07770 (2) APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES,USE BALL POINT PEN ONLY
CI'I'YOFCUPF.RTINO I -EL, I A. PERMIT NO,
BUILDING DIVISION APPLICATION/PERMIT PING PRNG CITIJEANICAL
FICA 27770 7 7 7 0
BUILDING PROJEt:'T IDI:N'1'IFIf,ATION L r
BUILDING
/ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
W O�I✓Y�OSa..I
OWL '. UNIT# LOT
OW}Vli SNAMF:: �� I'110N& _ CONTRACTOR'S NAME: LIC ND:O�� 7
I�L ✓ ' N/C CONTROL.#
�ARCHITECr/ENGINL'PR: LIC NO: ADDRESS:
S 003 PIC- 1zo
CONTACT: PHONE: QTY. ELECTRIC PERMIT FBE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE ❑ RE El El
n IR
LICIiNSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
py.Z Ihereby affrrn that l am licensed underprovisionsol'Ctapter9(commencing with JOB DESCRIPTION
P400 Section]000)af Divisimt 3ofthe Businessond l'r.fexsi.neCode,and my license is in PANELS
yVE full to
Srce and orrery 10 S� �+"l2 `Z:ff
FZu1 Liunx Class [i Liap 10 V UPTO2WAMPS
Nay DuleContractor 201-11100 AMPS
ZOy� — ��SDECLARATION ' OVER IOOO AMPS SQ.FT.FLOOR AR EA $/SQ.IT.
O Z^ 1 understand my glare sM1all M1e used as public reands.
W SIGNS ELECTRICAL
Liwnsul Professional
OWNER-BUILDER I DECLARAI ContraION SPECIAL CIRNIT/MISE.
.Et, I hereby affirm that I am exempt from the Cocoons Co e:My
Law for the
1i13O to following mason(Section]031.5,Business and Professions Code:Any city coronary TEMP.MET'F.R OR POLF.INST.
y which visions a permit to construct,otter,improve.demolish,or repair any mmaure
poor o its issuance,also requires the applicant for such permit o file a signed statement POWER DEVICES
pj 00K that he is licensed pursuant to the provisions of the Commmors License Law(Chapmr SWIMMING POOL ELECTRIC adoLL 9(commencing with Suction]000)of Division 3 ofthe Business and Professions Cndel VALUATION
y Mo, or he is exempt herefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIXTURES
4 Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of
not more than five hundmd dal tars($500). NEW RUSIDI3NTIAI.P.LECIR —SQ.FT.
W ❑ I,nsownerof the xnSTORIES TYPE CONST'RUCT'ION
prof y,ormyemploye swish w.gce ae theirsolecompeasution,
S _ will do the work,and the structure is not tendo moffercdforsdo,(Sec.]044,Business
and Professions Cede:The Cont cluesmL' Law does nm apply to an owner of
properly who uildsorimpm tl dw does such work himselforthmugh his
nwnempiny ,p vi h t ch ent menotinterdermroffctdforsele.If, OCC.GROUT' RES.UNITS
however, c 'di rot emissoldwlthinon omptction,the.wner- TO r1
builder wit ebur nn mvi h of q a prove for purpose,(
sate J. / APN
❑ Las ow r the In
nye a ludvel conuuctit tmicensedcontmctnnm QTY. PLUMBING PERMIT' FEE FLOOD ZONE
instruct'its protect(Sou. , and Professions Code:)The Contractor's pERMI'1'ISSUANCE
License Lawtl.es not apply In w cwnerofpr,peny who builtle or improvice therron,nnJ
whocommms mrsuch pmEO.with.canna qe)licensed pursuant to the Contmcmr's ALTER-0RAIN&VENT-WATER(PA)
License Law. FEE SUMMARY
❑ 1 am exempt under Scc. B&P C for this rcaum BACK FLOW PROTECP.DEVICE OUTSIDEFEES
Owner Date
SANITARY Y N
RECEIPT
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF.AREA,GOND, SCHOOLTAX YN
❑ I hereby affirm that l have a cerifica,e ofconsenuo self-insure,oracenilicate of
W,rkors'Compensaty Insurance or acenifled copy thmwf(Seo.3g00,Lab CwhichPIXTURPS-PER TRAP RF.CF.IPf#which PARK PEE Y N
cover,.11 employee's mulenl,is permit. GAS-FA.SYSTI?M-I INC.4 foun.ET,S RECF.LPT#
Put icy# BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) P)ANCHECK FEE
❑ CuriGd copy is herehy famished.
Certified dopy is filed with the ciry inspection Division. GRFASFJLNDIISTRL WASTE INTERCEPTOR GRADING DEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(TElssemionnceal not hec,mpldd ifthepermit is foraoohWdrddollars($100) SEWER-SANITARY-STORM EA.200n. ENERGY FEE
,or low")
I ceddythm In the performance of the work for which this permit is issued,Isholl WATER I I IiKI'ER W/VENT/ELECTR
nut employ any person in any nernme,so as In become subject m the WorkersPAID
Compensation Laws.(Celifomia. Data WATER SYSTEM/TREATING Date Receipt of
O z Applicant
z Q NOTICE TO APPLICANT:If,after making this Ceni&are of Exemption.you should NEW RES)DFNTIAL PLMB. SQ.FT. TOTAL
I"' rn become subject o the Workers Compensation provisions of the Labor Code,you must
� ; forthwith comply with such provisions or this permit shall he deemed revoker. BUILDING HE
LkI Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
z Ihereb ...r hat then, uc,naructi,n lending agency for the perfommnecof
O the work for which this permit is issued(Sea 3097,Civ,CJ TOTAL: ELECTRIC FEE
Lender's Name
OF Lenders Address QTY. MECHANICALPERMIT FEE PLUMBING THE
V 1 rectify thin 1 have read this epillusion and ambethat the above information is
correct.I agree to comply with all city and county ordinances and state laws reltaingto PERMITISSUANCE MECHANICAL FEE
�^ Do, buildingemosauction,and hereby authorize representatives ofthis city to enter upon the CONSTRUCTION TAX
V Z above-mentioned progeny for inspection purposes. ALTER OR ADD TO MECH.
(We)agree to save,indemnify and keep hannlesx the City of Caperton,against
liabilities,judgments.costs and expcnseswhich may in any way accrue against said City AIR HANDLING UNIT(TO 10,000 CFM)
in c.ousegmmn nanthtg of ihisp it.
�'_ J� AIR HANDLING UNIT(OVER 111,gN)CPM)
Signature of Applicam/C,mractor Date EXHAUST HOOD(W/DUC) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,0(10 BTU) Done Rtteipt#
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(OVER 100,000 BTU)
us refined by tn
he Caption.Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section
Y s32(a)'! ❑N VENTILATION PAN(SINGLE RESID)
BOILER-Cf3MP OHP OR 100,010 BTU) ISSUANCE DATE
Will the applicant orfmurcbuilJing occupant me equipmemordevices whicbcmit 11
immune,ail comaminams as dcfind by the Bay Are.Air Quality Managemem BOILER-COMP(OVER 100.000 BTU) f A 1 D
District?
❑Yes Cl No NEW RESIDENTIAL MECH. SQ.FT. '�r,MK ArIA F� 2 1 (SS
I have read the hazardous materials requirements under Chapter 6.95 of the 9J
California Health&Safety Code,Sections 25505.25533 and 25534. I m odentand that '
if the bui lding does not currently have a tenant,that it is my responsibility,.notify the �"I (fir gym,,
enpom.Tobe requlrcmcros whtab must be met prior m Iseuanca of a Cartilicmc of LVO
Owner or euthoriuJ egcm Date TOTAL: ISSUED BY:
OFFICE
Citv of
Caperthio
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
8005 Rainbow Drive
Cupertino, CA 95014
Subject: 8005 Rainbow Drive, Permit# 27770 -Spa
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 � 1
i
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