27927 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO RUILRIRLG-FTE PERMIT NO.
nuJLDlvc DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 2 7 9 27
IIUILDING PROJECTIDENTIFICATION I J
BUILDINGADDRESS: SANITARY NO. APPLICATIONSUBMITTALDATF.
Ine-1 2- 3 �v_6ls
UNIT LOT
I) : S NAME: O 1? C RACT g..ofML': LIC y�� ON/C Cos"Hi p
ARCIIITECl/I:NGINEER: LIC NO: AOO (��� ❑
CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELE PLUMB MECH
PERMIT ISSUANCE ❑
LICENSED CONTRACTOR'S DECLARATION ,APPLIANCES-RESIDENTIAL JOB DESCRIPTION
pWZ I herebyaffirm that l am licensed under previsions ofChaptult heammrncing with
u100 Section 7030)of Division 3 of the Business and Profession Cade,and my license is in PANELS
FawI1., full force and cHcc=. D l b� -
FUz,yVj License F s Lic.p 111 IIP T02110AMPg
yF-<o. DatC COnVeel 201-1000 AMPS
Z O y Z ARCHITECTS E OVER 1000 AMPS SQ.FT.FL R AREA .USQ.PT.
O Z`^q I understood my plans shall be used as pub[' centers.
F H�:; SIGNS ELECTRICAL
<y2• Licensed Professional 17
Et < OWNER.BUILDER DECLARATIONSPECIAL CIRCUIT/MISC.
fipitS50 cL I herehy affirm that 1 um exempt from the Coansame License Lew lariat,
maO fallowing reason.(Section 0(131.5,Business and Professions Code:Any city ar county TEMP.METER OR POLE INST.
4o,J j which requires a permit to construct,alter,improve,demolish,or repair any swcture
Y.2 prior its issuance,also reclaims theapplicont far such pereniuo Eleesignesmtemem POWER DEVICES
MO that he is licensed pursunm to the provisions of the Commences License Lew(Chapter
re 9(commencin th Section 7")ofDivision 3 afthe Business and Professiam Cale SWIMMING POOL ELECTRICotrgwi ) VALUATION
,-y or that Sectiohei31.5 by
therefrom and t for the
a Peristfor
subjthe alleged eaempti to Anyviolationof OUTLETS-SWRCIIES-F[%TURCS
CZQ SecriomthanSby mydreddollars $permit mbjauthe applicant to civil Penalty of
04 not mare that five hundred dollars($500).
K � ❑ I,eaowneroDheprop:ny,ormyemployecswirh wages as theirvelecompmsetion, NEW RESIDENTIAL ELECTR _SQ.FT. STORIES TYPECONSTRUCTION
willdothe war k,md the muctme isnot intended or offered for sale(Sec. Emitters
and Professions Code:'Um Contractor's License Low does not apply to an owner of
property who buildsmimpreves Nemou.sad had.such work himselforthrough his OCC.GROUP
R .UMTS
own employers,provided that sochimprnvemenn emmtinteneredoraffcrcd forsale.If,
however,the building or improvement is sold within oneyear ofcnmpletion,the caner. .T �.�
holder will have the burden ofproving that he did not build or prove for purpose of
\
❑ I,asownerofthepmpeny,amexelusively cont c'ngwi nsedconvvet to QTY, PLUMBINGPERMIT FEE FLOODZONE APN
construct the projcm(Sec.Of144,Business and Pro ser The 's
License Lawdmsnorapplytoanownerofpopcn h h s s e mo PERMIT ISSUANCE
whocommcis far such projects with a common )1 a aapgtt11th es
License Lew, u/ ALTER-DRAIN&VENT-WATER TEA) FEE SUMMARY
❑ lamexemptummo Sec. ,B P or this mason BACK FLOW PROTECT.DEVICE OUTSIDIUrVES
SANITARY Y_N
Owner 5ma RECEIPT#
DRAINS-BOOR,ROOF,AREA,GOND.
WORKMAN MP ATIO D RATION SCHOOLTAX YN
❑ Thereby affirm thetl heveeceni a ofco emmselLinsure,oracenificoteof FlXTURCS-PER TRAP RECFnivr-
Wnrken'Gmpensationlnsmmnceorace i0ed copy thereof(Sec.3g(gl,Lab C.)which PARK FRE Y N_
cnvece all employee's under this permit. GAS.FA.SYSTCM-I INC.4 ourLETS RECEIPT#
Policy# BUILDING DIVISION FEES
Company GAS-EA,SYSTEM-OVER 4(PA) PLANCHF.CK FEE
❑ Certified copy is hereby furnished.
❑ CeniOed copy is film with the city inspection division. GRE.ASIy1NDUS3'RI,WASTE INTERCEPTOR GRADING FEE
f
CERTIFICATEOFCOMPENSATION
EXEMPTIONMOM WORKERS' GREASE.TRAP SOILS FRC
COMPENSATION INSURANCC
(This section need not be complmed[fthe Permit is forone hundred dollars($100) SEWER-SANITARY-STORM PA.20RPF. ENERGY FEE
orless.) a
I cenifytham the effmanausVeafthe work which this permit is issued,l shall WATER HEATER W/VENT/C•LECfR
not employ any Proven in ammer so -be a 'act to the WmIlmri PAID
Co.' My1
nse'!a nl' ia. Date WATER SYSTEREATING Date Receipt#
O z ApN10
z NO'I'IC APPLE after em11isCnOceteofP.xemption,you should NEW ' ENTIALPLMB. SQ. TOTAL:
become subject to the Workers numpmvisianof Ne Laborcede,youmust
a � forthwith comply,
such provision ortr $chat shall be deemed revalued. BUILDING FRE
Ow. a CONSTRUCTION LENDING AGENCY SEISMIC FEE
z I hereby affirm that hem is a convection lending agency for the perfmmaoce of
V C) the work for which this permit is issued(Sec.3097,Co.C.) TOTAL: ELECTRIC FEE
{2-t E Lender's Name
O Lender's Address QTY, MECHANICALPERMIT FEE PLUMBING FEE
1 certify that I have rad this application and ante that the above information is
correct.l agree to comply with all city and county ordinmres and sure laws relating m PERMIT ISSUANCE MECHANICAL FEE
IA building convection,and hereby authorize representatives ofthis city reenter upon the
aMwe-menriaced n for inspection s ALTER OR ADD TO MECH. CONSTRUCfIONTAX
U `� pm, Y Pe ku p .
(We)agree m save ndeomi and lump haronlaa me City of et penia agoimr
Iiabilities,jadgmeam. made marwhichrmy inenywayaccrueagvnat mid Ci AIN HANDLING UNIT(TO 10.000 CFTC)
seance oft ring is permit.
AIR HANDLING UNIT(OVER III,IXIO CPM)
Signa eofA Intor nr Dau EXHAUST HOOD(WNUCT) PAID
US MATERIALS DISCLOSURE HEATING UNIT(TO IM."BTU) Date Receipt#
ill thee building occupant sromorhaddle hazardous materialryPATING UNIT(OVER IOO,IXq BTIp TOT
ndcd by rhe nicipal Cone,Chapter 9.12,and the Health and Safety
Cade.Section25532($)?
0 Yes ❑No
VENTILATION FAN(SINGLE.RESID)
BOILER-COMP(BI IF OR 100,0011 BTU)
ISSUA'CE DATE
Will the applicant or future buildingaccupant use cquiparcnmrdeviceswhichemit
memdous air comaminms n defined by the Bay Art.Air Quality Management BOILER-COMP(OVER 10,000 BTU) ✓/e _1
)IsMct? - /�/
❑Y. 13 No NEW RESIDENTIAL MECII. SQ.FT. '/'Gh �
I have read the hazapt
rdous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505.25533 and 25534.I undersand tut
if the building does not currently have a tenant,that i t is my respmsihility to notify the L,
mr.pam of the requirements which must be met print m issuance of n Certificate of ,//
Occupancy.
Owner err inumnzed agent Data TOTAL: ISSUED IJY; U�t
OFrIZS-
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
10212 Prado Vista
Cupertino, CA 95014 -� l
Subject: 10212 Prado Vista , Permit#27927 - 100 Amp Electic ' v�
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,
City of Cupertino
•
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