27759 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
4ARCHMUTIENGINE!
OF CUPERTINO H,I. 16'-ELECTRICAL PERMITNO.
APPLICATION/PERMIT PLUMBING.-.NECIIM'ICAI. 27759 C(]
W.
ILDING DIVISION NUIhDING PROJF,C'T IDENTFICA'TION r JJ
NG_ADDERS� �� � SANITARY NO. APPLICA�TTIION�SUB/MMIII FIAALDATE
II fo I.GTN
S MF w PHONE: CONTRAC70R'S ryAiyljtsa /st _ LIC NO:
!VN"a 5TJAL/1rv�`V`— NiUCOMROLp
ER: LIC NO: ADDRESS: ❑
\a CONTACT: PHONE: BUILDING PERMIT INFO
Q'fY. ELECTRIC PERMIT FEE
yLpG ELECD PLUMB MF❑CII
PERMIT ISSUANCE �� �7j /llp5
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
o=y I hemby affirm that l am licensed underprovisionsidChapter9(commencingwith
�00 Sectimi7000)of Division 3 ofthe Business and Professions Cade,and my license is in PANELS
y t-. full force and effect.
IIQ-..jlrCj U,croc Class Lie.N UPT02WAMP5
0, Date Conmumo, 201-1000 AMPS
Fyj ARCHITECT'S DECLARATIONSQ.FT.FLOOR AREA S/SQ.IT.
ZOh a I understand my plans shall be used m public records. OVER 1000 AMPS
O Z 1 Q
SIGNS ELECTRICAL L�
<Y7,4 Licensed Professione LL
C =< OWNER-HUILDER DECLARATION SPECIAL CIRCUOMISC.
XOaU I hereby efims that I an exempt from the ConmenWs License taw for the
W3 a y following reason.(Section 7031.5,Business and professions Code:Any city or county TEMP.METER OR POLE INST.
t LL.O a which requires a permit m construct,alma improve,demolish,(IT repair any strct
uure
' Y� priorto its iwurane,.N.requires theapplicant,.(such pere,to file.signed strement POWER DEVICES
C C<
1 00 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter
i SWIMMING POOL ELECTRIC �A���N
e or that he is
Division Businesssed.An ss iota Cad o) VL—�_�
W=m or that h<is exempt therefrom and the basis for the alleged exemption.Any violadon of OUTLETS-SWRCHES-FlXTURES [^J_71/•
FZQ Section 9031.5 by any applican,fora permit subjecestheappliesur ton civil penalty of
"0 not more tban five hundred dollars($500). _
NEW RESIDENTIAL ELECfII SQ
11I,asowneroflhcprnpeny,urmyemployceswith wages as theirsolecompeuvtion, .FT. STORIES TYPECONSTRUCTION
a will do the work,and the structure Esti intended oroffded formle(Sce.7046,Business
and Professions Code:Ile Contractor's License Law does not apply to an owner of
property whobt ildsorimprovarnemon,and whodoes such work himselfordaoughhis
employers.pmvid thatsuchimpmvementsv nwintendWarofferedforWe.If.
OCC.GROUP RFS.UNITS
hmever.thebuildingorimpmveme tissoldwiNinoneyeuofcampletion,Neowna- T
builder will have the burden of proving that he did not build or improve for purpose of
❑ Las ownendthe propcny.umex<luaivdycnntracting with licensed conwdnmto QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
mswcl Ne project(Sec.7064,Business and Professions Code:) no Contractors
License Law Jasn.e apply roan ownernfpropenY who builds.,improves rnereon,and PERMIT ISSUANCE
whoconmers forsuch projects with a contractions)licensed pursuant turn,Contractor's ALTER DRAIN&VENT-WATER TEA
License law. I FEE SUMMARY
❑ I am exempt under Sec. .B&P C for this mason OUTSIBACK FLOW PROTECT.DEVICE U tES
SANITARY Y N
Owner —Dart— RF.CEHvT`#
WORKMAN COMPENSATION DECLARATDRAINS.FLOOR.ROOF.AREA.COND.
ION SCHOOI.TAX Y N
❑ Ih'CormsJirm Na 11 brance onificam.f copythen,l6insure,oface C.)whic FIXTURES-PER TRAP RECIiIPTN
Workers C.mpcnsmion Insurance oracenified copy Nercofls .3800,Lab CJwM1ich PARK PEE. Y N
coveall employers under this permit ECEIP
GAS-EA.SYSTEM-1 INC.40UTLETS RDIVISI N
rs
Policys BUILDING DIVISION FL[S
Company GAS-EA.SYSTEM-OVER 4(FA) PLANCHECK FEE e
❑ Certified),is hereby famished.
❑ CenifiedcopyisfiledwiNthe ci inspection 's' \ /lam GREASEIINDUSTRL WASTE 1N ERCEPTOR GRADING FEE
CERTIFICATE OF EXIi H OM�s�gp'a'1)�ICERS' GREASE'I'RAP SOILS P[E
COMPENSATI SURANCIi/
01d:xection treed not be completed i t It mutisforonehundTddollars(SIM) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or less.)
I certify lhn in the perOTmance of the wart for which this pemtit is issued,l shall WATER HEATER WIVENT/ELECTR
not employ any peown in any manner m as to become object to he Worker: PAID
Compensation laws of California. Dam WATER SYSTEMITREATING Date Receipt IT
O Z Applicant
z � NOTICE TOAPPLICANT:If,after makim,ddsCerdficateofExemption.you should NEW RESIDENT IAL PLMB. SQ.FT. TOTAL:
.N� beenme Subject o the Worker's Compensation provisions ofthe Labor Code.you must
forr wnh omind,with such provisions.,this pemut shill be deemed revokW. BUILDING FE
G Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that there is a construction lending agency for the perfmmmce of
U Q the work for which Nisp mi,is i....d(See 3097,Civ.C.) TOTAL: ELECTRIC FEE
Lender's Name
�" F l,end,ra Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
0 U 1 certify the 1 have read This application and suer that the above information is MF.CIIA ICA E
>" D.1 corcct.lagfatocomplywithallonyande...ly ordiruncas and sum laws reining to PERMIT ISSUANCE
F•' Cn building construction,and hereby aurnonze reptesenutivesofthiscilylo enterupon The C Cf IO A
U above-memloned unputy for inspection purposes. ALTER OR ADD TO MECH.
(We)agree to save,indemnify and keep harmless she City of Cupertino against
Iiabi litics,.dgm .,sand expenses whi�h� 9y any way scaueagainn said City AIR HANDLING UNIT(TO I R00D CFM)
ns en grmli is, jff/I/1 IT 3-445 AIR HANDLINGUNIT(OVERIO,(K0CFM) TY (it liUrtkll
Sigonaurcof Applica.107mancmr Date EXHAUST HOOD OVIDUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO BIDp00 HIM Dam Receipt#
Will the applicant nr future building Occupant some or handle hazardous material HEATING UNIT(OVER IW.(gp BTU) T L'.
is def ncJ by Ibe Cupsnino Municipal Cede.CM1apmr 9.12,end IM1e❑eu1N and Safely
Code.Section 255:{2(.)1 VENTILATION FAN(SINGLIi RIiSN)
EI Yes ❑NO ISSUANCE DATE
WilHhcapplicantor(uwrebuildingacupantuuauipmemor Jcviaswhich<mit BOILER-COMP QHP OR 100,000 BTU) pryryp����fl R (7
hazardous air conuminants as defined by the Bay Area Air Quality Management BOILER.COMP(OVER 100.000 BTU) tt/n " 21995
Dislrierl
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT. ca
1 have read the b.mous materials Tcqulrnnsms under Chapter 6.05 of the / Ur �Uf•Ch IINQ
CulifnOn.Hculth&Safety Code,Sections 25505,25533 and 25534. 1 understood Nn
if the building tiresnmments yhavea Un um Natitis mymsryine of a Pro enotifythe
cupbui of Ne res nor c rre which must ed met pace m issuance of a Certificate hof
e
Occupancy.
Owner or authorized agent Dam TOTAL: ISSUED BY:
OFFICE
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
10677 Par Three Drive
Cupertino, CA 95014
Subject: 10677 Par Three Drive, Permit# 27759 -Addition
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, i
City of Cupertino
J
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