27040 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO ISO IIL 16�,G`b:LECi'x L FERVID NO,
APPLICATION/PERMIT PLUMBING-MECHANICAL 27040
)�O �O
BUILDING DIVISION IlUI1.DINfaeROJECTL
IDEN'1'IFICA'1'1(IN
BIJ5GA DIIESS: � � 1 D SANITARY NO. APPLICATION SUBMITTAL DA'lli
(//1� I VWf 1,r71'r/va,lr-PH x/1, I UNI'I'N L(19'M CtLIf
OWNIiR NAMIi: ` � PIIONT: CONT NAME: I NIC CONN'ROLN
�ARC]I A'I'/s GIN EER: LIC NO: AUD ElCO CT: PHONE: ' '
17LIT\ QTY, ELECTRIC PERMIT FEE BUILDING PERMIT INFO
(J—J/ PERMIT'ISSUANCE
BLDG F.LIiCI' PLUMB MIiC
my,Z Iheat,offrm d emNSEDI Jim,ic.NTRn CONTRACTOR'S Chape,9(cnmmencing with APPLIANCES-RESIDENITAI. JOB RIPf1ON e,
WOO Swed, 7000)of Div,/ay1, f .sine ,�/Nf P/,,,fes' nsC le, dm licenseisin
FZ
Liffilcense Clatgeflccl.1 •/ is#shy./� y UPTO 200 AM PS
mD. Duro Canv"c YYY{Vmr 201-IDWAMPS
70inz' ARCHITECTS DECLARATION OVER 1000 AMPS SQ.PI'.FLOOR AREA $/SQ.FT.
oz—c) - ImorenanJ my plans vhall he mad is puldicreconls.
F y F•; SIGNS ELECTRICAL
Q,Y „2 Licemed l'ndusianul
C�WU OWNER-BUILDER DECLARATION SPECIAL CIRCUI'DMISC.
pX,O a 1— herby affirm;hat 1 am exempt from the Cnmr;¢tur'.License Law fnr the
i+l3 LLN follawingmnes.teant to 7o31.$,Besleessanruve,dwanh Crsoe:Any cityercmmty
TEMP.METER OR POLE INS'f.
SON Q which reyuires u permit m croswcq:Jmr,improve,demolish,of repair my nru<turt
Y0 primIniliensed pursorequ)the poappllcsof the Co permit's License
LaJstatement POWER DEVICES
Op that9(c he islicensedwith Sectiouant n
")Od ivisinf the Contractor's license Law(Chapteraprer
as 9(cammeis e. its SeaiownNotthe Division teftheedexemptio Profusions Cade SWIMMING POOL ELECTRIC o�y 6w ) VALUATION
option 7031.5 by any.ppomand the basis for thet,thre,lienti 1. civiny l tart,,of
ZQ wo mo 7(1him by enrdredc.mfornpermit subjecu the opplicanna acivil penullY of OIl'1'LIiTS-SWITCIIES-FIX'fURfiS
not marc than Eve hundred Aollars($500).
NEW R1351DIiNTIA1.F.LECTIt MrOTAL-
sale.).
❑ Lunwnerofdthe sparty,ormyemployedorofwetforsalei(See campeusiiess STORIES TYPE.CONSTRUCTION
y 3� will da ieslimhe work,and the hp Cmdtructure is not,Lilaede Law does at p,le.1.a Business
end Professions Coda:The Cont amen,Cicero.l.uw does not apply m an owner of
mo,own enywho
es rowiddsor mproves ud suchcreon,and etuans oesSuch work ed.,oelfar throughhis
employees,ding Oridaps uchimt is add
hair Out
eyewnfterndfehadon,finthemle.H, .GROUP RES.UNITS
however,the
ave Ela mden ofpmentishathe within of completion,theowner-
hwill have the burden of proving that he did not build or Improve fnr purpex of❑ I,os ewnendthe property,am exdusively<nntrnaingwith licensed ennvednrs to QTY. PLUMBING PERMIItCFLOOD ZOrvE APN
construct the project(Sec.]044,Business and Professions Code)The Commorturs pBRMIT ISSIIANCF.License Law doesnot apply man ownerof property who buildser improves;hereon,andwho contracts finsuch posers withacantmaods)licensed pursuant to she Concomes AI TER-DRAIN&VENT-WATELicense Law. J ITE SUMMARY
❑ 1 am exempt under See. ,B&P C for this rarer BACK FLAW PROTECT.DEVICE U'1:1D1
SANITARY YN
Owner Data REClill'l'p
DRAINS-PLOOk,ROOF,AREA,GOND.
WORKMAN COMPENSA'T'ION UEChARATION SCHOOLTA% YN
❑ Thereby effimUhn,lha a eccnifica1111 conunuo f(Sap.rt.m Lah C.)which FIXTURES-PER TRAP RECEIPT#
co�e"'Compem;in s,r�'`�cor.�/art�ifeJ co`ry�p'(�w)f(See,9g00,Wpb CJ which PARK FEE Y N
Work,
allemploY s dila ;V /�1 v GAS-IiA.5Y.S1EM-I INC.40UTLF,TS Rlirrivra
Policy# BUILDING DIVISION FEES
Coto
[DCCon;Tal copy . GAS-E.A.SYSTEM-OVER 4(EA) PLANCHECK FEE
edified copy is bled with the city inspia i ndivision. GREASFONDUSTRI.WASTB INTERCEPTOR GRADING FEE
CERTIFICATE OF EXHMPTION FROM WORKERSGREASETRAP SOILS FEE
'COMPP.NSATION INSURANCE
(This seai.nneed not N completed if,he pen"it is farina hundred dollars I$100) SEWER-SANITARY-ST'ORM IA.NgIFT. ENERGYFEE
or le".)
I cenify,ha intbe performance of the work for which this panni,is issued,l shall WATER HEATER W/VINT/BLEC'IR
not employ any person in any manner so os m become subject to the Workers' PAID
Compcnsution Lawsof Califomia. Date WATER SYSTEM/IRUATING Datakncipt#
O z Applicant
z C) NOTICE TO APPLICANT.FL after making this Campeau,of Exemption,you should NEW RESI UENTIAL PLMIC SQ,FT. TO'T'AL:
� :1) become ambled al the Worker's Compensation provisions of the Labor Cal,you must
a , forthwith comply with such provisions or this permit shall be deemed!revoked. BU ILDING FEF:
Q CONSTRUCTION LENDING AGENCY SIEISMIC FEE
z I bandy effimt that there is a cnnsoruction lending agency for the performance of
O the work for which this permit i6 i...M(Sec.3197,Civ.C.) TOTAL: ELECTRIC FEE
Lender's Name v PLUMBING REE
O F Lenders Add.... QTY. MLCIIANICALPERMIT FEC
U I certify that 1 have mad this application and state that the above information is
W correct. Iagreemcomply with all city undcounty onirancuand state laws relating to PERMIT ISSUANCE MSCI IANICAL FEE
U1 building constru and bembyauthorim representatives ofthis city menter open the CONSTRUCf10N TAX
V z above-metria d n n f rinspcction purposes. ALTER OR ADD TO MECH.
(We)ae t mnify and kup harmlus the City o[Cupenino agninm
IiuM1ilities,ju gown,co ax,mN,whichmayinanywayacc pallet stmid City AIR HANDLING UNI'TOG IOp00CFM1
in amsprye "oft mi this
AIR HANDLING UNIT'(OVER 111,000 CFM)
Signatumof 1' nConvaaor Date EXHAUST HOOD(W/DUC) PAID
I IAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) [)-are Receiptp
Will,he applicant or future building occupant stere or handle hasardous material
as darned by the Cupertino Municipal Code,Chapter 9,12,and the Health and Safety HEATING UNIT(OVER 100,000 BTU) TOTAL:
Cele,Section 25532(x)'!
❑Yee 1:1 Na VENTILATION PAN(SINGLE RESID)
BOILER-COME QHP OR 100,0110 BTU) ISSUANCE DATE
Will the applicant ants as building by the H.,Area Air Quality
Managemehich nt PAID
haeardous air contaminants as defined by the Ray Area Air Quality Management BOILER-COMP(OVER 100,000 BTU)
District? ���
❑Yes ❑No NEW RESIDENTIAL MECH. SQ,PC (j 1995
I have real the Safety
Code.
materials reyoirt5533 under Chapter first of the 17 J
iftheiindesealth notctyarelyhveatsant,tht it and
Ly to motif that GII4i�t
occupaofbuildinge na,h cuneml which
m st be, et d is my responsibility oil.Cedimify Nf 1
Ooccupant of the reyuiremcm which must be,met prior ns isxnunce of a Ceniticwe of
ccupancy. _
Owner or authonsed agent Data TOTAL: ISSUED BY:
OFFICE
e,r'
CiLN, of,
Cupertiiio
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
2221 Quintemo Court
Cupertino, CA 95014
Subject:2221 Quintemo Court, Permit# 27040 -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
alternative but to resolve your permit as expired and discard the records.
Thank you for your assistance.
Sincerely,
City of Cupertino
I
Prinleo on Recycled Paver