28102APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUD. LNG -ELECT HICAL
APPLICATION/PERMIT PLUMBING - MECHANICAL.
BUILDING DIVISION BUILDING PROJECT IDEN'I'IPICAVON
PERM IT NO. 2 O 1 O Z
L o 1
B .DING AUUHIi55:
Z4Q UNIT# LOT#
SAN/ITARYNO.
PPLIICA'11IIII'IONSUHMI'SFIALDA'IE
PHONE:
'w966&`72,5—_ -V
LIC NO:,4e
NC
❑
CON 'IHUI.8
ARCHITECT/F.NGINEER: LIC NO:
ADDRESS:
CONTACT: PHONE:
QTY. ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
BLDU ELECT PLUMB MECII
s
PERMIT ISSUANCE
❑ "'rt El 0
LICENSED CONTRACTOR'S DECLARATION
I hereby ofwthm 1 am licensed under proviaiams ions Cpm, and mmecense with
Division3of the Business and Professions Code. and my license is in
APPLIANCES -RESIDENTIAL
JOB DfSCRIPi'ION
FAUCES
far forcean)of
full fore and offset.
License Class Lia p
UP TO 2M AMPS
Date Contract
- I AMPS
ARCHITECTS D DECLARATION
1 understood on, plans shell be used as public records.
OVER 100(1 AMPS
OVER I
SQ. FP. FLUOR AREA
$/SQ. PP.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
L SPECIAL, CIRCUIT/MISC. 0—
I I hereby affirm Thal 1 am exempt from the Convector's License ityw for the
TEMP. METER OR POLF:INST.
followingmason,003L5, Business and Professions Code: Any city
which to
which requires issuance, permit re cursed, alta, improve, demolish, or mash any swmum
Permit structure
prior mslcensedalmretohthe for such pewiun statement
POWER DEVICES
visios
that m is licensed pursuant ro the provisions of the thentmdor's and Pro lye (Chapter
the Co Liease La
9 (commencing with Section 7000) of Division Sof the Business and Professions Code)
SWIMMING POOL ELECTRIC
VALUA770N
or that he is exempt herefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil nocky, of
OUTLETS - SWITCHES -FIXTURES
not marc than five hundred dollars (8500).
❑ I, asownemfthe praperty,ormyemployees with wagesaatheirsolecompemation,
NEWRESIDEbITIALELECIR_SQ.FT.
STORIES -
TYPE CONSTRUCTION
will dome wmk,rmd*m samureis nut intended,Offered foreale(Sec.]044, Business
and Professions Code: The Contractor's License Law drew not apply to an owner of
�w V
property who buildsor improves thereocandwhodces such work himselforthrough his
nemployces, providedthat such ian ryement not in¢ndWoroffered Tarsale. If,
however. the building,,, improvement ismId with neyeorofoompletion,theowner-
OCC. GROUP
RES. UNIT'S
e
builderwillhavetheburdenofpmvin the tbuild or improve for pufxsx of
QTY. PLUMBING PERMIT FET,
sale')'
❑ Lmowneroffheprope ty, mexcl i yconnactingwith lice nu 1 mato
FLOOD ZONE
APN
common the project (Sea ] as' ass and Rofesslona CodeO o rb
License Law snot o nerofprapenywhobu'dsorim 1. t n d
PERMIT ISSUANCE
Lwhoice and h ,,je awithaconwnor(s)licenx rsuant mheC mora
Lice lye.
ALTER - GRAIN &VENT- WATER (BA)
PEESUMMARY
❑ 1 um (¢ box, Sec. P C for thio moa.
s
HACK FLOW PROTECT. DEVICE
I I`
SANITARY YN
RECEI1Tp
Owner Data
W RKMAN COMPENSA O DECLARATION
DRAINS-PLOOR, ROOF, GOND.
SCHOOLTAX YN
❑ I hereby affirm that l have a certificam mermen to self -intim, or a certificam of
Workers'Compensation insurance or acertified copy thcreof(Sec. 380, Lab C.) which
FIXTURES - PER TRAP
RECEIPT#
PARK FEE. Y N
covers all employee's under this permit.RECEIPTp
Policy #
GAS - RA. SYSTEM -I INC. 4 OUTLETS
BUILDING DIVISION LEES
Company
❑ Certifiedcopyisherebymmished.
GAS - EA. SYSTEM -OVER 4 (EA)
PLANCHECK FEE
GREASE/INDUSTRL WASTE. INTERCEPTOR
GRADING ISE
❑ Certified copy is riled with Ne city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS'
GREASE TRAP
SOILS FEE
COMPENSATION INSURANCE
SEWER - SANITARY - STORM EA. 200Ff.
ENERGY FEE
(This section need not he, completed ifthe permit is for one hundred dollam(SIM)
or less.)
WATER HEATER W(VENTIE.LF.CfR
I certify that in the performance of the work for which this permit is issued, i shall
no employ my person in any mmm"r so as to became subject to the Windom
PAID
Compensation Lawsof Califomia. Date
WATER SYSTRM/IRFATING
Date Receipt
Applicant_
NOTICE�M APPLFCANT:If, slier making this Certificate of Exemption, you should
NEW RESIDENTIAL PLMB. SQ. iT.
TOTAL:
become subject o the Worker's Compensation provisions of the Labor Cade, you must
forhwithcomply with such provisions or this permit shall be deemed revoked.
BUILDING FEE
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hereby nation that there is a conswnion lending agency for the perfowarme of
me work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
TOTAL:
ELECTRIC FEE
CAP
Lender's Address
QTY. MECHANICALPCRMfT FEF.
PLUMBING FEE
1 certify that 1 have read this application and state that the above information is
correct. l agree to comply with all city and county ordinances and sate laws relating m
PERMIT ISSUANCE.
MECHANICALFEE
building construction, and hereby authoriu repreummives ofthiscity tomlerupon the
ahwe-mentioned for inspect urpous.
ALTER OR ADD TO MECH.
CONSTRUCTION TAX
(W ce to save d ec hvmlcss the City of Cupmino against
list" es,judgmen, exp" bmayin ay cmeagainst said City
AIR HANDLING UNIT (TO BLOW CFM)
co sequence f e amingof rs
AIR HANDLING UNIT(OVF.R IO,Ofp CPM)
Sig tore of licant m m D e
EXHAUST HOOD(W/DUCD
PAID
HEATING UNIT (TO 100.0(10 BTU)
HAZARDOUSh IALS DISCLOSURE
Dau Receipt#
. Vill the applicant moment building occupant storeorhandlemoardnus material
as defined by the Cupertino Municipal Code, Chapter 9.12, and me Ham and Safety
H[?ATING UNIT (OVER 100.0011 BTU)
VENTILATION FAN (SINGLE. RESID)
r,
Cade. Section 25532(a)?
❑ Yu ❑ No
ROLLER - COMP (HIP OR 100,000 BTU)
ISSUANCE DATE
p1
PAID
Will Neapplicantorfuwrtbuildingoccupanmuequipmenwrdeviccs which emit
BOILER-COMP(OVER 100,(100 BTU)
Interactions air contabrimnts m defrse i by the Bay Area Air Quality Management
District?
D
❑ Yes ❑ No
y
NAY
����((mems
NEW RESIDENTIAL MECH.—SQ. FT.
have read m the houndn.,Chat. rcquimunder Chapter 6.95 of the
r d 95
��I
Californiathe building tires not SafetyCoale.and 25534. I undemtend met
ifteuling do & Safety Code, Sections 25505, t it
have i tenant, Nm it is my responsibility to notify the
occupant of the requirements which must be met prior to issuance of a Cermfrcau of
/7� Uf
L��EHI
Occupancy.
ISSUED BY: 1
Owner Or autbotiud,,gem Date
TOTAL:
OFFICE
0
December 4, 1995
Resident
10471 Phar Lap Drive
Cupertino, CA 95014
Subject: 10471 Phar Lap Drive, Permit # 28102 - Electric
Dear Resident,
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408) 777-3228
Fax(408)777-3333
According to our records the above mentioned permit has never been fmaled 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 fmaled, 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
0
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