27462 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO B ILUINO-ELECTMECH NAI. PERMIT NO.
APPLICATION/PERMIT PING PROJECT
IDENTICAL
FICATION
BUILDING DIVISION tlU11.DINf.PROJECT IDEN'fIFICATIDN
BUILDING ADDRESS: SANITARY NO. APPLICATIONSUBMITTALDATB
- . UNIT LOT Is
OW E SNA PHO E' CONT OR'SNAIkaE: LIC NO: NIC CONTROL#
I
RCHITECT GINEER: LIC NO: ADDR 5: ❑
CONTACT, PHONE: BUILDING PERMIT INFO
QTY. ELF.CfRIC PERMIT FEE
BLDG ELECT MECH
PERMIT ISSUANCE [I11LICENSCDCONTRACfOR'SDECLARATION PPLIANCES-RESIDENTIAL
p00 Ihereb Divihatl amlicensed Business and allesims Catu9(commencing with TOB DE•SCRIPIlO
co:0EE fuOoull rceandof Divisian3of the Business end Professions Code,and myli<anuie in pp fS
KUU LicenreClass effect. UPT WAMPS
pQ,2W License Class Contractor
mf—Qy Dau ARCHITECTS
lDl 201-I MPS
ZOtV'irZ ARCHITECTa DECLARATION OVER 1000 MPs SQ.IT.FLOOR AREA SBQ.P1'.
I undmlmW my plans shall be used as,public records.
SIGNSELE AL
Q W
Licensed Professional
CC OWNER-BUILDER DECLARATION SPECIAL CIRCUIT TSC.
O C.FF.. 1 hereby affirm Net 1 am exempt from the Cmm mods Licen w fo he
Bl3Oy following macron.(Section 71131.5,Business and Professions C y city mcau TEMP.METER OR POL NST.
�]y which regaims a permit m Conswc6 slur.improve,demoli or repair any atmcm
priono its issuance,Am requim the apan
plict foraunoadsaum
ch Ifilesi'mou POWER DEVICES
yl e_� pm
that he is licensed pursuant to the provisions oft omrauor's License Law(CMpur
d�e4 9(Commencing with Section]0W)af Of of the Business and Professions Code) SWIMMING POOL ELECTRIC �VALUATION��/
W_rat anhat heisexempt therefor arms(orNetsalleged exeicamso A civil Porosity
of OUTLETS-SWITCHES-FIXTURES L ASN C%i
y Q Sermon 7031 applicant for o permit subjects the applicmuo o civil perulty of
G
—.me anfivehonorphryiormyemp. NEW RESIDENTIALELECTR _s
❑ I so ork.a dthestpeny,ormyemploy swirl# sgesastheirsole compensation, STORIES TYPE CONSTRUCTION
a3— wind Nework.and thenmctmeisnolinu orsale(sec.]Oa4,Business
and rofessians CWe:The Cmnmetars Lic er s not apply to >ssorne,of
pro ny whobuildso 'mprove art n, ad o sat workhi i t his OCC.GROUP RES.UNITS
nowemployus,provi t I. ch r .are time dNor fe IL
no ever,Ne buil) I. em n Idwfthinm, a gNrw sm-
M1u der will haver ofprovrng so did not rimprove purpos TOTAL'
QTY. PLUMBINGPERMIT FEE FLOODZONE qPN
I'mmurerofthe of ny,ame qct 1 nwctinB with licensW onuxmnto
c cam the project(S .]044,B.4 and Pr0feuiom CodcrTUe Continuum's
Li ease Lawdoeswupplymanownerolpropeny wits buil 6rimpmves Nermn,and PERMIT ISSUANCE
umuuufnravch ryojecn wiNecannecmKs)licen panamfaodu Conaenore\
LioaALTER-GRAIN&VENT-WATER(G) FEE SUMMARY se law.
❑\I am exempt under Su. -,B&P C builds reason O
BACK FLOW PROTECT.DEVICE SANITARY Y N
Owns Dole
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF,AREA,COND. SCHOOL TAX YECEIPI'N N
❑ Ihemby effum NmlhavcacenYicate of continuo self-insum,meecrtifirete of FTXTVRPS-PER TRAP RECEIPT#
Workers'Comlunsatian lmmarue wecmlfiM copy thereof(Sec.JBW,Lab CJ which PARK HE Y N
covers elle de'ih' a t. RECEIPT N
'Iss' GAS-G'01 .SYSTT?M-1 INCA OUTLETS
Polic N ^ BUILDING DIVISION FEES
Cavgyp/ ❑ QnrBe " s. Yti " GAS-G.SYSTEM-OVER 4(EA) PGNCHECK FEE
1liercnpy arc cashed.
❑ Cerium copy ie Rledat hthe city Inspection division. 4 GRGSEANDUSTRL WASTE INTERCEPTOR GRADING ME
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This secdmimsdnm becompored ifthe permit is forone handreol dollars($10i SEWER-SANITARY-STORM EA.20as ENERGY FEE
or lass.)
ICertify that in be performance of the work for which this permit is boom.I shallTERHFA ER NENT/ELECIR
not employ any porous in any manner so as in become subject to the Workers' PAID
Compensmion Lewsof California. Dole WATER SYSTEMRRGTING Pau Receipt#
Q z Applicant
C) NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should NEW RESIDENTIAL PLMIL SQ.FT. TOTAL:
In become subject to the Workma Compensalimpmvisionsofthe labor Code,you muss
a ;
' , 4
Clperth-lo
10300 Torre Avenue
Cupertino,CA 95014
Building Division,
(408)777-3228
Fax(408)777-3333
November 29, 1995
Resident
7618 Hollandberry Place
Cupertino, CA 95014
Subject: 7618 Hollandberry Place, Permit#27462 - Waterheater
Dear Resident,
-. According to our records the above mentioned permit has never been fmaled by a
City Milding 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
Printed on Recyrled Paper