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27542 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPER'PINO .Lot. ;\.-ELECTRL,AI. PERMITNO. BUILDING DIVISION APPLICATION/PERMIT PLUM RODE T IDENTIFICATION 27542 BUILDING PROJECT IDEN'fIF1CA'TION BUILDING ADDR/C/S��S�'1�//��-n&- ],/) SANITARY No. AP/PLICA'I ION SUBMITTAL DA'IE /,5/ / V(/1/ CA n UNIT N LOT a OW F.RS NAME: ONE: C ACTOR'S NA LIC N : NIC CONTROL RCHII ECIALNGINEER: LIC NO: S. ❑ - 1 CONTACT': PHONE: 7j�OQTY. ELECTRIC PERMIT FEE ILDING PERMIT INFO W12 PERMIT ISSUANCE BUD ELECT PLU L M❑CII 10 LICENSED CON4 ACS)WS DECLARATION APPLIANCES-RESIDENTIAL ❑Wz Ihembyaffirn that I am licensed underprovisions of Chapmr9(commencing with IDH DFSCRIPI'ION Ia;0f0E-.. Secfalltt`oKe00o)to(fPDivision 33oofdo,Business[.4P/rorafesnsions Code,and my license is in PANELS pit FGL� License Clamic / UPT02W AMPS � \ to=y Date Commctor 201-I(Nq AMPS SQ.FT.FLUOR AREA " $/SQ.;'1'. 7Fnz ARCI IITF,CP'S DECLARATION OVER]"AMPS oz-0 1 understand my plans shall be used ns public records. SIGNS ELECTRICAL Licensed Professional C�a'Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. CW, L hereby affirm that 1 am exempt from the Contractor's License Law for the t,, folluwm,reason(Section 703L5,Businesaand Proreasions Code:Any city Or county TEMP.METER OR POLE INST. 01 which requires n permit to construct,alta,improve,demolish,or repair any surelum pWNY� ono its issuance,also the licant forsuch Permit file a sat Wstatement POWER DEVICES pn requires pp T2 gn , E:Mo that he is;immsed pursuant to the provisions of the Contractor's License Law(Chapur SWIMMING POOL ELECTRIC 66��' 9(commencing with Section 70of Division 3 of the Business and Professions Code) A VALUATION Wimor he is exempt thercrrom and the basis for the alleged exemption.Any violation of t4r Section 7031.5 by any eppliutnt for ape man subjoins the soft canna or a civil penalty of OUTLETS-SWITCHES-FIXTURES 4 net more than rive hundred dollars($500). ❑ NEW RESIDENTIAL ELELTR _S T. STORIES TVPB CONSTRUCTION C Lo ❑ Lase w work, sur thesmcnyormyemtended Taff agesasthe(Sole comperosiness Lo will J.fiewons Coo i smtaum isnot LiceeseLawreoesnot apply 9U 1St Business and Professions Code:The Comment s License law does not apply to an owner of QV I property who builds or improves theuon,andwhodo,ssuch work Nmselforthrough his OCC.GROUP RES.UNITS own enrployms,provided that such improvements ort not intended or offered hassle.If, however,the building orimprovement is sold within one yearof e-advount,fl eowner- TOTAL: builder will have the burden of proving that he did not build or improve for purpose of 'sale')' QTY. PLUMBING PERMIT FL•E ❑ I,asownerof the pmpenY,tunadusivdymntmc,ing with licensed convactonm FLOOD ZONE APN construct the project(Sm.7043,Business odd Pufessions Cale:)The Contractors PERMIT ISSUANCE License Law does not apply loan ownerofprogmy wM1obeilds m improves there".,and whottmtrects krauch projects with a contmetims)licensed pursuant to the Contractor's Licence Law. ALTER-DRAIN&VEN T-WATER IEA) PEE SUMMARY ❑ I an exempt under Sm. .B es &P C for this reod BACK FLOW PROTECT.DEVICE OUTSIDE FT: S SANRARY YN Owner Dam RECEIPTp WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,RUOF,AREA,COND. ,CHOOL TAX Y N ❑ Iherebynftirmthalhuvcuceniriota"feonsnntoself-insum.oracenificamnf FIXTURE-PERTRAP RECF.IPI'p Workets'Cnmpensation lmumnce orucenifeJ copy thereof($ec.3NIX1,Lab CJwM1icM1 KE YN covers all l�ylJ991p�'1nQQ�Ysef��p��d--yL, /— _ L GAS-EA.SYSTEM-1 INCAOUTLEB REIVISI M Policy / h BUILDING DIVISION ItiFS Company/ ,7", �1a / l;f� GAS-G.SYSTEM-OVER 4(EA) PIANCHECK FEE ❑ CeinfTO ay he( fumuhed. ❑ CcniticJ rnpy if with the city inslxction division. GREASrVINDUS'I'RL WASTE.INTERCEP'JOR GRADING FEE CERTIFICAT B OP EXEMPTION FROM WORKERS' GRPASF:TRAP SOIISFEE COMPENSATION INSURANCE (This a{tion need not be completed ifthc permit is boron,hundred dollars IS 100) SEWER-SANITARY-STORM EA.20017. ENERGY FEE or lets) I minify that in the performance of the work for which this permit is issued.)shall ! A'1'ER HEAT W/VENT/ELECTR not employ any person in any m r as to become subject to the Worse.. PAID Compenintailawsof Culifemla,manner s WA'I'ER SYSTEM/TREATING Dam Receipt# Q Z Applicant Z 0 NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.IT. TOTAL: F' .. become subjmt to the Worker's Compensation provisions of the Labor Code,you must � > forthwith comply with,ach provisions or this permitsha;l be deemed revoked. BUILDING FEE 0. Q CONSTRUCTION LENDING AGENCY SEISMIC FEE z I hereby affirm that hem is a construction lending agency for the performance of TOTAU ELECTRIC FEE U O the work for which this permit is issued(Sec.3097,Civ.C.) Lender's Name U" F Lender's Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE U 1 cenify that I have rend thin application and slate that the aMrve information is MECHANICAL Flil? correct.I tgom to comply with all city and county ordinances and slate laws relating to PERMIT ISSUANCE. F-' buildingcnnstrvaion.and hereby authotiu rtprtncnmtives of this city tocnmr upon th, CONSTRUCTION TAX U z above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. (We)agree to save,indemnify and keep hamlam Ne City of Cupertino against 2;2� expense,which ma in ,,,aidCity AIR HANDLING UNITO 010.000 CFM) of ALR HANDLING UNIT(OVER;0,00UCFM) ctor Dam EXHAUST HOOD(WMUCO PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,00(I BTU) Dam Receipt a Will the applicant or future building occupant store or handle hazardous material ❑EAl'ING UNIT(OVER 100.000 BTU) TOTAL: as defined by the Cupertino Municipal Cale.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? VP.N'HLATION PAN(SINGLE RESID) ❑Ys E3No ISSUANC DATE Will the opplicamor future building"ccupanmxequipmenmrdevicesvehichemit BOILER-COMP(311P OR 100.000 BTU) ff� p p� hat ardous air contaminants as derined by the Bay Area Air Quality Management BOILER_COMP(OVER 100,"BTU) E1 A B D Dlstric0 ❑Yes ❑No NEW RESIDENTIIAL MECH.—SQ.FT. I have mad the hazardous material,requirement,under Chapter 6.95 of the FEB 16 1995 California Health&Safety Cstde,Sections 25505.25533 and 25534. 1 understand that if Ne building does not currently have a moan,,that it is my respnreibility to notify the c....I of the requirements which must be met pri.r to isnnmtce of.Certlfcam of CII V I41" U'r Occupancy. Owner m.tolimiue agent Dam �IAIISSUED BY: OFFICE city ;r Cupertino 10300 Torre Avenue Cupertino,CA 95014 Building Division (408)777-3228 Fax(408)777-3333 December 4, 1995 Resident 951 November Drive Cupertino, CA 95014 i Subject: 951 November Drive, Permit# 27542 - Waterheater Dear Resident, According to our records the above mentioned permit has never been fmaled 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. h 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 �^ P,^too cn Pecicrea Ricer -