27878 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OFCUPERTINO x U.DI G-ELF.CI'RI AL PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 27878�f Q O
BUILDING DIVISION BUILDING PROJECTIDENTiFICATION L r o 0
SANITARY NO, APPLICA'I]ON SUBMITTAL DATE
'F/IF//✓l.pV UNITM LOT
Uval p}If1Ni _ C BA�1'Ok'S NAME: LIC NO: �J
LrQ!/N/i1{/J. I4(//G�i/( 'U NIC CONTROLp
ARCIf11'HC'17I zNGINEHR: LIC NO: ADDRESS: ❑
CONTACT: PHONE BUILDING PP.RMIT INFO
QTY. ELECI'RIC7ERMIT FEE_ BLUG ELECT PLUMB MECII
PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDEN'T'IAL JOB DISCRIPI'1 N
Qyz I hereby affirm thin l and licensed under provisionsof Chapter9(commencing with
Id00 Section70010)ofDivision3oftheBusinessandYrofeeamsCode,endmylicenseisin PANELS
ytF full force and affect.
FZm License Class Lic.If UPT02MAMPS
m m Date Coulmour 201-IIIW AMPS
zo,z ARC)I1 rHCTS DECLARATION OVER I"AMPS SQ.NI'.19.0011 AREA $/SQ.IT.
0 Z"10 1 undcremnd my pWm shall be used as public records.
F rn t Iv SIGNS ELECTRICAL
6y�� Licensed Professional
L yw6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
4a�O a.0 1 hereby affirm that I it.exempt form the Cmdo mr's License Law for the
W3wti fallawing reason.(Segion 7031.5,Bminessmtd l'rnfessionx Code:Any eitynrcoud, IFMP.METER OR IDLE INST,
0 1ON¢ which mfores u permit to construct,alter,improve,demolish,or repair my structure POWER DEVICES
;!(>.2 prior to its i.ssuance,also reyuims the applicant for such Permit file a signed sta¢mem
ea;_0O Nm he is licensed pursuant to the provisions of the Contractor's License law(Chapter
la. rree 9(commencin with Section?fl )of Division 3 ofthe Business and Professions Code SWIMMING POOL F.LECfRIC
xoly (commencing ) VALUATION
W_y onbet he iv exempuhercfrmn and the basis for the alleged exemption.Any violation of
[. 4 Section 7031.5h applicant for permit subjects then Ilennunt clv0 OUI'LI.TS-SWITCHES-FIXTURES
^� y any app P 1 Pp Penalty of
C mnt ml,mownfvehundreJaollurmyemp. NEW RESIDENTIAL ELECIR SQ.FT.
n❑ oche wok,and the openy,ormyemswithwed farsthei(Sm.70mpensiiessSTORIES TYYF.CONSTRUCTION
y will do lesions and e:The Contisnm intendediversero w do s not apply to an wrier of
and Professions Cade:The Contractor's al who Lew such
not apply to an Owner of
propertyloyms,rovidmproveuchereogandwho Jeensuchwork orofffor through his
owneer.],aes,provlded Ndtsucment is vememsainne intended theafiersae.lf, OCC.CROUP RES.UNITS
howeveg0l have
burden
ofpmentishat he iinaneyedr or improve for
theownc f ,T
builder will Lave the burden of proving Nm he did not build or improve for purpose of
CI I
❑ Le, he ,JoNe See.7 y, . e sines lycontract,imes C da:)The Contractors QTY. PLUMBING PERMIT PEE FLOOD ZONE. APN
onswm the project(Sec..fano Business and Professions Culex)The Contractors
whoco l.uw does forsucapplyto with aerofpfopcdy who buildsorimpro the Contua,aml PERMIT ISSUANCE
License Law.
forsuch projects with acontroaorts)licensedpursumn to the Ctnvannr'x ALTER RA
License haw. IRA) FEE SUMMARY i
❑ 1 am exempt under Sec. ,B&P C for this meson BACK MOW PROTECT.DEVICE OU SIDE.FIMS
SANITARY Y_N
Owner DateDRAINS-FLOOR,ROOF,AREA,COND. RECEIVE If
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y
❑ Thereby nfOrm Nmlbuvouceni0ute of wnsam to solGimvremacedl0cum of
Worker.'Cnm FIXTURES-PER TRAP RECEIPTX
pensetion lnsumnccoreceni0ed copy Neinof(Sec.3AW,Lab CJ which PARK FEE Y_N
rsoveratill employee's under Nis permit GAS-F.A. LET'S A.SYSTEM-1 INC.4 OURECHIPI'X
Policy X BUILDING DIVISION PEES
Company GAS-FA.SYSTEM-OVER 4(EA,) PIANCHECK FEF,
❑ Cenilied copy is herehy rtmakhed.
❑ Cenillttl copy is filed with the city inepuctinn division. GRIA.SIVINDUSTRL WASTE INTERCHPI'OR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERSGREASETRAP SOILS PEE
COMPENSATION INSURANCE
(Dr,.,firm need not lx completed ifthe Permit is for one hundred dollar($[III) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
m less.)
I certify that in the performance of the work for which this Permit is issued,l shall WAIT FR REAMS WNENT/ELECTR
not omploy any .on in any manner so as to become subject or the Workers' PAID
Compensadm awsof Colifomia. Date WATER SYSTEM/TREATING z Applicant Date Receipt If
O O NOTICEI0 APPLICfANT:IL after mukingthis Certificate of Exam o n Q FT.
pC ,youumuld NEW RESIDENTIALI'LMB. 5 .
tz-• VJ becomes comply
o the Worker's Compensation provisions emt hall do the deemed
evoked, mint TOTAL:
ta^ ; fonhwiN comply with such provisions orchis permit shall be deemed invoked. BUILDING FEE
0. CONSTRUCfIGN LENDING AGENCY SEISMIC HE
z I herehy affirm that there is a construction lending agency for the performanceof TOTAL: ELECTRIC FEE
V O Ne work for which this permit is issued(Sea 30Y7.Civ.C.)
V Lender's Name - PLUMBING FEE
0 Lender's Addross QTR, _MEQIdANICAL PERMIT P F
1 certify that I have read this application and state that Ne above information is
cnmxtl agree to comply with all city and county ordinances and state laws rattling toPEkMI'f ISSUANCE MIKE IANICAL PER
F' y building construction,and hereby nuNonm repsomadves of this city to enter upon the
V Z above-mentioned property for inspection purposes. AUIRR OR ADD TO MECH. CONSTRUCTION TAX
(We)agree to save,indemnify and kap Iwnn ass the City of Cupertino against
liabi lilies,] gments,corn undcxpenses which may many way acerae against said City AIR I IANDLING UNIT(TO 10,000 CPM)
ce of rimailt okisolieurnal a /3I
AIR I IANDLING UNIT(OVER 10,0(11)CFM)
,igausame of A,licantlCommctorDme EXHAUSTHOOD(W/DUCI)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt p
Will the applicant or future building odemamsmre or handle lomadom material ❑EATING UNIT(OVIiN 103,000 BTU) TOTAL:
ns defined by the Cupertino Municipal Cade,Chapter 9.12,and be Health and Safety
Code,Section 25532(x)?
11 Yes 1:1 No TIVENLATION FAN(SINGLE BESIDE
Will the applicantnrfmuinbuilding occupant uscequipmcntnrdevices whichemit BOILER-COMP OHP OR 100,000 BTU)
ISSUANCE DATE
•hmciandiv wminantair cnns ru defined by the Bay Area Air Quality Management BOILER-COMP(OVER 1110,000 BTU)
Dde,? {ry n f/�
❑YLiflhabdildm,rlav�,um.mamly
s ❑No NEW RESIDENTIAL MECII. SQ.FT. it A P D
read the h seam us materials reyuirametns under Chapter&95 of the
California Health&Safety Cade.Sections 25503,25333 and 25534. I undemand Nm MAR 3 0
g does um.mamly hovealant.Nat itismyinspeamibilitytoamitythe
the reyuiremen6 which must he inn prior m issuunue of a Certificate of
\ ChonrN agent Data TOTAL: ISSUED BY:
OFFTUE-
&-' Citv
of
Ctipertirio
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
10489 Rampart Avenue
Cupertino, CA 95014
Subject: 10489 Rampart Avenue, Permit#27878 - Two Outlets
Dear Resident,
According to our records the above mentioned permit has never been fmaled 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
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