27027 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUERTINO rl't. RICA
PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBN -MECHANICAL
27027
BUILDING PROJECT IDENTIFICAl KIN
BUILDING ADDRESS: 1 SANITARY NO. APPLICATIONSUBMITTALDATE
4Uox.
UNIFN OT p
OW
PHONE: CoM C 'S NAME: LIC O:
16V
CONTROL#
ARCHITECT/ENGINEER: LIC NO: ADD ' / ❑
CONTACT: PHONE QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB M C)
PERMIT ISSUANCE ❑ El ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
p07 Ihereby rxr)o&nmhalantha Bad underprovisionsio Chepmr (commencing TOB DFSCRIPf10N �f
<00 Seninn](NXl)of(yy� /l�fth<Business end Testi ylicenu is inPANELS
V F full force and efleq�// t W
1,l Ue¢nuC Vlessk> V`•' Cmaracror ��/111[[[/// Up T0200AMP5 ^I/S
F m Z �11yyL�ARCHITECTS DE 201-1000 AMPS SQ.FT.FLUOR AREA $/SQ.FT,
Z O m— OVER 1000 AMPS
O Z_m I understand my plans shall be used as public records. ..
F-�,1_•W SIGNS ELECTRICAL 7 ' -
<,j�,"Ij Licensed Professional
1,1< OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. NOV e 9 1995
FO-
M1 hereby affimt,hal I am exempt from the Convector's Liceme Uw for the
FO a following mason.(Section 7031.5,Business and Professions Cade:Any city or county TEMP.METER OR POLE INST.
..1 which m0uires a permit to colutruct,alit,,improve,demolish,or repair any slrvc,om
x� T� prior to its Issuance,alaareyoiers the applicant for such permitto file asigned sutemem POWER DEVICES rII
m C OOz due he is Ilcemed puts...In the Provisions of be convenors Lope Law(Chapter Vr VUT't l'I I 11wrLKOLL 9(commencing with Section"1(I(I )of Division 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION
W_to or thin he is exempt therefrom=it the basis for the alleged exemption.Any violation of FIXTTJRES �,\
FZa
Section 7031.5 by any applicant for a permit subjects the applicant a civil penalty of OUTLETS-SWITCHES- //''�� /V\ /VI
nm more than five hundred dollars(5500). V r
NEW RESIDENTIAL ELECTR S .PT.
o ❑ LmOwrk.and
eis 1brandedon.hwagesasatei(Sec.compensation, Q STORIES TYPE CONSTRUCTION
y 3°O will dashes won,and thestructureComputeriemn emu,Law doverd .,apply up an cower,of
send Professions Coke: Lac Computer's License Law Jas not apply,o an owner,of
property won builds.,improves thereon,and who does such work Wool through his
own empinyces.providedtha,such i mpmveaemsam not intrndedorofferW fmsnle.If,
OCC GROUP RES.UNITS
however,the building or improvement is sold within one year ofcompletinn,the owner- OTAL:
builder wil I have the burden of proving that he did not build or improve for footfalls,of
vleJ.
❑ I,ct the profth(Sec,7y,c, urines,and Professions
with licensed Courepmrsro QTY. PLUMBING PERM IZT--c
FEE FLOOD ZONE ppN
mawm,he project pply oour Business and,whobuild CWe:)The Contmctors
Liansrmers oes for
appotects ithaco mete s)whosed pursuant
to
thereon,end PERMIT ISSUANCE
whocnnlacts for such projcets with aconlmrmrts)licensed pursuant ro the Contractor's
License Law. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
❑ 1 am exempt under Sec. ,B&P C for this proton BACK FLOW PROTECT.DEVICE OUTSIDE EES
OwnerNOTARY YN__
Data DRAINS-FLOOR,ROOF,AREA,COND. RECEIPT#
• WORKMAN COMPENSATION DECLARATION MME
Y N
❑ 1 herchyafrro that l have ac nificateofennsennoulf-insure,nraceNfeatcof Fl%TURFS-PER TRAP R[CEIPT#
Wnrkcri Com `' wl �t�y(�d5ppy (Sec.3800.Iib C.)which Y._N
covers
all
c.1 szu 's�m�,o / \ GAS-EA.SYSTEM-I INC.4 OUTLETS RECEIPT#
Policy# yn ING DIVISIONFEF
Company d GAS-EA.SYSTEM-OVER EA)
❑ Certified ropy is hereby f ( PLAN'
❑ Certified svpY ix filed with the city inspection divisio GREASE/INDUSTRL WASTE INTERCEPTOR
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP COMPENSATION INSURANCE(This sgtion arced not he completed irthe permit is France hundred dollars($100) SEWER-SANITARY-STORM FA.20P0FT. .
or less)
I crrtify that in the fmmnnee ofthe work far which this permit is issued.I shall WATER HEATER W/VENT/F.LECTR
nut employ any person in any rammer an as as become subject ,r the WorkerPAID
z Compcnutionlzw.of Califrmia. Dom WATER SYSTEMITREVRNG
Apd,c t Dae Rcccipl#
z 0 NOTICE TO APPLICANT.If,diet making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT,
� (q bccoaembjec,to the WICompensation provisions of the Labor Crile,you out TOTAL:
�
forthwith comply with such provisions.,,his Penni,shall b,dceaed revoed.k7 thBUILDING FEE
yA CONSTRUCTION LENDING AGENCY SEISMIC FEE
z I herebyaffigm that three isawnsvurtion lending agency for the performaneeof
U O the work for which this permit is issued(Sa.3097,Civ.C.) TOTAL: ELECTRIC FEE
Lenders Name
CU Lenders Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
[1a I certify that 1 have read this application and spite deal the above information is
F0. correct, legs mcomply with all city and<ounry rminmmarM stale hws gelating to PERM) ISSUANCE MECHANICAL FEE
_ IA building convection,and hereby aurhmixe respacroldves clubs city,remerepomhe
U z above-memioncd pro pec umpurposes. ALTER OR ADD TO MECIL CONSTRUCIIONTAX
I Wr)agree m a ify and keep harmless the City of Cupertino against
Iiubilities,juJgmem.cat nxs which may in any wet eagainst id Ciny AIR DANDLING UNII'(TO 10,IKN)CFSD
in ront"rence
or,
a gra g is rail.
AIR HANDLING UNIT(OVER 10,%xd CF',M)
S'to of ApPli a 1tot ter ale EXHAUST HOOD(W/DUCI}
AID
I IAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.0 a)BTU) Dane Receipt#
Will the applicant or fumm building occupant an a or handle hdrardous martial
us defined hydee Cupertino Municipal Code.CM1apma 9.12,and dee Heulth and Safety HEATING UNIT(OVER I(XIM BTU) TOTAL:
Cale.Section 25532(a)7
❑Yes 0 N VENTILATION FAN(SINGLE RESID)
BOILER-COMP(3HP OR 1 W.000 BTL) ISSUANCE,DATE
Will the applicanmrfmure M1uildingrccupunlusecquipmentmdeviceswhich em it )
M1vallous air comamin:uns as JeOned by the Bay Ares,Air Quality Management BOILER-COMP(OVER IOO,IYJp BTU)
Disrict)
❑Yes ❑No NEW RESIDENTIAL MF-CH. SQ.FT.
1 have read,he havrdous mareOWs rrquiremenu umler Chapter 6.95 of the
Ga Iifnrnia lleallh&Safety Cade,Satirns 25505,25533 and 25534.I understand tha
if the building does not currently have a tenant,that it is lily responsibility to notify the
tecupant of,he reyuireaeas which mux be met prior at issuance of n Cep Ecce of
Occupancy,
Owner or authonuA agent Date
TOTAL: ISSUED BY:
OFFICE
O- Cltx of,
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
20648 Shelly Drive
Cupertino, CA 95014
Subject: 20648 Shelly Drive, Permit#27027 - Furnace
Dear Resident,
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
Pr ivoa on F3cvr..ied PaPcr