28615 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY of CUPERTINO BU1,DING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 28615
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANHARYNO. APPLICATION SUBMITTAL DATE
n0 e o3 o
UW R'S NAM': PHO N CONT C RSMIF LIC NO.�
QRS
NIC CONTROLp
RCHITECf/ENGINEER: LIC NO: SS: ❑
CONTACT: PHONE: 40 BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLU MECH
❑ ❑ ❑
LICENSED ttNSEDCONTRd under
DECLARATION QTY CLECTRIC PERMIT FEF,
I hereby nfOmd that I am licensed under proviairns of Chapter 9(commencing JOB DESCRI ION
WOO with Section]000)nf Disisinn3ofthe Business and Professions Cale.eWm license is RESIDENTIAL:
FOO full force and PERMIT ISSUANCE
LL r^ 9999��,� ❑SFT)WI. [I KITCHEN REMODEL
�UU
License
"as,
las N Lia — APPLIANCES-RESIDENTIAL ❑ ❑
ADDITION PLUMBING RE-PIPE
F�LL Dec Lie 0 n
Fly ARCHITECT'S DECLARATION PANELS ❑MUL'FI.UNIT ❑STRUCTURAL
ZOtt2Z 1 understand my plans shall be Used.,public records MODIFICATION
OZ-0 UPT0200AMPS L1 INTERIOR ❑CHIMNEY REPAIR
p.ci,iF'uWI Licensed Professional 201.100BAMPS IMPROVEMENT
CXN, OWNER-BUILDER DECLARATION OVER 1000AMPS ❑BATH RIiMODEI/REPAIR ❑DEMOLITION
K
9< 1 hatch,affirm that 1 am almond form the Contractor's License Law for the
O y V following reamer(Section]1131.5.Business and Professions Coi Any city or county SIGNS ELECTRICAL ❑OTHER
which requires r permit to construct,alter,improve,demolish,or repair any,manure s( 1 1 A
F.LL.O at pnations issuance,alnnrequim,duaapplinnn on,mhpemJua 111hu.dgnedsmtement SPECIAL CIRCUI'UMISC. TI I
} that he is licensed pursuant to the provisions of the Contrariness Liver,Lim,(Chapter 9
Iy�C�O (commencing with Section 7100)ofDivision 3ofthe Business and Pmlessirns Code)or TEMP METER OR POLE INST. COMMERCIAL:
6 d o eC that he is exempt therefrom end the basis for the alleged exemption.Any violation of Cl NEW BLDG/ADDITION ❑DEMOLITION
^m
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
[-Z} not more than five hundred dollars(55110). IMPROVEMENT
QQra
1,as owner ofthe ppeny.or my employees with wages as Meirsole compensation, SWIMMING POOL ELECTRIC
O will do the work,and thesuuctum is not intended muffercJ
d for sale(See. Business []OTHER
and Profession,Coda:'Ibe C.a.mrls License Law does mat apply to an owner of OUTLETS-SWI'I'CHIPS-FIXTURES
a' r property who builds or improves thereon,and who does such work hinudf or through
his own employees,provided that such improvements are not intended or nfiemd for NEW RESIDENTIAL ELECTR SQ PT.
ale.If.however,the building or improvement is sold within one year ofeempletion.the SO.FT FLOOR AREA $/SQ.FT.
owner-builder,will have the burden rf proving shat he did not build or improve for pur-
pose of salay
I,os owner of the pmpetty,am cadusivdy contracting with IicenseJ comndnn m OTAL:
ase Law
a the project(Sec.o an Business and rty who
builds
ut Corea The Conherimu.,and
whomonwdtsforsch plymts ownerontra ol any whobollJsrrantto[li Coot , ur% Q]'Y. PLUMBING PfiRMI FEP,
who contracts for such projects With a ramractor(,)IicenseJ pursuant at tnc Comm vnesx
License Law. PERMIT ISSUANCE
❑Ism eacmpd und"S .B&PC for din son
Date ALTER-DRAIN&VIiN I'-WATE (Ip VALU
OwnerATIOjy
W ER'S COMPEN.AT ON DECLARATION BACK FLOW PROTECT DEVICE
1 hereby air r n under Penally M perjury one of the following declarations:
I have and will caiman a Certificate res Consent)sel6lnmre for Worker's Compcn- DRAINS-FLOOR.RUDE.AREA,CONE). TYPE CONSTRUCT ION
. tion,ns presided far by Section 1100rf the Labor Coda,Ia thie per omm"m.1 he 4T0RIli3
' work for which this permit is issued. FIXTURES-E'ER TRAP
❑1 have andwil mainmin Workers Compensation Insurance a requited by Section
,.."a La
C ,fon penormanceo thmwrrk "which this permit is issued. GAS-FA.SYSTEM-I INC.4 OUTLETS DEC.GROUP APN
My Workd u Batu P T numbs,'am:
Came. GAS-EA.SYSTEM OVER 4(EA)
CRRTIF ATE OF EXEMPTION FROM WORKERSGREASEINDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE NUILDING DIVISION FEES
(Tak,rcllnn narrator he complcmd ifthe pcnnit is furore hundred dallas(5101) GREASETRAPP �{4 r"(
nr less.) f.ANC111iCK pEH D rl
I cenifydha inthe performance fthe work for which this pandit is issued,]shall SEWER-SANITARY-STORM EA.200 FT.
not employ any person in any manner us as(r become subject to the Workeri Compcn- ENER '•�
Z it..Laws of C.lif ands Data WATER HEATER WNENT/ELECM
G^ADING E
O ' Q
O Applicant
to NOTICE TO APPLICANT.If,after making this Cenificare.f Exemption.you should WATER SYSTEMaREATING r
F^ become sullen to the Worker's Compensation f the LaMar Code.you must SOILSTEE'/-
1 ns or
provisions. (f ( r ,
W �
forthwith nmdpiy whh such provisions err Ibis pcnnit shall he JcenmJ revoked. WATER SERVICE �s t117�U
Q
z CONSTRUCTION LENDING AGENCY NEW RESIDENTIALPLMB. SQ.FE PAID Dade Receipts
VO 1 hearsay work to,
issue loomslending agency forthe performance of
the work for whim this pcnnit is trued(Sm.3097,Civ,CJ
QI" LendcYs Name TOTAL:
LUk1 Lenders Address TOTAL:
1 cer if,that I have read this application and,tae that the above information is BUILDING FEE
m correct.I agree to comply with all city and county ordinances and,nnc law.relmingm QTY. MF,CHANICALPERMIT' FEE
U building commelion,and hereby auWnrize representatives of this city to enter upon the SEISMIC FEE
above-membned property for inspection purfuses.' PERMIT ISSUANCE
(R's,)agree to save,indemnify and keep harmless the City of Cupertino again. ELECTRIC ME
Iiabilities.judgmers.costs and expenses which may in any way acaueagainst said City ALTER OR ADD TO MECH.
PLUMBING FEP.
in consequence of the granting ofthis Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.0110 CFM) MECHANICAL EEE
SOURCE RFlR[3?,MIONS.
�
AIR HANDLING UNIT(OVER 10.000CFM) CONSTRUCTION TAX
ofF.jData I EXHAUST HOOD(WNUCD HOUSING MITIGATION FEIi
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hmzNous material HEATING UNIT OD 100.000 BTU)
as defined by the Cupertino Municipal Code.Chapter 9.12,and the f]e tan and Safety
Coda Section 25532(a)'f HEATING UNIT(OVER 100,000 BTU)
❑Yes ❑NoPAID
VENTIi.A'i'ION PAN(SINGLE RESIU) pads, RemipdM
Will the applicant or future building ovempant roc equipment or Je"'a'which
emit hazardous air ronmminanfo an cleared bthe Bay Area Air Quality Management BOILER-COM E1(3HP OR I W,M)BTU)
Y Y '1 OI'Ai,:
Diariet^ BOILER-COMP(OVER 100,000 BTU) ✓
C3 yes ❑No
I have read Nm havatdous materials requirements under Chapter 6,95 of Ne Cali- AIR CONDITIONER ISSUANCE
rami.Health&Safety Codd.Sections 255115,25533 and 25534.1 undersmnd Bond the NEW RESIDENTIAL,MECH. SQ.FT.
building Does not c met I hvea mn.m,that root no1ality to notify the occupant
ofdhemqu which tine dp' u.is -nfa Cenllice c
0..,,.,au n agent Date TOTAL ISSUED BY:
OFFICE
10300 Torre Avenue
Cupertino, CA 95014
Ctpei tC�ily of*
ino Building Division
(408)777-3228
(408) 777-3333 (fax)
September 23, 1996
Delmerk Wrensch
7689 Peach Blossom Dr.
Cupertino, California 95014
SUBJECT: Waterheater: Permit#28615
Dear Homeowner:
We have been cleaning out our files in the Building Department, and contacting those
people with permits which have remained "open".
• According to our inspection records, the subject permit has never been finaled. Many
times an inspector will sign the permit in the field, but neglect to report all of the
information to the clerical staff for input into the computer. If your records show the
subject permit as finaled, would you please contact us so we may complete our records?
If the permit is not signed off your permit can be reactivated and an inspection could be
scheduled for final closure of the permit
If we do not hear from you within ten (10) working days, we will dispose of the file and
remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
•
P.,niev on Recvdoo Paoe,