26143 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING—ELECTBICA. PERMIT NO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING-MRCHANICAL n C aI /I
BUILDING PROJECT'IVEN'1'IFICA'1'PON L o 1 LI
❑UILUING ADURESS:�/k A .�1 /`1�`�/- SANITARY NO. APPLICATION SUBMITIAL DATE
Z / ml&W b UNIT LOT p assists' �
JOW,NIzRSN.yNE: e �SjIONE: CON'T'RA OR'g NAML': LIC�O: N/C CONTROLN
G 7 l3 aver �"'c U SL L�3
RCHI'IEC /ENGLNEHIC LIC NO: ADDRESS: ❑
G �bo6/ —USI CAl,' fr!
CONTACT: PHONE: �iTd"rt u' 1EraS K'k.$¥S 4#L`- R r '.BUILDING
a L a ELE�RIC ." '.FEE, . 'PERMIT INFO
PERMIT ISSUANCE '3 BLDGE PLUMB F:ClI
LICENSED CO CTOR'S DECLARATION APPLIANCES-RESIDENTIAL pYRERIPfION /1
Amz IherebyalfirmlheTlamlicen dunderprovisions of Chepmr9(commencing with «+
=OOtE' fulliforeemdelfalvrsion3of the usmesa e�/fda�Professions Gde,and my license is in PANELS G� `
15NL' Cmars Y Ij UPT02W AMPS VW
,F�-D y me Conlrucmr , 201-1000 AMPS
Oyt CHITECTS DE O SQ.FT.FLOOR AREA $/SQ.IT.
O'Z N O 1 understand my plans shall be used m public records. OVER IOW AMPS
FN W�,r SIGNS ELECTRICAL
J
a LiccnsW Professional
am
OWNER-BUILDER DECLARATION SPECIAL CIRCU91MISC.
OaF 1 hereby infirm not I am exempt from the Contractor's Liecnse Law for the
W ¢ following mason.(Section 7031.5,Business and Professions TIE
Cade:Any city or county TEMP.MER OR POLE INST.
which requires a permit to construct,alter,improve,demolish,or repair any someum
2 N 'mono its iasunam,also remora the applicant Forxuch permit to filen signed statement POWER DEVICES
CCy�'f' a Oz that he islicensed punuent to the provisions of the Contractor's License Law(Chapter
d�o�LL 9(commencing with Swims 7")of Division 3 ofthe Business and Professions Cade) SWIMMING POOL ELECTRIC V^ALUATION_y
orthe h7031.5 y tyappomand the Permit s bjeasegeapxemant to civilf family
of OUTLETS-SWITCHES-FIXTURES 2 / imi A,
Fla Smlino,non than v eundredido])for(15M).it subjects the applicant to ecivil penalty of t(f
90 not non.thanfivehundreddollarmSSW). NEW RESID LfiGTR _SQ.FT.
�22 ❑ Linewrk.andeestructy,mmyemplayeeswlThwaidlfor hei(Sm.c0m, nsaaon, STORIES TYPU.CONSTRUCTION
y'3_ will dmhewons and the he Geo is terot inmicense naw do fors t apply 1.
an owner
of
and Profusion Cade:The Canthrrma,License Law does or apply lf an owner of
property who buildsotimprat such
Thereon,undwhodassuch work haufferedthrough his
ownemployees,proviJN that sudlimprovemen¢wenoT imm�ded oroffereJ fvrsde.If, OCC GROUP RL'S.UNITS
however,The building or improvement is sold within oneyearofcompletion,the owner- TO
builder will have The burden of proving That he did wybuild or improve for purpose of
sale.). T
El1,asownerofthepTueay,aniaclusivelyconuacdngwithlicenadconwctorsm QTY. PLU 1 P- MIT IBE FI.00D ZONE "N
onswct the novice,(Sec.7004,Business and Prmfession Cade:)She Conracmr's PERMIT ISSUANCE
License Law docs not uppl y re un owner 0 f pro,Ay who bei ld x ar int prov es theteun,end
ad
who contracts for such pmjacs with a com nctort9 licensed pursuenuO the Comrncmrs
Licene Law. ALTER-DRAIN&VENT-WATT ) FEE SUMMARY
❑ 1 oro exempt under Sm. ,B&PC for ibis reasen BACK FLOW PROTECT.DEVICE, O 'SIDE 'LES
SANITARY YN
Owner Date. DRAINS-FLOOR,ROOF,AREA,CONI. RHCEIP1'N
WORKMAN COMPENSATION DECLARATION DRAINS Y N
❑ IherebyufEsmthm i have a cedificam ofcomanuo self-inners,ora cenifceeaf FIXTURES-PER TRAP RECEIP 4
Workers'Compensation Insurance ora certified copy lheaof(Sec.31 Lab C.)which PARK PER Y_N
covenullemd.,ce's cancerous permit GAS-EA.SYSTEM-[INC.40UTLETS � RECEIPI'p
Policy p BUILDING DIVISION FE-ES
_0-40
❑ nifieJ copy is hereby fumishW. GAS-CA.SYSTEM-OVER 4(L'A) PLANCI IECK FEE
Certified copy is fled with the city inspection division. GR EASE/INDUSTR W I GRADING FEE
CERTIFICATE OI'EXEMPTION MOM WORKERS' GRGSETRA~L�/ MEED SOILS PEE
COMPENSATION INSURANCC
(This section need not becompleted Him permit is Intone hundrWdollars($IW) SEWER-SANITARY-STORM EA.20l ENERGY ITE '�
of less.)
I certify that in Ne performance ofthe work for which Nis permit is issued.)shall WATER HEA PER W/VENTIELECfR
not employ any person in any answer so as to become subject to the Worker' PAID
Z Compensation Lawsof Calif rrom. Date WA9'13R SYS9'EM/1'REATING Uatc
Apnt
plica
Z 2 NOTICE TO APPLICANT:If,after making Ws Certificate of Exemption,you should NEW RESIDENTIAL PLMR. SQ.IT. TOTAL:
!-+ (•A become subject to the Worker's Compensation provisions ofthe Labor Code,you must
•�-� ; forthwith comply withsuch provisions.,this permit shall be darned revoked. b BUILDING IEE _r
CONSTRUCTION LENDING AGENCY S17ISMIC FEE
Uz I hereby affirm that them is a conswction lending agency for the performance of / ELECTRIC PEE
O The work for which this pt is issued(Sec.3W7,Civ.CJ
Lender's Name PLUMBING FEE
O F Lender's Address QTY. `"' :MECHANICAL;PERMIT - PEE
C) 1 certify that 1 have read this application and state that the above information is
acomet, l agree to comply with all city and county ordinsuces and state lawn relating to PERMIT ISSUANCE. � MIiCHANICAL FEE
y building construction,and hereby smhonee repreenadvesoflhiscity to emerupon the CONSTRUCTION TAX
V Z above-mentioned property for inspection Imposes. ALTER OR ADD TO MECH.
(We 7 agree to suer mnify and keep hurmlesx the City of Capetian against
liabilitiev,' menu,cv en dexpenses which tneyinany way eccncagains said City AIR HANDLING UNIT('1.0IL"C1+M)
an c cof the gr of this permit.
3 �6 AIR I IANDLI NO UNIT(OVER 10,0W CPM)
ignot o Applicant/ Data EXHAUST HOOD(W/DUCD PAID
HAZAR S MATERIALS DISCLOSURE, HEATING UNIT(TO 100.000 BTU) Date
Will Tbcapplicam or to,..building occupant store ar handle hscardous materiel HEAPING UNIT(OVER 100,000 BTU) T TAC:
us ddineJ by the Cupertino Municipal Cude,CM1upmr 9.12,anti the I Icelth unJ Safety
Code,Section
Yes 13 No 25532(x)?
❑ VENTILATION PAN(SINGLE RFSID)
ISSUANCE DATE
Wi111heapplicant urfuwmbuildingtzcupantuxequipmennrdevices whichemil BOILER-COMP(3111'OR 101,WB B'I U)
harmJous air mannish n defined by the Bay Ams Air Quality Management BOILER-COMP(OVER IMI(KA BTU) pF��
`♦ ,urn? El Yes ❑Nu NEW RESIDENTIAL MECH. SQ.14. P {�
c,J 1 hove road the bmwdoux materials mr,m marms under Chapter 6.95 of the `\ /
California Health&Solely Code.Sections 25505.25533 and 25534.1 understand tbm NAR 16
if the building does nm currently have a moat That it is my responsibility to notify The Q
cupn (]�� /-,//
a. m of ilia requirements which must be met prior to issuance of a Certificate of 9� ;
euPwey_ CITY � ,
Owner or amhorired agent Dote ISSUED BY: l V
OFFICE
®' 10300 Torre Avenue
Cupertino,CA 95014
Cin <lf
Cupeftiiio Building Division
(408)777-3228
(408)777-3333 (fax)
April 23, 1996
Resident
21627 Rainbow Drive
Cupertino, CA 95014
Re: Expired permit (copy attached) /C
Dear Resident: C 'T'zz'c-r�
According to our records, the referenced permit has not 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 (408) 777-
3228, so we may arrange to extend your permit and schedule a final inspection.
The City of Cupertino requires a response within ten (10) working days from the date of
receipt of this letter. If we do not hear from you within this time, the building department
will have no other recourse but to resolve your permit as expired and discard the records.
Thank you for your cooperation,
Building Department Staff, City of Cupertino
Prm(ed on Reevcled Paper