28193 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CI YOF CUPERTINO x IL1\.- ..,C 'RICAL PF,RMITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 28193
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. AIRLICATWNSUBMHTALDATF.
L UNIT♦ LOTX
N AME PIIONI's CO ACTOR'S NAMI?: LIC NO:
/c� ?y/ ./ N2 CO OLI
RCI...ECT/FNGINF.FR: LIC NO: ADDRESS: N ❑
CONTACT: PHONE
QTY. ELECTRIC PERMIT FEE BUILDING PFRMI'f INF-0
BLDG ELECT Pi MECH
PERMIT SSUANCF. ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENFOAI, JOB DESCRIPTION
007 1h7")ofiDi ThalI amfthe Bdunisund idorsof sCode,9(mmtemdng with
+f Jmz Sect'wn]0007anDivision Jof theBuxina'.wd Profe.ssidCCalc,andorliareeIxin PANELS
Fy-�� full fmm adcRar vbq*P4.c%c4
UI'T02xxAMPS
tQZIy Litems Ions Lic.X
y6y DyeConlraclar 201.I000 AMPS
)ONLp CHI'1T:CTSDE RA ON OVER HXCAMPS SQ.17.FLOOR AREA 55Q.FT.
okratard in"IO<—W lunmy plans l.:taNmpublic recorder
SIGNS ELECTRICAL
Ucrnud Pmleznimal
GCtwu OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
SCxOe. 1 heoehy affirm that 1 am enemp fmm the Comm.'.Liceme Lew for the
t+134v�ai follawing matin.L9tt'lion]IIII S,Bunions wd%ufnsiwn Coln Anycitynrwmnty TEMP.M EIER OR POLE INST.
u' I which pe,,uirea a permit to com4rvcL alter.imgove,dcmolialt,M repair tiny svueme,
S rS primp.its isaumre,dso rewires the applicant for such perni'm flee signed tainmem POWER DEVICES
n5<p Owl he is licep.Jpu.,1.0e provlsim.of the ConlacmrS Uccose Law(Cn.mef
ad camrcrci SWIMMING POOL ELECTRIC
9
Xo� ( ngwith 5c-tion]000)of NvWm 3 of the Businusud Prof.i.Code) VALUATION
w"„� ordat M1e i.eacmpl lhttefrmn and the basis fon the alleged nemptim,Anyviel.timof
> Seerion]031.5 by an Ifora I tib ulhca 1 uoa civil t M OUFLETS-SWITCHES-FlKTIJRFS
CZQ yappl ken panni s jee pp than purely
mporwmplain fofthepropmylua(SSm). NEW RESIDENTIAL ELECTR _SQ.FT. STORIES TYPEC NSTRUCIION
E ❑ Lmowncr.fthc
p,somemormyr indent gree wegeamthe(Spe.compemerlon,
y3� win mtlewons Orae he c omrpe aoofwU.LaTeredf not impl".an,ownes of
shier ts
1'n,rnalma cede:The cmhmet«.U.Law don�.apply t.an.w,e,err
pnopcny who built.urimptuvcs lM1emm,mJ who des Tach work hlmsdfur tnruughhf, RO P RFS.UNITS
ncmpbycn.ping in improvement
mpve inti ssainrntsmetwo intcnvfcm.freral fox owes
If,
h.waver,illhhe-p he thu sen fpsoemurtat he did boildr or ,mmplcllon,IM1e auve4 /
ask.). will novo:Inc buNen olpmving that he did MX Wildwbnpmve for putlmeo>•
ask.). QTY. PLUMBI. FEE FLOODZONE APN
❑ I.vownerofnc�pmpcnY.inn cxcluvvcly eonrrvering with licrnsW cmuvcmnro I
tons.,the pmje.(See.IU14,Busveca and Pmf.i.Code:)The Couppe,ter's
U.la
❑ w donntgapoy to an owhtcrofpmTerry whobuildsorimpovn thenen.and PERMIT ISSUANCE tVl
who contracts for.mah pt.Jccns with a contramoos)lice d putsuent to the Conmanr'. ALTER.DRAIN&VPM-WATER
Fly
Ucerve Law. ( ) FEE SUMMARY
❑ 1 am exempt mokr Sec. ,B S P C for this reuan BACK FLOW PROTECT.UEVICIi I
ANITARY T N
sin WORKMAN COMPENSATION DECLARIATION DRAINS-FLOOR,ROOF,AREA,COND. SCHOOLTA% YI.CEIPfN N
❑ IM1aebyefxrritN lhevcacwifimeofc. tlomlt.imwm.oracmiriweefRECEIPTM
s
WorkerCmn
ryvation Infatuate or a nifexi ermyphcrtof(See.3800.Lab C.)which Fl%'IURES-PER TRAP PARK IEE Y—N
corm all employ ndeq' GAS-F.A.SYSTEM-1 INC.4 OUTLETS REC=D
PoIayI_ I /JJ BUILDING DIVISION FEES
0 Cho 61k16--d b1YIlAr{y GAS-EA.SYSTEM-0VFR4(FA) PLANCI IECK FEE
❑ Consist mpy.a lemny fumi.ne.
�
Cerifrcd copy is fd wthe . GEASFJINDU,STRL
lith city inspection do WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF FEMPIION FROM WORKERSGREASEIRAP SOILS FEE
COMPENSATION INSURANCE
(This satins need not he completed ifnc�pemtit in for me hundred dellars($100) SEWER-SANITARY-STORM ISA.20011. ENERGY FEE
or lttc)
I certify chin in the per(mnwxzof the work for which this permit u issued,l shall WATER HEATER WNPNT(ELECIR
not employ any pehwn in tiny mut m 1.be.me subjecr m the W.Arne' PND
Compc4smimt lawnnf Glifomia Dam WATER SYSTEM[OEATING Dine RecNptX
zO NO I'ICF 10 APPLICANT:If,after pprom,this Cerdf m of E.emption,you.m,aa NI?W RESIDENT IAL PLMIL SQ.P]'. TOTAL:
W 7 formwim ply
l withWumkep'.Caon,or this pooh shall be deemed mvaked.the Labb� hmnu BUILDING FEE
pywi povisiom on pcxhni
Lk] " SEISMIC FEY.
6. Q CONSTRUCTION TENDING AGENCY
I thereby affirm that there k auxuWakFl lending egey for thepMtmmntec of :
U Q the work for which this permit is ivsucd(See.309].Co.C) TOTALELECTRIC FEE
Lada',N.
OF^ bender.Andres. QTY. MECHANICAL PERMIT FEE PLUMBING nM
U I ernify that I b,ve mad this applenupon and sate that the above information i1
cancer, ply with ell 61,andcountY prolm need are laws relntingm PERMIT ISSUANCE MECHANICAL FEE
Wilds canWtclion leocby audai.cre,imerond,esmiti clly menterupon he
U z abov nrnllorncd fa impcctim ALTER OR ADD TO MECH. CONSTRUCTION TAX
e)ppgine swq in oily n ell as rhe City of Cupwino against
liabilities.id k sets dexpe nr 'c nany wayarnhe egaiw.aN City AIR HANDLING UNIT(10 Ix,IW CFM)
cmt¢q��i6ef sp t,P t AIR HANDLING UNIT(OVER 10,001 CPM)
Sigvmreof AMIkernbCmlxlor Date FI AUSTROOD(VIMUCIJ PAID
IIAZARDOUS MATERIALS DISCLOSURE HFATING UNIT(TO 100,000 BTU) ' /` Date ReecipX
Will the applicant or fugue building. tnanl store or bmtdle harnrdnus material 1IEA'fING UNIT(OVER Itp,UJU BTU) T
as defined]by Ne CoWom t Mu cep i Corte,Chillier 9.12,and the lm hReaand Safety
aasa
Coca,Seeker 21532nd? VENTILATION FAN(SINGLE RFSID) a,
❑Ya ❑No ISSUANCE DAtiE,
WBI NeapplicuntmfutucbuMingrccupaotu=gWMmtw&vimwhichemir BOILER-COMPLUIPOR 100,000 BTU) A
araNnm air conwmiamtn m defnnl by the Bay Ate.An Quality Muragcomm, BOILER-COMP(OVER 100,000 BTU) 1� [!
Y V(�
ClYa' ❑No NEW RESIDENTIAL MUCH. SQ.19'. Cit y .,
1 have and The harmdw.s maperia4 requbemrnps under Chapier 6.95 c f rlbe `r L`r 9gS
Calif Irma I Iwlln&Safety Code,Sections 25505,25533 and 25534. I understand!that
if the building don rwt currently lave a term,that it is my responsibility to rotiry the r
.ec%am of Ile requimrcnn which mus b,met prior to iseuahce of.p Cenifmte of
Occ,mpl
Owner or emhortrM agrnl Guide ISSUED BY:
OFFICE
® / 10300 Torre Avenue
Cupertino,CA 95014
Citc of,
Cupertino Building Division
1 (408)777-3228
(408)777-3333 (fax)
May 8, 1996
Homeowner
1032 Tuscany Place
Cupertino, CA 95014
Re: Expired permit, (copy attached)
Dear Owner:
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
Printed oo Recycled Paper