27541 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE-BALL POINT PEN ONLY _
CITY OF CUPERTINO IIftNC-F"'Er ICAL PERMITNG.
CAL
BUILDING DIVISION APPLICATIONAIERMIT PINGPRNO:-MF.CHANIFICA n7C /I 'I
HUIIAING I'NO.IKCI'IIIEN'I'IFICA'ITON G JL�1
B,/UJIILDING ADDRPSS: SANfI'ARY NO. APP�LICA'`I[O.N SU�ByMIaTrTAL DATE
Alves/1 UNI'I'K - -- LOT'p 1 �F�`
OWNilisg NA Ili •P O RACI'ORS NA LIC NO: - I� b V-�V
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NIC CONTROL p
ARCIII'IE(Z- GINf'i: CX LIC NO: AfjNX/$ ,ia
coNTACI': P-HOJN�E: QTY. ELECTRIC PERMIT , FEE _q9T1102 PERMIT INFO
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�/If/ PERMIT ISSUANCE BLDG ELECT PLUMB mrCH
❑ ❑ � ❑
hIC DCO A OH'S DF.CLARA'I'ION APPLIANCES-RESIDENTIAL
C]CZ Ihercbyalfnnthatlamlicensdun erprovisions of Cheprer9(cmnmencing with JOB DESCRIPTION
F[[100 Section 1810)of DIvt'' 3 of the Business and Pro essions CIA,and my license is In PANELS
y�I+IF full force and /7/ 1
FyVjD License Clus a.g UPTO200AMP5 `.{..�
w y IJutc Contrncmr 201-1000 AMPS Y J
ZOyZ
—ARCHITECTS DECIARAT"ION OVER I"AMPS
SQ.17.FLOOR AREA $/SQ.PI'.
O Z—O I understand my plans she be used m public recants.
F vi
Q Licensed Profesinnal SIGNS ELECTRICAL
LgF V OWNER-BUILDER DECLARATION SPECIAL CIRNIT/MISC,
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�p(.O d.W I hereby affmt that 1 am exempt from the Commences License law for the
1+13 a m following reason.(Section 1031.5.Boniness and Professions Code:Any city or county TEMP.METER OR POLE INST.
�atv� which requires u parmi to construct,alter,improve.deolish,or repair troy marturc
�W} m
V prior to its issuance,also requires the applicant mrsuch Permit to file o signed samment POWER DEVICES
�jp q<a that he is licensed pursuant to the provisions of the Contractors License law(Chapter
G.qM 1) commencmg with Section 7000)of Division 3 of the Busmessead Pmfessions Code) SWIMMING POOL ELECTRIC VALUATION
�My or that he is exempt mcmfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any rpplieam for sannil madeas the apidw nt m a civil penally of OUTLETS-SWITCHES-FIXTURES
€S
at more than Gvc hundred doll are($5(10). NEW RFSIDENTIAL ELECTR S .PI'.
C3w
Lasanerofthe property,maryeloployesswith wages astheirsolecoeNnsafion, Q STORIES TYPECONSTRUCTION
W willdnthe wm1a,tndfiesuuawre isrm intended mothered formle(Sec.7044,13miness
and Professions Code:The Comeactor's License Law does not apply to an owner of
property who builds or improves thereon,and wha does such work himself or Ibmugh his
own employees,provided that such improymoentsam not ieladdedoroffereA formic.If. - OCC.GROUP RES.UNITS
however,the buildingor improvement is sold withinone yecrofcompletion,the owner. TOTAL:
builder will have the burden of proving ilia,he did not build or improve for purpose of
s lc.). QTY. PLUMBING PERMIT FEIi FLOOD ZONE APN
❑ las Ove Imitthepmry7094, exclusively contmairgwith licensed c.mindicrem
ures 'I
lddmcommd l Ne project(See.rain Business per Profeasmns mintpo Te therso ,mal
Lhenulawdt-11.a11cieoan mitrnumenenywhasedlaorimprovee thereon,and PF.RMIT'ISSUANCE
he contracts forxuchfmjectswdhaernnmntor(s)Ilmnxd punuenumhe Commemr's ALTER-DRAIN dr VENT-WA'I'ER(HA7
Lice FEE,SUMMARY
❑ Imnrx
, am exempt unddeo r Sec. ,B&PCfonhia rtason BACK FLOW PROTECT.DEVICE O TDF. :ES
SANITARY Y_N
Owner Dam RECR11'TA
WORKMAN COMPENSATION DECLARATION - DRAINS-FLOOR,ROLE,AREA,COND. SCHOOLTAX Y N -
❑ Thereby nflinn trntlhavcuwni0cem of consent wmll'-insure,non cenifwte of FIXTURES-PER TRAP .RF.CF.IPrk
Wnrlw 'Compemadonlmumnecoracenifiedcopythemof(.S e.38M.Lat C.which PARK FEE 'Y_ N_
nail Ip m GAS-EA.SYSTEM-1 INC.4 OUTLETS kF.C1i1PTM
PobcyM 1 BUILDING DIVISION FEES
'C1jp Ccs, F _ GAS-EA.SYSTEM-OVIiR4(liA) PLANCHECK FTE
❑ CenifieJrnpy rs hcrey r eJ. I
❑ Certified copy ix fid ' e city impaction division. GREASH/INDUSTRL WASTE INTERCEPTOR
GRADING PEE
CERTIFICATE OF EXEMPTION FROM WORKERSGREASE'1'FOU, SOILS FEE
COMPENSATION INSURANCE
(This section need not IN,completal if Ne permit is forom hundred dollars($100) SEWER-SANITARY-S'I ORM EA,2(IOF7E ENERGY FEE
.ries.
I eerily that in the perfarmanceafthe work for which this permit is ismrtIaI AM HEATER /VENVELECIR '
not employ any person in any manner so as to become subject the Warks ' PAID
CUmpcnmlionlawsof California. Date WATER SYSTEMnREATING Dam keniptM
zZ A,loa m
C) NOTICE TO APPLICANT:Ifafer making this Cenificme of E n, uNEW RESIDENT'IAL PLMB. SQ,FL TOTAL:
F^ V] bccomesubject to the Worker's Compensation provisions oft Ea Co/e,sYbu t
� ? frnthwith comply with such provisions ar this Rcnnit.,mil Irevok 11 - BUILDING FEE
W Q
CONSTRUCTION LENOI SEISMIC FEE
CI y hoist thanhnc is: rnnslrumion len c myf perforunw Uf TOTAL: ELECTRIC FEE
C1 O the workork farfor which this permit is imucd(Sec.3091 .)
ty ders Name-
0
dme
0 Learess
Q 1'� Lender's AJdQTY. MECHANICAL PIiRM1'I' FE-1, PLUMBING FEE
V 1 certify that 1 have read this application and atom the,the above information is
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correct.ronaemcomply with all city and county ontimncesand city
tolaws
atmlulingm PERMIT ISSUANCE MECHANICAL RF;
L) % Imsebuildingc.timnedroert hereby Inspection
repreaemmives.fNiscitytoemeruponthe CONSTRUCTIONTAX
L.) Z nbuve-mentioned propertyformnifytiad parposes. ALTER OR ADD TOMIiCH.
(We)agree nd sum,indemnify and which
duty hardoo
me CityofCupeninn id City' �nk pp
~ liabilities,judgments,rnstsand expenses which may in any way eccrueagainat mid City AIR HANDLING UNIT(TO IU,fI(1(1 CFM) r q
Ml the".all. l ie per[it
AIR HANDLING T LIUNI (OVER 10,081 CIM)
1 6 asibna/Appificam/Contructor a Data EXf1AU5'1'HOOD(W/DUCI) PAID 1995
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IW,0001i'TU) t Rcceiptp
Will the applicant or future building occupnnl stare or handle harard.us material
As defined by the Cupertino Municipal Code,Chapter 9.12,and the Emilia and Safety HEATING UNIT(OVER 100,000 BTU)
Code,find 25532(u)l
0Yes ❑No VENTILATION FAN(SINGUi RESID) LV lissall'
BOILER-COMP(TIP OR 100,000 PTU) ISSUANCE DATE
Will air contaminants.
as building by ilia
Ards,Air Quality Management pk Q I D
hmmdam air contaminants m defnnl by the BeY Arte Air Quality Management BOILER.COMP(OVER 100.0110 BTU) (r /V
Oistdefl }.
❑Yes ❑No NEW RESIDENTIAL MECH.—SQ.FT. EB
sl have read Tho Imvudous mmeriiia roquiremeres order Chapter 6.95 or the 1995
California Health&Safety Code,Section 25505,25533 and 25534. 1 understand that /s
if the bei ming does not currently have a mount,that it is my responsibi lay to nodlylhe CI L)F
LUr
occupant of the requirements which must be met prior to issuance of a Cent!fea,e of I /
7D
Occupancy.
Owner or autbmncd agent Date TOTAL: ISSUED BY'.
AW
City oI,
Cup ETtll10
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 28, 1995
Judy Young
20899 A1vesDrive
Cupertino, CA 95014
Subject: 20899 Alves Drive, Permit#27541 - Waterheater
Dear Ms. Young,
According to our records the above mentioned permit has never been finaled by a
l� 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
Primed an Pecycled Paper /
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