27546 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOB ILDI li-KLLhrRCA1. PERM]I'NO,
APPLICATION/PERMIT PLUMBING,-MECHANICAL. 27546� C /I C
546
BUILDING DIVISION BUILDING PROJECT'IDENTIFICATION' L
BUILDING ADDRESS: SANITARY NO, APPLICA'1"ION SUBMITTAL
`DA'lic.
p '- LOT# 3^ O
O iR.*NAF" NE _ CI'OR'1 NAME IC NO.
NIC COM ROLA
v,•A CI TTiCI'n GI .FR: LIC NO: A - 5: ❑
CONTACT: PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
BLDG ELECT PL,aU�MB MliCfi
PERMIT ISSUANCE 11IyI 0
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL S
GKZ Thi affirm that l am licensed under pmvisimxmf Cnpter9commencing with TOB DESCRIPTION
m
FJ02
Sectifull on 7030)e and ef Division 3 of the Business end fesswns ode,end my license is in PANELS ` �k/)
<_ // UPT02MAMPS tVI K C .�
141 Liccmc Class- Lic.p ' P
m=N Ua¢ Contract 201-I(AMIAMPS SQ.FT.FLOOR AREA ABQ.FT.
GOyZ ARCHITECTS DECLARATION OVER 1000 AMPS
O Z—O I understand my plans shall be used in public mards.
SIGNS ELECTRICAL.
K
Q�Wa Licensed Professional OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC.
X060 I hereby affirm that I am exempt from the Co..merr's License Law for the
W 3 LL y following reason.(Scctiot 003L5,Business and Professions Code:Any city-tum ty TEMP.METER OR PULL INST.
which requires n pcount m ear swct,alcor,improve,demolkir m repair any structure
E YE prior to its issuance,also ne drew the applicant for such permit to file a signed statement POWER DEVICES
C cep ,bat he is licensed parmeat o the provivionxnf the Contractor's License Law(Chapter
s—y0y, SWIMMING POOL ELECT RIC VALUATION
KCLL 9(commencing with Section 9000)of Division 3 ofthe Businessd Professions Code)
W_y nnhet heisexempttMmBrom end the basis(r the alleged exam or of OUTLETS-SWITCHES-FIXTURES
I_Z. Section 9031.5 by any applicant f a pcmtI bjens the apple t it peralty of
Wnot more Ihun f ve hundred dol lac 1 //
0 I' . fr NEW RESIDENT[AL.ELECTR _SQ.FT. S"(ORES TYPE CONSTRUCTION
yC o ❑ Lasowneroral,hex ny,or ssd n [TB.dncvx
3a will do iM1c work,andtheswcN rale(Sa.J044,Business
and Professions Coote:The t n I doe not apply man owner of
pnopcnywhobuild. i p v ereo unJe ho hwmkhimselforthmugh his
can fryers,pr c is himpn cadedorofferedfmati If. OCC GROUP RES.UNITS
however,the buildi pmvcmcnti first, in one year ofemmpletion,thrower- TOTAL.
builder will have the o ur ofproving that he did not build or improve for purpose of
sale')' QTY. PLUMBING PERMIT FEE FLWDZONE APN
❑ Lzsmwncrofthe ny,emexclusively. contracting with licensed conuacmnm
lmstmq the project(Sce.9044,Business and Professions Coda)The Comme or's
icense PERMIT ISSUANCE
whocomracts for such Projects with acroactors)licensed pursuant tome conuanorr se Law.
LicengLTiiR-DRAIN&VENT'-WATIiR(EA) FEE SUMMARY
❑ l am exempt under Sec.= ,B&P C for this reason BACK FLAW PROTECT.DEVICEg�AR
OUTSIDE FEES
(_, YN
Oster Date DRAINS-FLOOR,ROOF,AREA,COND. RECEIPTp
WOR KMAN COMPENSA'[ION DIiCLARA'HON Y N
❑ 1 hereby affirm that l have a certificate ofcommin to self-insure,or a certificate of FIXTURES-PER TRAPRECHIPT#
Workers ComMnsation Insurance ora ecrufiedcopy thereof(Sec.3800,Lab C.)which Y N
ns aIlelr i RECEIPT#
JI- �. GAS-HA.SYSTEM-IINCAOUTLIGSBUILDING DIVISION FEES
put."#
Company GAS-EA.SYSTEM-OVER 4(EA) Fl3Ecob f h❑ Cenilial copy is file w' the city inspection division. GREASEINDUSTRL WASTE INTERCEPOR ECERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP
COMPENSATION INSURANCE
(This section need not be amiplewdl rine permit is formic hundred dollars($100) SEWER-SANITARY-S'1'ORM EA.200FI. ENERGY FPiB
less.)
Ittnify thetimhe perfonnmce of me work fm whichthispennii isissuW,l shall WATER HEATER W/VENT/ELECRt
not employ any penin in any manner so as to become subject r the Workers' PAID
Compensation Lastsof California. Dam WATER SYSTEM/TREA'I'ING Data Receipt#
O z Apploceni
z O NOTICE TO APPLICANT:If,after making this Cerificate of Exemption,you should NEW RESIDENTIAL PLMIL SQ.FT. TOTAL:
t•-' N become subject to the Workers Compensation previsions of the Labor Cole,you must
04 � forthwith comply wlih such provisions on bis permit snail be deem
ed revoked. BUILDING FEE
WQ CONSTRUCTION LENDING AGENCY SEISMIC ITT:
F4 I hereby affirm that There is a construction lending agency for the pcifonnaace of
U z TOTAL: ELECTRIC FEE
U p me work for which iota permit a iaaaea(sec.3WI,Civ.c.)
Lender's Name PLUMBING FEE
Lcndcr's AJJrcss QTY, MECHANICAL PERMIT FEE aV
U I certify that 1 have read this application and state that the above information is MECHANICAL FEE
W correct.I agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE
F-' N building cnnstruction.and hereby,mthuriee represemativec ofthis citym enter uprrhm CONSTRUCf10N TAX
U z abowc-mc toned property for inspection purposes. ALTER OR ADD*10 MSCI{,
(We)agree to save,indemnify and keep harms.the City of Cupnino against
liabdities.jud,recul,rests and expenses which may inany wayaccrueagmomedd City AIR HANDLING UNIT(TO 10,000 CFM)
in wmequenee of the gemming or ibis pemtit.
AIR HANDLING UNIT(OVER 10,000 CFM) �7 �
Sigmaare of Applicant/Convenor Dam T
EXHAUST HOOD PAID 3-1(61f 'F5'Z7tf
IIA''ARDOUS MATERIALS DISCLOSURE HEAPING UNIT(TO 101.000 BTU) Date Rcecipt x /l�V�l
Willtheapplicant or Bruce building rampart store or handle haum
rdous artial TOTAL: �- W
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEAPINGUNI'1'(OVF.RI(0.W0BI'U)
Cods,section 25532(x)? VENTILATION FAN(SINGLE RESID)
❑Yes ❑No
ISSUANCE DATE
Will the applicamor future building occupant use equipmentordevices whichemit BOILER-COMP(314P OR IW,IXO BTU)• p hazardous air comsms as imar definrd by the Bay Area Air Quality Management BOILER-COMP(OVER 100,0[0 BTU) A I D
District?
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT.
1 have mad the hmarduus materials requirements ander Chapter 6.95 of the MAR 1 0 1995
Cnlirnmia Iealth&safety Code,Sections 25505,25533 and 15534. 1 undcrsland mat
if the building does not currently have a tenant,mai it is my msponsibiloy to notify the
occupant of thc requirements quireents which must be met prior to issuance of a Cerificam of CI1 r l/f l+Uf Cff I II�U
Ocmpancy.
Owner or authoved agent Dare TOTAL: ISSUED BY:
OFFICE
City of,
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
10069 Oakleaf Place
Cupertino, CA 95014
Subject: 10069 Oakleaf Place, Permit# 27546 - 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 Y �L
•
hnnfp(1 an RCC:'Cl2J P30Cl '