27526 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 27526
BUILDING DIVISION BUILDING PROJECTIDENTIFICATION
WILDING ADDRESS: A.,A ,kms SANITARY NO. APPLICATIONSUBMITTAL DATE
101VO A-' 49"Al� Y /IIeVfVe rvc UNIT LOT#
liffNERS NAME: PHONE: NTRACTOR'S NAME: LIC NO:
—'2pz 3t
AD K./1 S : NIC ClONP RO
ARCHD'ECT/E INEFR: LIC NO: ESS ❑ /\� 1
CONT Cr: ^/ _y-' ..rr Pxorve: QTY. e ELECTRIC PERMIT FEE BUILDING`PERMIT INFO
®ArIoN VIV/fIWV /zs zo�� BLDG ELECT
1 PERMIT ISSUANCE PLI ^IDLgJ�C�=
LICENSEDCONTRACfOR'SDECLARATION APPLIANCES-RESIDENTIAL RI
qyy lheroby affirmthat I con CENSEliCONT under proviCONTRACTOR'S
DECLARATION
Vi 0W0 Section 7000)of Division 3 of the Business and Professions Code,and my license is in I PANELS
or
F U C full force and effect ./�
<ZU License Class ic.
L # UP T0200 AMPS �.�/s�f .Qt'�'1 -/kl
m,=y
Data Contractor. 201 OVER I0AMPS I VISI+ V R����J�/
'OZ-2..1 ARCHITeCfS DECLARATION OVER IIXXIAMPS SQ.FE FLOOR AREA $/SQ.FT.
0 Z_,G I understand my plans shall be used as public records.
ate,2 J
yy��2 Licensed Profeastonal SIGNS ELECTRICAL
Kia OWNER�BUILDER DECLARATION SPECIALCIRCUIT/MISC.
A'Oa U I hereby affirm that I am exempt from the Committees License Law for the
' 3oat following reasrnt.(Section]031.S,flusinese and PmPossions Code:Anycityorenmy TEMP.METER OR POLE INST.
call which rveluires a permit to construct,alter,improve,demolish,or repair any structure
ISL uv 2 priorto its issuance,also requires the applicant for such permit to file a signed statement POWER DEVICES
aKyO� that he is licensed pursuant o the liravisions of the Contractor's License Law(Chaprer
%� 9(cormnencing with Semina]000)of Division 30f the Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION
�r^y or that he is exempt therefrom and the basis for thenlleged exemption.Any violation of ^/
Z< Section 7031.5 by nay applicant for a permit subjects the applicant w a civil penahy of OUTLETS-SWITCHES-FI) /m M
ot more than five hundred dollars($500). CA/
nL� ❑ I,asownereftheproperty,ormyemployeeswithwagesastheirsolecompensation, NEW RESIDENTIAL ELECTR SP3 STORIES TYPE CONSTRUCTION
a 3... will dome work,and theslructure is not imendedoroffered for sale(See A044,Business
and Pmfia,siom Code:The Contmmods License Law does not apply to ea owner of 1
pmpeny win builds a rimprovestherami whodoessuchwork himselforthrough his
If, l (JCC.GROUP RFS.UNITS
empl0yees,providW thersuchlmprovememsnrenotlmendedoroffemd foreale.
however,the building or improvement is sold within one year of completion,the owner-
�buiildeer will havehe burden at'proving that he did not build or improve for purpose of
TXi.,_ TY, PLUMBING PERMIT
I in,
pmpeny,amexdrsively contracting with licensed Q FEE FLOOD ZONE APN
construct the protect that.7044,Business and Professions Code)The Contractor's
License Lawdocame apply toanowscridpmperty whobuilds at improves thereon,and PERMIT ISSUANCE is
wh0commens forsuchpmjects with acentractorls)liceneecipursuant lathe Contractor's WATER(EA) FF SUMMARY
License ALTER-DRAIN&VENT-
A
❑ 1 n e empt under Sec. ,B&P C for this reason BACK FLOW PROTECT,DEVICE
O SIDE FEES
SANITARY Y N
Own IM• Date DRAINS-FLOOR.ROOF,AREA,GOND. RECE N
WORKMAN COMPENSATION DECLARATIO SCHOOLTAX Y N
❑ I hembyaftirm that l have a certificate ofcomear toself-insrr,oracerd to of IgX'TGRES- RE 'IPI'#
Workers'Cnm tion lnsuranceoracertified PER TRAP
pensa copy thereof(Sec. 00,Lab CJw PARK FEE 411,711-1.
N
coversy all employee's under this penniL CEIPT N
Policy# GAS-eA.SYSTEM-]INC.40UTLETS DUILDIN DIVISION FEES
Company -EA.SYSTEM-OVER4(EA) PI CHECK
❑ Certified copy is hemby th in,ed
❑ Certified copy is fled within,city inspection division. REASEANDUSTRL WASTE INTERCEPTOR ING FE t
CERTIFICATEOPEXEMPDON FROM ORKERS' GREASE TRAP SOILS FEB
COMPENSATION INSURA E
(This samion need not b,completed ifthe permit l oronehumbe 1W) SEWER-SANITARY-STORM EA.200Ff. ENERGY
or less.
I certify that in the performance of the work f whichmisp J.I shall WATER HEATER W/VENT/ELECIR
not employ any person in any manner so ar o became wrote Workers' PA V
Q OCompensation Lawaof Cnlifomia. Data WATER SYSTEMOREATING p ReceiptIs
Applicant
NOTICE TO APPLICANT:If,after makings 's Certificate of Exemption,y amid NEW RESIDENTIAL PLMIL SQ.PT. TOTAL:
(q Income subject to the Worker's Compensation sons of the Lobar Code,y most
�. ; forthwith comply with such provisionsorthls pe tritshallbedeemedrevoked. I BUILDING BE �y
CONSTRUCTION LENDING)KIENCY SEISMIC EE
z 1 hereby affirm that there is a construction lending th forte performanw of LLE C
U O
he work far which this permit is issued(Sec.3097,Civ.CJ FEE _e
LT. Lender's Name
lerdera Address QTY, MECHANICAL PERMIT FEE PLUM ING FEE
," LU cit 1 certify that I have read this application and state that the above info ' is MECH ICAL FEE
meet.l agree to comply with all city and county ordinances and stale laws mlating to PERMITISSUANCE
�,y'" buildingcnnsrmerion,and hereby uvthorize representntivesof tuffs citymentermpan the
V z above-mentioned prapeny far inspection pwpwes. ALTER OR ADD TO MECH, CONSTRU ION TAX
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,cosis and expenses which may in any wayacerwagaitutsuid City AIR HANDLINGUsl 10,000CHA)
in ohe gtanting of t 's penin.
e fencef t((// O4 ,�/3i/4 AIR HANDLING UNIT(OVER 10,000 CFM)
Signamreof ApFh—�wUCOmfmar )r4j III —Dole' EXHAUST HOOD(W/DUCD
PAID
HAZARDOUS MATERIALS
DISCLOSURE HEA'L'ING UNIT(TO 100,000 BTU) Data
Will the applicuntor future buildlogoccupantstare or handle bazmdous material BEATING UNIT(OVER IOO,tXro BTU) OT
as defined by the Cupertino Municipal Cale.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)?
❑Yes El No VENTILATION FAN(SINGLE RESID)
BOILER- (. ISSUANCED E
Will thea licanmrfmure buildin quipmen COMP LHP OR 100,0[1(1 BTU)
pp goy the Bay tmality Mange ant
,hxzndous air contaminants as defined by the Bay Area Air Quality Management BOILER-COME(OVEK IW,M BTU)
rJixtrict?
11 Yes C3 No NEW RESIDENTIAL MECH.—SQ.FT, 4s"
1 have read the hazardous materials requirements under Chapter 6.95 of the Cr
California Health&Salary Code,Sections 25505,25533 and 25534.1 understand that (�
if the building does not currently have a tenant,thus it is my responsibility or notify the �#.
occupant of the requirements which must to at prior to issuance of a Certificate of n/f - x�
Occupancy. O (Jr L�/f7Cr
Owner or amounted agent Data T ISSUED BY:.Ml l/ r'
OFFICE
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 28, 1995
Pacific Gas and Electric .
10900 North Blaney
Cupertino, CA 95014
Attn: David McKinnon
Subject: 10900 North Blaney, Permit# 27526 -Natural Gas Fuel Station.
Dear Mr. Mckinnon
y
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
a
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