27806 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF.RTINO UIILDI r-ELECTRICAL PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT PIAMBINO-TIDIIAIJICAI. 27806
BUILDING PN(I.IECI'IDI:N'I'IUTCA'1'ION
BUILDING I.
FSANITARY NO. APPLICATION SU
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U5P21Lc_ A�Y LOT
OW RgNjIwl, ^ rOEEIRACTS NAM?: IIiOiss— C
NIC COlsTROL
ADDRE4AR ITFCT/ENGINER: IICNO:
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FCONTA� PHONE: BUILDING P13RMIT INFO
QTY. ELECTRIC PERMIT FEE
BLDG ELECT PLUMB MF.CH
PERMIT ISSUANCE El 0
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAI. JOB DESCRIPTION
Oo4zffirm that l am licensed underpmvisiooso(Chapter9(commencing withPOWOqof Divison 3 ofthe Busineas and Professions Cade,and my license is in PANELS
Uuffect, t11PT02021 AMPS
Li0.N
N7H Date Contractor 201-1000 AMPS - L
ZO,z ARCHITECTS DECLARATION OVER IOOOAMPS SQ.FT.FLOOR AREA S/SQ.FT.
O Z I understand my plans shall reused as public records.
FN LLL SIGNS ELECTRICAL
qq Licensor Professional
yyceQ OWNER-BUILDER DELLA ION SPECIAL CIRCUIT/MISC.
xa
CR'LL!
I hereby affirm that I am exempt fir the Cont csCo a:Ary law Births
u13LLy (ohowingtuesa (Sedan VO3L5,Business nA .fie aCme:Any city.county T'F:MP.MEIER OR TOLE INST.
F❑F❑&�y� which require¢nPermit reairewm,alter,it pro, m 'I or repairany structure
prior to its issuance,also requires the applican ors pe 't mfik nyy ¢ em POWER DEVICES
KyJ C p that he is licensed pars ant m the Prov . Comracmra Lice�M�ppmr
a0. z i si audit ff SWIMMING POOL ELECTRIC
xc 9(mmmen<ing with5 ton] f 7 ftheB a cede) VALUATION
Wim m iliatheisescmpnhe t t is or the g e do ,Any nano( Of1TLCT5-SWITCHES-FIXTURES
Z< Scction]031.5hyraya a fnrepe. "J ets a I to a civil Penalty of
IY�onot more than fiveh ]ars lf5 a NEW RPSIDIiNT1AL L'LECTR S .FT.
❑ I,aowneroftheP n ormyemplo withwoga asthei...lec.mperouna, Q STORIES TYPECONSTRUCHON
yam willdothewmk,ondthe at c nm incited.rotferedformle(Sec.70,14,13tomes.
and Professions Code:The Comracon's License Law does not apply to an owner of
property whobuildsor improves themon,and whodaessuch work himselfordamugh his
ownemployces,providedilat such impmvementsamoot inlendedoroffemd foreale.If, I OCC.GROUP RBS.UNITS
however,the buildingorimprovement is sold within one yeua(completion,theowner- TOTAL:
builder will have the burden of proving that he did not build or improve for propose of
sale.).
❑ Las ownerofthe propeny.amexclusively contracting with licensed contractors to QTY, PLUMBING PERMIT FEE FLOOD ZONE APN
construct in,project(Sec.7004,Business and Professions CodeE no Contractors
License Law drosnot apply manownero(propany,who builds.,improves thereon,and PERMIT ISSUANCE
whocontansforvuch projects with a contractors)licensed moment to the Comraanr's pLT'IiR-DRAIN&VGN'T-WATER 1?A)
License Law. ( IEE SUMMARY
❑ 1 am exempt under Sec. ,B&P C for this moon BACK FLOW PROTECT.DEVICE i PS
SANITARY Y N
Owner Date RECEIPTp
WORKMAAI COMPENSATIDNDECLARATION DRAINS-FLOOR,ROOF,AREA,COND. SCHOOL TAX Y N
❑ Ihereby affirm lhatlhav<acettiflcnte of c.nunl t.self-insure.nrecenificale of RECHIPTIt
Wnrkers'Compenation].man.ora eenified copy there.f(Sec.3800,lab C.)which I'1%TURES-PER TRAP PARK FEE Y N
covers all employee's under this permit GAS-EA.SYSTEM.I INC.4 OUTL RECEIPT N
Policy N BUILDING DIVISION FEES
Company
ED Certified copy is hereby famished. GAS-EA.SYSTEM-OVER 4(EA) PLANCIIECK F13Ii
❑ Certified copy is film with the city impceriom division. GRFASFJINDUSTRL WASTE INIERCEPTO GRADING FEE
CERTIFICATE OF EXEMPTIO O O KERS' GREASETRAP SOILS FEE
COMPENSATION SURA E
section need not be completed if epermit' fora eIn I dd (SUM) SEWER-SANITARY-STORM EA,2001'f. ENERGY FEE
or las.
I try than a rf anceofth wh this ti. ,Ice HEATER W/VENT'/LLECTR
nil nip ny to el s er PAID
z ton L- D WATER SYSTEM/TREATING Date Receipt It
O A ani
Z !q hould NEWRESIDENTIALPLMB. SQ.PT. TOTAL:
become ileW .visonsofE.-=pCmyy.smust19" NOTOPICANTIaoerm mtCn
forthwith complywah mchpmvisionsmthis Permit shall hedmmed revoked. BUILDING FEE
W CONSTRUCTION LENDING AGENCY SEISMIC FEE
z 1 hereby ufli,m that them is a construction lending agency for Ne Performance of O 1: ELECTRIC ME
O tho work for which this permit is issued(Sre.3197,Cls.O)
lenders Name ¢ PLUMBING FEE
O F lenders Adtrees MECHANICAL PERMIT FEE
V 1 certify that I have read this application and sum a above info n is MECIIANICAI,FEE
>^ RWi correct.l agree to comply with all city and coo di nice e a a -1 it PERMIT ISSUANCE
F-1 building cnnstructinn,end hereby authndu resrnr ov thiscit me u nn the CONSTRUCTIONTAX
L) z above- nedpo, nyfnrimpectio pripmes. cs ALTERORADDTOMFCH.
(W erg aave, minty keep ha le th i fC ranagainst
liabilities, d me lexpe as ch nanyw cru a t stseit City AIR HANDLING UNIT(TO 10,0021 CFM)
in w na th r mi th' pe
AIR 1{gND1.IN('UNIT(OVER 10,00007M)
lgnamm fApplicmnt/Contactor V V Date EXHAUST HOOD fW/DUCD
PAID
HAZARDOUS MATERIALS DL CLOSURE HEATING UNIT(TO 100.0fh)BTU) Dam Receipt N
Will matipplicau or future building occupantrame or handle haeard.us material HEATING UNIT(OVER]Bit,"PTU) TOTAL:
as defnm by the Cupeninn Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section Yes, 11 No
a)?
13Ves VENTILATION FAN(SINGLE RESIDE
pe
Will due applicant. m
rfurcbuildingoccupanmum
equipmeordeviceswhich emit BOILER-COME(3lIP OR 100,000 IS UACr DATE
PTU) BUR
hamplous air contammunts as defined by the Bay Area AR Quill Managemrnl BOILER.COMP(OVER 110,000 RTU) 15
DlDistrict?District?
❑Yes ❑No NEW RESIDENTIAL MECH.-SQ.PT. CI�Y U Mj�� 119951 have read the lorardous mnedala requirements under Chapter 6.95 of the {,Uf;.HI
California Health&Safety Code,Sections 25505.25533 and 25534. 1 undemand d n r iN
if the building does not currently have a tenant,that it is my responsibility to notify the
occupant of the tequirctnems which must fc met prior to issuance of a Certificate of
Occupancy.
Owner or outhowati agent Data TOTAL: ISSUED BY:
OFFICE
pcit� OI
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
19945 Price Avenue
Cupertino, CA 95014
Subject: 19945 Price Avenue, Permit# 27806 - Repipe
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
alterative but to resolve your permit as expired and discard the records.
Thank you for your assistance.
Sincerely,
City of Cupertino
,• 1
Primed on Recycled Paper