28247 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
BUIL UING-ELRC'1'RICAL PERMITNO.
r CITY-OF CUPERTINO APP[ [CATION/PERMIT PLUMB N I-MECHANICAL n^ ^
BUILDING DIVISION BUILDING PROJF.C'I'IDENTIFICATION L 8
BUILADDRESS SANITARY NO. APPLICATION SUBMITTAL DAT,
*'INURS
YA-IIJI� UNITpLOTHAMU: PHONE: CO NTRACfOR'SNAME: LIC NO:41SrAKAI'ItiCf/ENGINEFR: LIC NO: ADURIiSS: El C l-f n vs .
CONTACT: PHONE: BUILDING PERMIT INFO
/�.�pp�� , I ' t �,,,,s! QTY. ELECTRIC PERMIT FEF.
51.N)'�- V o 14 L14IrA �� PERMIT ISSUANCE BLDG ELECT PLUMB MF,CH
❑ ❑ ❑
LICENSED CONTRACTOR'S DIiCLARATION APPLIANCES-RESIDENTIAL
Mertz, IhcrebYuffrrodall am licensed underpmvisions of ChaPtcr9(commenting with JOB DESCRIPTION
,[ C full foreland of Divixmn3nf Om Business unJ PmEssinna CnJC,and my license is in PANELS
y W full force and effect.
< u�i License CleoLe.# UPT02MAMPS
vt=y Data Contract., 201-IOW AMPS
Z O'z ARCHITECf'SDF.CLARATION OVER IINq AMPS SQ.FT.FLUOR AREA $/SQ.IT.
O z_ I unersJ m
cmny plaro sll h
hae Escd xs puM1lic rcm.ly.
P'4 1=W SIGNS ELECTRICAL
6y�,, Licensed Pmfesvinwl
�yVC OWNER"BUILDER DECLARATION SPECIAL CIRCUIT/MAC. .
KO W V 1 broke affirm that I am exempt ftom the Cmajactor'x License Low for Inc 'r
W 3LLy following reason.(Section]0315,Business and Professions Csfe:Any airy M county TBMP.METER OR POLE INST.
���� whichre,fruaNa permit to construe.after.improve,demolish.or repair any suueum I'OWIiR UIiVICG$
� :F prior m its issuance.alaoreyuirestheapplicum hunch permit m filersignedstammem
=1<0 tlwthei.slicensedpumuanllolhepmvisionsoflhe Contmetor's License Law(Chipter SWIMMING POOL ELECTRIC
i 2-L X 9(aimmencing wish Section'IIKKBorDivisi.n3nf the Business ane Prolusions Cole) VALUATION
^y or that he is exempt herefrom and Ne basis for the alleged exemption,Any violation of
FZQ Section 4113156 licam fora yl OUTLETS-SWITCHES-FIXTURES
by permit subjec¢the applicwuoa<ivil penalty of
S D not more than five hundred aollara($SI)). NEW RESIDENTIAL ELECTR SQ.FT.
YFo ❑ `aaowneroflheprnpeny,ormyemployees wiN wagcsazthcirsolecompcnsation, STORIES TYPECONSTRUCrION
a3= will da the work,ova lM1ceweurC is nolimcnece oroffercJ rte mle(Saa.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of
property who buildsor intprovcx Iherenn,and who does such work himselforthmugh his
employer,provideJtna such improvamentarrema nncndedonfffaed fors ale.If. OCC.GROUP RES.UNITS
hoxover,the bLilding or impravemcnt is sold within one yeroofcampletion,the owner- TOTAL
.
builder will have the burden of proving that he did not build Or improve for purposC of
sale.).
❑ I.asowner ofthe property,tett exclusively contracting with licensed contractors to QTY. PLUMBING PE IT FEP/ FLOOD ZONE qPN
omuum the project(Sec.964,1,Business and Professions CudeQ The Commnnr's
License Law docs not apply tit annwnerofpnnpeny whobuilds or improves Hereon,and PERMIT ISSUANCE.
who contracts forsueh projects with aconoactuds)licensed pursuant o the Contractor's ALTER IA
License Law. (t FEE SUMMARY
❑ I am Ot under Sec. ,tl&P C for Iris,ancon BACK FLAW PROTECT,DEVICE OUTSIDE FEES
SANITARY - YN
Owner Datc DRAINS-MOOR,ROOF,AREA.COND. RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ Ihcrcby affirm lhatlhaveeccnilicam ofcuvent 1.ttlf-insure,oracertificate of FIXTURES-PER TRAP RECEIPT#
Workers Compensation Insurance or a certified copy darrof(Sea.3800,Lah C.)which PARK FEEN
en all employee's under this permil. GAS-IiA.SYSTEM-]INCA(lI1TLLT5 1; EII .
Policy# E BUILDIN DWIS10NX"ES
Company GAS-F.A.SYSTEM-OVER 4(EA) PLANCHF.CK FEE
❑ Canifiedeipy is hereby famished.
❑ Certified ropy is files with the city inspection eivisinm GREASI7INDUS'fRL WASTE INTERCCPTOR GRADING FEE
CERTIFICAIP.OF EXEMPTION FROM WORKERS' GREASEI'RAP SOILS ERE
COMPENSATION INSURANCE
(This action need not beetannmcd if1he pcnnil is future hundred dollars($HXh SEWER-SANITARY-STORM EA.201 ENERGY FEE
or less.)
Iceni fy that in the perhnntanceof the work for which this pcnnil is issued,l shall WATER HE,V1TR W/VENT/ELECI'R
net employ any person in any manner No as to become s.hja,t ui the WorkersPAID
Compcnsauonlawsuf CullfmMa. Data WATER SYSTEMGREATINGReceipt#
O z Applicant
z NOTICE*10 APPLICANT!If.after making this Cenificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
become subject to the Worker's Compensation provisions of the labor Cade.you must
� > forthwith comply with such Provisions or this Permit shall be deemed revoked. BUILDI NItEE
Z CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby alfirm that there is a construction lending agency for the pcomarmnce of
the work for whichlnia Memo,is isancl(Scc.3099.Civ.C.) TOTAL: ELECTRIC FEE
Lenders Name PLUMBING FEE
O U Larches v/s f,that QTY. MECHANICAL PERMIT FEE
I certify that I have read this city
an coomin and ordinances
nhat the abvc information is MECHANICAL PEE
OW.. correct.lagree mcomply with yall cityaW countyryntatives cssnd emm)entrupon the PERMIT ISSUANCE
E" Z above mentioned
proavd freM1yaulhoneeoposeemarivcsofaniscity to enter upon the CONSTRUCIONT X
C) z abovee-mcinlgree to savnyfor mastication,keeposes. ALTER OR ADD TO MEC[[.
(We)agree to save.indemnify and keep braless the City nl'Cufstifloo s against
liabi li<s,juJgments.case andeapenxs which may in any way.carve against said City AIR HANDLING UNIT(TO 10,000 CFM)
nxc4ucn' nil A granting [this permit.
if AIR HANDLING UN,I'(OVER Q0IX)CFM)
Signamnilf5f Applicam/Colprocior L Dare EXI MUST HOOD(W/DUCT)
PAID
HAZARDOUS !RIALS DISCLOSURE HEATING UNIT('1'O 100,000 BTU) Use Receipt#
Will the applicant or future building weapons store or handle harordous material
as defined by the Cupertino M amciied Calc.Chapter 9.12,and the Health and Safety HEATING UNIT(OVER IOOAOO BTU) TOTAL:
CMc,SCctom 25532(.)?
e, ❑Yes 0 N VENTILATION FAN(SINGLE RESID)
Will thea licanror(murt huildin occu lose pmcn BOILER-COMP MHP OR IW,IXp RTU)
ISSUANCE DATE
PP % pan aqui muality Management unlnus air umtaminnnls as defince by the Bay Arca Air Quality Manngemem
nniel BOILER-COMP(OVER 100.000 BTU) P Ali)
J
❑Yes ❑No NEW RESIDENTIAL MECH.-SU FT. JUL n�p
de
1 have read the hauNous materials requirements under Chapter 695 of the ^
California Health Safety Coda,Scetionx25505,25533 and 25534. I undcormadtha 1a/� 199";W 001!'
if the building does not currently have a traitor,that it is my rcf
spromibility to notify the y 'I
caupanl of thmb m
e rcyuireents which must mel prior issuance of a Cena
iOce of Lk9Y�
Occupancy.
Owner.,authorized agent Data TOTAL ISSUED BY: .
OFFICE
ev 10300 Torre Avenue
Cupertino, CA 95014
o1•
Cupertiuo Building Division
(408)777-3228
(408) 777-3333 (fax)
February 16, 1996
Homeowner
21915 Eaton Place
Cupertino, CA95014
Re: expired Permit(copy attached)
Dear Permit Holder:
Our records show that the referenced permit has not been finaled by a City building
inspector. A per
tit is valid only six months from its last inspection date. If your permit
shows that the anal inspection has been completed, please send a copy of the permit
along with this letter to: 10300 Tone Avenue, Cupertino, 95014, Attn: 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 date of receipt of this letter. If we do not hear from
you,the City of Cupertino Building Department will have no recourse but to resolve your
permit as expired and discard the records.
Thank you for your assistance.
CITY OF CUPERTINO
Ponrea on Pecvded PaOer