27286 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-LLL 'IRICA], FERMI'I'NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 27286 I O Ga
BUILDING DIVISION BUILDING PROJEC'f IDENI'IFICAI'[ON L I Q v
ILDING ADDRESS: SANITARY NO. APPLICATION^SUBMMIITTPAL DAMUNITp LOTM I _ i�rvf
Q.
NIiR$NAME: 1 IONF,: C NTRACT 'S NA li: LIC NO'. ` )))
A NIC CONT'ROLM
02)
�A CHI :CT/ENGINiiR: LIC NO: DO ESS:
CONTACT: PHONE: a QTY, ELECTRIC PERMIT FEE BUILDING PERMIT INFO
ULM ELECT PLUMB MECII
PERMIT ISSUANCE ❑ ❑ fS< 0
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
0zy I hembyaffimt Onit l am licensed undcrprovisamsof Chapter9(commencing with
�1300 Section 7000)of Division 3afthe Business and Professions Code.und in,license is in PANELS �I
C� full fence and effect.
license ClUP T0200 AMPS
F L W ass Lic.p
m?y Date Conuanrn 201-10ppAMPS SQ.PT.FLOOR AREA $/SQ.FT.
ZOas z'ARCHITECTS DECLARATION OVER 1000 AMPS
O Z—a 1 understand my plans shall Mused as public records.
P 5JSIGNS ELECTRICAL
Licensd Rnfessit)nal
�y�Q OWNER-BUILDER DECLARATION SPECIAL CIRCUI I'/MING.
°,OyU I hereby affirm Wan 1 ten exempt from the Contractor's License Low far the
W3a, lollawingreoson.(Sectinn 7031.5,Bminess and Professions Code:Any city nrcuumy TEMP.METER OR POLE INXU
F' O Q which requires a permit in conawct.sitar,imPrme,Jemnliah,m¢pair my swcturc
.WTS prior to its issuance,alit)requires the applicant forsuch Permit to file a signed statement POWER DEVICES
K Q that he is licensed pursuant to the provisions of the Comreaur s License law(Chapter
m—O SWIMMING POOL ELECTRIC
ddxM 9(commencing wathreaSection
immidbe basision3ofthe9usinassvW Professions Code) VALUATION
W—rn orthathcis exempt Nemfromand lite basisfee bje is thedexlicanu n.Aivil .any of OUTLETS-SWITCHES-FIXTURES
Fla Section 903 IS by anY aDDlicamforupcnrdt subjects the applicanno ecivil Densly of
5hundred dollars y❑ not more than five ars(
NEW REMDENTIALELECTR _SQ.FT. STORIES TYPE CONSTRUCTION
Wm ❑ I,usuwncroftheproperiy,ormyemployeeswi$wagesmtheirsulecompcnsation.
1 will do the work,and the structure is not Intended ermined for solo(See.I04,1,11usinens
and Ponfeomm,Code:'Her Contractor's License Law dues not apply to an owner or
property who builds or improves Hereon,end who don such work himselfor through his
cmployces.provided that such impmvemeres manor intended oroffned for sale.If. OCC GROUP RES.UNITS
M1 wever,the buildingor improvement is sold within one yearofcompletion,theowne. TOTAL:
builder will have the burden of proving Nat he did not build or improve for purpose of
.Cls.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
C) 1, nI, erofthe propcnte y,acadusivelyconhazting wird licensed contractors to
consunct the project(Sec.7044,Business and Professions Codc:)The Contractors
License Law dues not apply to an ownerofFornamy who builds or improves thereon,and PERMIT ISSUANCE,
whocnntmcts forsuch projects w 7th u enntracten(.$)licensed Panama to the Contractor's
I.iccow Law. LTER-DRAIN&VENT-WATIiR(HA) FEE SUMMARY
❑ 1 am exempt under Sec. ,B&P C for this reason BA\K ROW PROTIiGT.DEVICE. OUTSIDE FEES
SANITARY Y
Owner Dam DRA S-ROOR,ROOF.ARFA.COND. RIiCHIPI'p
WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN
❑ Ihereby affirm that l haven certificate ofconunuo sel6insure.ot a afar, It FIXTU FS-PER TRAP RECEIPI'M
Wnrkeni Compensation lnmrmme aracertified copy thcnmf(Sa.3800. .)which PARK HE YN
covers all employee's under in rant, GAS- .SYSTEM-1 INC.4 OUTLET, HECIiIYI'p
Policy M BUILDING DI VISION FEES
Company GAS- .SYSTEM OVER 4(HA) PLANCHECK FEE
❑ Cerilicl copy is hereby rumi'S
❑ Ccnified copy,is Glµrvithtbe city inspe 1Jiviaiun. GREAS NDUSTRI.WASTE INTERCEPTOR GRADING HE
CF.RTIFICATEOF, - PTION FROM WORKERS' GREASE AP SOII S FEF.
COMP- SATION INSURANCE
(lhisseetion need not be ca Pined ifNe permit is for eachod� MCHOJ) SEWER-SA ITARY-STORM EA.2001T. ENERGY FEE
or less.)Icenifythatintheperfrsm sofNewrnkfnrwhichthihill IIEATF.R W/VEN'DELECfR
not employ any person in any nner so io ubcco PAID
ComDenxmion Laws of Cnlifnmin. m WATER SYSTEMaRPATING Data Receipt#
O z Applic:mt
zC) NOT ICE TO APPLICANT:If,after makg da team or E.on, a.yousho NEW RESIDENTIAL PLMB. SQ,IT. TOTAL:
y hccnmc subject to Workers ComDcnsa\nMvtnsoftheheWrCode,yo ust
allbedeemedtevok BUILDING FEE
CONSTRUCTION AGENCY SEISMIC FEE
I hereby afPom thatthem isaconstrvingagenyfor performance ofU O T ELECTRIC FEE
the work(or which this Dennis is issued(SCiv.CJ
Leaders Name PLUMBING FEE
LE,
F Lenner's Addmsa QTY. MECHANICAL PERMIT FEE
U I certify that I Imvc ren this application and stem that the above information is Mlil'l1ANICAI,IT.I,"
�" C>a concct.l agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE
I"' N builiingeonsmation,and hereby authorim representatives of Nis city menterupon the CONSTRUCTION TAX
U z aMrve-mentioned property,for inspection poryous, ALTER OR ADD TO MECH.
(We) mon.save,indemnify and keep harmless Ne City of Cupertino against
Iiabiliti4.,judgments,costs and expenses whichmaymany way accrue against said City AIR HANDLING UNIT(TO 10,000 CFM)
in tie of the granting of Nis perm
a AIR HANDLING UNIT(OVER 10,000 CFM)
�_
Sillamilm of ApplicantContractor I Data EXHAUST HOOD(W/DUCU
I'Alll
HAZARDOUS MATERIALS DISCLOSURE HEATING ONI'1'('TO lBOXJO BTU) Date Receipt a
Will the applicant or future building actinium store at handle broadens material HEATING UNIT(OVER 100.000 BTU) 'TO AL:
as defined by the Cupenims Municipal'Code.Chapter 9.12,and the Health and Safety
Code,Section 2553204? VENTIIATTON PAN(SINGLE RFSID) CT
❑Yes ❑No
ISSUANCE DATE
Will the applicamor(ware buildingcecupantun Nuipmemardevireswhich emit BOILER-COMP CHIP OR 100,000 BTU) PAID A 8 D
hae:udams air conmminunta as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) 1�
Cotct?
❑Yes ❑No NEW RESIMN'I'[Al.MECIL SQ.IT. NOV Jr �9
I have read the[currencies materials requirements under Chapter 6.95 of the
94
California Health&Safety CMc,Sections 25505,25533 and 8534. 1 understand Net 01'y
if the building does not currently have a tenant.that it is my essponsibiliny to notify Ne
Occupam of the mquircmems which must at,met prior to issuance of a Carl of
cupancy .
Owner or auNorired agent Dam TOTAL: ISSUED BY:
OFFICE
Ocit� ,of
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 20, 1995
Bart Hood
10961 North Sky Square
Cupertino, CA 95014
Subject: 10961 North Sky Square, Permit# 27286
Dear Mr. Hood,
• According to our records the above mentioned permit has never been finaled by a
City,tBuilding 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 N�:)
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