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27874 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINOILD ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL n 7 Q BUILDING PROJECT IIIKMI'IFICA'TION L r o 4 BUILDING ADDRESS. G ��J j��\/ SANITARY NO, APPLICATION SUBMITTAL DATE ✓v � a.JV "�RIGITM /'r LOT# OWNS! AM : PHONE.: CONTR DR'S NAME: LIC NO: .1: s. NIC CONTROL RCHI 17"GI E' :QV LICNO: ADDRESS: ❑ x CON'T'ACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PC•RMIT INFO BLDGELECT MECH PLU PERMIT ISSUANCE ❑ LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION OKZ Ihereby affirm that l am licensed under pmvisiomofChapmr9(commenciagwlth $100 Section 900B)a17 Division 3ofma Business and Professions Cod,and on,license is in PANELS full face and effect. Ia,Zsq License Class Li..It UPT02MAMPS va?y Dam Commcum 201-1000 AMPS SQ.FT.FLOOR AREA S/SQ.FT. ZOyz ARCHITECTS DECLARATION OVER 1000 AMPS O Z—O l understand my plans shall h used as public records. rn�; SIGNS ELECTRICAL Licensed Poomssional cS� Q OWNER-BUILDERm the Contractor's SPECIAL CIRCUIT(MISC. 5L5�EIOU 1 hereby affirm that 1 am exempt from the Cantons Co License Law for the R13Wy following reasons.(Section 703 1.5,Business and Professions Cale:Any city or county TTiMP.METER OR POLE INST. C which rt9uircs a pemtit m commuo"aper,improve,demolish, a reps"any stmcturt poor to its issuance,Wso"ec,mes the applicant for such perMuo file asigmai statement POWER DEVICES ul!L'`10O Thal he is licensed pursuant o the provisions of the Convacmrs License Law(Ompmr Lyx o�' 9(commencing with Section TH10)of DivisiaN ofthe Business and Professions Cade) SWIMMING POOL ELECTRIC VALUATION W_m or that he is exempt therefrom and the basis for the alleged exemption.Any violation of UTLETS-SWITCHES-FI%TURCS ate" I=zQ Section 7031.5 by any applicant fora permiterbjecu the pit,.,to.civil pandty of nor more Ihnn f ve hundred dollars(5500). S� NEW RESIDINf1ALELECIR _SQ.FT. STORIES TYPECONSIRUCTION f—Po ❑ I,usownemfthepmpcoy,or my employees with wages as lheirsolecmn,amsmian. will dame work,andthesuunme is nal ismndedorafferM Jurassic(So..7 W.Bu am. and Professions Code:The Contmcmrs License Law does am apply to an owner of pm,ny.1mhmIdvnrimpmve Banana dwhodoessuchworkhimulfonmaughhis OCC.GROUP RES.UNITS employees,pmvidcdthat a him r catsarenotimcadedorofferedfmaale.If, however,the building c npmv e, i within yeerofcompletian,theowner- builderwillh yet ebord fp t a he di olMTiild or improve for puryou of vac')' 11¢¢AAPP ��M''�� QTY, PLUMBING PIERMIT FEE FLOOD ZONE APN ❑ I.as len lu�yy�tltCt�with licensed comracroulo construct the It 1 efSec. 4, Vis' d Pro essions CMeJ The Contracmrs Lime.Lawd Iapplym n uwofpropeny whobuilds orimpmvesthereon,and PERMIT ISSUANCE /' wil...ac..for svchprojttu ilhnconvacror(s)licensed pumuanuotM1e Convenor's ALTER-DRAIN&VENT-WATER EA License Law. I- ) FEE SUMMARY ❑ 1 am exempt under Sec. ,B A P C for this mason OUTSIDE BACK FLOW PROTECT.DEVICE SANITARY YN Owner Dale RECEIPT# a DRAINS-FLOOR,ROOF,ARCA,COND. WORKMAN COMPS SATION DECLARATION SCHOOL TAX YN ❑ Ituew Compensation o pen on Tra mucemaficau of cmtacmeneof( Scum 0,Lab C.)tmhch FIXTURES-PER TRAP RECF.IITa Wakes Compemmionlerthis ermit. fled copy themaf(Sm.Jg00,LebCJwhicry PARK FBG Y N cola ml employee's under this permit GAS-EA.SYSTEM-1 INC.40UTLLTS Rp DIVISION Policy p BUILDING DIVISION PEES Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE. ❑ Cmmedwpylshembyfsmished. ❑ Cenified copy is filed with the city inspection division. GREASHANDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERSGREASE TRAP SOILS FEE COMPENSATION INSURANCE (This sectionnecdnol be completed ifthe Permit is for ate hundred dollars(SIM) SEWER-SANITARY-STORM H.A.200n. _ ENERGY FEE or less.) l unify That in the perfmoranceof.he work for which this permit is issued,I shell WATER HEATER W/VENT/ELECTR not employ any person in any manner so m to become subject to the Workers PAID Cma,m tion Lawsof Califomia. Dam WATER SYSTEMTREATING Data Receipt 0 z Applicant z�-+ C NOT ICE TO APPLICANT.If,after making this Carificle of Exemption,you should NEW RESIDENTIAL PLMB. SQ,FT. TOTAL: r In become subject to the Worker's Compensation provisions of the labor Co ,deyou must BUILDING FEE forthwith comply with such provisions or this permit shall M deemed revoked. 4 Q CONSTRUCTION LENDING AGENCY SEISMIC FEB 1 hereby affirm that there is a construction lending agency for the perfomunce of �� z TOTAL ELECTRIC FEE U O Lo Lework for which this permit is issued(Sec.3099,Civ.CJ nders Name u" F Lenders Address QTY, MECHANICAL'PERMIT FEE PLUMBING FEE �- {U1 comity that I have read this application and state that the above information is correct l agree toccmply with dl city and county aminances and sura laws relating to PERMIT ISSUANCE MECIIANICALFF.P. building construction,and hereby authorise repesenulivesof hiscity to enter upon the CONSTRUCTION TAX Vabove-mentioned property for inspection purposes. ALTER OR ADD TO MUCH. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilitics,judgments,cado' an in comequen ft gran d peneswhic eyinywayeccrueagalm...id City AIR HANDLING UNIT(TO I Q000 CFM) of Ihis �/ Z (r/ AIR HANDLING UNIT(OVER I0,00)CFM) Znature of APPlicw•Contrac or 5" Data EXHAUST HOOD(W/DUCT)aaee PAID HAZARDOUS MATERIALS DISCLOSURE BEATING UNIT(TO I0LM0 BTU7 Date Receipt# Will the applicant or future building occupant store or handle hevudam material HEATING UNIT(OVER 100.000 BTU) TOTAL as defined by the Cupertino Municipal Code,Chapter 9.12,and the health and Safety ❑No Code,Section 255❑Yes 32(e)? VENTILATION PAN(SINGLE RGSID) �— BOILER-COMP(JHPOR100,000BTU) ISSUANCE DA E Will the npplicantorfuturebuildingoccupant uuequipmemordevices which emir maordons air commnimnu m defined by the Bay Arca Air Quality Management BOILER-COMP(OVER 100,000 BTU) PAID �)istrd1 ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT. I have mad the havNous mnseriala requiremema ander Chapter 6.95 of the MAR 291995 Celifomia 1lullh&Safety CrMe.Sabana 25505.25533 send 25534.1 undersand dom /s if the building does not currently have a formal.that it is my responsibility m notify the CI I Y Ur aacupant of the requimmems which..at be met prior to iasuvnce of a Cenificam of L .ICU Occupancy. Owner or mab aired agent Data. TOTAL: ISSUED BY: OFFICE- elcll.voI, upertino 10300 Torre Avenue Cupertino, CA 95014 Building Division (408)777-3228 Fax(408)777-3333 November 28, 1995 Resident 10211 DeAnza Boulevard Cupertino, CA 95014 1 n Subject:10211 DeAnza Boulevard, Permit# 27874 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 i - Primed on Recycled Piper