27537 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BIRI"LING-Rl,oLI IUA' 1'ERMITNO.
APPLICATION/PERMITPLUMBING,-MECHANICAL 27537
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
BUI/LyD�ING{kDURISSD: SANITARY NO. APPgLICATIONSUBMM]TTALDATE
UNIT# - LOTp / -16-9
O ERSNAME: - PIIONG: RACI'OR'SNA + LI O: !�
NIC CONI ROLA
� t
ARCIII'fECf NEER: LIC NO: A S:
CONTACT: PHONE: BUILDING PERMIT INFO
C /,I/.S 1 QTY. ELECTRIC PERMIT FEE
7610/ BLDG ELECT PLUM MECH
/ -
eeed2;�SA9yjPERMIT ISSUANCE ❑ ❑ g 0
LICEN SED CONTRACT'OR'S DECLARATION APPLIANCES-RESIDENTIAL
OCZ I herebyaffnn that l on f,imtsi nderprovis insofCTapter9(cnmorremgwiN JOB UISCRIPTION
400 Sttiion JUW)of DivisinnJnf the Business and Prolissions Cada and my license is in PANELS
CIDeP.. full force and M=7.
fZcc License Class �ic.p UP T0200AMP5 Wh It
w Q N Dec Convector N' 201-1000 AMPS
h y'L. ARCHITECT'S D A LGµ SQ.FT.BOOR AREA S/SQ.IT.
Z O rn— I understand m I shall be used as public records. OVER 1000 AMPS
OP—w my SIGNS ELECTRICAL
yK6Lianud Pm[rssinnul
OWNER-BUILDER from th ARA Groin rue]ON SPECIAL CLRCUIT/MISC.
KO p-V I hereby n.(Se the I am exempt from the Comr ns Co License Law for The
W 3 LL y¢ following reams(Section to construct.
Business and improve
de Professions Code:Any city or county TEMP.METER OR POLE TNST.
I_^aOJ which requiresapermit toacmres do deq imforsudemolish,orre,aske.sig an,structure
C QS
that
he
issuance.
Pursuant Loth Nrovisicanrfthe Co permiuo filLicensor
Laned w
POWER DEVICES
c.E a Nal he is liceved pursuer to the Rovisions of Ne Contractor's Limnu law(Chapter SWIMMING POOL ELECTRIC
a%04. 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) VALUATION
W_y orlhalhelsexemptaherefromand the basis forte allegedexemption.Any violationof
�
Fi¢ Section 7031.5 by any applicant for a permit subjects The applicant IX
o a civil penalty of OUTLETS-SWITCHES-FTURES
nor more than fvc hundred dollars($5110).� NEW RESIDENTIAL ELECfR _SQ.FT. STORIES TYPE CONS]RUCTION
yK 22 ❑ o the wrk,a ihepsinucl.ormytintri edmidamd as The(Sec.co44,Bsiiess
3°�° will probework,andthe he Contra not is License
ma
1044,Business
andpro professions Cafe:The Contractors ndwho taw does not apply m m owner of
property whohuilJanrimproves rM1creon.and whndtcs such wmkhimulforthmughhis
ownemployers,provided thatmchimprovcments tau not intended orofremd forade.If, .rte C.GRO P RES.UNITS
however.the building or improvement is sold withinone yearmcompletion,the owner- TOTAL: V
builder will have the burden of proving that he did not build or improve for purpose of
sale.). -
❑ L as owner ofthe proprny,am exclusively contracting with licensed commemrs to QTY. PLUMBING PERMIT NF. FLOUG - NJ AIN
mmtmer the project(Sec.9144,Business and Professions Code:)The Contractor's '
License Lawdocsnoumpplytnanpe
ownerofpronywhobuildsorimprovesohemnn,and PERMITISSUANCF-
whocontmctsfor such projects with accomicmr(s)licensed pursuant a the Ciamacwr's
License Law. (.ALTER PA
) FEE SUMMARY
[31 an exempt under Sec. •.B&P C for this reason BACK FLOW PROTECT.DEVICE OUTSIDE FEES
SANITARY YN
Owner Data DRAINS-fE00R.ROOF.AREA,GOND. RECEIPT#
WORKMAN COMPENSATION PECLARATION SCHOOLTAX Y N
❑ Thereby affirm lMtlleveecenifcae of consent mself-insure,...cariGemeof FlXTURES-PER TRAP RECEIPT
Worker,'Compensation lnmmnce ora certified copy thereaf(Ste.3800,Lab C.)which0xr PARK FEE Y N
RECErs all Ir�yjunJcr i p rod. � U�I GAS-IIA.SYSTP,M-Ito 9'OU RbT'. DIVISION
p
Palmy# ❑I111,DING DIVISION PERS
Co. ,(- ` � '( GAS-Its.SYSTEM-OVER4(EA) PLANCHECK FEE
❑ Ccrt tea copy a hem fumi ed.
❑ cenified copy irf with Ne city irtspecaion division GREASE/INDUSTRL WASTE INTERCEPTOR GRADING HE
CERTIFICATE OF EXEMPTION MOM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section need not he completed ifthe permit is for one hundred dollars($Ugly SEWER-SANITARY-STORM FA.20(1ENERGY FEE
or less.)
I certify that in the performance of the work for which This permit is issued,l shall / ATEIIhATCR /VEM'pi1.E(:TR
not employ any person in my manner so a,to become subject to the Workers' PAID
CounNisatioofawsof Califomia. Dare WATER SYSTEMnREATING Date Receipt#
ZZ Applicant
C) NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
became subject in the Wicker's Com,parron provisions of the labor Code.you mast
� > fomiwith comply with such provisions a,his permit shall he deemed revoked. BUILDING FEE
r CONSTRUCTION LENDING AGENCY SEISMIC FEE
CW
U z 1 hereby afford that There is a construction lending agency for the performance of TOTALN ELECTRIC FEE
O the ork for which This permit is issued(Sec.3097,Civ.C.)
w
Lender's Name PLUMBING FEB ['
U" F Cmil 's Address QTY. MECHANICALPERMIT' FEE
V 1 cer ify that 1 have read This application and amte that the above mformum.is MECHANICAL ITE
>. W correct.l agree to comply with all city and county mdimposm and some laws oloam,to PERMIT ISSUANCE
h bulldingcommullagand hcmbymodmdm repmsenalweeofthls 61 menet upon me CONSTRUCTIONTAX
U z nlawe-mentioned pmpcny for inspection purposes. ALTER OR ADD TO MECH.
(We)neem save,indemnify and keep harmless the City of Cupertino against
Iiuhilities,jol,wrts,costsmmdcapenses whichmay many wayaccmcagainstsaid City AIR HANDLING UNIT(TO 10,00()CFM)
in comayuen of the grunlm,of Nis
AIR HANDLING UNIT(OVER HL000 CPM)
5 na of Pir otracmr Doe EXHAUST HOOD(W/DUCD
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.000 BTU) Dae Receipt#
Willthe applicant or future building occupant same or handle haurdnus material HEATING UNIT(OVER 100,000 B'IV)
TOTAL:
as defined by The Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)'l VENTILATION FAN(SINGLE RESID)
❑Yes ❑No
ISSUANCE DA'I'S
Will thea Ream or futom buildin tutee tordevicmwhich emit BOILER-COMP(3HP OR 100,(NN)H'1'U)
PP d by he 4mpmcn Pk !'}
h .Nous dr conTmttinants us Jefncd by the Boy Area Air Quality Management BOILER-COMP(OVER 14.000 BTU) Y�
DiouicR
11 Y. Cl No NEW RESIDENTIAL MECH. SQ.FT.
I have mad the hamdaaa materials rcquirrmcms model Chapter 6.95 of the FEB 16 1995
California Health&Safety Code,Sections 25505,25533 and 25534. I understand that I
/x
it the buil ding Jresnmcurrentlyhave aenanL ohm it,,my sourceiof.Crnocoit he CIIT In
the bui of the res.,it c i,, which mm,T he mm pilo,m issuance of l C.moose hof
e p,Rv�A%'•�/1
Occupancy.
Owner m mthorieed agent Dae TOTAL: ISSUED BY:
ICE
&Cltx-
10300 Torre Avenue
Cupertino,CA 95014
cif,
Cupertul.o Building Division
(408)777-3228
(408)777-3333 (fax)
April 23, 1996 1-1
Z.G
Resident
1049 Pennington Lane
Cupertino, CA 95014
6�
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
•
Pr,o;ed on Receded Pana: