28251 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CIT}'OF CUPERTINO11 ILD;.G-ELECTRICAL PERMITNO,
BUILDING DIVISION
APPLICATIONMERMIT 1'LUPIR NG-MECIIANICAL Q C
BU I LDING PROJECT I DENT WICA'ILION o J
ill- — � � / UNIT# 0/JtgN/h]/r LOT N.vX SANITARY NO. A CATIpN SIJryy{D'fy,DATE
OWNOS F.
ONAM : I PHONE COpQ 9C1 ^V� �7Saq� CNQ CTR
N/C /MIX/'6
12.
1`Yf/G ,1 l L !i CONTROL#
.\RCIIITHC iN INIiIiR: LIC NO: ADD HSS: ^ IV 4lei V Q�� �7f� El
PHONE: V d BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
' BLDG IiLECT. PLUMB MECII
PERMIT ISSUANCE - ❑ ❑ ❑
LICENSED CONI RACfOR:S DECLARATION APPLIANCES-RESIDENTIAL JOp FSCR ON
299 I hereby office that l ma l icemsed under pmvlslonsoWle er9(com,neacing with
iu00 Section 7000).f Division 3.fthe Business on Pmfessions Coeandmy license is in PANELS
K Wp tali force and iffffg��''I.� � ,
F-G yuj Liccmoj s�Lic.M O�O /� UP TO 2M AMPS
md� Drs C.nue.tot 201-IIXIO AMPS
ZOyZ ARCHITECTS DE ON SQ.IT.FLOOR AREA $/SQ.1'I'.
OZ—C) pibic
demand my plmiss abo use dosrtcords. OVER 1000 AMPS
F o W.W.I SIGNS EI.ECDtI;x,L
6��^,' Licensed Prefessicand
% Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
XO; I hereby affirm that I am exempt from the Contractor's License Low for the
W 3 W m following cal(StIdmm 703 L.5,Business and Professions Cale:Any city or county TEMP.METER OR POLE INST.
wbleb requires a permit In construct,nitcr,improve,demolish,or repair any moodure
priortoilsissmunce,almn requires theuppliewer int such prand,to fileasignalsmtement POWER DEVICES
W L�C,0m that he is licensed punuennn the provisions of the Cornlmmm's License law(Chapte,
d oLL 9(commencing with Section 7000)of Division 3 ofthe Business and professions Code) SWIMMING POOL ELECTRIC VALUATION
_rn or that he is exempt herefrom and the basis for the alleged exemption.Any violation of DDTLETS-SWITCIIES-FIXTURES
ZQ Section 7031.5 by any applicant for a permit subjects the applicant'.a civil penelty of
K � not more than five hundred dollen lSSlp). NEW RESIDENTIAL ELECfR SQ,
❑ I,asowneroOheprnperry,.rmyemployecs with wagesmtheirsolemmpewtion, Q STORIES TYPECONSTRUCTION
ta,3^ wil l do the work,and the structure is not intended or offered for sale(Sec. Business
and Professions Code:Tho Ciaturc nr's License Low docs not apply In oa owner of
prnpenywhobuildso,improves therenn,anJ whodoessuch work himselfnnhroughhls OCG GRO P RPS.UNITS
wnemployra,,providedthm such on -Imentsene n�����ccc#yyyfppppf��readcdnroffenedfnraale.IL FIT
however,the building.,improvementissold wilK ofcomplction,theowner- OT'AL
builder will have the burden of proving that he dig t build or improve for putpeseof
❑ I,as ownnofthepropentmm
y,sin exclusivelyconcting with licensed ntmmr
cam QTY, PLUMBING PERMIT FEF FLOOD ZONE APN
amsWct the project(Sm.7844,Business and Pudessi.na CodeO The Contractors
PERMIT ISSUANCE
License Law does nmapply m an ownerof propenywho builds nr impmvesthereon,end -
whn con real,mrsuch projects with arearacorhd Iicemed Pursuant t.the Conuactar's
License law. ALTER/DRAIN&VENT-W TER(HA) PIiFSUMMARY
❑ I am exempt under Sec. .B&P C for this mason BACK FLOW PRO D,VICE tJTSIDF ES
SANITARY YN
Owner Dole RECEII'f#
DRAINS-FLOOR,ROO ,A ND.
WORKMAN COMI'I;NSATION DECLARATION SCHOOLTAX Y N
❑ Ihercby atfitm shall have ecertifi.am of conunuo selGinsurt,ora ceniricate of FIXTURES-PIR TRI/
R RECEIPT#
I'veket%Compensatinn lnsumnce oracenified copy thereof(Scc.3B00,heb CJ which PARK FEB. Y N
Policy X11 e�plpy�wNj lh Rpryyt _ _ RECEIPT#
i S_.l`f-/ GAS-EA.SYS'I'fI-I'INC.40UTUBTS BUILDING DIVISION PE ES
Company q GAS-EA.SYSTEM-OVER 4 BIA) PLANCI Iii KFFE
❑ Certificdrcpy is hereby famished
❑ Cenilicd copy isfilcd withthe city inspeminn division GREASPANDIISTRL WASTE IN' nN ,R IN' +EE
CERTIFICATE Op EXEMPTION FROM WORKERS' GREASETRAP air 03 SOI FEE
COMPENSATION INSURANCE
(Thissectlom need r.,he compleed lfthepemsit is future hundred dollars($100) SEWER-SANITARY-STORM FA.200IT. ENERGY FEE
or less.)
I certify that in the perfornmers ofthe work for which this pnmil is hall I shall WATER HEATER W/VENT/ELECTR
not employ any .an in any manner so as or become subject t.the Worker' PAID
Compenswinn Lows of Caifnmle. Date WATER SYSTL'MfrREATING Data Receinis
C) z Applicam
z C) NOTICETO APPLICANT:If,after making this Certificate of Exemption.you should NEW RESIDENTIAL PLMIL SQ IT. ,
H to hccome subject to the Workers Compensation provisions ofthe Labor Code.you must
forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE
1 IM CONSTRUCTION LENDING AGENCY SEISMIC FEE
Uz I herehyaffinnthauhere is ac.nsouction lending agency hurtle pnformancenf _ TOTAL: ELECTRIC PEE
O thew.rkY.r which this permit is issued(Sec.3057.Civ.CJ
U. Isnder's Name -
Leaders Address QTY. MECHANICAL PERMIT ITE PLUMBING FEE
L) 1 ready that 1 have mad this application and state that the above information is
correct,ligraemcomplywithellcityandcnuntynrdinances and stmelnwa relmingm' PERMITISSUANCE MECTIANICALFEE
Cjj building construction,and hereby holurriu representatives ufthis city to enter upon the CONS'T'RUCTION TAX `
move-mentioned n f t
V z props y or mnify ion purposes. ALTER OR ADD TO MECH.
(We)ugmc m save,indemnify mal keep harmless the City of CLpcni t s against
in traves,judg If the
or i hiseswhieh may inany way ncrneagainst said City AIR IIANDLING UNIT(TO 10,(1(111 ChM)
eonsequence.f the grunting of this Hermit.
' AIR HANDLING UNIT(OVER IB,fXIII CFM
Signature of Applicam/Contractor Date EXHAUST I IOOD(W/DUCO PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(10 100.000 BTU) Date Receipt#
Will the applicant or forme building occupam store or handle havnrdnus material
as defined by the Cupertino Municipal Curie,Chapter 9,12,and the Health and Safety HEATING UNIT(OVER H00,000 BTU)
Code,Section 25532(.)1 VENTILATION FAN(SINGLE RESID)
C3 Yea 0
BOILER-COMP(3HPOR i00.W)BTU) __ ISSUA ATE
OL
Will theapplicaninamsas refined by uIII ay Areequa it Quality Management
AUG 1 0
h sad t t refined by the Bay Area Air Quality Management 001LIiR-COMP(OVER 00,00d BTU) 'OAC
nimrimlx tat can amt VJJ
❑Ya Z'N. NEW RESIDENTIAL.MECIL SQ.FT. CI
1 have real the hmardous materials requirements under Chapter 6.95 of the
Calif ooda Health&Safety Code,Sections 25505,25533 anti 25534. 1 undersand that
if the building does not currently have a tenant,drat it is my responsibility to notify the
occupant of th quircme I which must Is,met prior'.issuance of a Cenifirme of
Octoph
Owner or a.th rmabl i gen Date TOTAL: ISSUED
OFFICE
y
10300 Torre Avenue
-(y y1` ( 1_ Cupertino,CA 95014
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
April 23, 1996
Resident 7
10596 John
Cupertino, CA 95014 /
Re: Expired permit (copy attached)
Dear Resident:
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 finaled, 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
•
Parted on Recycled Pace,