28274 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING I, -ELE6 RICAI. PERMITNO. 2 H Z 1
7
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENI'IF'ICAJ'ION
BUILDING ADDRESS: //,,//gyp a SANITARY NO. APPIJGSTTON SUBMITTAL DAT
K E.
O ^ i M1 UNIT# LOI'♦ 1 l
pWNFRSNVN IAJQ/ PHO COWel N14 NAME: vOr-6_� S qCO: NhrC CON'IAOLI#
ARCO[I HCFANGINEER: LIC NO: ADUR r"
• FAVI l/ V
CONTACT: PHONE
�Lia /tw/s �J QTY. ELECTRIC PERMfI' FEE BUILDING PERMIT INFO
Ifo
JV C ICs 'Z52- PERMIT ISSUANCE DC; M RCT PLUMB MECCH
LICENSED CON'IRACfOR'S DECLARATION APPLIANCES-RESIDENTIAL 1:1 %1T1-}I•
El
OZZ I haebyaffirm Out l ton lice 1uMerpnvia'mnofClupter 9(mmncxing with — JOB DESCRIPTION
Ji400mid Near.7]end).fecyv�.J Mole Bistos. vu
rProfectiCoda Beaman u ELS s. my Beain PAN
FZty I�avc Clms_1,)_—tic.# 530139' UPTON AMPS
QN Doe Comerear 201-1000 AMPS
ZOhz' ARCHITF,CTS DECLARATION OVER 1000AMPS W.IT.FLOOR AREA S/SQ.FT.
O Z—0 I umknnnd my Plums 001 be used is Public mc«d.a
F vel'-uI SIGNS ELECTRICAL
4Y�y� I,iansN Professional
OWNER-BUILD ER III?CLARAI'ION SPECIAL CIRCUIT/MISC. n
x•0 10F.. I hereby r,(Ss that I am csempk ar the Catrxhxa L'lanu law round,
the L
tvl�OyQ fnlhwing reuann.lSalion]OJl s,nminets artl Prm(casinns Cade:My my ac�unty TEMP.METER OR PWE IZIL (+
m.] which myuike a prmtit to cowmet.Weq Impmve,demolish,urrepair any Wvctum
ty`a'jY� primm iu i.sm...Iso squirts tte applicant for.ah Permit to file asigtlai sr.ru POW ER DEVICES t i
w'<0z that he is li¢nted pursuant to tK mvie.of dia C.&,Liana Law(CM1aptc LL ommencSWIFIMING POOL ELECTRIC '
as 9(ci,with Section RM10)of Division Jof the Buirea told Professiore Coda) ATION
or don heitcacmPt thcrtfmm artl tie,buffsher the WkgMeaatytim.Myvidetimor OULETS-SWITCHES-Fl RI!
ion
tZ,Q Sccr ]O3"by any apgican for a permit subject. m the iWieto a civil prulty of
tla mactban five M1urdrtd loiters(53(101. NEW RESIDENTIALFLECIR _SQ.FP. RI TYPE 1 N
s�� ❑ I.anmfiva u
ptopeny,«myemployen wikhwageudehsakcompolsesimt,
a32 willdo the wak.Col he Centratasr.Ur. I'wclems isle(Sa.1.sm visian
and Rofaskxu Code:The CauactNa Liceme law Jas rot epp1Y to an owrcr of
o.nm whotwillsorimprovethemm,venwhouc ouchcnrthimself«thmagh hiz
rmPloym',priu,,it,FmvrM1imis-h!cnlsme mtinlrndcdaoRacd fmsale.If. OCC, P RPS.UNITS
however ill buildingorien o"smie.mldwithinnayear of c«nova for theowrcr- TOTAL.
sal..) will have Oe burden of proving that he did tun buildaimprove f«Nrpuse of
u1c.).
❑ Lmowncr oftn<pmpmy,emescludmly nminain¢wiN lianscd cankrnmmto QTY. PLUMBING PERMIT FEE t ID o E AI'N
crostmct the projem(Sea 701L Soames and 14ofe.iae CMc:)The Cmmma ar'S
(jcerue Low dee tmkapply to anowmcofmoperty wllo builds or improves thaan.mcl PFRMITISSUANCE
whin c..,fa inch Projects with.amuadirB)Bern i pmuaot to tie Calextac
Licenve law. ALTER-DRAIN&VFM-WATER(FA) FEE SUMMARY
❑ 1 em cacrtgt uMa Sec ,B!P C fm This tan BACK FLOW PROTECT.DEVICE, SANITARY Y DE N
pear Date DRAINS-FLOOR ROOF.AREA.COND. RECEIPT#
WOR KMAN COMPENSATION DECLARATION SCHOOLI'AX Y N
❑ Ihertby affirm tlwlfurcearifkwte nfumsent to selNin.ac,as atdf kc of PIXTURPS-PFJt TRAP RECEIPT#
Wmken'Cum;rn.,ion ltuurmameccnifcd ttpy thcrmf(Stt.Jg(p.lab CJ which PARK IFI. Y N
ctivcm all emPliryec z.fide.this Pumit. GAS-EA.SYSTEM-I INC.4 OUTLETS RECEIPT#
RJicy# BUILDING DIVISION IIJS
Comlwny GAS-HA.SYSTEM-OVER 4(EA) PIANCI IECK FEE
❑ Ccnifac t,y is hcrtby fumishad.
Cl Cenired copy is film with the city inspccdom division. ORFSR9NDUSTRI.WASTE.INTIRCFJTOR GRADING FEE
CIiRTIRCATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE
COMPENSATION INSURANCE
Mi.sect ion tml na be carylerd iftbe permit u forac hwdmd dollan(SI0B SEWER-SANITARY-STORM EA.2IMIFT. ENERGY FEE
alis )
I ttrtify that in ths,performarcc of the work for which thi.Parini is used.I shall WATER HEATER W/VEJELECIR
tont employ any Pennon in my owrcr is,u as 1,ac.tubjttt to the Workers' PAID
Z Comctumim Law.of Coliform. Dam WATEA SYSIEM/IRFATING Due Rcxi #
Applicant
Q2 N[YI'ICIiTOAPPhICANT:If.efurmekingtM1isCrnirwenfr ertpian,ya should NEW RISIDENf1AL PLMB. SQ.ET. OTAL:
r G bec.mambjwnuthe Workn's Contprn.wtitm revidism ofthe__
Cade,yw moat
fX > fmhwikh cunPly with such a.,isi«u'oethi.s Pernik shill he deentedrevokeJ � BUILDING FIJI �•
W CONSTRUCTION LENDING AGENCY SEISMIC FIJI
Q Ibcmby affirm that there is a construction lending.gamey fa the performance of E=RIC
U O die work la which this Permit is is.aed(,Scc.XyG.Civ.C.)
Letukr.N. PLUMBING
0 F Leader.AM. QTY. MECHANICAL PERMIT FEE FPV
U I cerity Ban 1 have mad this alglicatian am time that the above htf«roatim u
Cl1�" comet,lags an comply with all any lord rnumy aahle ofv tywe srtl•"gb PERMIT ISSUANCE MECHANICAL FEE
F' y daidin8cw.ractian.ed hcmby auth«ire teprettnutive ofdda cityroetl¢.upon the CONSTRUCTION AX
U Z above morn onM pops,fa im,ts ori pnpaa ALTER OR ADD TO MECE.
(We)a rue 10 save.iMomtifY W tap hmmku the City of C.'.'ma u
B.1liti .) ycosumdcalgtsc.wM1ich mayln.ny way ecmre.gait.vii City AIR HANDLING UNIT(TO[0,"CFM)
nfthcgrentin Cr
1 AIR HANDLING UNIT(OVER 10. CFM) '
Sig es(Applic.UC me.r '7
orMfc FXHAUSTHOOD(W/DUCI) PAID
HAZARDOUS MATIRIAIS DISCLOSURE BEATING UNIT(TO 100,00(BTU) Disc Rttcip#
Will kle oppllaut er form building occupant sires re htadk herardws marsdiW BEATING UNIT(OVER 100,00(t BTU)
u Jame]by the Capenino Mo din cil Cada.(hrync 9.12,andde mill uSafaty
Cade,Satin 255]2(.)? VENTILATION FAN(SINGLE RFSID)
❑Ya ❑No
Willdeappliruu«(artva balldirt�accupW urcquipmrntadrvrm whicM1mJt BOILER-COMPUHPOR 100.0(BBTU) ISSUApN1E DATE
cwtvml..",<u delved by the Bay Arta Air QlulitY Muugemmt W !l
Dwrin] err
BOILER-COMPIOVER 1001000 BTU) aY r �
❑Ye ❑No NEW RESIDENTIAL MECH. SQ.ET. (7/4
is JII q
1 have teod ire hvardous matcrieu tc9ummde
mem.under CTugcr 6.95 of the �s/4 �V/�
C+dd is l truth&Safety Code,Samek.253115,255]1 and 255]4. 1 under, 1h.1 !!�� a[
if the building dtws n«currently have a tern mt,thin it is my asponsibiliky to mtify the V/- `
xcupum of the �
rabCmMnki which may he tat prhb .N i ,,a of a CaOrralc of
oc",,aay.
pwrcr«eathariud.gem Date TOTAL: ISSUED BY:
OFFICE
of,
&(:,,I
10300 Torre Avenue
Cupertino, CA 95014
Cupei roll Building Division
1 (408)777-3228
(408) 777-3333 (fax)
April 23, 1996
I
Owner
19680 Drake Drive
Cupertino, CA 95014
Re: Expired permit (copy attached) ��� �
Dear Owner:
According to our records, the referenced permit has not 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 (408) 777-
3228, so we may arrange to extend your permit and schedule a final inspection.
The City of Cupertino requires a response within ten (10) working days from the date of
receipt of this letter. If we do not hear from you within this time, the building department
will have no other recourse but to resolve your permit as expired and discard the records.
Thank you for your cooperation,
Building Department Staff, City of Cupertino
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