27043 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CI'PY OF CUPERTINO RIIII.DING—ECECTRiCA. PERMIT NO. 27043
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION BUILDING PROJECT IDENI'IFICA'1'[ON
BUILDING ADDRESS: ��} SANI'T'ARY NO. APPLICA'UONSUBMIITALDATE
81 ' l(V UNITp OTp Ili /1� ip
OW SNA E: PHONH: unNTR N ME: IC Vl V
fMMW _0 N/C CONTROL#
�AR 1111hCT/ENGINEER: LIC NO: UU ADD KC� ❑
CUM' PHONE. BUILDING PERMIT INFO
! QTY. ELECTRIC PERMIT FEE
BLW ELECTPLUMB M
PERMIT ISSUANCE
LI Suml CONT RACTOR'SDECLARATION pPPLIANCFS-RESIDENTIAL JOB DESCRIPTION
pceZ Thereby affiwCI I aEDCONTRAcTORSD CLAR,pmr9(commrncingwiN ,''/Iy,NWI/,_J yl_//J
m00 Section]IXIU)of Sion 3,fthe Business u�+ o stuns CodN,wd my license is in PANELS w�
w�DfP-�. full tome and cf ect.i IJI• C/!/•,
NSW Livcnx CT s- Lic.N UPT02WAMP$
6py Dwc Cnmrucmr 201-1000 AMPS SQ.F-1'.FLOOR AREA E/SU.11'.
Fye ARCI{1TECT5 Ula OVER 1000 AMPS
ZOmCl IunJcrsmnd my,l.a,shall beuseJaspublic rccmds.
OZ�O
FyFw SIGNS ELECTRICAL
Qy:5�, Licensed Professional
cecece6 OWNER-BUILDER DECLARATION SPECIAL CIRCUR/MISC.
XO W V 1 hereby aWw that I am exempt from the ConwctNs License Law,for the
W 3 4 hG following xaxn.(Section 7031.5.Business and!Professions Code:Any city or county TEMP.METER OR POLE MST.
F L J which requires a pewit to construct.altar,improve.demolish,or acpair any swctuac
Eco prior to its issuance,also acquires the applicant mrsuch Pemduo file a signed statement POWER DEVICES
K¢ tbar he is licensed pursuant to the pnrvlsnuns of the Convector's Licenx Low(Chapter
SWIMMING POOL ELECTRIC
9 that h eis ixempt therefrom
000)oe basis
3 of rM1e ed"emptioss and Professions Code) VALUATION
m_rn Se Nm h731.5banyap romnt f the permit.suheallegeJexlicant n.Aiviny 1pemion of OUTLETS-SWITCHES-FIXTURES /-�-
F Z Q Section]031.5 by any applicant fora pewit subjcas the applicant m u ulvll penalty o[
nor nwm Nen rive hundred dollars(551(0.
E9p NEW RCSIDENTIAL ELECfR —SQ.PT STORIES TYPE CONSTRUCTION
ace F_o ❑ 1,usownera depropiny,,rs not ire eyecswiNwagesasth,Solec�.7044. nsuie.
3°= will dothewons and e: he Ca cis not's License
La doesed not apply
to cot Boniness
and professions Cale:The Comrxror's Licenu law does not apply to rn owner of
propcny whobunIdsorimproves hereon,and whadoes such work hitone for through his
wnmployees,proviried si
thatsuch impvemam enlsnot nntrnM
doroffcmdforxle.If. OCC GROUP RFS.UNITS
e
however,the bunldnngor improvement is sold within one yeerofcamplerion,the owner- TOTAL:
builder will have the barriers of pmving that he did not build or improve for purpose of
sale')' QTY. PLUMBING PERMIT FEE
E] I,.s nwncrofNc propcny,am cxdusivdy conwaing wiN licensed convenors to FLOOD ZONE ANN
construct the project(Sec.7044,Business and professions Code:)The Contractor's
License Law dues not apply man owneraf propcny whobuilds or nmprovesrheren.and PERMIT ISSUANCE,
whoc transforxchpmjems with.comrnmor(O licensed pummnuo No Comractor'n
Liccnnvlaw ALTER-DRAIN&VENT-WATER(PA) FEE SUMMARY
❑ 1 vm exempt under Sec. ,B&P C fur this rcaxn ACK FLOW PROTECT.DEV ICF, OUTSIDEMES
E
SANITARY Y N
Owner Date RECEIPTp
` WORKMAN COMPENSATION DECLARATION D AINS-FLOOR.ROOF,AREA,COND. SCHOOLTAX Y N
f� ❑ Iberebyaffirmthmlhaveacenificateofconsennoself-insort.are nficam Fl TURES-PER TRAP RECEIP #
I Workers'Cwnpensy pp qh r (edgwpJ9tr{smf(Sxa1Mix.Lab CJw h PARK FEE Y N
covers all stop th u !]/`\>(/ CA EA.SYSTEM-]INC.40I1TLETS RECEIPT#
Policy# _ BUILDING DIVISION PEES
Comprny _ GA -EA.SYSTEM-OVER 4(EA) PLANCHECK FEF.
❑ Crified copy is here y' s eJ.
Ccnilicd copy is filed with the City inspection div is OR ASMNDUSTRL WASTE INTERCEPT OR GRADING ME
CERTIFICATE Of EXEMPTIO MWORKERS' GR ASE TRAP SOILS FEE
COMPEN NSURANCE
Tbissectionners na Cee mplemdiflhepamit Ls for onchundreddo11ms0101B SE ER-SANITARY-STORM EA.20EFT. ENERGY ME
or Icxs.) 1.
leemythwinfneperf a ofthe work for wV this ixsuoLlsh w HIiATERW/S'PM/ELECTR
not employ any person in any crnnu an as w u u Nc Work PAID
Compensation Laws of Califomin Dne ATER SYSTEM/IRFATINC Date Receipt#
O z Applicwl
z0 NOTICE TO APPLICANT:If. it r gt is ,W. should NEWRGSIDEM'IAL PLMB. SQ.FT. TOTAL:
F .�. become subjecuo the Worker's Cos f e Lo C e,you
hnrM1wirh comply wnN suchpmvix me or wiIsshal WrcvokeJ. BUILDING IgiE
[2] Q ` SEISMIC FEF.
0. CONSTRU [ONE. DING AGENCY
Ihcrehy nlfiw Net there is onsvumio per,Cis
(Nobe rfowenx of
V O the work for which this pewit is is ued(Sec.3047,Civ.CJ TOTAL: ELECTRIC RiE
I<nJcr's Name PLUMBING FEE
L, F Lender's Address QTY. MECHANICAL PERMIT FEE
O L� n I cenify Nerd have mad this plication and state the above infowNon is MECHANICAL ITE
>. wn.loge o omply with ell cit arMcomayo ces and sate laws relating a PERMIT ISSUANCE '00
F" building con do dherebyauth tart rives of Nis city mender upon the CONSTRUCTION TAX
U z aMwe-men un try for inspeniu s. ALTER OR ADD TO MECH.
(We agree a c,indemnify and keep hawless the Cit of C Wino against.
b.bilities,uJgmc , send expenses which rosy inany way accrue gainst aid City AIR HANDLING UNIT(TO IQBBOCFM)
umx, once of a Tngnfdri,pewir.
AIR HANDLING UNIT(OVER 10,000 CPM)
$ignmureo cu 4Comracmr ate E%HAUST HOODOKMUCD PAID
HAZARDOUS MATERIALS cacAIS DISCLOSURE
HEATING UNIT GO 100.00D BTU) Data Receipt
Will the y he Cuantm.Mu building Core,Capterme or9A2.and
Health andrdour Safety HEATING UNIT(OVER 100.000 BTU) OT
as dcrincd by rM1e CLpcnino Municipal Cone,Chapin 9.12,end N<I1eaIN errd Safety
Cute.Section25532(a)? VENTILATION FAN(SINGLE RESID)
11 Yes ❑No
ISSUANCE DA'Z'E
Willthe. IicanrorfutuachuilJin ruscc ui mrJcvicsswhich emit BOILER-COMP(3HPOR 100.000 BTU)
pv Boecupm q Amen
nioudous air Cnntaminams as deflated by he Bay Are.At,Quality Management BOILER-COMP(OVER 100,000 BTU) PAID
is tic C3 yes ❑No NEW RESIUIiM'IAI.MECH. SQ.IT.
1 have read the haormous materials requimmenrs under Chapter 6.93 of the NOV 10 1994
C.IiRrmla Health&Safety Cale.Sections 25505,25533 and 25534. 1 understand that
if the building does not currently have a tenant.that it is my responsibility to notify the Coparent of the mmmems which must be met poor to issuance of a CenC
ificale of �1 1 VY iaij Ch I
Occupancy.
Owner or authooud agent Dole TOTAL: SSUEDBY:
OFFICE
Ci IX &
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax (408)777-3333
September 25, 1995
Irvin Franson
8162 Park Villa Circle
Cupertino, CA 95014
Subject: 8162 Park Villa Circle, Permit# 27043
Dear Mr. Franson,
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
L