27446APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
OFFICE
CITY OF CUPERTINO BUILDING -,E'LECT'RICAL
APPLICATION/PERMIT PLUMBING - MECHANICAL,
BUILDING DIVISION - " BUILDING PROJECT' IDENTIFICAT
PHRMIT NO,
27446 n 'n C
LI4 VION L
B_ UILDINGADDRESS:
SANITARY NO.
UNIT# LOT#
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QTY. ELECTRIC PERMIT 'CB
BUILDING PERMIT INFO
BLDG CLE(➢' PL M ME' If
PERMIT' ISSUANCE
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LICENSED CONTRACTOR'S DECLARATION
Ihereby afford that l am licensed under provisions ofCbmdu 9(commencing with
Seedon7000)of Division 3ofine Business and professions Codqund my license is in
mme ana<
License Class Lic.#
am
DM./R Contrazto,
ARCHITECT'S DECLARATION
l anderstand to,,dium shi ll heated as public reconls.
APPLIANCES RESIDENTIAL.
JOB DESCRIPTION
PANELS
UPT02MAMPS
201-HKO AMPS
OVER INJO AMPS
SQ. FT. FLOOR AREA
$/SQ. FT.
SIGNS ELECTRICAL
Licensed Profevainnal
ecQ
Qat
y
OWNER'BUILDER DECLARATION
1 hereby affirm that I um exempt from the Conhuctors Lierme Law for the
followingreason.(Section'/031.5, Business and Professions Cade: Anycitymcounty
which requires a permit to construct, alter, improve, demolish, or repair any structures
SPECIAL CIRCUIT/MISC.
T' EMP. METER OR POLE INST,
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prior to its issuance, also requires theapplicam for such penniu0 file a signed statement
pursuant dim he is pursuano the provisions oRhe Contrtnors License Law(Chapter
9(commencing with Section 7000)of Divhion 3 ofthe Business and Professions Code)
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
-,y
Za
O
pm
or that he is exempt herefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the affliction to a civil penalty of
at more than five hundred dollars ($50P.
CII,asownemfN<pmperty,mmyemp oyeeswithwugesoe theirso ccnmpensmion,
will do the work, and the sanctions is not intended or offered for sale (Sec. 7044, Business
OUTLETS SWITCNIS- FIXTURES
NEW RI?SIDF.NTIAI. F.LCCTR _SQ. Ff.
STORIES
TYPE CONSTRUCTION
and Professions Code: The Contractors License law does not apply to an owner of
property who builds m improves thereon, end who dors mch work Idlnvelf or through his
own employees, providedthat such improvemenrsarins mordedorofferedforinle. If.
OCC. CROUP
RES. UNITS
TOTAL:
however, the building orimpmvernent h sold within one yeafofrompletion, the owner-
builder will have the burden of proving that he did not build or improve for purpose of
FLE `g`
QTY. PLUMBING PERMIT n fir
❑)1,uowneronhepmpeny,amexclusiveyconwchngwithhenaedcono-a iontu
consh et the project (Sec: 7M4, Business and Professions Code:) The Contrnatnrs
FLOODZONE
APN
License l.usvd0es not apply to nn nwnerofproperty who builds orimpnrves thereon,and
PERMIT ISSUANCE
whocantracts forsuch projects with a connections, licensed pursuant to the Conuunoes
License Law. (
ALTER (EA)
1'.rEUS1JMMARY i"
❑ 1 eon exempt under Sec. , B & P C for this masno
Owner Date
CK FLOW PROTECT. DEVICE
D NS-FIAOR. ROOF, AREA, COND,
OUTSIDE FEES
SANITARY Y N
RECEIPT#
WOR KMAN COMPENSATION DECLARATION
❑ Ihcrebyaffirm that l has <acmificmeofeonaentmaelfinsum, or a cenifcvl
Woderv'Compeneutlan sumo¢ nraoertifinl copy thereof (Sec.3gIXl, Leb C.) tioh
SCHOOLTAX Y N
RECEIPT#
FI RES - ITER TRAIT
PARK FEE YN
covers idle ee'e Permit.
Policy N
GAS -.A. SYSTEM. I INC. 4 OUILUS
RECEIP #
BUILDING DIVISION FEES
CO1^I1p^y-GAS
- kA.SYSTEM-OVER 4(EA)
PLANCHECK FEE
❑ Ccmfid copy is hereby famish¢ .
GREAS NDUSTRL WASTE. INTERCEPTOR
GRADING FEE s
❑ Certified copy is fled with the city inspection division,
CERTIFICATE OF EXEMPTION FRO YORKERS'
COMPENSATION INSU CE
GREAS NAP
SOILS FEE
SEWER- ANITARY - STORM EA, 2001f.
ENERGY PEE
(This section need nothec0mpleted ifflic it is formulditred dollars ($100)
or less.)
WATER fI TER WryFNT/CLECIR
Icertifythminthepsomadianceofth ork for whichthis con.,
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0
rq
not employ any Person in any in so as to become subject to the Workers'
Compensation Luwsnf California. ate
Applicant
WATERS TEMITRPATING
PAID
Date Receipt
NOT'ICETOAPPLICANT: ,afar making this Certificate of Exemption,you uld
beco subjeclothe Wo rs Compemationprovisioasofthe Lmi It
NEW REST iNTIAL PLMR. SQ. IT.
TOTAL:
7
forthwith comply with such envisions or this Permit shall be deli
BUILDING FHE
c5
CONS ULTIGN LENDING AGENCY
Ik
SEISMIC FEE
z,
Q
ULenders
Lu
0.
pj
Z
Ihereby off that ecunstruction lendingv enc rf e f
agency e � r/
the work forwhich this permit i isod(Ses.3 ,Civ.
Traders Namc
s T L:
CLI!CIRIC FEB
Address
MECHANICAL PERMIT p Y$?a'PEE -
PLUMBING FEE
I certify Dat I have read th spplicati m hat thea e' remained. is
cermet. lagreemromply with vl ity and <ountyo res Dods aws relating to
building construction, and h<rehyt thnrize mpresentab sof this ciyto enter upnnt
above-mentioned property for item cfor purpnme.
PERMIT ISSUANCE
MECHANICAL FEE
ALTER OR ADD TO MECI I.
CONSTRUCTION TAX
(We) agree to save, indemai wd keep haon cas the City of Cupertino dost
liabildienjudgments.emnsnd<a rawhichmayin soy wayaccrue against ACity
AIR I IANDLINGUNITOO I0000CFM)
in consequence of the granting of th s permit. ,
AIR HANDLING UNIT (OVER 10,000CFM)
Signal eof Appliem"'comod a Date
EXHAUST HOOD(W/DUCT)
PAID
HEATING UNIT (TO l0d,000 BTU)
HAZARDOUSM RIALSDISCLOS E
Date Receipt#
Will the applicant or turn moldin reclaim store andle hazurdons material
as Jcfind by the Cupertino Munictyal . 2, sod the HeahM1 and Safety
BEATING UNIT (OVER IOO,OOp BTU)
TO'fAl.:
Cade, Section 255J2(a)? /
E) Yes C]IDL.,IK(
VENTILATION FAN (SINGLE RES] D)
D
Will the aPplicant or future building accupunt use equipment ordevicea which emit
no d is s air contamin u der by the Bay Amo Air Quality Management
❑Yes �YfJo
SSUANCE DATE!
R 191995
BOILER- COMP(3HP OR 100,000 BTU)
BOILER -COMP (OVER I00,00D BTU)Di
NEW RESIDENTIAL MECH. SQ. FT.
I have read the hormones materials requirements under Chapter the
uurr:nt lNU
r'� ser
California Health & Safety Cone, Seen.. 23505.25533 and 25334. I understand that
erne ad
if theboildingd of currently have a tenant, that it is my responsibility to notify the
ccup to ort vi ii Tw''h It must to met prior to issuance of CraificuteyL
0 en
Owner a authorized agent Dam
TOTAL:
ISSUED BY:
OFFICE
Of
Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 28, 1995
7916 August Lane
Cupertino, CA 95014
Subject: 7916 August Lane, Permit # 27446 - Waterheater
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
•
Printed on Recycled Paper
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