27943 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO mZ� '�" PERMIT NO.
APPLICATION/PERMIT PLUMBING CI IDENN'ICAL
FIC
BUILDING DIVISION BUILDING PRO.IECT'IDENTIFICATION 27943
BUILDING ADDRESS: . SANITARY NO. APPLICATION SUBMITTAL DATE
�C �/M" — // UNIT# LOT#
( 'RSN E: PHONE CONTR TORTS NAME: LIC NO: N/C
aW- 773a -e-35,- �IJEN w CONTROL p
R IIT /ENGINEER: LIC TIO��IV� ADDRESS O. T/aEl
CONTACT: PHONE: QTY. N ELECTRIC fxl, IT FEE BUILDING PERMIT INFO
7/ c � 77 Dr/ r' BLDG E�I:C' P UM MliCll
PERMIT ISSUANCE }�{
LICENSED CONdRSDE.CLARATION pppLIANCES-RESIDENTIAL JOB DDEESCRDESCRIPTIONp y.2, Ihereby affirmtbmlam licensed under,xnderpmvisionsof Chapmr9(<ommrncingwith
FOO[ Section700P.f Division Jofthc Business and Professions Cod,and myl'ense isin PANELS
��U full force andeffjy✓'����/psswn��
1a-,Zu1 Licenu Class�eL Lic.# IIP TO 200 AMPS L
tn?y Date �(./mss Cnow. or 201-1000 AMPS
T FO,,z ARCHITF,CFS DE SQ,FT.FLOOR AREA 5/SQ.FT.
Ion smn IyPI s I dos per ads. OVER ION AMPS
SIGNS ELECTRICAL
QYE; Lice d I O
�p4 a'Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
kO a F 1 hereby a - that 1 am exempt from the Contractor's Licenu law for N
3 w fallowing reason.(Section]03 L5, usmess and Professions Code:Any city or county TEMP.METER OR POLE INST.
which requires a'mNt 1.roost err,improve olish,or nepam any strucruu
5=,.}n prior to its issuance,also ea can opo noun gnedstaument POWER DEVICES
W W Q Oz that he is licensed pursues W to es
on of e s Lice. w(Chapter
D.KOOLL 9(commem,mgwit to ) :vitt o t on eines and Pmf stares Code) SWIMMINGPOOLELECIRIC VALUATION
,:2 to ort M1e is ex a iA akited exemant to Any iolationof yrs '
FZQ, Semi ] L. ya : licam s it subjects the applicant to nahy of OUT(-TTS-SWITCHES-FIXTURES .
ESp
are tk rl�e u d n 500). NEWRESIDENTIALELEC'PR _S FT.
W Fo'� efofth p y,brneyemployeeswith wages as tbeirsolecompe ation, Q' S"1'ORI[g TYPE CONSTRUCTION
W r3_ willdo, Work,an c reisnmimendedorefferedforsale ca 04,LB in.
and Pro ns C e e Commchn"License Law p of A/C4/ ✓90a7
propenywhobuilds rimprwesthemomandwhodrssu bi
c rsulfortluough 's
employces,prov edthntsucM1improvemenuare no' twd re.fferedforsalc.1, �G�c �/O. �J< OCC.GROUP RES.UNITS
h.wever,tbcbrildnu, impmvernamoseldwi yc .completion.Ne r- // �e ,TA �•
builder will have the bu nofprovin Ihmhedid .t dor lmpmvcfor ='
sale.).
❑ Las.enendthepm rty,amexe mractingwithlicen contra oto QTY. PLUMBING PERMIT FEE FLOOD—ZONE APN
construct the project(Sec.]044,Bit Profcoions Cal The C.nvacmr's
License Lawdoesnot apply ow,erof op ywhobuildso' provesthereon,and PERMIT ISSUANCE
whoLicense contracts for such projec uwiNacomr )licensedp uantsmhe ContmCni"s ALTER-DRAIN&VENT-WATERER FEE SUMMARY
cuLact - (EA)
❑ 1 am exempt under Sec. ,B&P C fm this moon BACK FLOW PROTECT.DEVICE- IITSIDE '1
SANITARY Y
Owrtcr Dau / DRAINS-FLOOR.ROOF,ARF. O D. O RIiCE
WORKMANC PENSAT NUF.CLARATION SCHOOL TAX N
Iberebyaffirmthallhaveac ificm fconummulf-insure,.rattni0cau of PER TRAP
orkers'Compensoiio oleo'. ifiedeopythcrcof(Sec.3800,L.h CJwhich FIXTURES- PARK FEE t # N
cminens Policyplemploy<' Iera GAS-EA.SYSTEM-I INC.4 OUTLETS � E' #
G ION Pi S
Company 0c, 1F
[03Cenificd espy is hereby,fumished. GAS-EA,SYSTEM-OVER 4(EA) iFEE
❑ Certified copy is�ed with the city inspection division, GREASE/INDUSTRL WASTF;INTERCEPTOR 1 FEE
CF-RTIFICATE OF EXEMPTION FROM WORKERS GREASETRAP SOILS SEE
COMPENSATION INSURANCE
(Misuctionna mgO complet ifthepcmtitisforonehunduddollars(SIN) SEWER-SANITARY-STORM EA,2001T. ENERGY
or less.)
Icertify that in the perfortnrtce of me work for which thispembit is issued,Islash WATER HEATER WNENT/ELECTR
not employ any person in any manner so as to become s .ubject tit the Workers' D
Compensation laws.(Califomla. Date WATER SYSTEM/rREATING Du Receiptp
Q z Applicant
z 0 NOTICE TO APPLICANT:If,after making this Cmificam oBxempoon,you should NEW RESIDENTIAL PLMIL SQ.FE TOTAL:
Z) become subject to the Workers Compensation previsions ofthe Labor Code,you must
> forthwith comply with such provisions or this pemot shall he deemed revoked. BUILDIN iE
CL Q CONSTRUCTION LENDING AGENCY SEISMI FEE
Z Ihcr.by affirm thauhercisac.nswaiov lending agency for thepertotmencc of
U O I the work for which this pamtiris isy-W(Sec.3097,Civ.C.) ELF IC FEE -�
Lenders Nam.
O U Lcndcrs Address s QTY. MECHANICAL PERMIT FEE P MBINGFE-E
1 certify that 1 have read this application and state that the above information,is
F1 conem,l agree to comply with all city sand county ordinances and sum laws relating to PERMIT ISSUANCE ECHANICAI,ME ---a#
_ (n building constmction,and hereby amM1oriu representatives ofthis city tocnterup it the
U z ebve-mentionedproperty for inspection p set. ALTER OR ADD TO MECH. C STRUMON TAX
(We)ag m save,indemnify and c hurtnless the City of Cupertino against
liabilities.' "exonsand achmayinnnywayaccrimit"i sI said City AIR HANDLING UNIT ITO Iq(IBO CFM)
in con ftM1c granlin of, ' tetroti.
'!p / AIR HANDLING UNIT(OVER UJ000CFM)
ignaure Ap c door au EXHAUST HOOD(W/DUCD
PAID
IIAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO I0h,000 BTI, Dm Receipt p
Will the the Caper or future building«',Chan erre !,handle hti Health
a material
as Code,
Section
the Cupertino Municipal Cole,Chapter 9.L!,and the Hrahh and Safay HEATING UNIT(OVER IN,BgO BT'U) TOTAL:
Coda Section 25532(,)1
11 yes No VENTILATION FAN(SINGLE RFSID)
BOILER-COMP HIPOR 1n0,000BT11 P ISSUA ' .E DATE
Willtheapplicantorf.tumbuildingoccupantuw Nuipmentrdevittswhichemii ( 1
hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP OVER 100,000 BTU Q�
District? s l ) I (/
❑Yes y1 No NEWRESIDE IALMECH. SQ.FT. � �O
I h:ovc acrd the ,\ as Sections
ray saner r Chapter understand
of he /J _ ��C /,� I, 1-995
Cali6mia lleahb& a'ode,geeti.ns2 and 25534.(understand that �/l/ (/ / J�(
ifthc mildin d t e trendy have 1.that it is my responsihili m n ly the r LUr
occupant n ,are tits whit met prior a issuance of Ce m.f
Occupon . tNIho
9s
Dwne hot' sag. Date T'O' ISSUED BY`_�
OFFIC
a..0
MIC UI tip„
Cipertuio
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax (408)777-3333
November 29, 1995
19980 Homestead Road
Cupertino, CA 95014
Attn:S. Vega
Subject: 19980 Homestead Road, Permit# 27943 - Tentative Improvement
Dear Sir,
According to our records the above mentioned permit has never 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 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
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