27966 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUMBIN E T.ELI A PERMIT NO. 27966
BUILDING DIVISION APPLICATION/PERMIT - PLUMBING-MECHANICAL
BUILDING PROJECT'IDENTIFICATION
BUILDING ADDRESS: a,i^ �� UNTTk LOTM
/ ISANITARY NO. APPLICATION SUBMITTAL DAM
OWN NekplE:,_ _ C/—�ut�
ONE:Z� � CONTRACI'O ' AME: S CG cC N(,cL/ _ r• N
M62-P9 T/Y^J NIC CONTROL k
ARCHIL CT/ENGINEER: LIC NO: ADAS:-pC_ r / I� " �,! ( � ❑
-�I„ZLs.1 C_ �clJ1tlC'i .
CONTACT: PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT PEE
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE El El El
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION (L�
pMz thereby affirm that l am licensed underprovlslonam'Chaater9(commanaingwith
VJ00 Section'/01 Division 3 of the Business and Professions Codpand my license is in ppNg15
ty full force and eR 4
IQ„Z License Cl ss UPT0200AMP5 Ja .1cO
w]y Dere��Comrncmr 201-1000 AMPS �y4
z O R a 1 understand m W ARCH 5 DE OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
Oz'-Gra1 Yp'nsshall be a&ed as a ¢rec _
Q,j„"14 Licensed Professional SIGNS ELECTRICAL
LL Yy� OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
°C y F I hereby affirm that I am exempt from the Commodes License Law for the
W 3Oy fallowing reason(Sectinn]03L5,Business and Put...Code:Anycityorcounty TEMP.METER OR POLE INST.
y J which requires a parmitelo consumer,epee improve,demolish,or repair any structure
} prior 0 its issuance.also requires the applicanlforsuch Pero n,to file a signed smtemeat POWERDEVICES
00 that be is licensed pursuant o the provisions of the Cornronm's License Law(Chapter
9(commencing with Section 7")of Division 3 of Ne Business end Professions Code) - SWIMMING POOL ELECTRIC VALUATION 6L
ty_y or that he is exempt therefrom and the basis for the alleged exemption.Any violation of OUTLETS FIXTURES
F. Q
Section'!031.3 by any applicant for a permit subjects the applicant to a civil penalry of �a
y'q^• O nor..,ban five hundred dollars($500). NEW RESIDENTIAL ELECTR .
❑ I,mostarofthepirpmy,ormyerap yeeswith geeastheirsolecompensalion, 5Q FT. STORIES TYPECONSTRUCTION
y will do the work,anithestmctum isnot ince d o (.,sale(S..9044,Business
and Professions Cod The Contme Lr e r d I s 1 an-STn"of
properrywhnbuildso ' p v t ,a doessuc khat r ro hhis OCO GROUP RES.UNITS
woemployaes,p i t ch on [e ata not! m offe df la.If,
wm
hawevcr,the build provemwtiav d Ilhinpley wmpletl sous TOTAL:
builder will have the It r a of proving r t not build or improve for purpose of
le.).
Cl I,asownerofthemNny.amexclusivelycontracting with licensed contractors in QTY. PLUMBING PERMIT FEE FLOODZONE APN
construct the project(Sec.7044,Business and Professions Code:)The Contractor's
License Lavedocs not apply to anownerofproperty who builds orimproves thereon,and PERMITISSUANCE
who contracts for such projects with acomractor(s)licensed pursuant to the Commoto's ALTER EA FEE SUMMARY
License Law. ( 1
❑ I am exempt under Sec. ,B&P C for this rens n BACK FLOW PROTECT.DEVICE OUTSID FES
SANITARY YN
Owner Date DRAINS-FLOOR,ROOF,AREA,COND. RECEIPT I
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ I hereby affirm that l have a eani0cate ofconsant to self-insure,ora cerrifcime of FIXTURCS-PER TRAP RECEIPTk
Wnrkers'Compensatinn lneumnceor.certified copy thereof(Sec.3g00,Lab CJ which PARK FEE Y N
covers all employee's under this pannit' GAS-EA.SYSTEM-]INC.40IITLETS RECEIPT M
Policy N BUILDING DIVISION PEES
Company GAS-EA.SYSTEM-OVER 4(EA) - PLANCHECK FEE
El Certified copy is hereby fomiahed.
❑ Candied copy is filed with the city inspection division, GREASEANDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS PEE
COMPENSATION INSURANCE
(Tnis section need marine completed ifthe permit is forone hundred dollars($100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
nr lass.)
Icaro yr a m he work for whichu sp ill i&sueQlshall WATER HEATER W/VENT/ELECTR
person m any manner so /c Abe a PAID
O z A'mpeoation Lis fCalifornia. Date Y r rs WATER SYSTEMOKEATING Date Raceiprg
Fr OTICET mmption,you should NEW RESIDENTIAL PLMB. SQ.PI'. TOTAL:
_ p] fto�o—kers Compensation pareisigll eLaW Cade,you must
forthwith comply with such provisions orlhis permit shell be deemed revoked. - BUILDING PEE
W z
CONSTRUCTIONLENDING AGENCY SEISMIC FEE
1 hereby affirm that them is a construction lending agency for the performance of TOTAL: ELECTRIC PEE
V O the work for is Ionia this permit is issued(See.309],Civ.C.)
Lkn Lender's No.
Lender's Address QTY. MECHANICAL PERMIT' FEE PLUMBING PEE
U I certify Brat I have read this application and state that the above infommrion is
correct.I agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE -,p/� MECHANICAL FEE
Vbuilding consituction,and hereby authonze representatives ofrhis city to enterapon the ALTER OR ADD TO MCONSTRUCTION TAXMECH.(We)agree to save,Indemnify and keep harm ass f Cupertino.,most � llc -
li wrjdgmemmSMRex'emn hmayinanyway accrues id 'ty AIR HANDLING UNIT(T010,000 CFM) �v J• Vn
in CO �
s ,ragtla),'Of1 em'
AIR HANDLING UNIT(OVER 10,000 CFM)
ofApplicanrTOTffScfor —'
Data EXHAUST HOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE / HEAPING UNIT(TO 100,000 BTU) tf V Dare Receipt N
Will the applicant or future building mention&Core or handle hazardous material HEATING UNIT(OVER 100,000 BTU) TOTALIX
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cada,Section 25532(x)7 / VENTILATION FAN(SINGLE RESID)
❑Yes Nn IS
Will then licam ttutur ibuildin fusee BOILER-COMP(3HP OR 100,000 BTU)
pp gwcupen quipmemordevices whichemit
hazardous air contaminants as defined by the Bay Area Air Quality Management Nsa cup El Yes ,OILER-COMP(OVER 100,04))BTU) APR 211995
NEW RESIDENTIAL MECH. SQ.FT.
I have read the hazardous materials requirements under Chapmr 6.95 of the GI I V'( VVI-ch l INV
O5,25533 and 25534. I un erst that
if the building docs not curremly haveamnan, neibilit moot ythe
' to issuanc of a ¢rlifl ale Of
ccuPancY, zt /.
Cor authorized agent ate TOTAL: -D ISSUED BY:
OFFICE '
&(*it\,
of,
cupeltillo
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)717-3333
November 29, 1995
Resident
10797 Linda Vista
Cupertino, CA 95014
Subject: 10797 Linda Vista, Permit#27966 - Furnace
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
ti alternative but to resolve your permit as expired and discard the records.
Thank you for your assistance.
Sincerely,
City of Cupertino
Primed on Pecycled Paper