28153 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO 1 I k. AL PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL. ^ (� a� I�
BUILDING DIVISION BUILDING PROJECT IUENTIFICATTON L 8 11 3
NU DING ADDRFSS: 1M SAN NO. APPIJCATION SUBMITTAL DA'llr
1 ` UNfI'N LOTH r //014
OWNER. NAME: PHONE CONTRACTOR'S NAME LIC NO: N/C CONTROLN
G
NCHH '/ENGIN TA: WC NO: ADDRESS: ❑ / O
NT PHONE: Qom. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC
PERMIT ISSUANCE � E]
EJC'F145ED rmlicCONTRACTORupmvisi DECLARATION Ch TrN APPLIANCES-RINIDINTIAL
4100 Ihcmlly ofDivihell emlice Busiosl mall Psiomons Cccer9n mwlncing wish LOB DFSCRIPIIOIJ _
&j00 $et lfeer,andeffDivi.skm 3.fine Businessud Rnfesims Cede,and myliccllm is in ppN r1(_S
<1+ fdlforaaal cffet.
IGI...y VV(y Licenro Clnv LiaN UP TO]fp AMPS
nnQd Due C_.mc 101-1000 AMPS
Fur z ARCHITECTS DECLARATION SQ.FT.FLOOR AREA
p7'y_r wM 1uMlsrud
emy plmd rnrts
Plants shell be uu public lc . OVER 1000 AMPS SRQ'FT.
QNF'] Licenmd Professional SIGNS ELECTRICAL
CC_ n'GGG OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
I Mrebyaffirm IMI 1 am own the Cmlmeams Lirmso Low for 010
LL]�ON "Imovingreuo, S,Busbcs ud Pmfenmans CuEe:Anycirymeonty TEMP.MINER OR POLE INST.
C NJ whi, Prar 5.PCmlil m emrrmel eller, Ipmve,demolish,m rtpmr uny senacmre
Pon to is i.svrerlre,alw rtywru the appT fm such prrmit to Oleesigrleil YUGnrnI POWER DEVICES
<pK Nn he in licensed purvuanlw Ne pravisreme Ne Cmm.un'aL.LItw(C'hnphr
dKCLL 9( menacing wish Scdion 70000.fDivi.viml of'hc Burinaa wJ Pmfcuinns Gde) SWIMMING POOL ELECTRIC // VALUATION
tKy a o 7031xmyrm ap iantfranormfat elkScdescmprion.Myvipindonof N;
�SY marc ninI by It applieam Lnepmnil sub u'he npplie'1ml In eeivil p,lwty of OUTLETS-SWITCIIPS-FIX'1VRFS
0 mart Nanrmift drd lu 5W).
Y nW Y gesude'uwlecemlpensation, NEW RESIDENTIAL SQ.PT.
I,'un nmufl lu ce 'Nwa --trees TV PE NSIR N
d _ wit da Bernd fames(S¢AM1W.Businris
aM 'mf C lor's Licrnse w doss m sort In on o oesr of
In nay lmprovelheram I pch wnhhinvelfmlhom milis OCC. OUP RIS.UNIIS
npby vide)mus vallrnlaveminte woffe far.ule,if,
Prose cm i tinges vcncm is sMd wiNln one ycua0.vmPlaion.me.wtxc-
99
hordewill ate ofpmviM road M did nut WiM or improve for purpose of T 1
Uc.l.
❑ L of Neprgcny,moexclusivelycmP.dngwithliccnwdcmtrenoalo QT' PLUMBING PERMIT P, FLOODZONE AM
construct the Project(Sm.7044,Business end Pmfemienu Cade:)The CmVelols
U.Law door at nPply lnanrnmerof)mrpenywhn builds.,improves lhertmn.ud PERMIT ISSUANCE
,menotredor.ah pojmswiNacmlrvlw(.s)li¢rtsed pursaam to lheCmuacllx's
Lianas lawALTER-DRAIN&VENT-WA FEE SUMMARY
,
❑ I un eaemq under See. ,B A P C fa this rtum BACK Fl.O W M _Cr.DEVIL OUTSIDE
SANITARY Y N
Owm Due DRAINS-FLOOR ROOF. C RF.CEIPI'N
,( WORKMAN COMPPNSATION DECLARATION SCHOOLTAX Y
❑ IMrtby aRrm thulheveeccnifiralc nfmnscnt t.self-invure.aecenifreu of FlXTURFS-PER TRAP RECEIPI'N
Wortai Carnpcuulan lm. ors,certified coEs d'ermf(Sec.3&10.Lab C.)whah PARK PEE Y N
rets ell employee's unarm Nis Permit. GAS-Et.SYSTEM.-INC. OUTLETS
PoEcy# BUILDW O VI ON
CanPeny
❑ CcnifcdeoPYi.sherchYfrcola N. Gn5-EA.SYSIFJN OVIJt4(FA) PIANCIIECK Illi ,
❑ Genital mPY u Tiled wim me city ilupcOm division. GREASMNDUSTRL WASTE IN TYCHPTOR GRADING FEE
CERTIFICATE OF EXFR1PfION FROM WORKERS GREASP.TRAP SOILS FFR
COMPENSATION INSURANCE?
This section lred m M camoleled ifthe permit is for ems huMrtd doll.(SIM) SEWER-SANITARY-STORM EA.1(IOF-`L ENER
Ir lcvJ
Icmifydw in Ne perRmlwccafthe wet lawhich Nis prrmil isisweJ,lctrl WATER HEATER WIVFNDELECIR
m employ eny p c,on in any m.m1e w m an,bee. subjxr to the Wakm' PAID
O z Ceml�tionlswanf Califanie. Dose WATER SYSTEMfGUTAI'ING g RenPrN
APP
Ir.
2 NOTICETO APPLICANT:II,nfmr matin,'hia Cesifc.uof Exemption.you strould NEW RESIDENTIAL ELSIE. SQ ET. TOTAL:
E" y baame subject to me WMers Canpellsrtion pans lnu of the labor Code,you must
fonhwi h comply will'Inch .I.or osis pmNt"I Be dmiscd revNM BUILDIN
GW. D CONSTRUCTION LENDING AGENCY SEISMIC
z Iherelryslfimt Net lhee is.construction lending agency for that pedlmrwee of
V Or d¢oak permssued
fa which this is i (See..g7,Civ.C.) TOTAL: ELFCTRIC FEF,
IL F-' Lender's Nem, PLUMtlING FEL:
O U Isr ,Acelt QTY. MECHANICAL PERMIT FEE
I certify Nat I Mve read Nis ypliesrim vd sure NY OIe above informed.is
correct.I sigrte to comply wnh all city end co my ordinances erlJ w¢lews rtWring 1. PERML ISSUANCE MECHANICAL FEE
F" MdWinSamstructian.and hereby audlmiu rtl*ercnutir¢of0 eery.lnrnrerupm the CON UCItON TAX
U z abor,e- lelnimadl MoPeny for mspmtion pcoPr , ALTER OR ADD TO MFCIL
(We)ogre to mm indemnify add t hanml�fits Ci -
cep City Cupcniasud City
inbilieics.judgnrenl cudeaprtuew yin anyway ec .gabw mid City AIR HANDEJNG UNIT(TO 10,000 CFM)
111[ tin8n it.
AIR HANDLING UNIT(OVER 10, CFM)
pw
for 000 EXHAUSTHOOD(WMUC`I
PAID
AZAR S MATERIALS DISCLOSURE HEATING UNIT(TO 700."BTU) Date Roe 'pt N
Width, -Cost orf bui War,nectrud uwe or handle harudolo material
deHEATING UNIT(OVER IgI,(Ig)BTU) TAE;
m fircd by rhe Cupeni . i
.epal Code,Chapter 9.11, ad a010 Health nand Safety
Calc,Seenm 25532(.)'
❑yes ❑No VENTILATION FAN(SINGLE RISID)
Will the npnowurr'mfts so buihlillg by the use A.Airtmeslay which emit
BOILER-COMP(3HP OR 100.000 BTU) ISSUANCE DATE
M1avrdala sir cmumil'm1u u dcOnlcd by the Bay Am Air QuelilY Mwlgarcnt
[)food? BOILER-COMP(OVER 1004 O BTU) PAID
❑Yn ❑Nn NEW RESIDENTIAL h1ECH. SQ.FT.
I heve mad rhe hvudoun mwerials rcyuiremeoll order Chapter 645 of the JUA/ 08
Cor ifornu Health A Sofery Code.Secrioln 25505,25533 and 25534. I undm'u1d that
^ /0
reccPsuilofJ Jaesmncelr whicly vealelw and lPanaru to founre,forrot
of ay rifm file kr
mllat Net of Il!mgdremer, which mase o mel Pries In issuoree nal. to nonnrc o, �fr(Jronnw
fxcup111cy. /'(.� f 0
�\�\y/�jy N
Owner a au'naiud.grnr Due 7 ISSUEDBY:
OFFICE
O. Cit'v
10300 Torre Avenue
Cupertino,CA 95014
ul,
Cupertll10 Building Division
(408)777-3228
(408)777-3333 (fax)
February 16, 1996
Bethel Lutheran
10121 Finch
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 permit is 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, 95014, Attn: Building
Department.
i
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
Pnnrea on ROCYLIna Paver