27183 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOINr.RCRc7RFCA' PERMff NO, p
APPLICATION/PERMIT PLUMBING-MECHANICAL. O
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS:[ �,,,/p SANITARY NO, APPLICATION SUBMITTAL DATI
//� /7(!/V/`�C�N /. UNIT LOT# (.
O ERSNA E:r. PIIONE: CONTRACTOR'SNAME: LIC N(J:
N/C LONI'KUL#
a�P k66 a -a7a3 ,�N P.s� Ly .�
ARCHITIC"GENGINEER: LIC NO: AgDRFS L ❑
CONTACT: PHONE:
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MI-'.CII
PERMIT ISSUANCE ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
nmz Ihereby offirmthat l am li<ensedundcrprovisionsof Chapmr9(cormnencing with
00 Sec Tome avd elf Division 3 of the Business and Professions Coulee,and my license is in PANELS ,A'
<z License Class Li
Z�/J SO UP TO 200AMP5 //GCl 'V
ti M ub Date—. Contractor 201-1000 AMPS
ZO'z ANCHITE(TS DECLARATION OVER IOOOAMPS SQ.FT.FLOOR AREA S/SQ.FT.
OZ—O I andentand my plans shall be used res public retorts.
1=.�(_uu SIGNS ELECTRICAL
KQ nj Licensed Professional
CW< OWNER-BUILDER DECLARATION SPECIAL CIRCUTT/MTSC.
Xow, I hereby affirm that I an exempt from the Contemns License taw for the — P
m3ay following reason,(Section 0031.5,Business and Professions Code:Arl or county TEMP.METER OR POLE INST.
F�on which regaire'a permit 10 Coruwct,alter,improve,demolish,or repair any sbumart
X #norm its issuance,also requires the applicam nonsuch permit to file.signed statement POWER DEVICES
,M<C> that he is licensed p..a.,to the provisions of the Contractors License Law(Chapter
a p,MP4 9(commencing wlrh Senior Alfrtp of Division 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC VALVA N
int—ti or that he is exempt herefrom and the basis for the alleged exemption.Any violation of OUTLETS-$WRCHFS-FIXTURES
F Z Q Section 7031.5 by any applicant for a permit subjects the applicant to a civil pevlty of
not more than five hundred dollars($5(10).
NEW RESIDENTIALELECTR FT.
C � ❑ oche w work,
andc the
y.ormyemployeeawoffemd or arde(Sce.compensation, —SQ. STORIES TYP NSTRUCTION
y3— will dothework,ande: heContistors License La do for apply to an owner
v
and Professions Cade:The Contractors tad who Law rims or apply tort owner mf
property wwees,Pd.orimproventh impo andw taccansuch walkM1rofferor throu e,If.
employees.providcd Oprvsuch lmprovememsam not imendcomplfercd dr,o ner, OCC GROU RES. NITS
however,the llhave the burden of,mentishin he ii noneyear of completion,theowna- TOTAL:
builder will have rbc burden of proving that he did not build or improve for purpose of
❑ Las the pro e,(Se peny,1.Business
and onuxtiio s Code:)The QTY. PLUMBING PERMIT FEEAPry
Construct the ens not applyc.to an
Business vier Professions Code:)The Contractormon,and
whoc,tra is fors notapplywith acrolproperty whnsed ds foorim the Contractor
PERMIT ISSUANCE
whocontractsLaw.forsuch projects withacontrucmr(s)licenses punumno the Conuacmr's ALTER VENT-WATER A
DLicIi Law. ( ) BY
❑ I am exempt under Sec. B&P C for this rayon BACK FLOW PROTECT.DEVICE
_
Owner Dam DRAINS-FLUOR.ROOF,AREA.COND.
WO0.KMAN COMPENSATIONDECLARATION
❑ Ihcrcby affirm rhmlM1avc ecenificem nfconscnno self-insure,orecenificme of FIXTURES-PER TRAP
Wnrkers'Cnmpensetion lnsurunseecmacenifed copy rhercaf(Seb.3800,Lab C.)which MEN
PullicyeweersMlcmyloyFp{g¢d tlJrJp]'�.I GAS-EA.SYSTEM-1 INC.4 OUTLETS RE^_EIPfis
Company a� BUILDING DIVISION FEES
V❑ nified co GAS-EA.SYSTFN-OVER 4HA) PLCHECK FEE
VC
copy is hereby furnished. AN
nifiM COPY is filed with the city inspection division. GREASMNDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(Thissecdonnecdnot be rompletad ifthe permit is far one hundreddo11ars($100) SEWER-SANITARY-STORM EA.200FT. ENERGY ME "
less.)
I vanity that in the performance ofthe work for which Nis pemdt is berate,I shill WATER HEATER W/VENT/ELECTR 4'C
not employ any person in any member sat as to become subject to the Workers' PAID
z Cap,nsationlaw.so(Califomceipt
ia. Date WATER SYSTEMYTTEATING Date Re #
Apprcent
zm
O NOTICE TO APPLICANT.If,after making this Cenificateof Exemption,you should NEW RESIDENTIAL PLMB. SQ,FT. TOTAL:
H � hecomesubjecrtorn,Workers Compensat me,babisioasafda Labor Code,you must
7 forthwith Comply with,.ch provisions or this permit shall b,deemed revoked. BUILDING FEE
z
CONSTRUCTION LENDING AGENCY SEISMIC FEF.
I hereby affren that there is a conswerion lending agency for the performance of
U O the work far which this permit is issued(Sec.3097,Civ.C.) TOTAL: ELECTRIC FEE
Lenders Name
O U lease,Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
I certify that I have read this application and state that the above information is
F0. comer.I agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCRMHCtIANICAL FEE
_ OG building construction,and hereby authorize representatives ofthis city venter upon th,
U Z abovementioned properly for iaspecmion purposes. ALTER OR ADD TO MECH, CONSTRUCTION TAX
(We)agree m save,indemnify and keep harmless the City of Cupcoino ag.lost
limbiliries,judgmenis.cosrs andexpens,s which may inany way accrue against said City AIR HANDLING UNIT(TO 10,000 CFM)
in consequence Of the gratBing/d/this permit. ,
AIR HANDLING UNIT(OVER 10,000 CFM)
Si m of Appil.a.VConmen, EXHAUSTHGDD(WB)UCD
PAID
HAZARDOUS MA F-RIAI.S DISCLOSURE HEATING UNIT(TO IOO,W()BTU) Dam Rcceipr#
Will the applicant or future building occupant store or handle baurdous material
as definW by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100.00)BTU) TOTAL:
Code,Section 25532(a)'1
❑Yes - 11 No VENTILATION FAN(SINGLE RESID)
BOILER-COMP DHP OR 100.000 RTU ISSUANCE DATE
Willthwpplicant OrfuwrehuilJingmecupanmucyuipmem ordevices which emit )
Mheizz'r on,contaminants as defined by the Bay Area Air Quality Management BOILER-COMP Cisuin? (OVER 100,000 BTU) � w
C,Yes E)No NEW RESIDENTIAL MECH. SQ.IT. P
I D
.
1 have read the hvnrdous materials requirements under Chapter 6.95 of the DEC 919 94
California I Health&Safely CMC,Sections 25505,8nd 25534.533 aT understand than
if the building does not currently have a tenant,that it is my responsibility to notify the /�
orcapant of the rcyuircnmms which moat be met pit m in ,come of a C,m neat,of II Y
OxeupaV
ney. Ur Lunt
N I INV
owner or aalnanaM.sent Dare
TOTAL: ISSUED BY:
OFFICE
Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408) 777-3333
September 20, 1995
Ralph Jubb
1161 Huntnterson Place 1� '
Cupertino, CA 95014
Subject: 1161 Hunterson Place, Permit# 27183
• Dear Mr. Jubb,
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
•
Pnnleal v: Rac."cde I i';Iper