27962-APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO-DILDI
BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL
BUILDING PROJECT IDENTIFICATION
PERMIT NO,
/� (� C /�
G J v L
BALDING ADDRESS:
rmo✓ UN LOT#
SANITARYNO�.
PRACATONSURMfITALDATE
�rONM x7
PRS NAME NUMB.
N/
CONTROLNO
El
)A
IRCHITECT/FNGINFFA: '.IC NO;
okg
ADDRESS:
CONTACr: PHONE e
QTY. ELECTRIC PERMIT FEE
BUILDING PERMIT I
.BLDG UM
P
11 461F RID60 y7q a0 /d 0
PERh11T ISSUANCE
LICENSED CONTRACTOR 'SDE DECLARATION
I he,eM.Irml WI I em IlcerltM umly pmvivas olChegct9 (mmrcsingwith
APPLIANCES - RESIDENTIAL
JOB DESCRIPTION
Section TN10)of Division 3 ofthe Business end Profeasims Code. Old my license is in
PANELS
full forte mIJ efftty.
Liana Clea Lic.N i -X �°I Sf �-
UPTO2f10AMPS
Ilme Contr .
1pl - EDW AMPS
ARCTUTECTS DECLARATIONSQ.
I uMcretwJ ."Isms M uW u public rtcaJ
OVER 1000 AMPS,
FT. FLOOR AREA $/SQ. FT,
/ O3 `��
Il7—
SIGNS ELECTRICAL
I.icrnxd Rofrni.nul
OWNER -BUILDER DECLARATION
SPECIAL CIRNR/MISC.
am cxcm I from
I hereby .firm Aon 131 caem t frau the Cosaars; is License, Ina for oy
.rvl Pmfusiwe Code: Any city aPYWIy
followingre.wn.comit
TEMP. METIER OR POLE MST.
m]031
which rtyuira a pamil Inc nal, tiler, p.vc, demolish, m rtlmir.nY uruclae
prior to lu issuvice,Ww nsdcapplium' .ochpmmirmfilettm,"..e ,
POWER DEVICES
Nv he is Ikenseal pu I m Ibc provinau of Cnnoector's Licenx Enw (Chep,,
9 (c.mwercing wit foo7000)oflNvismr3o Bushv_ss ON Roleuiau Code)
SWIMMING POOL FT RCIRIC
VALUATION
atica he ise Ihvcfran.rd theb�sfa the Vl exerr,,, nAnyviol.tim of
Senian 903 a M any apllicamfor. mn"a"cc I pphcatOu.civil penally." ll
tet fofmcresc aiym IS
❑ arof0epopeny mm wcN hcirwlecanpenuetian,
I�
`
O �1 `��
OIIH,ITS-SwRCIICS- IIKRIRFS
NF.WRF_SIDF2sf'IALl1LECIR SQ,FT.
STORIES
TYPE CONSTH Cfl N
will de wak,.nJt so -un I aoRetd 5«.]ONa,Businnn.
mccl
vnd fewons Code The a License law nm y,Ay to no owns of
pct wMbullNmi ,nM wlmda aakhim JfalWough M1ls
own em .pmv himfawlrcmlmm
cs Icnndtll.ffemdfasele. If,
/
OCC. R PEA
TS
^
v
Mtwevco ,Wil&ngai vcmcnt issad wit' ane yesofamlplefoO, de .surer
builderwil eve Nebo povillg llW he dna bwWaiminwe fa purµrxM
TY. PERMIT FEE
wle.).
❑ I,m fftsoperly,emexclusi lycomroctin vdth Hecn,seci .ctorato
F. NE
caulmn the pm (Sc. 7014, Basin s end Profasia n CWe:) The Coal.,,
PERMIT ISSUANCE
Liccmc lnwJm .pplym..own<r popctry who bwldsaimpwethcmn,and
whocamh.cofawc ojecuwilh Iractol(s)Iicenxd p...allifucooronor'e
License law.
A1 ALTER -DR-WA )
FEE SUMMARY
❑ I .m exempt cancer B & P C Sothis
BACK IIAWP VICE
ID
SANITARY Y N
RECF.IPTN
0.w DateDRAINS-FLOOR.ROO
ND.
WORKMAN COMPENSATION DIiCLARATION
SCHOOLTAX Y N
' Iheeeby aff menI ove. ceflillcue Mcroser. to scf- me, a.ar fc.le of.'FIXTURES-PPR
Workni Comlcnsadtn lsmarc,cor.mnlfiad copy fficccf(Sec. 3X00, Wb CJ which
TRAP
/
R IPf1
PARK PER
veea.11 employee's aqp yey�rul,�
Polity#�y'O �+S y�s"f �4 "!fi1
ICE
GAS - EA. SYSTEM -1 INC.4OVD-L'TS
DING VI NItJJ
PIANCIIE .F.
Conow! %(t Ee ur.N CO.. F!"cA: eJ
❑�t fel copy is thereby fumishel.
GAS - EA. SYSTEM -OVER 4(EA)
GREISMNDUSTRL WASTE INTERCEPTOR
GRADIN `19Cl
ElCmifeJcoy le fid with the city inspfmn division.
CEFU IIICATE OIt MEMPIION FROM WORKERS
COMPENSATION INSURANCE
GREASE TRAP
SOILS '.
SEWER- SANffARY - STORM EA, 100Ff.
ENERGY FEF.
(This section need not ba completed lftM permit B for one huntirtd dollan(Slgl)
orlcssJ
WATER HEATER W/VENT/ELFCR
I certify that In the perfmwwce of the wok for which this permit is i.oucl. I shall
not employ tiny Persian in tiny nirurr so u to becarx subject in de Wakm
PAID
WATER SYSTiNL REATING
Comprnsationlawsof Califanie. Date
A191ica l
Deo ccciptIf
NOTICETO APPLICANT: If. .Rer m.kiny this Cmifc.tc of Excmptia, you should
NEW RESIDENTIAL PLMB, SQ, FT.
'TOTAL:
beameh Wakcrs Canpctumian povislouof0e Isbol Cao,you mut
corril1. it
forthwith canply with such poW.lors alba pemdldWl be deened rooked.
BUILDING FEE
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hcmhy affirm chat mere is a commaciwn Ending agency fa the perfmrence of
be, wok for which this pmNl is issuN (Sec. 3(19], Civ. C)
aI.CTR IC
N.UMBI
Lcmler's N.
lender's Addeus
QTY. MECHANICAL PERMIT FEE
I ccaify Ihnt I thaw reed thin application .M Otte IMt the .Inve informction i.
amccv I.grtcmrnmgy wlth.Il city OM.nanny adinuea.M nate tete rtleting to
builch.,oma.ction, erM hcrtM.ulhaimrtpexnotivu.f"this city to emcr upon the
.Mac-mcntia e ] popcny for inspection'r,osev
PERMIT ISSUANCE ��
esa
M r'
ALTER OR ADD TO MECI I.
CONS CIlO TAX
(We) agrtc to mvc, iMcmrlify end kap hundesa de City of C.pctEm.geita
Iiahilitici,judgnxno.c.Os.nJcxpnsccwltich may many way.aaacegoinutmid Ciry
2 AIR HANDLING UNrrao IO.0011
an rcs of the pend' of Nu pemdt.
AIR HANDLING UNIT (OVER 140011 CPM)
If
18mt . App' meta me
MHAUSTHOOD(W/DUCT)
PAID
FH:ATBJG UNIT (TO IW.M BTU)
H RDOUS MATERIALS DISCLOSURE
lipte Rcccipk
Will 0e Ec C. nl mfurore ici* Cr occupw vat a hmldk htiasNexs materiel
u 4fined by the Cupcnmo MUNcipJ Calc, Ch.Vla 9.12, and IhC Halth mM S.fcIY
HEATING UNIT (OVER 100,000 BTU)
TO
VENTILATION FAN (SINGLE RPSID)
CNc, Sestina V1532(a)?
❑ Yu ❑ No
Will the remafmursbuiWin ar adevi
.ppl' oche
BOILER.COMP(311POR 100,000 BTU)
ISS 'CE DATE
' ;
l Mman eaoit
�Wadoua air mnuminens u defnd M the H.Y Area Air Quality Mvugemrnl
Bitty Area it
■_�y avictP
„V w-
BOILER -COMP OVER 100.000 BTU)
❑ Yes ❑ No
1 have mad the hn.mdan rluveri.I v. under ¢ 95 of de
C.lilnmie llulU&Sxfery Cale,Secllms 25505.255 7'..a 2S5urli IFa
/
JUN .07 7 ����
y�/
Y Ur'(.Ur.t
NEW RFSIDENHAL MSCI I. SQ. PT.
Elbe bviWi�dou mtcu.rtnly luve.Ierwi4'llol it in ter mlwnOMl'Ily lo'oey tip
occupant of the r�uircoacau which mwt IN, mci priry m iaeuance �f a Ccnifimte of
«cup y.
ISSUED BY:
Owren a vulhonirr 1 egmt Da"c
OFFICE
E
of
10300 Torre Avenue
Cupertino, CA 95014
Cupertino Building Division
(408)777-3228
(408) 777-3333 (fax)
May 23, 1996
Homeowner
Cu ming, oveCA Dr. t
Cupertino, CA 95014 ,
Re: Expired permit, (27962 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 fmaled, 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
Primal on Rocvcled Papa