28379 (2) r APPLIC� F,C
Aj�NT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY VP CUPERTINO BUILDING-RLI'RICAL PERMIT NO.
APPLICATION/PERMIT PLUMPING-MECHANICAL 28379
�O �'�(I
BI�ILDING DIVISION BUILDING PROIF,CI'IDEN'TIFICA'TION Go J
HUILDINGCOI�IsRI{i'SYS: y� �S Ave,
SANITARY NO. APPLICATIONSUBMITTAL DATE
O`'•+N Ig/Y1 n y e, UNIT# LO f,N
OWNER. NAM;: • PIiONF:r COM NAC]OR:S NA P: •� OC N0.
W 5 ppRF�c y JT(/7[2.1
N/C CONTROL p
ARCf UP(7OLNGINEER: LIC NO'. A Is �rm� ST7 ❑
CONTACT: PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEF,
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE, t no
❑ ❑ ❑
LICENSED CONTRACfOR'S DECLARATION APPLIANCES-RESIDENTIAL [N
004% Thereby affirm that l um licensed miderprovisions of'Chaplains ocomanowingwilh 71,
SCRIPTION
�00 Section](100)of Div ionJof the Busineu onJ professions Code,and my liana is in PANELS
CDU_ fan fora and effect//f#-� '�I^� 4
4 ty License Class�lZ Lfc.# // UPT02MAMPS / ' G �
vFi?ve Uam Cnmme G 201-IMO AMPS M l/
20v'i? ARCHITECTSDECIARATION OVER I(NIB AMPS SQ.I.T.FLOOR AREA SISQ.Fr.
O z—O I understand my plans shall be used as public records.
F_E ea SIGNS HLEC'RICAL
4,L fol..1 Licensed Professional
S�CQ or I am
front
nt the Contractor's
, SPECIAL CIRCUIT/MISC.
2,62.00
axOC, 1 ngrne erg(Se thm um exempt from the Cantmcmra Licensee Law for the
W 3 wwhichfollowingrequires
is exam,1.to31.5,Uusivmsmpr. Professions h,or b,An,ai ciry ,tradmy TEMP.MITTEN OR POLE INST.
ts'�J which rtquires a peat os n,res the afore improve,demolish,or rtryoig any awerrt
Kt�s rC, Chior to its t be
lcensed ,also...an,,to
the
theappllcamfor the ch Cmdcrmitm Licele a seLaJstatement POWER DEVICES
p)CQp that9(com sncinwithSction7h )of Division
Sof Ce Business
License Lawns Coale)
d6 s 9(cnmmdncing with Section DivisionJof the Rosiness end Professions Code) SWIMMING PoOI.ELECTRIC
xoy, VALUATION
W=rn Sector he is exempt L5byayapplimandme berms for mectsalleged axemanalo Any violation of OUTLE'T'S-SWTICITES-1, 'U
EZQ
Section703 L5 by hundred
dollarsr$500).txnbjects me applicant In ncivil penalty of
not mom than five h ep and Jullars(SSW).
C � ❑ I,lha rnLr dt m n NEW RESIDENTIAL ELIiLTR
� p pe y,ormymnployees with wageaastheiraolecompenmsian, S'I'ORIIiti TYI'IiCONSTRUCTION
will aorework,Com, shn cure is Commnnim icensernffered far sele Pneewdoes not
wrier of
and Professions Code:The Contmcton,Lunare Lew docs not apply m an owner of
propenywyeas,provided
vemeandwnoam not ihwork hintselredmrnughhix
ovanempinyees,providedmproveat impmvemwthin me earof omplleered for sula.If. OCC.GROUP RFS.UNITS
hilderwillhawever.the v l the burden f mem issolhe within build or improetiommmfou,o TOT
builder will have She burden of proving mat he did fora build or improve for purymu of
ales).
❑ Lii,iwmar it
p.jf]Is(See.70y . exclusivelycontracting,with Thscvmhhoutm o QTY. M I G PERMIT' E FLOOD"LONE ppry
constrLicense the oss not(Sec.]044,Business and Pmfemionx Crimp The Comon.add PERMIT Iii-���������� fRE
who contracts
not epplymanownernfpmr(s)I wasedpurs improves thereon,end aatsNpCl(
whncomractsfor such pmjectswith ncnmrazmr(e)IicenseJ pursuant to the Comma°rs
Liberec Law. ALTER-DRAIN&VENT.WATER rA
) FEE SUMMARY
❑ 1 and exempt under Sec. ,B&P C for this mused HACK FLOW PROTECT.DEVICE UTS D'
SANITARY Y_N
Owner Date DRAINS-FLOOR,ROOF,AR EA CON WORKMAN COMP FNSATIONDECLARATION # )SCHOOL
YN
❑km,'
penrmmaInsura Insurance
Or
ccmeof aracmmof(Sesure,o,Lrh C.)are ofwhich FIXTURES-PER TRAP RIiCE1Pfp
Wnrkec CompcnsoOonlnsurance nnmertiOeA rnpytherenf(SecJg00,lahCJwMch PARK FEE Y_N
ersall employee's underthispennit. GAS-IiA.SYSTEM-1 INC.40UTLL-f5 RECEIPT#
Policy# Alla BUILDING DIVISION PEES
an.
Company ./i{1 •.y Ops-EA.SVS'1'EM-OVER4(EA) PhANCHECK FEE
Cm'edcopy is hereby famished
❑ Candied copy is riled with the city inspection division. GREASIVINDUSTRL WASTE INTERCEPTOR
GRADING EEE
CERT IFICATIi OP EXF,MPFION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
('This xctianneedmd be completed ifthe permit is fortune hundred dallars(SIM) SEWER-SANITARY-STORM EA.]00FT. ENERGY FEE
ar less.)
I certify that in me performance oftbe work for which this permit is issued,I shall WATER HEATER W/VF:NT/ELECI'R
not empby,any permn in any manner m as m became subject m the Workers' PAID
Z CFplmpensetionlawsof Cohmmie. Dam WATER SYSTEM"FATING Date Receipt#
Applicant
z 0 NOTICE TO APPLICANT.If,after making this Ceniricatn of ExemptM.1,0ushould NEW RESIDENG]AL PLMB. SQ,IT. TOTAL:
V) become subject m the Worker's Compensation provisions of the Labor Code,you must
Ki , fimhwith comply whh such provlslone nnhis pertnit shall ba damod mvokeJ. BUILDING FEE
Z
CONSTRUCTION LENDING AGENCY SEISMIC FEE
1 hereby of inn that them is a consmuction landing agemy for the perrrnmwce of i 61-00 O
V O the work for which this perm,is issued(See JOY],Civ.C.) TOTAL: ELECTRIC FEE
Lcndc/s No. PLUMBING FEE 2. O
O F Lend Ic Address QTY. MECIIANICAL PERMIT PEE
V 1 certify age mm 1 have twit this application and arrow mut the above information is MECHANICAL FRE
building Construct amply with al amhornd representatives
ofanJxtam laws r upingm PERMIT ISSUANCE .n
h-'
building comhuctinmand hereby prpo,eentmives ofmiscity,toemerupon the I✓ CONSTRUCTION TAX
V 7 shove-me) goo,
property for indemnify
and pts p herd ALTER OR ADD'1'O MSCI I.
E'7
(We)agree to save.Indemnify and kap harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in my wayacamengainst skid City roAIR HANDLING UNIT(TO ULOW CFM) / QA
in e sequenec of the granting admix permit. V
NR HANDLING UNIT(OVER 10,000 CPM)
Signature of Applicai/Contractor Date EXHAUST HOOD(W/DUCO PAID
HAZARDOUS MATERIALS DISCLOSURE, ' I fEA'TING ON]](To 100,0100 BTU) Date Receipt#
Will the appliceno orfmore builmngoccupantsmrt or hmulle heurdoos material ❑GATING UNIT(OVER 100,0010 B'I'll) TOTAL: S
as died to]by the Capertma Municipal Code,Chap...9.12,and the Health and Safety
Code.Section 25532(e)1
Cl Yes 11 No VENTILATION PAN(SINGLE RISID)
Will the spplicantorfuiumbuildingoccupanI use equipmenmrdeviceswhich emit
UOILEIt-COMI'(31lP OR IIp,0IX113TU) ISSC ATC
havict? air comeminants as defined by the Bey Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) DEC 111995
District?
❑Yen ❑No NEW RESIDENTIAL MliCll. SQ.FT. //ss pry %C ! t�L1
I have rear)the hasardes,vmteriala mcIiihemcros maker Chapter 6.95 of me y�l 1 Vr Vur Lf171N0
Curfomim Health&Safety Code,Seamans 25505,25533 and 255]4.1 undwntend that
if the building does not currently have a tamnL that it is my responsibility in notify the
arupant of me requirements which must be met prior m issuance of a Cenificate of
occupancy.
Owner or amhonud egem Data TOTAL:11 I ISSUED BY:
OFFICE
Pc
10300 Torre Avenue
Cupertino, CA 95014
of
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
September 25, 1996 eL�������.
Homeowner
10560 Rampart Avenue
Cupertino, California 95014
SUBJECT Furnace/AC, Permit 428379
Dear Homeowner:
We have been cleaning out our files in the Building Department, and contacting those
people with permits which have remained"open".
• According to our inspection records, the subject permit has never been finaled. Many
times an inspector will sign the permit in the field, but neglect to report all of the
information to the clerical staff for input into the computer. If your records show the
subject permit as finaled,would you please contact us so we may complete our records?
If the permit is not signed off your permit can be reactivated and an inspection could be
scheduled for final closure of the permit
If we do not hear from you within ten (10) working days, we will dispose of the file and
remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
Punted rr Pecyclon Psoor