27641 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO1,"Tri=RI" PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMTIING-MECHANICAL C /1
BUILDING PROJECIADENT'IPH 'PION o GI
BUILDING ADDRESS \ ` SANITARY NO. APPLICATION SUBMITTAL DAM
I(opI S —S lIYI TI,
OW L•: Pfl P,: CONTR C R'S NA LIC
N/C CONTROL#
ARC[I TIiC'I'/IiNGINEI?k: LIC NO: ADDRESS: ❑
cGl�^jaCf: PHONE: Y. P` BUILDING PERMIT INFO
.../7 Q7'1;.i '. t�6� E�LECFRICPERMIT. u ; FEE,
,`Vv` BLDG L PLUMB MECII
cxvPERMIT ISSUANCE
El El
LICENSED CON'TRACTOR'S DECrARATION APPLIANCES-RESIDENTIAL
that y0y0 Ihuehyaffnmamlicensednf (commencing TOB DESCRIPTION
Section 70gBoDivision 3ofme Business and Ronensi,ow Care,and my license
is in PANELS ^ —
y�1�. full fncernd effect. -
FZW License Class Lie.# UPT02M AMPS
wI-�Q y D:nc Contractor 201-1000 AMPS
Z8yK ARCHITECT'S DECLARATION OVER 1000 AMPS SQ,FT.FLOOR AREA $/SQ.FT.
OZ-0 1 understand my plans shall be uud as public records.
W SIGNS ELECTRICAL
...y..{]] Licensed Professional
WWaiW OWNER-BUII.OER DECLARATION SPECIAL CIRCUIT/MISC.
k 3 t 1 hereby affirm that 1 am exempt from the Contractors License Law for the
u] following reason.(Section 7031.5,Business and Profession Code:Any city or wunty TEMP.METER OR POLE INST.
�w0 which requires a Permit to construct,alter,improve.demolish,or repair any sractum
Y� prior to its issuance,also requires the applicant for such pemtifto file a signed statement POWER DEVICES
p that he is licensed pursuant to Ne provisions of the Contactors License law(Cliapmr
6LoW 9(commencing with Section 7")of Division 3 of the Business and Professions Code) SWIMMING POOL PI ECTYC VAI UAITO
yI wood he is exempt therefrom and the basis for theulleded exemption.Any violation of � �C
S4G �Station 7031.5 by any applicant for a permit subjects the applicant a civil Penalty of OUTLETS-SWR B - URES CED
� �J
t rclban fivehundred dollars(5500). NEW RESIDFNTIA SQ.FT.
W�m ,asowneroFlhe properly,ormyemployeawith wagesmtheirsoleconFewtion, STORIES PECONSTRUCTION
a 6 11 do the work,and the suucwre is not intended or offend for sale(Sec.7044,Business
nd Professions Code:'fhe Comrncnnx License Law docs not apply to an..in of
property whobuildsor improves thereumared whodoes such work himulfortivoughhisOCC.GROUP RES.UNITS
own employees,provided that such improvements smnmimendedearofferedforsale.If,
however,the building or improvement is sold within one year ofcompletion,theowner-
builderwillhavetheburden dphaving that he did not build or improve forpopo,of
Named. �, .
❑ I.asownerofthepmpay,ameaclusivelycontactingwithllcensedcontr Wmio QTY. PLUMBING PERMIT FEE FLOODLONE APN
construct the project(Sec.]014,Business and Professions Code:)The Convenor's
License Law does not apply town ownerofpropeny who builds or imprnves thercogand PERMIT ISSU CG
who contracts forsuch projects with a convuclons)licensed pursuanto the Commemes ALTER-DRAT A'TF.R IFA)
Licenu Lew. FEE SUMMARY
❑ 1 am exempt under Sw. ,B&PC for this mason BACK FLOW PROTECT.DEVICE SANI'T'ARY Y FF N
Owner DateRECEIPT p
AINS-FLOOR,ROOF,ARP D.
WORKMAN COMPri SmSCHOOL TAX Y N
[IIhemhy effinn thmav
lhe accnificamof COMPENSATION of conserve sclGinsurc,oraccnificam of FIXTURES-PER TRAP RECEIPT#
Wnrken'Cnmpeneatinn lnsuanocorncenlfieJ copy therwf(Seo.3800,Lab CJ whleh PARK 17EL Y
coversPoll,all employee's under titin permit GAS-EA.SYSTEM-1 INC.4 OUTLETS Rlit"It Tp
Policy p BUILDING DIVISION I+-
El ley GAS-EA.SYSTEM-OVER 4(EA) PLANCIMCK FTE
❑ Certified copy is hereby famished.
❑ CeniliW copy i;Bled with the city inspection division. GREASTy1NDUSTRI,W STP,INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE AP SOILS FEE
COMPENSATION INSURANCE
(This section need not be completed lfthe permit is for one hundred dollars($100) SEWS - TORM I1A.2 ENERGY FEE
or less.)
I certify that in the performance of the work for which this permit is issued.)shall WATER II' TERW „ECTR
not employ any person in any manner so us to become subject to the Workers' qPAD
0 z AC�lp ,tion laws of California.. Date WATER. S'f FArFIND Dat. Receipt#
Z 0 NOTICETOAPPLTCANT:If,aBermeking this Certificate of Esemption,you should NEW IDENTIAL PLMB. SQ.FT. TOTAL:
(A become subject to the Workers Compensation provisions of the Labor Code,you must
a ; foNswith comply wird such provisions or this permit shell he deemed revoked. LDINGP rCONSTRUCTION LENDING AGENCY MIC FEE
ZI hereby affirm that there is a construction lending agency for Ne Performance ofTOTAL: CfkIC FER
UO the work for which this permit is issued(See.3097,Civ.C.)lenders Name[" lenders Address QT,Y: MECHANICAL PERMIT MBING FE.
E I ccnify thar 1 have read this application end state that the above information is
correct. I agree m comply with all city and county ordinances and state laws mining m PERMIT ISSUANCE; MECHANTCAI FEE
Fa' building eenstructiorand hereby sudden.repmuneuvesofthis city menteraponhe
above-mentioned n f i CONSTRUCT ON TAX
U z #rope y for ton peewees. ALTER OR ADD MGCH.
(We)agree to save,indemnify and keep ns the City of Cupcnst s against
liebilities,jndgm de, ."uses
ines which may in any way accrue against said City AIR HANDLING UNI'I'(f010,01%1 CPM)
I.conseque a antingof permit.
I AIR HANDLING UNIT(OVER IO,g10 CFM)
of pl' m/ coo Dem EXHAUST HOOD(W/DUCT)
PAID
HAZARDOUS MATLRIAIS DISCLOSURE d HEATING UNIT(TO IM."BTU) Dam Receipt#
Will the applicant or future building occupant store or handle barardous material ITEATING UNIT(OVER 100,000 BTU)
as demand by[lie Cupertino Municipal Code,Chirpier 9.12,and the I health and Safely
Code,Section0Yes El No 25532(x)'1 VENTILATION FAN.(SINGLE RESID)
BORER-COMP UUP OR 101000 BTU) fSSUA C-DATE
Will thempplicant nr fuwrehuilJingwcupum meeyuipmemor Jeviceswhich emit PAID rarardoas air comaminunn ts defined by the Bay Area Air Quality Management BORER-COMP(OVER 100,000 B'I'U) D
Oisv cC
❑Yes ❑No NEW RESIDENTIAL MEC L SQ.FL
I have read the hard a s materiels reSsno mends under Chapter 695 of the AN 19 1995
California Health&Safety Code,Sections 25505,25533 and 25534.I understand that (s
if the building does not currently hove a tenant,that it is my responsihility to notify the cl'a
ccupant of the madirem us;which must be met prior to issuance of a Cenifiewe of UI UUNt�
Occupancy.
Ower"mamhich,edagem Dam TOTAL: ISSUI7D
Cupertino
10,300 Torre Avenue
Cupertino,CA 95014
1 Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
I
Jack in the Box
1601 Saratoga Sunnyvale, Suite 131
Cupertino, CA 95014
i
i Subject: 1601 Saratoga Sunnyvale, Suite 131, Permit# 27641 - (2) Walls
Dear Resident,
According to our records the above mentioned permit has never been finaled by a
j 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
�1L I ID
IL/
Printed on Recycled Paper