26727 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO Rte' - "" RICAL PERMIT NO.
APPLICATION/PERMIT PLUMBING-.MECngnICAL C 7 r�'7
BUILDING DIVISION BUILDING'PROJECT'IBEN'I'IFICATION v I L 1
BUILDING ADDRESS' SANITARY NO: APPLICATION SUBMITTAL UATI
7811 Orion Lane UNIT# LOT# 1
OWNERS NAME.. PHONE: 2 5 7— INTRACfOR'S NAME: LIC NO: `
St . Sava erbian Orthodox Cu ch P. .A.A. Furnace Co . "U COM'ROLp
ARCIRTECU INNGINEER: LIC NO: ADDRESS: ❑
12 Stone Ave .
CONTACT. PHONE: M'ksword+ �'' - BUILDING PERMIT INFO
See Ra n d o 293-4717 QTLY,kiL' � si 'a§PERMIT' t FEE. BLDG ELECT PLUMB MECH
PERMIT ISSUANCE
LICENSED CONTRACT'OR'S DECLARATION APPLIANCES-RESIDENTIAL
mmz I hereby afford that l am licensed underprovisions of Chapmr9(commencing with JOB DCSCRIP
V100 Section]IXNgaf Division 3 of the Business and Professions Code,and my beer.is in PANELS �� I
y��F full force and if t.
<lzw License Ce � c.# 3� 6361 l UPTO200AMPS
m6d Date Cnnl� ,J rnAe 201-1000 AMPS
f—no, ARCHITECT'S DECLARATION OVER It1o0AMPS SQ.FT.FLOOR AREA $/SQ.FT.
ZOw— l unectsland an,plans shall be used as public records.
OC—q
SIGNS ELECTRICAL '
YLicensed Rolcssional
C
C� OWNER-BUILDER
pt from he
SPECIAL CIRCUIT/MISC.
noOMoo Ing hereby
mad affirm the 1 am exempt from the Cosions Cs License Low for the
W�+C`v following mason.permit
construct.
Business and improve.
de Professions Code:Any city stcounty TEMP,METER OR POLE MST.
F LL O Q which requires a permit m c.nstrvet eller,impmve,eemolish,m repair any atrveture
}� prior in its issuance,also leyuiers the applicant for such prmit to file u signed slalemrnt POWER DEVICES
aabuthe is l'acn.wd mroara to the provisions of the Conlruaors License Law(Chapter VALUATION
Q
dtio� 9(commencing with Section 7")of Division 3of the Business and Professions Code) SWIMMING POOL ELECTRIC
=m or that he is exempt therefrom and the basis for the alleged exemption.Any violation of OIITLErg-gWITCHE$-FLCrl1RE5
E D
F=Q Section 7031.5 by any applicant for a permit subjecu the applicant m a civil penalty of
not more than five hundred dollars($500).
NEW RESIDFJJTIAL ELECIRS .PT.
zCp% ❑ 1.asowneraDM1epropery,ormyemploy«swithwagesss'Eeirsolecompensedon, Q STORIES TYPE CONSTRUCTION
y3. will dmhcwons and the he Cormicum is License La does
an Business
and Professions Cade:The Commmors License Law docs not apply m an owner of '
property who builds or improves themon,ared whodres such work himselfor through his
employees,provided Nat such impmvemm
esam not immadedoroffemd forante.If, OCC GROUP RES.UNITS
however,the building or improvement is sold within one yearo(completion.the owner- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
sale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
❑ [,es ownerofthe pooped ,amexclusively contracting with licensed contractors'.
onsuuet the pmjcel(Sec.7044,Business and Paresdoes Code:)no Contractor's
License Law Jcesnot apply'.an owner ofpmpeny whobuiWsorimproves Nercon,and PERMIT ISSUANCE
whocontmcts for such pri with acontractods)licensed punianto the Contractors
License law. ALTER-DRAIN&VENT-WATER(G) PEE SUMMARY
'
❑ I am excmpl under Sec. ,B&P C for Nis rcawnIDEM 0
BACK FLOW PROTECT.DEVICE
SANITARY Y N
Owner Dam DRAINS-FLOOR,ROOF,AREA.COND. RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ IM1ereby affirm that have acenilicme of consent mself-insum.m enificateof FIXTURES-PI7R TRAP RFCF.JT#
Workers Compensation lnsumnceolacenifedcopythercof(Sec. ,Lab C.)which PARK FEE Y N
coven all employ I GAS-EA.SYSTEM-I INC. BUILDING BUILDING DIVISION FEES
RECEIPT N
Policy If
CompanyG -EA.SYSTEM OVER 4(EO �� PLANCHECK FEE
❑
Certified copy is heady umamed.
)Q Cenifiedcopyisfledwith the city inspection Jivisian. - GREA INDUSTRL WASTE IN'IERCEPfOR GRAUINGFLC
CHRTIFCATEOPFXEMPrONFROMWOR ERS' GREASETR SOILS FEE
COMPENSATION INSURANCE
(This section need not bocompbrod Bub,permit is for one rWdellnrs(SIM) SEWER-KITA -ST MIiA.200FT. ENERGY FEE
I certify y inthepenfm y mummer
so as for which this ect to issued.Workers RI W/V /IiLFCi'R
ma employ,any person in any manner so as m become s bject m the Workers'` - PAID
Z
Compensation laws of Cntiromin. Dem W T "1M/I
'ER ATING Dam ciptp
Applicant IF as
O 0NOTICE TO APPLICANT:IL after making Nis Cenifcat of Encmption,you shoo NEW ID@4T1 .PLMB. SQ.IT. TOTAL:
E-' become suhieetmthe workers Compensation provixinnsn eLabnr Code.
mahwith comply with such provisions or this permit shall t< red rcwke BUILDING R :
a [� CONSTRUCTION LENDING AGENCY SEISMIC
1 hereby offish that is a construction lending agency for th rfmoam
=) z EI.EcOt( F
1,.) p the work for which Nis permit is issued(Sec.2097,Civ.C.)
Lenders Name PLUMBING FEE
0 F Lenders Address QTY. ECIIANICAL PERMIT FEE
U I cenily that I have read this application and state that the above info 'ion is
connect. I agree to comply with all city and county ordinances and state laws rets gm PF-RMIT ,SUANCE MIiC11ANICA1.Flili
f" haildin,....omime,and hereby ambonae repromnumli vo of thiscirymemer upon CONSTRUCTIONTAX
U Z above-mentioned property for inspection purposes. ALTE R ADD TO MECH.
(We)agree to save,indemnify and keep homeless the C,of Cupertino against
Iiabilities,judgramucemaimad expenses whichmey in my way acermagainst said City AIR VANDLING UNIT(TO 10,000 CFM)
in mmoope nce of the granting of this permit.
HANDLING UNIT(OVER 10,(N%)CPM)
Signamrenr Applii,ma/Commemr Dam EXHAUST HOOD UW/DUCT PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.000 BTU) Dam Receipt
Will the applicant in future building«cupant store or handle momds, mnend HEATING UNIT(OVER 100,00e)BT # TOTAL:
as defined by the Cupertino Municipal Code,Chapter 9.12,and Ne Hiedthin'end Safety
Code,Section 25532(x)7
El Yes C3 No VENTILATION FAN(SINGLI3 RE51D)
ISSUANCE DATE
Will thmm pplicaorfumumbtildingoccupam use equipmenmrdevicin whichened BOILER-COMP(JHP OR 1W,000 NIU) pp
�mumdous air contaminants as dcfned by the Bay Area Air Quantity Management I P N i D.
Duane,? BOILER-COMP(OVEft IOO.gp BTU) S
❑Yes ❑No NEW RESIDENTIAL MECH.—SQ.FT.
1 have read the haeardnus materials requirements under Chapter 4.95 of the DEC 131994
California Health&Safety Code.Sections 25505,25537 and 25534. 1 understand Nal
Bite buildmm cti ently have tenant that it is my responsibility to notify the CIIY
cars. o><Ne or('muni ust be met prior m issuance of o Cenifvere of ur Vur Cl
Kill
p�cy1,2 ?
CK Xvixer, Titan bagcnt Dam T ISSUED BY:
a
i'
_- City (if
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 20, 1995
St. Sava Serbian Orthodox Church
7811 Orion Lane
Cupertino, CA 95014
Subject: 7811 Orion Lane, Permit#26727
Dear Sirs,
• According to our records the above mentioned permit has never been finaled by a y't
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
A
please send a copy of the permit, along with this letter to 10300 Torre Avenue, Tt,
Cupertino, CA., 95014, Attention Building Department.
r Fe:
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
Printed an Recycled Paper