27523 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUBIiJN.- ,., PERMIT NO.
APPLICATION/PERMIT PLUMB
ING-MEcunNICAL 27523 C 0
BUILDING DIVISION BUILDING PROJECIADENTIFICAINON 15J J
HUIIN(1Ilp IIRESg: C/;/� SANITARY NO. APPLICATIONS f1,DA'I]j
II(VY]—& UNIT# LOT# e
OWNE N ME: PHONE: CONTRACTOR'S NAME: LIC NO:
C N/C CON ROhp
�ARCI111EC'D INEHR: LIC NO'. ADD 'SS: El� . �v eC Glut_
CONTACT: PHONE: BUILDING PERMIT INFO
paQ/ QTY. ELECTRIC PERMIT FEE
Vet""��✓ / W->-6 PERMIT ISSUANCE BLDG ELECT P
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
Oy.Z Ihereby affirm that l am licensed undorpmvisionsof@apter9(co mcingwith
u00 Section7")of Division 3 ofthe Business and Professions Code,and my license is in PANELS
KYs kJU F. full force and eff¢t.
_& 661 UPT02MAMPS
,,,7 00 Liccnsc Class Lic.#
mDy Dae Cunlmemr 201-1000 AMPS SQ.FT.FLOOR AREA S/SQ.I.T.
Z FOofZ ARCHITECTS DECI RA ON OVER 1000 AMPS
O Z-0 I understand my plans shall M used es Public records.
p„an Ful SIGNS ELECTRICAL e-2
LO3
Q �� Licensed Prodawmanl
aywQ OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
U
xii� 1 hereby,affirm that that I um exempt from the Contractors License Law for the
W a un following noon.(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST.
l-4'0 which myui«anpermit tolors.he
tireic improves JemmlisM1,orrtsignedswenue
C,aS thatheslicensed pursuant
to the
tPreisions of the Comermiuo License
La staxmenr POWER DEVICES
Wr0p thathelicensedpursuanttotheprovisionsof the the Business
Licenselaw(Chapter SWIMMING POOL ELECTRIC
myo 9(commcncing with Section of Divisinn3aftM1<Buslness and Rohasiom Code) #�VALUA�sTION
=rn or that he is exempt hcrefrom and the basis for the alleged exemption. civilpralt,of OUTLETS-SWITCHES-FIXTURES ,`
F Z Q Section 7031.5 by any applicant for a permit subjats the applicant m e civil penalty of V \O
not mom than five hundred dollars($500).
pq�O NEWRFSIDENTIALELECTR _SQ.FT. STORIES TYPE CONSTRUCTION
It
rdFa ❑ othe wrk,andepropeny.o(myempendeeswithwed forsthei(ale ec.compeva0on,
y,3_e and
lessimk,and the he C isnots License La do es ntapply to 7W.Business
and Pndesdons Code:The Conwctar s Licensee Law does not apply m an owner of
property who buildsor improves theraminad whodeassuch work himselformrough his
emee
ploys.providul that.such bnenuaroemsarenot intendedoroffertd forsole.If. OCC.GROUP RIS.UNITS
however,the buildingor improvement is sold within oneyear of completion,the owner-
buildcr will have the baofm.f provingther he did b ve for purpose of
sale.).
❑ Lmsownerofthepropeny,a else. g wahlia,mo,d rnnuacnmu, QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
conswct the project(Sea 7094, in ofe"ams Code.)*Me Contractor's
License Lawdoeenotapplymano progeny whobdldsoomprei theremn.end PERMIT ISSUANCE
whmomeracs fmsuch projab a nachor(dicensedpmsuanumaConwaors ALTER-DRAIN&VENT-WATER
License law. FEE SUMMARY
❑ I am exempt under Sa. .B&P C for this m.m BACK FLOW PROTECT.DEVICE s I51DE FIiF.S
SANITARY Y
Owner Data DRAINS-FLOOR,ROOF,ARBA,COND. RECEIPT#
WORKMAN COMPENSATION DECLARATION I100',TAX - Y N
❑ Ihveby ef(thatlhuvm ttni0cam of conxmto self-insure.ma«rsificam of FIXTURES-PER TRAP RECEIPT'
Of-
Workers Compensation lmumnce ora certified copy theman(SecJg00.Lab C.)which KFF.E 'Y N
coven all cmpinya's under this permit. GAS-EA.SYSIEM-I INC.4 OUTLETS RECEI #
Policy BUILDING DIV ION F103.
Company GAS-EA.SYSIEM-OVER 4(EA) P NCHECK FEE
❑ Certified copy is hereby famished.
❑ Canniest copy is filed with the city inspection division. GREASSANDUSTRL WASTE INTERCEPTOR LNG FE' �-
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE9RAP S FP �a
COMPENSATION INSURANCE
(This falionnecdnotbaccmpleted ifthepennitisforonehundreddollan(5100) SEWER-SANITARY-STORM IEA.200FT. ENERGY f-
orless.)
I cenify that in the perfornanee of the work for which this permit is issued,T shall WATER HEATER W/VE- IELECTR
not employ any person in any manner so as to become subject to the Workers' P
Compensatienlawsof Califomia. Date WATER SYSTEMJTREATING On gracile#
0 2 Applicant
2O NOTICE TO APPLICANT:If.after making this Cenificam of Exemption,youshould NEW RESIDENT IAL PLMB. SQ.ET. TOTAL:
(n became subject tome Workv'a Compcawnon pmvrsrons of the labor Calc,you must
� � forthwith comply with sucM1 previsions or this gamin shall be d«recd revoked. BUILDINjo EE ��
Q CONSTRUCTION LENDING AGENCY SEISMIC ;EE
1 hereby affirm met them is a construction lending agency for the performance of
7 'Z the work for which this permit is issued(Sec.3097,Civ.C.) TOTAL: ELECT' IC FEE
U O Leader's Name PLUMB EE
Us F Lenders Address QTY. MECHANICAL PERMIT FEE
CU1I I cattily that 1 have read this application and state that the above information is MECHANICAL, �L
>" comm.l agree to comply with all city and county ordinances and state laws minting to PERMIT ISSUANCE
f" handingconsuuction,and hereby authorize representatives ofthis city mender Upon he CONSTRUCTIONTA
U z above-mentioned property for inspection purposes. ALTER OR ADD TO MECH.
(We)agree to save,indemnify and keep harmless the City of Conanine against
liabilities,judgmenu,cast,and expenses which may in any wryaceme against said City AIR HANDLING UNIT(TO IQgO CFM)
in consequence of the granting of this permit.
AIR HANDLING UNIT(OVER I0,0))CFM)
SignawrcoM cont/Cammcto( Dam EXHAUSTHOOD(W/DUCD PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) DaleRVll
Willthe applicant aT future huilding acapant same in,handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Sal ety BEATING ON]](OVER 100,0X)BTU)
Code,Section 25532(a)] VENTILATION I-AN(SINGLE!RISID)
❑Yea ❑No
ISSUANCE DATE
WilltheapplicantorfutumbuildingacuptntuuequiMmtordeviceswhichemit BOILER-COMP DHP OR 100,"BTU) pp
hazadous air eomm
ardeas arca s defined by the Bay AAir Quality Management BOILER-COMP(OVER 100,000 BTU) e'i Q f�
District] 4/
❑Yes ❑No NEW RESIDENTIAL MECII. SQ.IT. pre
I have reed the hazardous materiels requirements under Chapter 6.95 of the �/ y `� I'y19"Oy r
California Health&Safety Cade,Sections 25505,25533 and 5534. 1 understand that /
if the building does not currently have a tenant.that it is my responsibility to notify the Vr L
ccupani of ilia requirements which must l<met poor to issuance of a Certificate of Uh'rk
O«upu wy. /•
Owner ore aahenred agent Data TOTAL: ISSUED BY:
OFFICE
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
20800 Me Clelland Road
Cupertino, CA 95014
Subject: 20800 McClelland Road, Permit# 27523 - Single Family Dwelling
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.
1
Sincerely, I �Q ipp
City of Cupertino
3
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F"'Iod on Reoyc:ed Paper