27912APPLICANT;TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
ILDI G-ELEUI RI AL
CITY OP4 UPERTINO BUIL"
`HUILDINDIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL
BUILDI!G PROJECTIDRN'HF'ICAHON
PERMIT NO.
27912 7 9 2
G 1L
BUILDING ADDRESS: A /f[-t'�'/IO/!� A� Tr� ew 4/O,
OLOaWwI (.,C s KJ /'
SANITARY NO.
APPLICAATION/S�U�BMITTALDAIE
UUNITN LOT#
I b D
IiRSNAME: PHONE: -
CO R'SN ME: ILIC NO:
N/C
❑
CONTROL#
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ARCHITECfA•N=:
NFhER IC NO:
Li�++ tz L7,300O
IWR
ADDRFS I�11
CONTACT: PHONES
QTY. ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ry #C/1
PERMIT ISSUANCE
LICENSED CONTRACTOR'SIli
DECLARATION
1 hereby affirm Nat I am limn dunderpravisiomofQ pmr9(com m6ngwith
APPLIANCES -RESIDENTIAL
TOB DtSCRIPHON
Section 7") of Division 3 of the Business and Professions Code, and my license is in
full.. Clutdeffect.
License Class Lic. M
PANELS
UPT02MAMPS
w
Dam Corrector
201-IWO AMPS
ARCHITECTS DECLARATIONOVER
I understand my plansshall be used as public retards.
SQ. FT. FLOOR AREA
3/SQ. FT.
1000 AMPS
SIGNS ELECTRICAL
Ltcen.e Professional
OWNER -BUILDER DECLARATION
SPECIAL CIRCUIT/MISC.
1 hereby affirm that I am exempt from the Contractor's License Law for the
TEMP. METER OR POLE INST.
following ree umn. (Scetion 7031.5, Business and Pmmdskms Code: Any cityor county,
which requires a permit to constmct, slier, improve, demolish, or repair any structure
,
primm its isar.,alsortquimstheapplicard forsuch pernaRp Gleesignediuerman
dust he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
9(commencing with Section ]000)of Division 3 of the Business and Professions Code)
POWER DEVICES
SWIMMING POOL EL
VALUATION
or that he is exempt herefrom and the basis for the alleged exemption. Any violation of
Section ]OJ L5 by any applicant for u permit .1,yetylim applietat c. a civil penalty of
not mom than five hundred dollen (3500).
❑ Luownk,andt the
withwagesasthei(ec. c0mpensuress
will dothewons and the Business
0 - RFS
N SID AL ELEM _SQ. FT.
\\ . STORIES
TYPE CONSTRUCTION
License
rod Professions Code: The Cammnon, License law does nos apply to an owner of
he Contractor's notapply to an
ownprufertywbers, prolds orimpmvesthimprovndwhodmssucuoula hroffidedthrough his
If,
emplthebud
imm�dedoplefiod
\ .GROUP
RES. UNITS
ingorided Provenimpmvemcrosarene he ow
the
M1uilder, . the have
is an he did
of build or improve
the
builder will hove the harden of proving that he JiJ not build or improve for purpose of
of proving for N (pose of
❑)1, mowner ofthepropeny,ernexclusively, contracting with licensed contractors to
TOTAL:
`-
r
QTY. PLUMBINGPERMIT ,FEErt '4'
__ 'FL E
APN
construct the project (Sec. 7044, Business and Professions Cale:) The Contractor's
Licence Lew dcemot apply to an owner of properly who bun Ida or i mprovca thereon, and
I\7\1s��
PERMIT ISSUANCE
who contracts for such Micas wish a comractor(s) licensed Pa...Uothe Comracums
License Law.
nl
ALTER-DRAIN&VENT-WATER (EA)
FEE SUMMARY
❑ um exempt under Sec. , B & P C for Chia reason
BACK FLOW PROTECT. DEVICE.
ID RS
SANITARY Y N
RECEIPT#
Owner Dam
DRAINS- FLOOR, ROOF, ARG, COND.
WORKMAN COMPENSATION DECLARATION
SCHOOLTAX YN
❑ I hereby affirm that l homacertificate ofemisem toself-insure, orace(tificateof
Workers Compenution lm0mncemecenifit copy Nercof (gec.lgW. Lab CJ which
RECEI PT'#
TR
FIXTURES -PER AP
RK FEE YN_
covers all employee's under this permit'
Policy N
RECEIPT #
GAS - EA. SYSTEM -1 INC. 4 OUTLETS
BUILDING DIVISION FEES
Company
GAS - EA. SYSTEM -OVER 4(EA)
PLAN CII ftX, FE
❑ Cenifiedoepyisherehylhmi,lod.
GREASPRNDUSTRL WASTE INTERCEPTOR
NO FEE
❑ Cenified<opy is filed with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS'
GREASETRAP
SOI
COMPENSATION INSURANCE
SEWER - SANITARY - STORM EA. 200FT.
PN¢ FEE
('This section need not becompleted ifthe permit is for one hundred dollars(SIM)
or less.)
WATER HEATER W/VENT/ELECIR
I certify Nat in the performance of the work fm which this Permit is issued. I shall
not employ any pera. in any munnef ao as m become subject to the Workers
PAID
Compensation Lows.f California. Data
WATER SYSTEMMEATING
Dem Receipt#
Applicant
NOTICE TO APPLICANT: If, fser making this CeniOute of Enempom, you should
NEW RESIDENTIAL PLMB. SQ. FT.
TOTAL:
became subject to the Wmkels Compensation provisions of Ne Labor Code, you must
forthwith comply with such provisions or this Permit shall he deemed revoked.
BUILDING FEE
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agency for the performance of
the work for which this pemdt is issued(Sec. 3097, Civ. C.)
TOTAL:
ELECTRIC FEE
4
Isnder's Name
Lendera Address
QTY. MECHANICAL PERMIT FEE
s7
PLUMBING FEE US
I certify Nat 1 have ret this application and sum that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
PERMIT ISSUANCE
MECHANICAL. FEE
buildingmnstrumion, and hereby stationed representatives of thiscBy to enterupon the
above-mentioned pmpeny for inspection purposes.
ALTER OR ADD TO MECH.
CONSTRUCTION TAX
(We) agree to save, indemnify and keep hamiless the City of Cupertino against
liubilitics,jud enu,emtsandeapevu cola' yin an way eccmeageinst avid City
AIR HANDLING UNIT (TO 10,000 CFM)
c ofinegrunting t
AIR HANDLING UNIT (OVER 10,000 CFM)
ore of Applicant/ .ontommrIf
HOOD (W/DUC
(W/DUCT)
PAID
HEATING UNIT (TO 100,000 BTU)
I MARGOLIS MATERIALS DISOURS
Dau Receipt#
Will theapplicantorfuumhuildingmcupantsto a lehnurdommateriel
m defined by the Cupertino Municipal Cole, Chapter 9.12, and the Health and Safety
HEATING UNIT (OVER I00,BW BTU)
TOTAL:
Cede, Section 25532(x)]
❑Yes 11 No
VENTILATION FAN (SINGLE RESID)
Will Neapplicantorfumm buildingoccupantua uip ntordevimswhich emit
BOILER- COMP(JHP OR IN." BTU)
VU QaE V�A TE
BOILER - COMP(OVER IW,000 BTU)
hazorders air conuminrds as defined by the Day And Air Quality Management
�is"""❑ Yea ❑ Na
APR =7 1995
NEW RESIDENTIAL MECH.-SQ. FT.
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Cade, Sections 25505,25533 arW 25534. lundemmnd Nat
C(IY Ut CUh`LHTINO
if the building does not currently have a unset, that it is my mspmnibiloy toratify the
cupant o! the reyuircmentn which must be met prior to issuance of a Cenifeate of
Occupancy.
ISSUED BY:
Owner or authorized agent Date
TOTAL:
OFFICE
0-1
10300 Torre Avenue
r` Cupertino, CA 95014
Cii_v 0f
upertiulo I Building Division
(408)777-3228
(408) 777-3333 (fax)
February 10, 1996
Resident
22555 Cristo Rey Drove
Cupertino, CA 95014
Re: 22555 Cristo Rey Drive, Permit #27912, septic tank
Dear Permit Holder:
Our records show that the referenced permit has not been finaled by a City building
inspector. A permit is 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, 95014, Attn: Building
Department.
If your permit has not been fmaled, 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 date of receipt of this letter. If we do not hear from
you, the City of Cupertino Building Department will have no recourse but to resolve your
permit as expired and discard the records.
Thank you for your assistance.
CITY OF CUPERTINO
Pnnfed on Recvclee Paver
0
10300 Torre Avenue
Cupertino, CA 95014
Uttperthio Building Division
(408)777-3228
(408)777-3333 (fax)
April 23, 1996
Gate of Heaven Ceriretery
122555 Cristo Rey Drive
Cupertino, CA 95014
Re: Expired permit (copy attached)
Dear Resident:
According to our records, the referenced permit has not 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 (408) 777-
3228, so we may arrange to extend your permit and schedule a final inspection.
The City of Cupertino requires a response within ten (10) working days from the date of
receipt of this letter. If we do not hear from you within this time, the building department
will have no other recourse but to resolve your permit as expired and discard the records.
Thank you for your cooperation,
Building Department Staff, City of Cupertino
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