276497TYOFCUPERTINO PLU
APPLICATION/PERMIT MBING-MECNANII
IIUI!,D1g 15i DIVISION WILDING PRfIJECI' I DEN[ IF
JILDING ADDRESS:1 ry '
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- 1 e `' `r UNIT4 Im•a
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FEE: 'L
27649
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CONTACT: J La ��li PHONE;
40D (� 0 e$ Ace 7 —a3 °I�
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QTY ,, ye e '' CELE RIC PERMIT
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PERMIT ISSUANCE
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LICENSED CONTRACT'OR'S IIECLARATI N
I hereby affirm that lam licensed under provisions of Chapter 9(commencing with
Sectio 7")of Division Sof the Businesaund Paressiov Code, and my license is in
full fnrcental 9m.
Licen Cass Lic.#
Dme Chairman, n(Y
ARCHITECTS DECLARATION
I understood my plans shall to used as public records.
APPLIANCES -RESIDENTIAL
PANELS
UPTO200AMPS
201."RMAMPS
OVER 1000 AMPS
SIGNS ELECTRICAL
Licensed Professindal
OWNER -BUILDER DECLARATION
1 hereby affnd that I em exempt from the Commam's License Low for the
hollowing rcasoo. IScction 7031.5, Business and Professions Code: Any city or county
which requires a Permit consumer. alter, improve, demolish, or repair any structure�y�4}� prior to its issuance, also requires the applicant for such Permit mfile natured statement
that he is licensed putsoanum o the provisioof the ConwLicense La. Liclaw (Chapter
9(commencing with Section 71000) of Division 3 of the Business and Professions Code)
or that he is exempt harefrom and The basis for The alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of
SPECIAL CIRCUFQMMISC.
TEMP. METER OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETS - SWITCHES - FIXTURES
rY
y3_
not more had five hundred dollars ($500).
❑ I,mowneroflhepfopery,Wmyemployeeswithwagesuthelranleeompensa4on,
will do The work.and the stricture is disinterred oroHered bursae (Sm. 7044, Businces
NEW RESIDENTIAL ELECI'R _SQ.
and Professions Code: The Centimeter's License Low does not apply to an owner of
property wholumbirmingro,dathencia, itwhodonesuch work himselforthough Ns
own employees,provided thatsuch improvementsum notintendedoroffered forsme.If,
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however, the building or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that In did act build or impose for pal of
- � ' la
Q�P'Yv"•PLUMBINOjP1iRMIT -
sure.).
❑ Las owwcfthcproperty,am<xmuslvmy«mtradingwithlicensed conwmorsto
construct the project (Sm. 7144. Business and Professiorn Calc:) The Convenor's
Llccnso Lvw diatom applyman ownhrof pnsperty who builds or impreveslherchn,and
PERMIT ISSUANCE
who contracts for such projects %I$a commelor(s) licensed pursuant to The Conwemr's
License Law.
ALTER-DRAIN&VPNT- WA'IEII )
❑ 1 am exempt under Sec. , B ffi P C for this lemon
BACK Fl,OW PROTECT. DEVICE.
Owner Dam
DRAINS- FLOOR, ROOP,AREA, COND.
WORKMAN COMPF.NSA'f10N DECLARATION
j0 Ihertby affirm thatlhave ocmificme of conunnh ulbi...re.oracadificamef
.Whrkem' Compensmion Insurance or n mcifmcl copy thereof (See. 3800, Lab C.) which
Fl%TURES - PER TRAP
GAS - HA. SYSTHM-I INC.4 OUTLETS
vers all employee's under this tit.
Policy '�
QanprnY -�� l
❑ Certified copy is hereby famished. / /
GAS - BA. SYSTEM.OV13R4(13A)
GREASE(INDUSTRL WASTE INTERCEPTOR
❑ CerifiM copy is filed with The city inspection division.
CERTIFlCATE OP EXEMPTION I• -MOM WORKERS'
GREASHIRAP
COMPENSATION INSURANCE
SEWER - SANITARY - STORM EA. 200Ff.
(This section need not becomplmed ifthepermit is fofonehundrat dollars ($10(d
or less.)
WATER HEATER W/VENTJHLECTR
I certify that in the performance of the work for which this permit is issued, I shall
out employ any person in any inande, so as m ramps, subject to the Workers'
O
Compensation laws of California. Data
ITO
WATER SYSTF.MIMEATING
NOTICE APPLICANT. If, after making this Certificate of Exemption. you should
NEW RESIDENTIAL PLMB. SQ. FT.
V)become
subject to the Workers Compensation Provisions of the Labor Code, you must
7
forthwith comply with such provisions or This permit shall he deemed revoked.
aQ
CONSTRUCTION LENDING AGENCY
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LT.Lender's
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GU1
1 hereby affirm that the. is a construction lending agency for the performance of
the work fur which this permit is issued(See3097, Civ. C.)
Name
TOTAL:
Lenders Address
QTY: " - •, MECHANICAL PERMIT
certify that I have read this application and state that the above information is
rect lugrce to comply with ell city andcuuntyoNinencee and utominwe rcleting to
PERMIT ISSUANCE
building conxwctiomand hereby authorize representatives of this city to eager upon the
ALTER OR ADD TO MECH.
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shove -mentioned property for inspection purposes.
(We) agree to save, indemnify odd keep harmless the City of Cuperino against
Iiabilities,judgmed0a, costs and expenses which may many wayacomeagainst said City
AIR HANDLING UNIT (TO 10,000 CFM)
in consequence of the granting of this permit.
AIR HANDLING UNI']' (OVER 10,01) CFM)
Signulure of AppliencalComtrdemr Data
EXHAUST HOOD(Wp3UCT)
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT (TO IW,UW It ru)
Will The applicant or future building occupant store or handle hazardous material
as defined by the Cowed.. Municipal Cale, Chapter 9.12, and the Heahh and Safety
HEATING UNIT'(OV13R 100,00(1 BTU)
Code, Section 25532(a)?
❑Yes tPN0
VEWILATIONPAN(SINGLERESID)
BOILER- COMP(3HP OR IN),000 BTU)
Will rhea Iicansorfuturebuildin fusee poen
Pp gtwcupan qui mnleviaswhich emit
hanadous air commandants as defined by the Bay A. Air Quality Management
trio?
BOILER -COMP (OVER 100,000 BTU)
❑ Yca 07 No
NEW RESIDENTIAL MECH. SQ. FT.
--
I have read the hazardous materials requirements under Chapter 695 of the
California Health S, Safety Code, Sections 25505, 25533 and 25534. I understand That
if the building does not currently have a tread. that it is an, responsibility ro notify the
ooccupant or (he mquirem a which must7 et prior to issuance of a Cennfic/am of
`n
ccupancy. - ; I...I %" ma alb/ 4<
Owncrmauthhrmd gent -"C.ADam
TOTAL:
FEE: 'L
27649
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"BUII'.DING PERMIT INFO
BLDG
YU
PeLECT PLUMB
❑ Cl
MUCH
❑
111.
SQ. IT. FLOOR AREA
P A I'D
FEB 81996
n'
r1' ur l
A DATION
S'1'ORIHS TYPE.
1
OCC. GROUP
/ OOD ZONE
v�
a4jr FEESUMMARY
OU I;SIDE PLES
NI'f/sRY Y t
RECEIfTp_
SC- t.'1'A% Y I
R13CEI Vf #
PARK FEE Y P
RECEI I'1 #_
BUILDING DIVISION FE
PLANCI RICK FEE
GRADING PEE
SOILS PEE
ENERGY FEE
PAID
Date Receipt#
TOTAL:
BUILDING ITHE
SEISMIC FEE
ELECTRIC FEE
PLUMBING PEE
MECIIANICAL FEE
CONSTRUCfIONTAX
PAID
Dote
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September 25, 1996
Alison Hubbard
1007 September Drive
Cupertino, California 95014
SUBJECT Chimney repair, Permit #27649
Dear Homeowner:
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
(408) 777-3333 (fax)
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
Prmten on Pecvdea Piwer