27543 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPER77N0 °"�'�"�` . PERMIT NO. 27543
APPLICATION/PERMIT
PLUMBING PlEM CT UIIANICAL
BUILDING DIVISION Bllll.111NG PROJRCI'lI1F.N'I'IFICA'I'ION
BUILDING ADDRESS: - - SANITARY NO, APPLICATIONSUBMITTAL DATE
c W y UNITp •� LOTN
2
O N R NAMC: I NE: RACI'OR$NAM'' LIC O
L NC CON ROLA
�WCHIELUTE 4GINEE.R: LIC NO: S: _ ❑
CONTACT: PHONE: p °";*+" - 6UILDINC PERMIT INPO
,yQ6J QTI.-,r>4'}' PLP,CfRIC PERMIT FEE
ZS3l�3i PERMITISSUANCF.'-! BLDG CC' PLU MECH
LICENSED ONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
QWz Iherchyaffirmmet
LICENSED
P40C. Sca(ia.7000)af Division 3 of the Business and rofMm Cale,andnry Items.is in PANELS
FCU full fnrec end /'� C �J/��/ Iry Tp 2p0AMPS
F-L4,W License Cl¢s ,ic.p ///
H 6 y Due � Contractor 201-1000 AMPS
ZOyZ ARCHITECT'SDECLARATION OVER IODOAMPS SQ.FL FLOOR AREA ZQ.FI'.
CZ-0 IundecslvnA my plans shall housed tapublic records.
Licensed Professional SIGNS ELECTRICAL`
� ae6 OWNER-BUILDLM DECLARATION SPECIAL CIRCUIT/MISC.
Ax�('OyFVF.. 1 hereby affirm that 1 arr�monsit from the Contractors Littnx law for the
B134N fallowing reason.(Section 103 S,Busmc .nl Profession Code:Any city or county TEMRMEIERORPOLEINST.
FEj0 which requires a pcmtiva coon. 'C"I", a improve,demolish,.'rcpuif anyswemro
Wi•S prior m its issuance.also ui h a r at formch Permit m file asignedstemment POWER DEVICES
jC�p mm he is 'tensed u t p n of the Comrncmr'e hicenu Law(Chapter SWIMMING POOL ELCCIRIC
d6o�G 9(camme m t S i o Division 3 of Ne Business and Professions Code) VALUATION
❑,� ormet c ex w mecrnm andlheb sI the�{epsv!Inptiod.Any violation of OUTLETS-SWITCHES-PIXTURES
ZY Section ywy applies Ifmape teuh'cAsem Lp cant to a civil Penally of
had on, rvehuad ars(55 j�.•••�p1100 NEWRFSIDENTIALELECR 5 .FT.
P�' Om ❑ I,aa,, raphe Era n .n�em�1fj verb we Ptheirsolecompemation, Q STORIES TYPECONSTRUCf10N
d will Jo the work,mI the st a re isnotimcnded oroffercdfor sales(Sec.]t144,Businms
and Professions Code:The Contractor's I.iceme Law does not apply to an owner of
property whobuildsorimprovesthereon,and whodoesxuchwork himseHorthrnughhin OCC.GROUP RPS.UNITS
own employess,pmv ided that such improvemenu arc nm i mended w offered formic.If,
however,the building or improvement is sold within one yearofcompletion,theowner- - TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
sale.). QTY. - PLUMEING PERMIT FEE FLOODZONE pPN
❑ I,as owner at the property,umexclmively, contracting wit blicensedcontmemrsm
conswct the project(Sec.7044,Business and Professions Code:)'Gia Commnors
License Law doesnol apply loan ownerofpropeny who builds or imPmvas theran td PERMIT ISSUANCE
who convects forsuch projects with u crnwaclogs)li peed pursuant to the Conmetar'x ALTER (EA)License Law. FEE SUMMARY
❑ I ran exempt under Sec. ,B&PC for this reason BACK PLOW PROTECT.DEVICE - O SID. ES
SANITARY YN
Owner •_Date pRA1NS-Fl,OOR,RODF,ARPA,GOND. RECEIPTp
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ Ihereby affirm that l have a cenificatc of consent 11)self-insum.or a cmificate of FlXTUIiL•S-AER TRAP t RECEIPTN
W'a cis'Compensation Insurance ora certified copy themof(Sec.31 Lab C.)which PARK FEE Y N
covers all unLeer ti RECH1PTN
MI, r C GAS-PA.SYSTTiM-I INC.40UTLETS
Policy N BUILDING DIVISION FEES
❑mpCen mis GAS-EA.SYSTHNLOVER 4(I:A) PLANCHECK FEE
❑ Cemifiedcapylsfed iNNeciry impeniondivision. GREASEiINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE
COMPENSATION INSURANCE
(This suction noes!not be completed ifthe permit is forone hundred!dollars P1100) SEWER-SANITARY-STORM PA.2110FT. ENERGY FEE
or less.)
I certify that in the performance of the work for which this Permit is issued,l shall / AT117111 TERW INT/BLECIR
not employ any person in any wormer so ns m become subject te the Workers' PAID
Cmvpensationlawsof Celifomia. Date WATER SYSTENITREATING Dam Recciptp
O Z Applicant
NOTICE.TO APPLICANT:If,after had in this Cemificam of Hxem t TOTAL:
g pion,you should NEW RESIDENTIAL PLMB. SQ.FT.
mz-• beconumbjecuo the Worker's Compcnnmion provisions f,he Lalmr Code,you most
�^ > forthwith comply with inch provisions or this permit shall be d¢med revoked. BUILDING FEE
2. a CONSTRUCTION LENDING AGENCY SEISMIC WE
Vz Iherebyaflirm that there is a consmuction lendingigenery for me performance of TOTAL: ELECTRIC FEE
0 the work far which this permit is aimed(Ser.3097,Civ.CJ _
Tanders Name
0 U Lenders Address QTY. MECTIANICALPERMIT FEE PLUMING FEE
1 Certify that I bvvc read this application vad state dust the above information is
i^ 0. correct,l agree to comply with all city and County ordim mos and state laws relatingm PERMIT ISSUANCE MECHANICAL HE
IA buildingcnnswction,and hereby authorize representatives oflhis city to enter upon the CONSTRUCTION TAX
U Z above-mentiond propemy for inspection purposes. ALTER OR ADD TO MECH.
(We)agree to save,indemnify and keep M1amdem the City of Cupeninw against
liubil'uics,judgmems,costs and expenses which any many way accrue against said City IR HANDLING UNIT(TO 10."CFM)
in conuqu A,nf the granting of is miL'n �� AIR HANDLING UNIT(OVER ID,"CFM)
�i fgpdmararvrmaaaoar L—�/l/J'/ ((Laalw EXHAUST HOOD(W/DUCn
PAID
HAZARDOUS MATERIALS DISCLOSURE IIEATING UNIT(TO 100,000 B'I'U) Date— _W;__ _
Will the applicant or future building occupant Hoo or handle Inummnm maded.1 HEATING UNIT IOD,tXq BTU) TOTAL:
asdeOnM by the CuPeninn Municipal Code,Chapter 912,and the I feellh it,[Safety !
Code,Section M532m):'
❑Yes IJ No VENTILATION FAN($INGLIi RPSID) !
W i11 meapplicanr arluwrt buildingoecupam use eyuipmemordcices whichcmit
BOILER.COMP(3HPGRIMIGODBTU) ISSUANCE ATE
xarduus air coma ninums as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,M)BTU) P A I D
rxtdcn
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT.
I have read the harallous materials requirements under Chapter 6.95 of the - FEB 16 1995
California Health&Safety Code,Sections 25505,25533 and 25534. 1 understand met
if the building does not currently have a mount,that it is my responsibility to nod le,
Cupent of the requir menu which must be met Prior m issmna mit Cemifimm of CI I Y' .
Oc'cupvncy. Vv LI.11
Owner or aathori mot agent Data TOTAL: ISSUED BY:
O TC
&Q,
11 oI
Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax (408)777-3333
November 29, 1995
Resident
7572 Kirwin Lane
Cupertino, CA 95014
Subject: 7572 Kirwin Lane, Permit# 27543 - Waterheater
Dear Resident,
• 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
i
Primed on Recycled Paper