27338 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BILIN -E CA. PERMITNO.
APPIACATION/PERMIT PLUMBING-MF,CHAN'ICAI. /� O
BUILDING DIVISION BUILHNG PROJECT IDENTD'ICATION G o
SANITARY NO. AI1VLJCA'HON SUBMITTAL DATE
2 K UNITN LOT# � ) A
DATE-
OW! AME;: C u0 PHONE: _& C N'{RACTOR�SN M� is _ CNG: N/C (/CONTiOI.M
ARCHITECTiENGINEER: LIC NO: AME'
��C)� lYJ•LL-1••�1YJvl% - ❑
`�/-,/6aLll l
ACI': PUl QTY. ELECTRIC PERMIT FEE BUB-DING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE 0 ❑ ❑
LICENSED CONIRACITIR'S DECIARATION APPLIANCES-RESIDENTIAL JOB DMCRIPHONc.np
py% I herebyaffirm that l am licrmed urdnpmvisinna of CTepn9(cammetemg with
UII it
aree�al Uirvisian3 of tM1e Buviness cool Pm``[ev sCodc.W lianauin PANELS
� SccI
Ia.Z4I Leena Cl -20 .x LS /�' UYT02fN1AMIK .��1�
toQy Uvc�—Cmtmj/( 101-1000 AMPS
�L RCIIITECI'S DF,CLaRATION OVER IM)AMPS
SQ.FT.I9AOR AREA S/SQ,
4 1 unkrxwnd my plaou.hall h mm]as pili rtmnrs.
OZ-D
SIGNS ELECTRICAL A ' D
E LicensedI'mrenimul
ad OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
µX CJyF I hereby mffrm that 1 am excmp I.the Cmtractor's Liccna law fm the A
4C
tN'L+LLvs following ream.ISectim'/0313.Bmirev mrd Pmfemm
ions Cade:Any city arcmy TEMP.AIL-TER OR Pt[NS'L D 18 j/1[CV
Fg which rquias a peemit to camtmct,alta,imlm ere,demolish,m".".any nru . t'
d >� prim b its issuvtec,also requite the applicwIt fm.vuch posit to file a sigtmd swemmt POWER DEVICES CITY
oC<no Nat he is IicenscA pmwmt W the ponsiom M tic Contrai Liceme law(Chaps r 1
1�." 9(mnmcncin with Scniaa]1100)or Divi,ion 3.f me Bwiness and Profession.Co,lm SWIMMING POOL ELEMIC Mrd
gmoi V(�VALUATION
'M,,, Serhes he exbynoy setem t mss a batisfor ub*Bige apil cant to ciylp Wionof
tyQ
Semi- anyireci aatfmap:rmit.ubjecu the appicanr toacinlprneltyM OlI1LET5-SWRCHIS-Fl%TIJRCS
K � 0 mire oM f N n m dallwm(55(10).
❑ I.mawnnMdepoprry.mmYuwloYcawith wagnnthrirwkcompmadan, NEW RESIDENTIAL FAECIR SQ.FT. I PE GGNSfROCD N
i3� will dmhewmrk,mdthc he Co cis mti,I. awclos forst ,,1,1.X4,Business
atd Profasbm Code:The Cmtranar's Limmsc taw doe rot appy to an.worn of '
pmisi wlwbuildsorimpovethcmm,col whodoe.such,M himself-ilcm.ghnia OCC.GR UP RES.UNITS
mon employed,pmvWd tlbt.ucn impavrnenr as amt iruadN m diacd fa sale.If.
Itowra.the building m impmvenrnt n wWwithin onc yurofcanpinion,the owrer- 'TOTAL:
builder will have the burdrn of proving that he did utt build err improve far puryo.a of
'sal`)' QTY, PLUMBING PERMI FEE R DZONE pPN
❑ I,mnwmm�ftM pnp:ny,um ucluxivClY umuaNng with limvcdcmtrectmxm
anvun the pmjut(Sce.]Gad,Butmoss and Pmfmsimu Code:)The Camra«a
U.law does.applym an uwu+wfpopmy who milds a lmpordtM.em,and I'EXMITISSUANCE
wMrcmtracufwwchPmjecuwitnamNmctor(.)Iiarued puauenOo Jc Cmtrr'tvr's (EA) FEESUMMARY ALTCR-DRAINM
❑ I am eemp mdm Sec. .B&P C fa this rcasan BACK FLOW PROOF=DEVICE OLITHISANITARY Y 1 FEESN
Owen DateRECEIP .
DRAINS-FLOOR.RF.AREA.CO
WORKMAN COMPENSATION DEMRATION SCHOOL TA% VN
❑ Ibareby err(dutllurcavitifiote of mucor to al4'uwue,mattr4fWenf FIXTURES-PER TRAP RECIiIPI'N
Wwkm'Cnmpensutiun Im.mneeor aeenifad copy drerm!(See.39M.Lab C.)which PARK FFG Y N
cove^all tri.pmdt. GAS-EA.SYSTEM-I INCAOMT,ETS RECEIPI'N
PcEeyl ��� /'I eJ 0 ; "77 BUILDING DIVISION FEES
,pa
Q,Cmo atf-i� ste ri GAS-EA.SYSTI?M-0VER4(EA) PLANCHP.CK FEE
❑ CcnlfoN]Lop_y is Moil with the city iwi,so ioo division. GRFASFJINDUSTRL WASTE INTERCEPTOR GRADING ITE
CliRTIFICATIR OF I HMPHON FROM WORKEILT GREASE TRAP SOILS FEE
COMPENSATION INSURANCE
(This a von feta rmt be a ,ImM ifthe pnmit 4 for ere hundred dollar(SIM) SEWER-SANITARY-STORM EA.NIOFT. INH)(GY FII:
m Ern.)
I ccoifYthat inthc anformaeoofthc work fm whkhthie permit is icmcJ.❑hal[ WATER HEATER WIVENGUELECB
nw empty may pecan m my ommmr so ns to M1¢me subject m the Worker' PAID
Canpeutim
tlaw.of C.lifomere l.. Daa WATER SYSTCMnREATING DReecipl
O z Applicant
z NOTICE I'O APPLICANT:IL arts making It Ceeii6mae of Exemptim,you sMwld NEW RESIDENTIAL Pt SQ.FT. TOTAL
... Lesubject to the Worker's Compcnaim m o
povisiaf thebar f< Codou muste,Y
a mnc fonhwith comply with such pmvisiau m lhls psmit stall be deamsm mvaknl. BUILDING FEE
1 Q CONSTRUCTION LENDING AGENCY SEISMICFLL
I hereby mffimm thatere
thA a comemotiml krding agency(« p
the rfaw¢
nof TOTAL: F1F,CBIC FE I.
U p tic work perm
itis which this peit is ivuei(Sce.3(97,Civ.C.)
LI. Ludo.Name
O L ,Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
I cenily mm I have read this epplic.i..mod smote slut the above Ihimmutlm,Is
�-' Woclating MECHANICAL FEE
o lagrdtfi.o..compfy hs olb,lmt ,,mtnry mdlwtma and chyme
er."the PFRMITISSUANCE
UZ bwldi-menimnelpropert M1nMy section Imp«.movesufthiscityroamerupm the CONSTRUCTION TAX
Uz ebw(Wo)spece toapnymsemnpectim purposes. ALTER OR ADOTOMELTS.
(We).Cora otsave,iMcmnilYanal keep
myinmticy ofqu stodC[ty
Iia "Ie,jrlgtncnu.cmumdcxpnaawhicM1 nuylneny way accneagalnst.sald Clry AIR IIANDLING UNIT(TO 10,000 CITE)
cMthe granting of thi�sJ�"t.
A t AIR IIANDLING UNIT(OVER IO,WB CPM) -
moofAlpflimmUCTm.m Cote" FXIIAUST HCOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE BEATING UNIT(TO 10(1000 BTU) Date RnelprY
Will the tipplicem w fumm buJding occupunr shxe o-M1mdle mtardow mNc mal
m dcfred by the Cupnirto Mmicipal Code.Cheper 9.12,and the Health ad Safety HEATING UNIT(OVER IOO,"BTU) TOTAL:
Cade,Salim 255121a)'l
1:1 Ye ❑No VENTILATION FAN(SINGLE RESID)
Will UeBOILER-COMP(311P OR 100."BTU) ISSUANCE DATE
appiw,t m lutmc bui W ing ocmpant ata ryuipmcN m dciva which unit
I timdoua ah coodaoitat as clefted by No Bay Arca Av Quality ManeBene^t BOILER-COMP(OVER 1W."BTU)
Vlflcl?
❑Ye ❑No NEW RESIDENTIAL MECH. SQ.FT.
I have read the�rimmmi.ls Tequimrcnu mdu C'hmpn 6.95 of the
Califmaa Hei&Safety Code.Smimu 25505.25533 asd 255M. I mdmtard this
i r the It ng doer ml cuncmly mi tc r.0w it is my respomibil'uy,to amity the
cactiP4,of thetyu u which m be and pie to is tmmz f e Cmle of
(TivT aautMnegcNZ Date I TOTAL: ISSUED BY:
OFFICE
® 10300 Torre Avenue
. Cupertino, CA 95014
city nl'
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
November 3, 1997
Homeowner
Cupertino,
Gardeino, C 95
Cupertino, CA 95014 l ��
SUBJECT Permit#27338 i 0Z
Dear Business Owner: �3 l
We have been going through our files in the Building Department, and contacting those
people with permits remaining"open.
According to our inspection records, the subject permit has not had a final inspection.
Many times an inspector will sign the permit in the field, but overlook reporting all of the
information to the clerical staff for input into the computer. If this is the situation and
your permit card shows the final sign-off, would you please contact us so we may
complete our computer records? If the permit is not signed off, please call to schedule an
inspection for final closure of the permit.
Because of the large volume of paperwork within the building department, we cannot
separately monitor the progress of each permit. We ask that you give this notification
your immediate attention. 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
C
Christy Akatiff, Administrat Clerk
Printed on Pecvcloi7 Pape,