27154 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-lh, C'R A. PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-SIECIIANI
BUILDING IU
PROJRCTENTIMRICACATIUN 27154 G71 JC A
1•�
BULLRING ADDRESS: 1 `_ I SANITARY NO. APPLICATIIXJ SUBMfTTAL DATE161 alv(_
I
WNI:RS NNA ��rA, �PFIOt�•y� CON'Itf� Q y4Apt'�'f•`J LU(�`�A LI�P��"I
�"'fV/ 'TSS rr ��a•�1 �G /�/VN\Yt1"7/1 ,�.,�/ ',�J�j L NIC COMAOLN
• RCHHECf/ENGINEER: Qi) ADBRESS:.. ❑
Yi I
CONTACT: PHONE QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG EUICry5#U.�MB MECII
PERMIT ISSUANCE E-1 ElT ❑
LICENSED CONTRACTOR'$DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
nxz l hereby aRnn that l em limned unIm provisions ofaapim 9(commencing with
�c
ce
p Snfie ]and rfectvisosn J of the B-into,uoa Rofcraionv Core,and mY license H in PANELS
6Zu1 License Chis Lic.0 UP TO 20f)AMPS f/Y• 1
fn6y Dore ConVacwr NII-1000AWS
Fy>. ARCHf1ECT5 DECLARATION SQ.ff.P.00R AREA
ZOrn— lundenusd mY plw shell be usW mpublic re<mds. OVER IOW AMPS
OZ—O
crY u3 SIGNS ELECTRICAL
a� '] umnN Pror«.iow
�KW< OWNER-BUILDER DECLARATION SPECIAL CIRNIT/MISC.
My06 U 1 hereby affirm 0m 1 am e.empt fon,the Connn r is Lianru Lew f«the
y following rtaam.(Smion]0315.Busineaand Pmrensi«u Code:Anycit,orcounty TEMP.METER OR POLE.INS'.
vb1ch rmnirea.Perm to mn moher,iropteve.demolish,«reP.0 my mmcne
;!tY� prior to no issnrcc,Ww nquims the applicant for och permitm file o signed amtcncnt POWER DEVICES
as gut(corn
is.ccwsl pursuant m the povi Division
of of the u+nota license law(Clupu
c SWIMMING IMMING POOL F�CIRIC
ci ore t he,"ncontSrd.,ro 0it be boo For Sofdr Business and RAny,ioli Cod c) VALUATION
I_Zy «in703121 by aya,,lient f Webet.t sub*ls teJexemgi to civil cin of OVILBfS-SWITCI IES-FIXTURES
1—Z> Sectionhi 121byvnyappliamf«epesmitsubj¢uthe applicaitwecivil penity of
< man ave nmtmea mlWs(ssoo>.
❑ I,as ownerof0epopcny,ormycmpluyceswiih wagcsu meirsolecanspcnsmion, NIEW RESIDFNTIAI.ELECIR _SQ.FT. STORIES 'TYPE CONSI1tUC1'10
�3— will dothcw«sCock, he Conor',Li. ,vchoi for We(Sec.] .onsnerd
asd Profcasiom Calc:The Conuect«'a Liana law des nm apply ro an caner of
pmpenY wM1obuilda mimpmvrs tMrtun,and wM1odaa ouch work M1imaelfmtMe6M1 hie
anpbyces,pvvided mat wchimpmvemenrs ere n«imatMimoffertdr«agile.lf, OROf1P RES.U ITS
however,the bdldin6«improvanent Esold wiBtirtme yevofc«oplN«s,Oeovner-
huildn will have the huoJcn of provin,thin he Jid not build u improve f«purfstscof TOTAL:
sale')' QTY. PLUMBING PERMIT FEE - NE APN
CII.vovserofthc poppy,inn cacluuvclyenrtuectingwith liccmcd conurronm
craelmal Ne project(Sm.7040 Bpbress and Pmfe.aiaru Cude)The Comrecmr's
I.icnue lawdocarw apply men ovnerofpmperry whobuidaor'unprovestherm," PERMrIISSUANCE �
Li .» Law.
La
fmsuch po)ecu wiNaeanurt«(a)limucd puraunnOotheCmnanals ALTER-GRAIN&VENT-WATER(HA) FEE SUMMARY
Lcenu law.
❑ 1 am exmlpt mdn Sec. .B A P C f«this rtnsan BACK FLOW PROTECT.DEVICE SID
SANffAAY YN
DwMr DiaO DRAINS-19,OOR,ROOF,AREA,COND. RECTIPfp
WORKMAN COMPENSATION DBCfAIRAT'ION SCHOOL TAX YN
❑ Ihertby attain thmlhave accniEweofconuntroalbimure.a•artif eNA RECEIPT♦
Watcn Crmrpenution lmurucc«eanifr`iopy thacof(Src.38W,Iab .)w ' PARK PFi Y N
r.all cmpinycCs under Nice pnmLL 1" GAS-EA.SYSTEM-IINC.JOl1T1.IT5 DIVISION& ON
Policy N — BUILDING DIVISION FFJS
C«npany GAS-EA.SYSTEM-OVER J(E)) PLANCIECK FF!
❑ Ccnifim,opyicicrsbyfumit h
❑ Ccnifcd copy is fJM vita Ne ci rupeeno^dlv}� GREASE(NDUSfRI,WASTE INTERCEPTOR GRADING FTE
CERTIFICATE OIt EXEMPTION FROM WO ERS GREASE t'RAP SOUS FEE
COMPENSATION INSURAN
Obis section need not be compinM ifte pmob is f me huncred doll (S ) IEWFR-SANITARY-STORM E.A.2WFT. ENERGY FEE
m IcaJ
I anifY that in the perfmtumc of the v«k which mupemiit Oi shat WATER HEATER WlVEN'171131 GTR
not employ any person in my Dormer w m become wb)eet t Wort PAID
z Compcmatian Lowe of CuliOmia Def WATER SYSTFMITRFJIING Dma Receipt#
Apphc.m
OZp NOTICE TO APPLICANT:ILaf. Ncons�ti�
cnifintcMExpsW ,You M NEW RESIDENTIAL PMB. W.FT. TOTAL:
� ; hccwrro whjcctrothc Wohn's Cvisiau'of 136or C«k,yo must
fonhwiN mmply wilh each it revoked. BUILDING FTESEISMICFEE
CON.STRUG AI herthy efBrm❑st Gert is Nin,irl fm One pcifa cofFlEGIRIG FEEV p uew«tr«wnien tm.pmdtia cv.C)
Ll. lender,Nmne PLUMING FETE
lender'.AJdtua QTY. MECHANICAL PERMIT FEE
I cenlfy But 1 have mnsl this application gird sw TuJAr fomutim is MECHANICAL FEE
corrtYt. legma rocortply with Wcity etd county«dinesa rtluingm PERMIT ISSUANCIE
ildin,cenamicliw,udle can sentmlvn terupantM1e
Z mrntimdpro «rn' JonI ALTERORADDTOMECl. CONSTRUCTION TAX
Wcoa to save.indemnify, keep a menin a,.htmo,Jodgmenta,conaundcepenscs hic yin ywtutsaid Cry AIR HANDLING UNIT(TO Ht"CFM)
<oft
It 2. AIR HANDLING UNIT(OVER 10.00)CFM)
cT tin D.re [XIIAUSI'HOOD(WNUCT) PAID `
HAZARDOUS MATE AIS DISCLOSURE ORATING UNIT(TO IW,M)BTU) btc Racipi#
Will the applicont or future bu0ding«cupent st.ar herdic heurdous material HEATING UNTT(OVIBRIW,O(q BTU)v defued by the Culcnirm Municilel Cade,Cupter 9.12,and the Herith.rd Safry lie
CJtc,Smtion 8532(.)1
❑Ye 11 No VPNTIIAT'ION PAN(SINGLE RFSID)
ISSUANCE DATE
Williheelrpllcantm P•^hn—bui1doi, a toreegmpmm i«dcvlccawhirh emit BOILER-COMP(311P OR 110,000 BTU) • (� I �T
b :.L
h ardws
it cvnuuninenb as defined by the Ray Arta Air Quality M. rrcot BORER-COW(OVER IM."BTU)
Disuict?
❑Yes ❑No NEW RFSIUIEM'IALMECII. SQ,IR. CT 12 1994
_ n Iy
fthebui.11.11«.msftny�Codc,�S0'�mn 3554)5,25533nd B55U.order 1ttry 1YImteN lto notify� �1/Y(fir (,Lt..Ch,ll . .
«eulmm of me require nenn which ousu be met poor to houarce of a Cenifmte of
Qcupency.
BY:OwwnutMirdagent
OFFICE
i
Cite of,
Cupertilio
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408) 777-3333
September 26, 1995
20975 Valley Green Drive
Cupertino, CA 95014
Subject: 20975 Valley Green Drive, Permit # 27154
Dear Sirs,
According to our records the above mentioned permit has never been frnaled 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
P,Inw,!mi Fer,/C:ed F,q:^r