27476 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BwI,mNG-ELECrRICAI. I PERMI"r NO
BUILDING OF C DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
274761
BUILDING PROJECT' DIINTIFICATION
BUILDING
/ A(SS /,�AA le r a / b- UNIT# LOT# SANITARY NO AI'i'LICATION SUB/MITTA/?I.DAM
J iRS NAME: PHONE �CONTRA IOR'S NUsvfli �� LIC NO.
�mOhS �rn� —133-7_3f�R lJL7S�& Uly7 ggqlf ) w coNTRO x
K RCR ..Cr/ENGINEFR: 1 CNO A7XS^ )� �� /a I�) ❑
CONTACT PHONE:
111 ELECTRIC ELECTRIC PERMIT FEE BUILDING PERMIT INFO
�CiUi'Yl(�� 733 -238(x; FERMI'I'ISSUANCE BLDG ELECT PLUMB M3
LICENSED CONTRACTOR'S D1?CLARAT ION APPLIANCES-RESIDENTIAL IIL��/
I bereb tfimalhall ambeensed under fChal9(commencing with JOB DESCRIPTION
OU OO 5u prnveumso per '
{v00 geamn]00(1)of Divamn3of the buaneas en Profession,Coale,end my bcenu tam PANELS '
m�yW
Lice me �(j / 1 . /` jam `
FO Licemc Cl,,,Clms(�jJ�j(A.mc# ( UP T02IN)AMPS I 'l
V, Date Contract 1201-I INTO AMPS
7OV,Z ARCHITECTS ARA IOVER 1000AMPS SQ,In.FLOOR AREA $/SQ'In,
OZ—❑ I underdone!my plans shell he used as public records.
F^F to I SIGNS ELECTRICAL
3Sd .'.�I Licensed Prof e.....mil
❑y Q OWNER-BUILDER DIiCLARA9']ON SPECIAL CIRCUl9'/MISC.
o'Op,v I hereby affirm that 1 am exempt from the Contractor's License I.aw for the
gip¢ following reawo.(Sttuon 7031.5,Business and Predesames Code.Any City or county TEMP,METER OR POLE INST.
which rebates a permit to construct,alter,improve,demolish,or repair any structure
G� prior t.in issrar,e,ano nature,theapplicam tar such Permit to file a signed statement (POWER DEVICES
O the hems Loral pnrso:mno me pmvrsion,of the Common',License Law(Chapter -
a0.a�' 9(commencing with Section]Wlq of Dtv¢mn 3 of the Busmesxend Professions Code) SWIMMING POOL ELECTRIC VALUATION
iiW M, or that he is exempt herefmm and the basis for alleged exemption.Any violavon of OUTLLTS-SWITCHES-FI%'1LRES
f Q Section 7011.5 by any applicant for a permit subjects the applicant to a civllpanalty of
O not name than five hundred dollun(S5001 NEW RIiSIDENTIA1.13LECfR 5 IT.
W n❑ Las own era mcpntpedy,mmyemployee,aim wagesmmersolecompensatmn, Q' STORIES II TYPECONSTRUCHON
a _ rill do the work,and the structure isnm materiel or offered Resale(See 7044,Bumness ----
and Professions Cale The Comralols Liame Law dos not apply In an owner of I I I
prupenywhobuddsmimproves therm,andwhodoes such work hmselfor through his I
employees,provdedthatsuch mmprmemarl,mermnnendcdoroffereA forsule IL OCC.GROUP RES.UNITS
however,the an lJmg or mmpmvemenl is sold within one year of completion,the owner- TOTAL
builder will have the burden of Prmmg that he JW not builds improve fur puryou of
sale.).
❑ 1.®oa nerof theproNny,ameaclusivelycontra.:IingwiNhcemedcomraelorsto QTY. PLUMBINGPERMIT FEE I FLOHUZONE APN
Intminuel the project(Sec.7014,Branca,sail profession,Cale.l The Cnnitaron,
cense Lawdoes not apply loan.wnerofpropeny who builds nr improves lherc.n and I PF.RM1II'1'ISSUANCE
who contracts forsuch projects,with aconvacmrt,)licensed pursuantmme Cunlmcmrx gLT1iR-DRAIN&VENT-WATER EA ( FEE SUMMARY
ri,Lew. I ( ) I OUTSIDP",FS
❑ 1 am exempt unJe Sec. R&P C for his reason I BACK FLOW PRO'1'IiCf.DEVICE I SANI'T'ARY #Y N I
Owner Dale (DRAINS-FLOOR,ROOF,AREA,COND. t -RECEIP # --I
s WORKMANCOMPENSATION DECLARATION SCHOOLTAX Y N (I
❑ I hembYalfirm that l have a centrca,rofconsentmsdein,um,m.centficate of t _ RECFIPT#
Workern'Cnmpensmmon lnsurun a<enifieJ Cn them.((Ser.3900,Lab C.)whrch FIXTURES-PER TRAP — --- 11I
PY (PARK FF.F. YN
awcrx all a u�d �yp 0 GAS-W, SYSTEM-I INC.40U'1'LETS t 1117CIZIM 4 -
PnhaY# BUILDING DIVISION FEES
Company I GAS-FA.SYSTEM-OVER 4(EA) PLANCHECK Fri.
❑" Cmi to co t b is 1
❑ Certified copy ms fled the coy mspeam.n dtnsmn GRF.ASI;7NDUSTRI.WASTE INTERCEPTOR
GRADING ITAi
CERTIFICATE OFEXEM 1.WORKERS' CREASE TRAP SOILS HE -r
COMPIiNSATI INSURA I.
(ITts section need not be complete Ihtpcmmt.fm a hundred dollars(5100) ISEWER.SANITARY-STORM EA.20al f ENERGY FEE
or less) —'
Icerlilythatinjbeperformnt d idle work for which lh iermmttsroare ,ISFall ) IV{ATliltilI T�WNF.NT/EI.IiC'I'R III
oat employ any person or ary m m to become so act I.the Workers' -- rAID
Z
Compensate.laws of Calift a Dn1 so \ WATER SYSTEM/rRFATING Date Rtceipt#
Applicant
U
O0NOT(exTOAFo Wr T:If.of &Ihm �J)cat Exc Ion,y.a should NEW RIiS1DENTIAI.I'LMB. SQ.I+I'. TOTAL:(
NOTICE TO APPLIC T.1
wuh such S t t ti.n t to Jtbe huMrr Cole.you most
funhwnhcomp m sot pennns 11 be deemed invoked. BUILDING FEE
Lnnqk""I Q Ihereb If, I u� 1 b eENDen A kaAGENCY eyortheperfacestcenf I SEISMIC FEE
UO Ihework mr. ch is a tlmmsseed(Sce..097,0v.C.) TOTAL ELECTRIC FEE --
Leaders Nam-
0 U Leader',Addr^ (QTY. MECI IANICAL P17RNIIT FEE I PLUMBING FEE
1 comfy that ave read this app canon and slate that the above arformauon is
>a a correct,lagree ter.. ly,uh.11en PERMITISSUANCH MECHANICALITT
C,ii, buildutgcunstmeltoam dherebya aria representatives ofthis city to enter upon the CONSTRUCTION TAX
U .Z above-mentmned pro for Iron pury.see ALTER OR ADD TO MECH. I
(We)agree to save,in ramify and keep harmless the City of Cupertino against --
ladoluc„judgments,emb and expcnsn y way accmaagmnatsmd Cdy AIR HANDLING UNIT TO IO,WU CFMI
tens Inena (the grunimg nl that pc 1, AIR HANDLING UNI'I'(OVF.R IU,WO CFM)
-' '� °��
5 nature ofA ¢alt/Co r r Ina EXHAUST HOOD(W/DUCD
PAID
IIAZARDOUSMATERIALSDISCI.OSURE 11EAT'INGUNIT(T010g000B'rU) Date Rcceipl#
Will the applicant or future bmldmg occupant store or handle bassMom material I ([RATING UNIT(OVER 100.00011TU) TOTAL.(
as defined by the Cupertino Municipal Coda.Chapter 9 12,radius Health and Safety AL1�
Cale,S h.25532(a)7 VENTILATION FAN(SINGLE RI'SIUI
❑Yes ❑No
Will th eaMlmenniorfummbuildmgoccupunt useequipmcmadevr.whlchemh BOILER-COMP(3HP OR 100,bf0 BTU) ISSUANCE
hezm b us air connuniname as defined by the Bay Area Air Quality Marugement I BOILER-COMP(OVER 100.0(10 BTU) I /A� 6aJJ
DumcO
El Yes 11 No NEW RESIDENTIALMECTI SQ.F1. FEB 16 1995
I have read the hoomem s materials requirements under Chapter 6.95 of the
CAR, I li callhA Saf ctyCWe,SationsM5 05,25533and25534. IundembadWt CO UY GU'rcHll U
tithe building doe,not currently h�veamnanWhmnrsmy responsibility to notify the I
occupant of the ec,j semat,which must be met poor ro issuance of a Certificate of
Occupancy.
Owner or autboriaJ agent Date I I TOTAL( (ISSUED BY. _
�” I3 FFICF `
O- Citvof +
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 28, 1995
Raymond Descamp
10319 Ainsworth Drive
Cupertino,CA 95014
Subject: 10319 Ainsworth Drive,Permit#27476-Waterheater
Dear Mr.Descamp,
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 inspebtion 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,
Cuperfino,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.
•fit,ty
Sincerely, (1�
City of Cupertino
j
Prmred on Recycled Paper