27656 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO liILDL 1i-tl,',I;fRl(:AL PCRMITNO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING MECHANICAL 27656
BUILDING PROJECT IDENTIFICATION
BUILDWGADDRFSS: 1 SANITARY NO. AP1PLICA]TIIOON. SSUMMOTALDAM
�2087S l ✓ eo ✓. UNIT LOT#
�WIci�+_ Nj�??ME: PHONE: CONIACTORSNPPME, LICNO:
yVp1 Wfi v(e� wSoG/cewTEe ✓�(L t�11� rw� NC mnmoLx
RCFITIFCT(FI:GINfFR: LIC NO: AD
.3TSS2 6Q�p. a1Q Ka ❑
CONTACT: PHONE, ' f��1 `.'` i
L QTY. ELECTBUILDING PERMIT INFO
-r RIC PERMIT FEE
BLDG ELECT JB W611
PERMIT ISSUANCE ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RISIDENfIAL JO DIS RIPIIO
1hucby affirm thenI E liana' ACTORS DE DECLARATION
(cmmnocdlry with
]/ y�YV1•lf`
�00 SKtiunT(Xf)of Division of to ButimeasW Pmfin ens Cads,and my liccmc is N PANELS
full f«.<aM cffy. N
FFQZw IJccme Clm] fic.N 70C1107- Up T0200 AMPS
yQd Due Cmtmctm 201-LAMPS
FN/,. ARCIITfEcTs DECLARATION OVER I"AMPS
SQ.FT.FLOOR AREA 5,5U.IT.
O Z—O I understood my planes,]hall be usd m Public remi
rr,ont W SIGNS ELECTRICAL
Liccmd Rofc4imal
Z�dS OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC
xd0 y V I hereby affirm that 1 ern ,.mrstBuoib form the CmorriaCs e:Any
law co clic
u13 ay
follow ingramto.(SnSim IDJ 16,Btuitea.m more. xsi«u Codrne su city«cooly TIiMP.MISTER OR POLE,INST.
which iv iomepotnit to o«umtctdrn.iotly vsoch tWish.ore.si,artyatern ort
E }� prim to irsc4unnce,alwrtgtort, eeisio nlf«]ucwtrout=to lofikati& w(Cemrnt PON'FR DEVICES
<py IoW he in lion Upurwwd In ilio provi]inm of the Cmtrvctor's Licrnu low(Cmptn
aMLL 9cormrcrci SWIMMING POOL Ft cCTRIC
( xemith5ssiomand!the Divuim JM the BasireasaoW P AnyvimCodc) VALUATION
yt'4_',w mlltatlei3 L5 by
yg,,omWra berml sbfor callegd exern,Mlicam to 6v 11
of OUfLE1S-SWITCHES-FIXTIIRIS
t_� Sntiun da
Sby anyappl'tdollarsrzafcrmil suhlKla ilio opplicant loticivll pemlty of
rot n ,rt oh rive hwdtcd yl mSS(lo).
rr0 NEW RESIDENIIAI.ELECIR _SQ.FP. ;CONSTRUCTION
3F� ❑ I,esownnofthe propertY.«mYemlyoYcuwichweynasrhelradecompcmatim,
d _ will dochesom.vtdde he,Cor isbax"1nddmo.does,not.Sec.T(1an,Bt]vrt of
and Profusions Cade:Tic Cmbecur a liarue law don tr«apply m m owns M
propcny wMhuild]«impovn thcmm,arrd wMdousuch work himalf«duough hi]
cmployKs.proviJcllhuauchimpmvcmrnuart rt«irttrnhd«otfcrd(mule lL .GR P RFS.UNITS
havevn.Ile M1ulldioy«intpwvenrnti\wd within orc y�ofcaorpkvm.Ne owrar- TOTAL
builder will have the burden of proving that be did ret bei W«Improve for purpee of
sal`)' QTY. PLUMBING PERMIT FEEFLOODZONE APN
❑ Lv owrceoftt(Nm. unesirem lYcorracting wi rbde:)'d ContiI
coMNcl Nc prnjKl(.SK'..]TIM,Bu]irc4 vitt Profc4imn Cud[:)The Cmtreclor']
I�cemelaw dors msepplY loenowrerofpcopenywho bulldsmirnpwvn Jertan.W PCItMD'ISSUANCI; r
whacmlrslaf«wch pojcclswilhamhrenMa)Iicctucd pvsuanOol6eCmtrrlala
ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
IJanm law.
❑ I am esempt tmder Sec. .B&P C fsrIbu tenon BACK FLOW PROTECT.DEVICE E
SANITARY N
Owner —Dan— DRAINS-FLOOR.ROOFAREACOND. CEIPTM
WORKMAN COMPENSATION DECI . , ,.VtATION S N
❑ IhertbY efBem thulluveacaufivs,ofmnvw to xlf-imure,macertifiNeo! FlS- .�P R ,IPI'I
W«kna'Cmtpcnaim Immvac ore anifod copy cM1emrf(SK.JWIO,tali CJ which N
ro.cn ell employe i unkr this pvmit. GAS-EA.SYSTEM-I INC.J OVTFTS ESI N
policy N G DIVISION FEES
Corr,my GAS-EA.SYSTEMOVER C(EA) RECK FEE
❑ Cerufiedcopyis M1ercbyfmnishd.
fK Certified copy is riled wiN the city inspection division. GREASERNDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS GREASETRAP SOILS F'EC
COMPENSATION INSURANCE
(ITig seOion«d not be mmplued if hs,Permit is for me hwtdrtd dollars is ld0) SEWER-SANITARY-STORM RA.2()OPT. ENERGY HE
m Ra)
I sonify that in rhe PMearanttcx ofthe work for which this seroir is i]aved,I stall WATER I IEATFR WATNI'/F.LECITt
not employ any person in any manse,]o es tm be,,.subject to tM WMers' PAID
Compemadonlawsof Cahforman Date WATERSYSTEWREATING Date RacciMN
O Z Applicant
Z C NOTICE TO APMICANT:if,after making lhi\Cetti Ocaeof Esempdm.youshould NEW RESIDENTIAL PIMB. SQ,FT. TOTAL
(/, became,subject to the Workers Comptmmwn pirmoucm M Joe Labor Code.you cowl ' 3N V BUILDING IT+P
> firm illi comply with nosh proviniora or chi\Permit]hall be decried revoked. IV
ELI t � 1 SEISMIC PFJ:
Q CONSTRUCTION AGENCY �?QILJ tLTIU(r S Tc(
Tic for hick tIhet ttert i]•cued(Seim 7, ency f«IM1cpMrmmuee of
V O the work for which Nia pemur i.I]wd(Sec.J09I,Co.CivC.) TOT � ELECTRIC FFP
i" de
I<or']Name
L PLUMBING TEG
5 lV; Lt,wcr.Adem�r QTY. MECHANICAL PERMIT FEE
Lu 1 senify Jut I have read thia applicetbn and arae Nat de above Infomuum is MECUavNICAL FEE
�"' core". tomes to mmplY wiN dl<cry vd roomy«dinuen end nett lawn rcWiny to PERMITISSUANCE
F-' buidiny cotwr«lim.orW leteby autMriec rtprccntauvn of this city to corer upon the CONSTRUCTION TAX
V Z shot rtendmed Property for impKlion poUx . ALTER OR ADD TO MECH.
.- (We,)times,to mve,i dcmrdfy aM keep tum lea the City of Corset attaiw
linhiliti 'udgnenta.coetsan cxKmcs hichoor,manywayuccu<aguiw Clry AIR I IANDLINGUbt IO,0P0CFM)
in conof Noy u is
AIR HANDLING UNIT(OVER 10,000 CFM)
S7,au cf Appli d'C me" EXHAUST HOOD(W/DUCI)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TD 100,000 BTU) Uuc Rivet,N
Will rhe applicant or futurt building ocmp]mt store or lout haaard«u matmd L
v dcfoerl by the Cupenirto Municipal Code,Chapter 9.12,sod the Health and Safety HEATING UNIT(OVER I00,000 BTU)
Code,Semm 25532(•)7
❑ye, C]No FNVTRAt'ION FAN(SINGLE RFSID)
ISSUANCE DATE
Will doe ytpliwtr or forum buildingoccu,rot u\ecyuiprraNt«devlca wWchemil BUII.ER-COMP(3HPOR I00.00OBTID {�
be:udws au cmtaminamt es defued by the Bay Area Air Quafit,Muugemenc BOILER-COMP(OVER I(IO.IKKI BTU) I�
Iatric„ q 1 0
❑Yes ❑No NEW RFSIDFMIAL MF.CH. SQ.FT. A'O1' n
1 hove rod the haaardoo]materials re9uiramrnrs under,amber 6.95 of the 'v / >�
California Health&Wety Cade,Sections 25505.25533 arW 255M. Imdernad chat 0
iftheWilofberoc notcurrentlyybaveast b, et itumyrestrec of a ei nobly list � c��r •��{ J
«c a tbni of the Rgn t scat which ati ai mel prim to res ore of a Ceniobly lof �h u Wit./ �/}_
Occu y `+ C'a .
1
OwnK«outhoriccd egcm Due TOTAL ISSUED BY:
OFFICE
• x-�r
Ci U' Id,
Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408) 777-3333
September 26, 1995
20875 Valley Green Drive
Cupertino, CA 95014
Subject: 20875 Valley Green Drive, Permit# 27656
Dear Sir$,
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
• L-Z C7,- Ojq
Primad o.:i Paper
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