27038 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
F CUPERTINO
CITY Onl I.�P.. RI AL PF:RMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICALINn 0 p
BUILDING DIVISION BUII.UGPROJECIADEN1'IFICA'I-ION L O
BU•I/L��D�I/Ny�G AD�DR/CESSArfL:`\(/��YI�'/�.7 SANITARY NO. AVPLICA'HON SUBMITTAL DATE
(/ !/ O(f lUYyyVs� UNITp LOTH
OMA PHONE: ONTRA • ME: 1 � N/C CON TROL# .J
ARC II HUDENGINEER: LIC NO: A D ' S ❑
id r&v&oJ
CONT �p��P{H/�O�(NE: //J QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
/"/ '/�) T PERMIT ISSUANCE BLDG ELECT PLUMB 2tl ur
3NSED CONTRACTOR'S DECIARATION APPLIANCES-RESIDENTIAL TOB DESCRIPTION
im ad
(hereby affirm than licensed underprovisiomnfr 9(commencing with �
aVU fullfoscand)eo(Ditvisln'p^�f the Buslncas ant rofessjpns ori ,and my license is in PANELSpd,Zm License Clus (�✓ I.iaN /lc UP TO 200 AMPStaw&
m?0- Date Conmcmr 201-Hall)AMPS
Z O En$ ARCHIT! SDE A OVER I"AMPS SQ.Ff.FLOOR AREA $/SQ.FT.
O Z.❑ 1 understmd my plans&hull he used as public records.
yF W SIGNS ELECTRICAL
LiccmW Professional
0OWNER-BUILDER DECLARATION SPECIAL CIRCUIT'/MISC.
U 1 hereby affirm that I wn exempt from the Cmarimurs License Lw for the
W'Bg .y followingreoson(Section]031.5,Business and Professions Code:Any city or county TEMP.MEPP.R OR POLIS INET.
t�;O J which requires a permit to construct.alter,improve,demolish,or repair any amounts
m its issuance,alsorequires thea licant for such ttofileasi dstatement POWER DEVICES
priorpp practi gLaw
a
� �p ohm he isncinsedpursuam mdtcprovinnnsaf the ContractorBruins license Law(Chapmr
9(mmmcncing with Scctinn]Il(M)of DivisionJof the Business and Pndes&ions Code? SWIMMING POOL ELECTRIC VALUA'T'ION
py�alt or that he ix exempt therefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIXTURES I/„ O
CZQ Section]031.S by my applican,for a Penni,subjects the applicant to a civil penalty,,[ 10, UV
not mom than five hundred dollar;($500). NEW RESIDENTIAL ELECIR _SQ.
fel � ElLasowneroflheprnperry,army emPlnycerwith wugesastheirsolecumpensution, STORIES TYPECONSTRUCTION
y3— will do the work,and the structure is not intended or offered for&ale(See 7044.Business
and Professions Code:The Comment's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himsel I'or through his
onomemployees,provided that such improvements noon intendedorofferedformle.If, I Nal OCC.GROUP RES.UNITS
however,the building or improvement is sold within one year of completion,the owner,
milder will have the burden of,ro,u,that bedid not build or improve forpurm.of T L:
Wo.).
❑ I,as ownerofthe property,am exclusively contracting with licensed immormm,m QTY.. PLUMBING PERMIT .00DZONE APN
is
construct the project(Sec.7044,Business and Pro&asions Code:)The Container's PERMIT ISSUANCE
Licenm I.aw does newpply to an ownerof progeny who builds or improves thetson,and
who contracts for ach protects with acnnmcloos)licensed purxnanno the Conhaotorx ALTER-DRAIN&VPN'p-WATER EA
License Law. ' ( ) J FEE SUMMARY
❑ I am exempt under Sec. ,II&P C for this reason BACK PLOW PROTECT.DEVICE OUTSIDE PFS
S NITARY YN
Owner -- Dam RECP.IPTN
DRAINS-FLOOR,ROOF,AREA,COND,WORKMAN COMPENSATION DECLARATION DRAINS TAX Y N_
❑ Ihembyaffinn that l have o cenificatedconum to self insum,or a inenificate of MIXTURES-PERTRAP R.ruu #
W-voi Cordams. saran en enifigdc therrof(Sec.JBW,LebCJwM1ich P E Y N
covers ell empl a 'I'Lan77ll JJ((/a/t11 p 7L%.., GAS-EA.SYSTIiM-I INC.40U'1'LETS 00 REC131PfX
PalicyN BUILDING DIVISION PEES
Company GAS-FA.SYSTEM-OVER 4(EA) C
❑ Cenl cs y umish
❑ ifimcopyisfiled withamenyinspemiondivinou GREASFJINDUS'IRL WASTE INTERCEPTOR GRADIN
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This&ration newhou be completed ifthe permit is forone hundred doll ors($100) SEWER-SANITARY-STORM IA.20017. EN ERGY FEE
orlesa)
T certify that in the performance of the work for which this permit is issued,I shall WATER HEATER W/VENT'/ELECfR
not employ any person in any manner so m to become subject to the Workers' PAID
z CwrNrsution Lawsaf Cnlifnmia. Date WATER SYSTRM/fREAlNG Dam Receipt
O O Applicant
NOTTCRTO APPLICANT.If,after making this CeniGcme of Exemption,you should NEW RPSI DEISTIAL MIM(, SQ,Fp. TOTAL:
V� become smatin the Workers Compensation provisions of the Labor Code,you must
� , forthwith comply with such provisions or this Permit&hall be deemed revoked. BUILDING PEE
OWn (� CONSTRUCTION LENDING AGENCY SEISMIC FEE
=) z Ihembyaffimt daw the.is acnnstructim lcndingagency forthe perfmmameof TOTAL: ELECTRIC FEE
U O the weak far which this permit is issued(Sec.3097,Civ.CJ
Ieader's Name PLUMBING FEE
Q U Lenders Address QTY. MECHANICAL'PERMIT' FEE
I mnify that 1 have read this application and state that the nlxom information is
correct.l agree to mply with all city and county ordinances and stoic laws relating to PERMIT ISSUANCE MSCI IAN[CAI,FEE
fA buildiagconsm o,mdherebyauthomeriprosen...hmcoftbiscitymemcrupon 1m
U z ahovemortione pr pony for impaction purposes. // At'TER OR ADD TO MECI I. CONSTRUC IONTAX
(We)agm to av in emnify ant kap harmleas @e City of Cugainn
IlubI oles,judg ant,c sts Jexpensex which may in any way;coma ams,said City AIR HANDLING UNIT('fO IO,WO CPM)
in conseyuenc of ole rat i got this sennit.
AIR HANDLING UNIT(OVER 10,000 CFM)
Signaunmaf WI
"Gafor Data EXHAUSTHOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE ORATING UNITGO IW,00oBTU) Data Receipt#
Will the applicant or future building occupant store or handle hamrdc us material
us defi red by the Capon he M unicipal Code,Chapter 9.12,and the I health and Safety HEATING UNIT(OVER 100,00)BTU) TOTAL:
Code,Section 255321e)4
El Yes El No VENTILATION PAN(SINGLE RISID)
BOILER-COMP(311P OR 10d,000 BTU) T IS�UjN�E DATE
Will the applicant urfmurebuildingoccupanlnucgoipmrnt ordevices whichemil f
omaduuj1mb awants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU)
stria'? d001 ❑No NEW RESIDENTIAL MECH. SQ.FT. APR 13 1995
1 hae historians materialsmcots under Chpter 6.95 of the
CalifomiaS tory Code,Said 505,25533and255J4. lodnsmnd oC"rserVUf Cif the builnon cmm�amthatitixmy responsihility to notify the aexatt,em which must be mace of a Cenificam of
Ovetuarne
Owns r Nam agent Date -TOTAL: ISSUED BY:
OFFICE
_® r,
City of
Cupertino
10300 Tone Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
22420 Santa Paula Drive
Cupertino, CA 95014
Subject: 22420 Santa Paula Drive, Permit# 27038 - Furnaces
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 fmal 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
r� r
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