27990 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING- ELECTRICAL PERMTTNO. 27990���O
APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING DIVISION BUILDING PROJECT'IDENTIFICATION
BUILDING/A��USDRESS/:7 //nnnP/���I/I SANI'T'ARY NO. APIUCATIONSUBMITTASLDDrA�TE
70X/ �� ae " UNIT# LOT#
OWNURS AMyyyyF:11NAr Wyak .� 4ss . C 'R 0 AhIE:J� ,yLI Oy�p�� N/C CONTROL 7
Alt Ii llJ xa�C Lr/V!`•JCJ/1 A ��(J 7/O �Ur/
CONTACT: PHONE:
QTY. ELECTRIC PERMIT PEE BUILDING PERMIT'INFO
hn
BLDG ELECT' PLUMB ME'll
W3"9 PF.RMITISSUANCH El ❑ 13
LICENSED CONTRACTOR'S DECLAR N APPLIANCES-RESIDENTIAL.
Ihereh ffrmthullnmlicensedunder JOB DMCRIPIION
ppdZ yu pm Profiesi ml rmidinyenureselsh
aaul� full foree�leffic?ora n3of Ne Business an PrOfessi sC .and mylicense is in UP TO2
6E-Zu] Liccns LIC.# UPT02W AMPS
y Q y Dme Canlrael 201-101X)AMPS
ZOs` z ARCHITIdCI-S DGCLA OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
Oz_p understand my plans shall be used ns p tic rte
r41--N SIGNSELECTRICAL
Q , Licensed Prokeoional
rya OWNER-BUILD RDECLARATION SPECIALCIRCUIT/MISC.
°Cawu 1 hereby affrm Thal I am exempt hematite Coam9ner's License law for the �x
R1 VIfollowing reason(Section]031.5,Business and Professions Code:Any city or county TEMP.MIO
TfR OR POLE INST. 7
(h J which reqs ires a permit ns mnstmet,alter,improve,demolish,or repair tiny structure POWER DEVICES
J
!IY� primbatsi....are,als0«yain.theipplic liar such permit to file.signed statement
aad_<p That he is licensed pursuant to the provisions opine Conmn
lnr's License law(Chapter
aye 9(commencing with Section 7")of Division 3 ofthe Business add Professions Code) SWIMMING POOP.ELECTRIC VALUA'T'ION
axf�m or thea he is exempuhcrefmm and the basis for tha,mleged exemption.Any violationof O(fTLC'I'S-SWITCl IFS-FIXTURES
,ZQ Section 7031.5 by any applicant for u permit subjects the applicant o u civil penally of
Ep had more than five hundred dollam($50B). NEW RESIDENTIAL ELECfR _SQ.FT.
acro ❑ I,asownerofNepmpeny,ormyemploymswithwagesmtheirsolecompenution, STORIES TYP.CONSTRUCTION
will do the wnrk,and theswcwre norm imended or�fferFd fOnule SecJ(144,Businrss
and Profexnions Code:The Contrvclnrs License law fires a ly m ml owner of
prmpeny who buildsdrimproves marcor,and whodces chw Iforlhrougllhis
employees,pmvidedthatsuchimpmvements ren t 0fferedfarsale.If, OCC. P RES.UNITS
hnwevegthehuildingarimprovememi sold within ren y men plelion,IllI0(}}}}r�����!p
builder will have the burden of proving at t fid or ire rove for L TOTAL:
aide.). �! L/ QTY. PLUMBING PERMIT IEE DZ APN
❑ I,asowna ofthe Propcmy,am edyx nume with isrd imenclorsm
construct the project(Sea]044.Rusi s anJ Prof sie Code:)'Me Contractor's
License Lawdoes not apply to an owner f rancor who builds 0r improves thereon,and PERMIT ISSUANCE
whoconlrvnsf0r such pmjectswilhacn emr(s)licrnud pumuenumhe COnuanm's
License law. ALUM (EA)
EESUMMARY
❑ l am ex<mpI under Scc. ,B&P C for this reason BACK FLOW PROTECT.DEVICE F FEES
SANITARY Y N
Owner Date RL+CEIIspia
GRAINS-FLOOR,ROOF.AREA,COND.
WORKMAN COMPENSATION DECLARATION SCHOOLTA% Y N
❑ sm CoyaffimUhn Insurance mitfica¢0f consrnuo set 6ee.38or Lab C.)ate ofwhich FIXTURES-PGR TRAP RGCEIPfp
Wnrkere'Compensetion Insurance onmu9ifiul copy 0ueol'(Sec.3gIXLlah C.)which PARK PEP. V N_
covers all employ2,s undenNs proms. GAS-HA.SYSTEM-1 INC.4 OUTLETS RECEIPT#
Policy# BUILDING DIVISION FEES
Company GAS-EA.SYSTEM OVER 4(EA) PLANCHECK FGH
❑ Cenilial copy is herchy famished. ll
❑ Certified copy is fled wish the r' inspraian division. GREASIONDUSTRL WASTE INTERCEPTOR GRADING PER
CERTIFICATE -EXEMPTION FROM WORKERS' GREASE'[RAP SOILS ITE
CO [?NSATJSATI INSUNA
(Thisscmionneednot emn,let the rusforonehundrWdellars(SINd SEWER-SANITARY-STORM PA.200FT. ENERGY EEE
or less.)
Lcedify that ionic of ew0/f,
r f which pcapJahia,mul.1,dall WATER HEATER W/VENT/ELECTR
not employ ay per n c mer s tib{act m the WorkuF PAID
z Compensation I Dales a J WATER SYSTEWfREATING Data Receipt It
App1
O . NOTICETOAP LI : Lifter akin this Certificate of Exemption.you should NEW RESIDENI'IALPLMB. SQ.FT.
g p TOTAL:
f~/3 becmmeaubjee of or IsC sensation provisions mile Labor Code,you must
> fothwithco ly th such provssinns nr Nis permit shell be deemed revoked. BUILDING FEE
7
QCONSTpG ION LENDING AGENCY SEISMIC FEE
Ih cby nffnn thuul onsouction lending agency for the performance of
V O Ihewer for which this tis'soed(Sec.309],Civ.C.) 'TOTAL ELECTRIC FEE
l.ende s Name
O U Landers Address QTY. MECHANICALPERMIT FEE PLUMBING FEE
1 certify Iha have re this application an a that the above information is �^
correct. Iagree comply ithallcityandc y milinsne.thadsmrlawanclufiagm PERMIT ISSUANCE ML'CIIANICAI.PEE
V) buil ding cons ... hereh raids.' rtprcuntelives of this city to enter upon the CONSTRUCTION'TAX
U Z idnve-mein n yfor ins pe oa purpoma ALTER OR ADD TO MECTI.
(We ugra y nod ss keep harmlethe City of Cuprnino against
Iiahilitie. jus t xIs expenseswhich may in anyway accru gain7s eiid City AIR HANDLING UNIT(TO 10,"CPM)
gm Igmilaispermh.
J AIR HANDLING UNIT(OVER 10,000 CFM)
Si at Applin UC Imm�sr Data EXHAUSTHOOD(W/DUCT)
PAID
I{ RIDGES MATERIALS DISCLOSURE HEATING UNIT(TO IW,00)BTU) Date Raeiptp
Will the up mor fmurehuilding occupant store ter handle ha ordous material
Cdefined by Ilm Cuprnino Municipal Code,Chapter 9.12,and the Health and Safely 11 GATING UNIT IOBT00 BTU) TOTAL:
Code,Section 8532(a)] VENTILATION FAN(SINGLE RESID)
❑Yes ❑No
Will lheapplicamor lot=building occupant usacquipmenmrdevices whichemil
BOILER-COMP(311P OR IW,IXIO BTU) ISSUANCE D T
herandous air commninan6 as defined by the Bay Area Air Quality Management BOILER-COMP(OVER I00p BTU)
District? BOILER 271995
❑Yes ❑No NEW RF.SIDF.NTIAL MECIL SQ.PT.
I love read be haurdnux materials regmimmenls node,Chapter 6.95 of the CII Y Ur•
California Health&Safety Code,Sections 25503,25533 and 25534. 1 unrs
deand that (.�UrEH PINO
if the building does not currently have a tenant,that it is my responsibility to notify the
nccupanl of the requimmenls which must be mel prior to issuance of a Cenincre of
Occupancy.
j�/�\
Owner mmahmize ed agent DatTbfAL ISSUED BY,.\ �Y rf� X 1
OFFICE C� -
CILV oi,
Cuperthio
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
706 Stendahl Lane
Cupertino, CA 95014
Subject: 706 Stendahl Lane, Permit#27990 -Boiler
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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