27094 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-LLEU"R CA. PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 27094
BUILDING PROJFICTUIEN"1'1111CA'I'ION
BUILDING ADDRESS: w1 I ' f�/� SANITARY ND. APPLICA'HONSUBMITTA�LD(7TL'
21 gS2 WcoD13L)Q�( V—UNIT# 1.01*0
1O iKS NAMIi: ,A� /� p,..� PHONE: CONTRACT'OR'S NAME: LIC NO: 7/
r.t &(I AF{1'VV� sl.—.$e).EG0IN) CONsj' INC • NIC CONI ROL#
,. CI11GrI .IIiNGINiIlus. LIC NO: ADDRE'�S":"� r
ON 2 fvrert LANE, 55.
CONTACT: - PHONE: QTY ELECTRIC PER MIT FEE BUILDING PERMIT INFO
BLDGE PLUMB MECH
PERMD'ISSUANCE 32 RT Ev 0 El
.00
I� WWW I
LICENSED APPLIANCES-RFSIDENTIAI. JOB DESCRIPTION
py7, Iherc(4.17 mthu l 3 alicensedinssand iardexamns Code9nd mmecense with
Ls100 Section)000)of Division Sof Ne Business and Rvfexsiona Code.and my license is in PANELS
qF fun force and effect.'(2, b � /L
<�z License Cln "� LIC.It IIo I UP T02[q AMPS - 4/
rFii<y Dam - 3 Cnnlruclor_ c.o 201-IOW AMPS
Z 05Z ARCIIITECI-S pECIARA ON OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ,FT.
O Z�C I understand my plans shall In used as public records.
P:y W Licensed Profcvaraul SIGNS ELECTRICAL.
4
gi � OWNER-BUILDER DECLARATION SPECIAL CIRCUDDMISC.
°iJ 1 hereby affirm That 1 an exempt from the Committees License Law for the
3atrt following reason.(Seelion]031. 5.Rosiness andRofwsionsCale:Anyairynrcoumy TEMP.METER OR POLE INST.
,2,0; which rcyuiree a Permit m constrict,nlseq improve,dental ash,or repair any xtructam
}� prior to its is.sicuce,also requires the applicant basuch permit to file a signed statement POWER DEVICES
ul D O that he is licensed pursuant to the provisions of the Commumes License Law(Chapter
e,"a 9(commencing with Section 7")of Division 3 of the Busineasand Professions Cade) SWIMMING POOL ELECTRIC VALUATIO��
' ,_ce mnhm he is exempnherefrom and the basis fmnhe alleged exemplum Amyvmhtionof OUTLETS-SWITCIIFS-PIJCI'URBS `` ww �)
aSectiin)n1L5M1y anynpplicmn Brtoprmi[nuhjecm thenpplicum toncivilpnahy of • p0 /T Ue)
C nounmre than livehundred Jollurs(SSW). NEW RESIDFNTIALELECR _SQ.FT. VPORIFS TYPECONS)RUC110N
G'$ ❑ o the wnk.and t pmperry,ormycmployed oheregoaathelSelecompBusiness
ay_ will do the and the structure,isnot License Law
1,loan Business
and Professions CoJw'Ihe Commuters License Low Joea not apply m an owner of
property who builAe nrimpmvcs thereon,and whnJceseuclt work himself nrthnngh his OCC.GROUP RPS. NITS
employees,provided thatsuchimprovementsirenot,examOJ eoofferedfmstale.If,
howwce the building it Improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or improve fa purpose of TOTAL: �
We).
El 1,its iwnerofthe property,um exclusively contracting with aacemsednmtranors to QTY. PLUMBINtpFfTWIT FSP. FLOOD ZONE APN
construct the project(Sea.7011,Business and Professions Code:)The Contractors lie
Licrnse lewd«sna applym on nwnttofproprly whobuildsaimprovesthereon,and PERMIT ISSOANCE
whocmlb.al fur suchprojects wish a emmhamor(s)licensed pursuanumhe Cmmreators ALTER Law. WATER( FEE SUMMARY
❑ 1 um exempt nater Sec. B&P C for Chas reason BACK FLOW PROTECT.DEVICE '1'.IDF.F
SANITARY Y N
Owner Date RECEIPTp
DRAINS-FLOOR,ROOF,AREA,COND.
WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN
2oIhembyuffrm that l have acenificateml'mmsemrtmself-insure,oracertiricateof FIX)'ORES.PE RAP RECEIPT#
rken'Compensation Insurance or a cenifiM copy thereof(See3800,Lab C)which PARK FEE Y N
vers all employee's under his pernivGAS-13A.S TL'M-I INC.40D1'L6 RECEIPTp
Policy p BUILDING DIVISION(FES
Company GAS-RA. YSTHM-OVFA4 UTA) PLANCHHCK FEE
❑ Certified copy is hereby fumiumal 2.�
❑ Certified copy is filed whWila,city inspection division. GREAS NDUSTULWASTEINTERGEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GRIT STRAPSOILS FEE
COMPENSATION INSURANCE
(T his section need not be completed ifthe permit is formic hundred dullness($100) Sp F:R-SANITARY-STORM F.A.200FT. ENERGY FEE
or less.)
I certify that in the performance affhe work for which this mrmt u issued,)shall ATFJII@#TER W/VENDF.1. R
not empiny say prion i ny m nner so.1 bee 9mt s M1j5pt t he Workers' pAlp
G.mpnnuiarl.nwxo Of a` —.1V--2`� WATER SYSTEMITREATIN Date Receipt la
0 z Applicnm 4-
zO NOTICE TO APPLICANT:IL <r making this Certificate of Exemption.you should NEW RESIDENTIAL PLM SQ.FT. TOTAL:
{-� ( become Subject the Workers Compensation provisions ofthe Labor Cale,you must
> forthwith comply with such provisions or this permit shall be deemed revoked. % BUILDING(TIC 1 a`
0. Q CONSTRUCTION LENDING AGENCY SEISMIC DIE J . v�V
I hereby affirm that there is ecnmWWimn lending agency for Ne performsnce of TOTAL ELECTRIC FEB .#s
V O the work for which this permit is issued(S...109),Civ.C) .�Y
w lr Lenders Name NnuE
t-' Leaders Address QI lY. WHANICAL PERMIT' PER PLUMBING FEE
V I certify that I have read this application and slam that the above information is
7" 4 correct.Iugrtt to comply with all city and coumy mrditunca nnJ nam laws rtletingm PERM]'I'ISSUA MECHANICAL FEE
�-' building construction,end hereby limit representatives ofihis city roamer upon the CONSTRUCTIONTAX
V7 above-mentioned properly for inspaimn urlmses. ALTER OR ADD TO IL
R;
(We)agree manor.marmri cep harmless the City of Cupertino ngilinst
Iiabilitie+.jud acsen s which may many wtylserme egainn said City AIR I IANDLING UNIT(TO 10, CFM) •[� 00
c ccofthe gr of 1
AIR HANDLING UNIT(OVER 10,"CIM)
Sigmb cent/C tram Due EXHAUST HOOD(WIDUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO(WAW B'I'U) Due Ravichaa
Will the applicant or future building occupant slam or handle hasnrdous mumnal a e
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety JIRA1'I NO ONG(OVER 10gn00 ill U) TO'T'AL: V
Code,Section 255J2(e)'1
❑Yens (kjaa,,��No VENTILATION FAN(SINGLE RPSID)
BOILER-COMP(3HP OR 1 W,OOH BTU) ISSUANCE DATE
Will l air ru lrnm writs a bWredbc the Bae equipment unlit Mes w.gernah I�.T
mdnus air comeminan[s as delineJ by the Buy Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) f
�istrin? //
13 Yen �9.No NEW RESIDENTIAL MECH. SQ,FI'. SEP 2�j Q O 1994
I Imve read the harurdous namela1s raryirements under Chapter 6.95 of the
Califmnh I Ira th&Safety Code,Sections 25505,25533 and 25534.I undersand that
if the building does not currently have a tenant,that it is my responsibility to notify the (ili I yr l.ur rn I ni.;
cecupam of the :rent which man od met prior m issuance of a Cenifieare of I
oeenpam �q t� �11/�' 9—id'If� .
Owner or th wine pater q'O'TAL: ISSUEDB
OFFICE
Clty of
Ctlpertfiio
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 26, 1995
Barbara McArthur
21852 Woodbury Drive
Cupertino, CA 95014
Subject: 21852 Woddbury Drive, Permit# 27094
Dear Ms. McArthur
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 in.spection 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,
Cl<pertino, 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
•�i
Printery on Recvdod Paper