27622 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
(,,TTY OF CUPERTINO
HUH,UIN s-ELECTRICAL PERMIT NO,
BUILDING DIVISION APPLICATION/PERMIT PLUM PROJECT
n 7 6 n 2
BUILDING PROJECT IDENTIFICATION L I L
BUILDING ADDRESS: SANITARY NO. A1PPLICATIONSUBMITTALDATH
MAN �` LOT#
' SNA E: PHONE: C f LIC NO: l
N/C CONTROL p
r
RCHITECf/ENGINEER: LIC NO: ADDRESS:
CONTACT PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
n/� U ELECT' PLUMB MECH
V012 .7 1 PERMIT ISSUANCE ❑
OL
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
TOB DESCRIPTION
Q9Z Ihereby affirm that l am licenced underprovisions of@9
apter (commencing with
FOO full feeareefeDivisiontJol the Business and Professions Conde,and mylicense is in PANELS
LL full form urnl effect. S
�U♦, UP TO 200 AMPS
FZUI License Cl ass Corh
r0,0
Date CmnmetD OVER
-1 100 AMPS SQ.FT.FLOOR AREA
ZOriz ARCHITECT'S DECLARATION OVER IIXq AMPS
O Z^❑ I undr poral my plans shall be used as public recooN.
F..rue F w SIGNS ELECTRICAL
'1 Licensed Professional
aCQ OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
MU 1 hereby affirm Thal I am exempt from the Conmxnor's License Law for The
to following reason.(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST.
E" O f which requires a permit to construct,aIle,improve,demolish,or colour any strucwre
�r�Yco_1 wits issuance,also requires the applicant forsuch umfileasi ed statement POWER DEVICES
prmr quires pp pemm ignore
�Ca tbut he is licensed puts uan11.the providers of the Contractors License Law(Chapter
a4�d' 9cnmmencinSWIMMING POOL LLECTRIC
Koa ( gwifh Section J000)no01D3of the Business and Pmfensi,ns Code) ' VALUATION
WMm orthatheisesempuhepefromandthFZaScnion 0031.5 by any applicant forbjeds pp at to a civil pcnahy of OUTLETS-SWITCHES-FIXTURES
not mare than fi tic hundred dollars(❑ NEW RESIDENTIAL ELECTR 5 FT.Lasowncref[hepropc r it esn cusolccompensmion, Q STORIES TYPE CONSTRUCTION
d3� willdomewmk, the tr t time IF dhrrsale(Sec"/044,Business e
and Professions o tmel',`,.bLaw does not apply m an owner of
propertywhobta r..se dierv�uq,:md whodcessuch work M1imxlfor throughhis I OCC GROUP RES.UNITS
employees,pmvi c that suchimp sector menta are not intended proffered forsvle.IL
however,the building r mWovc real is sold within one yearofcompletion,the owner- .A
builder will have the burden of proving that he did not build or improve for purpose of
sole). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
❑ Lmownorofthcpropeny.nm ucluxively contracting with licensed commemrsto
consonant the project(Sec.2044.Badness and Professions Cm c:)The Commctor's
Liemse Luwdocx not npplymun ownmof property whohuildsnrimpmves Hereon.and PERMIT ISSUANCE
who contracts for such projects with h commator(s)licensed put mn d to the Connector's
License Law. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
❑ I am exempt under Sec. ,B&PC for this reasonEES
BACK FLOW PROTEA.DEVICE, OUTSIDE,F
SANITARY Y N
Owner Date DRAINS-FLOOR.ROOF.AREA.CONE, RECEIPT of
TI
WORKMAN COMPENSAON DECLARATION SCHOOLTAX Y N
❑ Ihereby affirm that l have a certificate ofcomsan to self-insure,or a certificate of FIXTURES-PER TRAP RECEIPT#
Workers'Compensation ln5urance ora orrobad copy thereof(Sec.3900,Lab C.I which PARK FEE Y N
v rs al I employees under this permit. GAS-EA SYSTEM-I INC.6 OUTLETS RECEIPT ia
Pot cy M BUILDING DIVISION FLE5
Company-• GAS-EA.SYSTEM-OV ER 4(EA) PLANCHECK FEE
❑ CeNdaplen,uliaobyfumishe4.
❑ Cenifiedcopyi s fled with the city inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERSGREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section need not be compleedifThe permit is for one hundred dollars 0100) SEWER-SANITARY-STORM EA.2041 ENERGY FEE
or less.)
Icanifylhatiotheperfomma fthe wa kforwhichthispeconitisissue0.l shall WATER HEATER W/VENGDELECfR
mol employ a person in u [o become subject to the Workers PAID
pensavo L "Cali I �So as WATER SYSTEM/TREATING Date Receiplk
Q z Applicant ICA
sr..ki
NO'I'IC[T APPLICANt:If.offer making Ois Cenifcvle of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
Z
become object the Worker's Compensu[ron provisions of the Labor Code,you must BUILDING FEE
�i > forthwith comply with such urnisions or this permit shall be deemed revoked.
1.4 E CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z I hereby affirm that them is a construction lending agency for the performance of TOTAL: ELECTRIC FEE
U O the work for which his permit is issued(Sec.3097,Civ.C.)
Lender's Name PLUMBING FEE
Lender's Address QTY. MECHANICAL PERMIT FEE
U I certify that 1 hove read this application and slate that the above information is MECHANICAL.FEE
>^ I3.) correct.l agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE
F' building construction.and hereby authorize representatives,fthis city toenRr mpon The CONSTRUCTION TAX
UZ above-mentioned property for inspection purposes. ALTER OR ADD TO MECH.
(Wo)agree to save,indemnify and keep fenceless the City of Cupertino against
liabililics,jud mems,coasame swhichmayinanywayacerucage as' ty AIR HANDLING UNIT(TO 10,"CFM)
in ecan, on sof Tbegmn' r.
AIR HANDLING UNIT(OVER 10,000 CPM)
Slgmrurc of Apphvzm/Czmrnemr Date EXHAUST HOOD(W/DUCTI PAID
HAZARDOUS MATERIALS DISCLOSURE ((EATING UNIT(TO 100.000 RTU) Dae Receipt#
Will the applicant or future building occupant store or handle hazardous material 000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,sued the Health and Safety HEATING UNIT(OVER 100, T
Code,Section 25532(#1'1 VENTILATION FAN(SINGLE RESID)
❑Yes ❑No
ISSUANCE DATE
Will thea applicant orfulmobuildinymcu tusse l ordevices which emit BOILER-COMP(3HPOR 100,000BTU) P A I D
pp g pm gmipmen
'Whazardous air concentration as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU)
DL tr cl!
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT. JAN 1�i
I have read the hazardous malerluls requirements under Chapter 6.95 of he
1995
Cnlifomia Health&Safety Code,Sections 25505,25533 and 25534. 1 undersand that
if The building does not currently have a board,that it is on,responsibility to notify the 17Y U- (,LINER IIN0
cupvnt of the requirements which must be met poor to issuance of to Certificate of
Owner or aulhnriced#gum Date TOTAL: ISSUED BY:
OFFICE
OcitVof
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
7706 Oakmeadow Court
Cupertino, CA 95014
Subject: 7706 Oakmeadow Court, Permit#27622 - Plumbing & Shower Lath
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 fmnaled, 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
alterative but to resolve your permit as expired and discard the records.
Thank you for your assistance.
Sincerely,
City of Cupertino
0
P,:f7xo nn Rcevcle'l Rl;)o,