subject o 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
f-k7FEF.
6. Q
CONSTRUCTION LENDING AGENCY SEISMIC
U z I hereby affirm that Nue is i sued(See.3 lending agency for the perfomwce of 41
TO ELECTRIC FEE
O the work for which this permit is issued(Sec.3097.Civ.C.)
Lt
Lenders Name n/Y
MBING PERlenders Address QTY. MECHANICAL PE'RMI'T' PEE PLO
U I certify that 1 have read this application and state that the above Information is
r,"' Lt1 correct I agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE MECHANICAL FEE
I"' building construction.and Mrcby amhorix representatives of this city toemer upon the CONSTRUCTION TAX
(� Z above-memioned property for inspection purposes. ALTER OR ADD TO MECIL
(We)agree to save,indemnify and keep harmless the City of Cupertino against
list, 'uJgments,costsandexpenses which may in any wayaccrue against said City AIR HANDLING UNIT(TO IUIIW CFM)
meq odea of Nc grPting n' tin permit.
AIR HANDLING UNIT(OVER 14(NN)CFM)
na re of ApplicanVC t mr 'V JDae EXHAUST HOOD(W/DUC) PAID
H RDOUS MATERIALS DISCLO. E HFATING UNIT(TO 100,00)B'I'G) Date Receipt
Will the applicant m furore building occupant slog or handle h®.ardeun material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING ON]r(OVER 101),01)R'IU)
Core,Section25532(a)4 VENTILATION 17AN(SINGLE RESID) itirS
El Yes ❑No FF pp y
BOILER-COMP QHP OR 100,000 BTU) p vUf"�r l 1l
Will tai.contaminrfuare building by due Bay equipmemQualit Management NU
Instruments air contaminants as defined by the Bay Arca Air Quality Management BOILER-COMP(OVER 100,100)B'I'U)
District'
❑Ys ❑No NEW RESIDIiN'I'IA1,MECfI. SQ.FT.
1 have rand the Incautious manni on,d ememn under Chapter 6.95 of the
California Death&Safety Cuda Sections 25505,25533 and 25534.1 understand that
if the building does nor currently have a tenant,that it is my responsibility to notify the
occupant of the requirements which must be met prim to issuance of a Cenifiute of
Occupancy.
Owner or authorized agent Date TO ISSUED BY:
OFFICE
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
21333 Vai Drive
Cupertino, CA 95014
Subject: 21333 Vai Drive, Permit#28053 - Bath Remodel
Dear Resident,
According to our records the above mentioned permit has never been fmaled 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 fmaled, 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
•
Primal on,30Cx1VV Paper