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28288 (2)APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING -ELECTRICAL BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL. BILI LDING PROJKCT IDENTIFICATION O. /1 ^ /N /N /� PERMIT NO -28288 L VX L �8 VX BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE UNIT# LOT# -IVa � V q� OWNERSNA PHONE: -IV CONTRACTOR'S NAME: LIC NO: N/C CONTROL # ARCHITECT/EN NEER: LICNO: ADDRESS: CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMITINFO BLDG LECf PLUM$ ME sfL—Jt ZZs—Y`�J PERMIT ISSUANCE LICENSEDttllCONTRACTOR'SDECLARATION mmecense wish n ss and isionsof Cheerer9 and I hereby of Division3 of th Business gati.n]IXXI)of Dlvision3of the Business and Profnsinm Cade. and my license is in APPLIANCES - RESIDENTIAL PANELS I FSCRIP ION full force and etre't. Licca licp� UP TO 200 AMPS Date GOnTS D ARCHITECTSDECLARA jr:G• ar. 1 aMcrsmnd my plans shall 4 used u public recda - AMPS SQ .Ft S/gQ. PI'. OVER 1000 AMPS OVER HI SIGNS ELECTRICAL Licensed Professional OWNER-BUILDERDECLARATION t SPECIAL CIRCUIT/MISC. 1 thereby ism that 1 am exempt from the Co Ca License Law for the as n. followingtures..(Section 7031.5, signs Code:Any city .,county TEMP. METER OR POLE INST. commuBusinessandve, deronv i a permit to conetruct, aper. improve, demolish, m repair ed swaum which its issuance.for such prime.i,lcensed.......he to fleaeLa POWER DEVICES peapplicent ommerpermit that he is licensed porsuanuo the) ofDiiom of rheum Bu iness Licerue Law (Chapter (Chain 9(commeis ixemith Semion90007of 3ofine Businessand Professions Cade) SWIMMING POOL ELECTRIC VALUATION basisisn of civil any subjects the uppllcunnoacivil penuhy of Sethat tion 7031.5 by nherefromnt for the a bnisfar tjects the applicant Seaton] OUTLETS -SWITCHES- STORES than iv dreddamfor$perrnit t more than rofthe roAM,larmyemp' compemanion, n❑ Ln wnerand NEW RESIDENTIAL CTR _SQ. FT. STORIIS TYPECONSTRUCIION the e(Slymvan Business will inteyceswithwagaradic(Sec. ande: swnureisnot idroicense Professions Lawfferect and Po(essionx Cade: The CantncmTs License Law don not apply ro an owner of property who builds or improves thereon, and who does such work himselfm throughhis ownemployces,providedthat such improvements are not i mended or offered formic. If, OCC. GROUP RES. UNITS however, the huildingor improvement is sold within one yearofcompledon, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). El1,nownerofthepropeny.0 exclusivelyemawtingwiihlicenscdcommctmia QTY. P' MR CPE I,T FEE FLOOD ZONE APN construct the pmjm (Sec. 7044, Business and Professimu Code) The Contmetar's License lewd«snot applymanovenerofpfopeny whohuildscrmpmvesthemmcand PERMIT ISSUANCE whocommets forsuch projects with acommetor(s)licensed pursurm in ncc Co11mmm'3 Lice se Law. n ALTER-DRAIN&VENT-W (EA) FEESUMMARY ❑ l stn exempt under Sa. . B & P C fm this reason BACK FLOW PROTECT. DEVICE UTSIDE FEES SANITARY Y N RECEIPT# Owner Uutc WORKMAN COMPENSATION DECLARATION DRAINS- FLOOR. ROOF, AREA, OND SCHOOL TAX Y cate oconsenno self -insure, or a cuuficate o hereby arm that l have a certificate f P -r"1 hf covers 11empermdan Insurance srncenified ropy thereof(S<c. 3800, Lab C.) which covers all empl yfiund N' Policy #. � Fl%TURLS - PFR TRAP RECEIPT# PARK FEE Y N RECEIFf# GAS-P.A.SYSTEM-IINC.IOUTLETS BUILDING ONISION PEES Company ❑ CcrjlljKopy s hereby tomo n . GAS - HA. SYSTEM -OVER 4 (EA) PLANCHECK FEE GREASEINDUSTRL WASTE INTERCEPTOR GRADING FEE ❑ Certified copy is fled with the city inspution division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE SEWER - SANITARY - STORM EA. 200F7. ENERGY FEE (This section need not becompleled tithe permit is for one hundred dollan($IN) m Ins.) WATER HEATER W/VF.N'rMLECTR I cenifythn in the performancenF,hc work for whichthis permit is issued, Is hull not employ any person in any m.nner so as to become subject to the Workers PAID Compensation Lawsof California. Date WATER SYSTEMIMEATING Data JN^6pt# Applicant NEW RESIDENTIAL PLMIL SQ. FT. TOTAL: NOTICE TO APPLICANT: If, after making Nis Cenificamof Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this pervert shall be dcemed revoked. BUILDING FE SEI MIC -E CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) ELE E Lenders Name QTY. MECHANICAL PERMIT FEE PLUM FEE Lenders Address 1 certify than 1 have read this application add stem shut the above information is correct. l agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE MECHANICAL FE buildingeonstruction, and hereby authorizerepresemativee of thisciry to en¢rupm the above-mentioned property for inspection purposes.ALTER OR ADD TO MECH, CONSTRUCTIO TAX (We) agate to save, indemnify and keep harrsdess the City of Coleman a i dnet es which may in any way meunion said City ,judgmes, costs and espauacc Iiabiliunnt AIR HANDLING UNIT (TO IgpOf CFM) AIR HANDLING UNIT (OVER IB,OW CFM) in consequence of the granfn6 of this permit. ' EXHAUST HOOD(W/DUCT) PAID Slgramre of AppliemUCminsctor Date HEATING UNIT (TO 100,000 BTU) HAZARDOUS MATERIALS DISCLOSURE Date Receipt# HEATING UNIT (OVER 100,000 BTU) TOTAL: Will the applicant or future building occupant store or handle havadous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Coda, Siacdon 25532(.)? ❑ Yes ❑ No rfututubuildingmcupant use eyuipmeorlevicee which ernit Will lheapplicunmm azardous air comaminadis as defined by the Bay Arca Air Quality Management Distrin? ❑ Yes ❑No VENT ILATION FAN (SINGLE RESIED qq Y`a BOILER- COMP(3HP OR 100,000 BTU) �U^ I$$ AN(DATE y y ©,I /' /1A / •g� O F BOILER - COMP(OVER 100,000 BTU) NEW RESIDENTIAL MECH. SQ. FT. materials requirements under Chapter 6.95 of the 1 have teal the the hazardousm California Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that /yG if the building does not currently have a tenant, that it is my responsibility to notify the occu ant of the 'mocrients whi the ma prior to issuon of a Certifcme of X up Owne ISSUEDB . — OFFICE eithio Building_ Divi- (408)777-3228 1: February 1 1991 10300 Torte Avenue Cupertino, CA 95014 Resident 21020 Classic Court Cupertino, CA 95014 Re: 21020 Classic Court, Permit #28288, Air Conditioner Dear Permit Holder: Our records show that the referenced permit has not been finaled by a City building inspector. A permit is 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, 95014, Attn: 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 date of receipt of this letter. If we do not hear from you, the City of Cupertino Building Department will have no recourse but to resolve your permit as expired and discard the records. Thank you for your assistance. CITY OF CUPERTINO • Printed on Recycled Pacer