27006 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING .Lb. RI AI. PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL. 27006
BUILDING DIVISION IIIIIhIIING PROIRCI'I DE N'TI FICATI0N
BUILDINGADDIGISS: SANITARY NO. APPLICATION SUBMITTAL.DATE
111 UNIT u• LOTM Cl star MAL+
=OWN SItA�y: G i PHONE: C ACTO ' NAA I.IC NO
` I 1C ✓4"�Ft�7M q'�gDa 1S Ix� pe" f — NIC CONTROLN
~ III' ;CTpiNGI ELR: LIC NO: ADDRESS: ❑
NTA
a'— PHONE: QTY,
PERMIT FEF.
iNi 1 RBUILDING PERMIT INFO
RtiP 1ll �e} meth off' �4l- Q . ELECTRICP
� PERMIT ISSUANCE BLDG ELECT PLUMB MI:CH
eC=Z
LICENSED CUNTRACTORISUECI.ARATION pppl.lANCES-REST➢ENTIAI. JOB DESCRIVIQ.
I herchyuafrmthat l 3 ofth Bruinsed t,rand isinnsimes Core9(cnmy beau e.. 1'YC_�V{• sTr`1_.1_.JGL
00 Section]BBO)of Division 3 of the tlusiness and I'rofasians Code,and my licrnu is in PANELS
K lad F full ce and effect. a r� -1 G 8�—
FZV tone s 17 Lin,# IIPT02011AMP5
y m Uam T�ComPS D 201-IrMlo AMPS S IT.FLOOR AREA S/SQ.FT.
ZOv ARCHITECTS➢EC.A A 1 N OVER I"AMPS Q'
O Z 1 understand my plans shall he used as public records.
ry W SIGNS ELECTRICAL
Licensed Professional
�'6 OWNER BUILDER DECLARATION SPECIAL CIRCUITIMISC.
�xR('C'M I hereby affirm that I annexempt from rhe Cutbacks's License law,for the
ts134.y following reason.(Section 7031.5,Business and Profeuions Code:Any city or county TEMP.METER OR POLE INST.
1"'faJ ONQ whichrequirena permifto rm,arat,alm0improve,Jemnlish,moolsirmy atmchne
>7 prior to its issuance,also requires the applicant for such Permit file a signed statement POWER DEVICES
,
e �Oz that he is licensed pursuant to the Provisions of the Contractor's Licenx Law(Chapter
P, 9(commrncing with Section 7")of Division 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC
6VALUATION
_on or Nat he is exempt therefrom andthe basis fmthealleged exemption.Any violation of OIITLLTS-SWITCHES-FI%'NRES
3 4 Section 7031.5 by any apPolandlicant for a Ped subjeta the applicant to a civil penalty of
FO
nFT.S r more than five hundred dollars($500). .
❑ ❑ I,asnwncmftheproparty,ormyemployceswithwagesastheirsnlecompensation, NEW RESIDCNTIAL ELF.CTR — Q STORIES TYPECONSTRUCTION
y3� will do the work,and thestmnure is not intcndedoreffond forsale(See.71144,Business
and Professions Code:The Comment Littnse Law does not opPly in on owner of
Property whrbuildserimpraves thercon.end whodoessuch work himulfordtroughhis
own employees,pervidedthat such impervermntsme not intendedoroffered forsde.If, RES.UNITS
however,the building or improvement is sold within armee year ofcompltion,the owner- TOTAL: `I. I GR
builder will have the burden of proving that he did not build or improve for purpose of 11
a Ie.) P
.
❑ i,.sownernfthep.o ny,amexclusivelyconvactingwiNlicenudconimtomto QTY, PLUMBING PERMIT F - APN
construct the project(See.70lbt Business and Professions Code:)The Conaators
License lawdeesnm apply man r,wnerofpropeny whobuildscrimprova Merton,and PERMIT ISSUANCE
whocomracu forsuch projects with a contractri licensed Pursuant to the Contractors ALTER VENT-WATER(FA
License Law. ) FEE SUMMARY
❑ 1 um exempt under Sec. B&P C for Nis reason BACK FLOW PROTECT,DEVICE OUTSIDE FEES
SANITARY Y N
j/' 50wner Date RECF.II'1'p
WORKM//�kNCOMPENSATIONDECLARATION DRAINS-FLOOR,ROOF, COND. SCHOOL TAX YN
r Ihcmby.fOrm than:Ta a cenificaa refcoment to self-iiame.ma ceriferac of RECHIPTN
"Worken'Comcertified
pensation Insurance ora copy themof(See.3801 Lab C.)which Fl%TURES-PER TRAP PARK FEE Y N
r! covers all employee's under this permit. RECETPTp
Policy N GAS-F.A.SYSTEM-1 INCA OUTLETS BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Cenified copy i,hereby famished.
❑ Certified copy is filed with the city inspection division. GREASEnNDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASHTRAP SOILS FEF.
COMPENSATION INSURANCE
('!Tis section need not becomploted June permit is for one hundred dollars 1$100) SEWER-SANITARY-STORM EA.2001T. ENERGY ITE
or less]
I cetifythmIndia perform...term e work I rich thispemtit is issued,l shall WATER HATER W/VENT/F.L.ECIR
of employ any person in y manner so as t b i subject m the Workers PAID
O z Compensation U, �Qme)i is ple WATER SYSTLMRREATING Date -/P,g
NOTICE.TO APPLCANT:II,aflcnnekng is enia eof.xcmpiion,you should NEW RFSIDENTIALPLMB. SQ.ff. 'TOTAL:
V] become subject o the Worker's Compensation provisions ofthe labra Code,you must
a ? forthwith comply with such provisions or this Permit shall be domed revoked. MIF1
OW. Q CONSTRUCTION LENDING AGENCY Stiltr
V
z I hereby affirm that there is a construction lending agency for the Performance of
TOTAL: ELECT IC
Othe work for which this permit is issued(Sec.3097,Civ.CJ
Lenders Wmm PLUMB G FEE
O rV Lenders Address Q'I'Y. MF.CFIANICAL PERMIT FEE
1 cenify that I have mad this application and state that the above information is
LL7cored. l agree to comply with.11 city and counyonlinanca and sate laws relmingto PERMIT ISSUANCE
MCC ANICAL FEE
Ca�CL buildingconsvaction,and hereby amhrrim represcnmtives ofthiscity to enterupon the CON UCf10N TAX
L) z above-mentioned property for inspection purposes. AUURR OR ADD TO MECH.
(We)agree m save,indemnify and keep harmless the City of Cupertino against /a
India lities,judparents,minimi expenses which may i any ay accrue against said City AIR HANDLING UNIT Gro to,"CFM)
consent f groomed of thio es
o e /1 r",
AIR HANDLING UNIT(OVER I0,000 CFM7
'Signature of App icanVContranor Data EXHAUST HOOD(WIDUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Dec Rectile a
Will the applicant or future building occupant Moro or handle harardous material HEATING ON]]'(OVER I00,INNI BTU) TOTAL:
as defined by the Calendar,Municipal Cede,Chapter 9.12,and the Itralth and Safety
Coda,Senior 25532(a)?
❑Yu ❑No VENTILATION FAN(SINGLE RESID)
BOILER-COMP(3HP OR 100,000 BTU) n ISSUANCE DATE
Willmeappiic...mature huildingoccupantusecquipmentordevices which emit A Y
�haaardons ab cnntaminats as defined by the Buy Area Air Quality Management BOILER-COMP(OVER 100,000 BTU)
District? E) SEP 15 1Jp /J
Ycx ❑No NEW RCSIDENTRESIDENTIALMECH. SQ.PT. A
1 have red a
athe haulms ma[ed.],requirements under Chapter 6.95 of the J��/J^p
California Health&Safety Code,Sections 25505,25533 and 25534. I understand that CUI Y ur
if rhe building does not currently have u tenant,unit it is my respmentel ly to unity the �urcrl I jry(
occupant of the requirements which must be met prior to issuance of a Certificate of
Occupancy.
Owner r inqudmd agent Data TOTAL ISSUED BY:
OFFICE
1 1
&C, of,
ClApertlllo
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 26, 1995
Shirley Eitrion
19945 Price Avenue
Cupertino, CA 95014
Subject: 19945 Price Avenue, Permit# 27006
Dear Ms. Eitrion,
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 n�
P!'wad on Rocvde,l Piper
o n,
a >
N O
N
Cl) J � C/A
� (D
O W!
O 0 t7
• n W
N K
a90
un a ]
O C
N CD
nim m
[,OH H
TI 10-1 1
mr)a n
p*Jm .o
1 HIIr
H 'SOOT
ZO A
m OmNE
m mzn
1n7,HDU
A3 11 tj Ln
y>rHHO
z Ozmzi
OI {4).0
1 OU I`
O rr HWC r
U i 3 W m GA
Ill 2 Di mh - [n
o N rn.o
m N x.o y
n MrMo
rno
ILI d. �m N j
— 10 rfr az,
N w i,rl
A r << �
, >tA Ti a.x�4. xx