27466 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECI'RICA[. PIiRM1r NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL. 27466
7 /I6C
BUILDING DIVISION BUILDING PROSKcr IDENTIFICATION G L� v
Ii UILDING AUI]RESS: SANITARY NO. APPLICATION SUBMITTAL DATE
D/•DNIT. LOT# 2,—/6
O RS NAME: PHONE: C RACTOR'S NAM LIC N�11
N/C CONTROL
ARCHITB :N NEER: LIC NO: AD S ❑
CONTACT: PHONE:
QTY. ELIiCBIC PERMIT HE BUILDING PP.RMIT INFO
BLDG ELECf PLUMB MECH
PERMIT ISSUANCE IV
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL IOB DESCRIPTION
O tYZ I herebyaffmn that l am llccneW underprovlslonsofChnpmr9(aommenoingwidt
W00 Section]00(pml liAwon 3of the Puniness an �P ft1ions Code,andinyhecowism PANELS
IK ❑t' full force and {i-7 // UP TO 300 AMPS
FZus 1.icenu Class .ic.4 ( `
w<. Data Croatia, 201-1000 AMPS
ZOyZ ARCIII'IECTS AI' OVER IWO AMPS SQ.FT.FLOOR AREA $/SQ.FT.
OZ O 1 understand my plans shall be used as public records.
�.� SIGNS EfPCfRICAI,
Q I Lice, JPrnlcuinnul
K�KJ QQQQ OWNER-BUILDERDECLARATION SPECIAL CIRCUIT/MISC.
OLF I hereby affirm fiat 1 am exempt from the Contractor's Co License Law for to
ty3ay which inquires a(S«don]OJLS.Business and improve,
demolish,
Code:Any tiny or county TEND.METER OR POLE INST.
CLLOJ which requirtsupermit to construct,alter. Demolish,or repair any structure POWER DEVICES
f,'W<� priorto its issuance,also requires thcapplicvnt forsuch permit to file a signed statement
ECO that he is licensed pursuant to the provisions of the Contractors License Law(Chapter
a 9(wmmuncin• th Section 00W f Division 3 of to Business and Professions Coda SWIMMING POOL ELECTRIC
oty bw' )o' ) VALUATION
my ambo h7031.5n,nherefromandta Bari t,abj Nthedexempni has
Any violation of OUTLETS-SWITCHES-FIXTURES
(=3¢ Section LS by any applicwtfore permit subjuuthe apPlicannoecivil pcnahy of '
not mom than live hundred dollars($500).
CFo ❑ Lasowncrofthepropcny,ormyemployees wit wagesutheirsolecompensation, NEW RESIDENTIAL EL[CIR _SQ.FT. STORIES TYPECONSTRUCOON
y3P.° will do the work.and the structure isnot intended oroffered forsnle(See.]M4,Business
and Professions Cade:The Contractor's License Law does not apply to an owner of
,.party whobulhlsorimproves there«,andadmil Bruch work hireselfrodhomgh his G'
will
REg.UNIT9
cmployces,provided that such improvements arc not Immadedorof Bred I'orsole.If,
however,0e building«improvement is sold within one year ofrompletion,theowner- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I,asawnerofthepropeny,amexclusivelycontractingwithlicensedcontmciomto QTY. PLUMBING PERMIT FEE FLOOD ZONii fid
construct the Project Uwc.7044,Business and Professions Code)The Contractor's
License Lowdmex not apply to canuownrref Imperty who Wilds m improve,thercon,nnd PERMITISSUANCE
whowntraetshnsuehmojects Milo conuacmgs)licensed pmannm to the Contractor's ALTER 13A
License Law. ( ) 'FEE SUMMARY
❑ 1 sm exempt unde-Sal ,B&PC for this reason PACK FLOW PROTECT,DEVICE SAND'ARY I'Y:FEES N
Owner Date RECEIPT.
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR, P, SCHOOLTAX YN
❑ Iherehy ufOrm that l haveactiificateofcansenuoself-insurc,ora aertificumof FIXi'URES-PERT RECEIPT.
Warkera Compenaaion lnsu 0 c ucemified copy thereon(Sec.3gW,1.uhC. which PARK FEE Y N
wvers ell oder a / GAg-EA.gYST1iM-I INC. OUTLET RECEIPT,
Policy p BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PL sNCHF.CK FEE
❑ Ceni m crpv is hereby umishad.
❑ Cenifiedc.1i isfile iffidmaityinspectiondivisom. ORGSFANDUSTRL WASTE.ESTIiRCEPfOR GRADING HE
CERTIFICATE OF EXP.MPTION FROM WORKERS' GREASETRAP SOILS ME
COMPENSATION INSURANCE
(This section
need not be wm,laed ifthepemtit is hands hundred do11na($100) MWER-SANITARY-STORM EA.2WPT. ENERGY TEE
mrleu.)
I redly that in the performance of the work for which this permit is issued,l shall , ATER fiGTP W/VENT(ELECIR
not employ any person in any manner so as to become subject to the Workers PAID
Compensation Lawsof Califomia. Date WATER SYSTF.M(rR1iATING Data Reccipt.
z Applicant
O0 NOTICE TO APPLICANT:IL after makingthis Cenlficam of Esemtion,you should NEW RESIDENTIAL PLMIL—SQ,FT.r Q TOTAL.:
> becomesubjectthe Worker's Compensation pmvb halo ft he Labor Craft,you must
FFF"a"' ? forthwith wm,ly with such provisions orchis permit shell be deemed revoked. BUILDING FEE
w z CONS9'RDCON LENDING AGENCY SEISMIC FEE
C, Iherehy infirm tanhere is aconstuction lending agency forthe Performance of 'TOTAL: F.LEC'I'RIC PEE
U O the work for which this permit is issued(Sce.3097,Civ.CJ
I<nder's Name
0 U Lender's Address QTY, ( MECLANICAL PERMIT FEE
PLUMBING FEE
U I ramify that 1 have rtad this application and ante that to above infotmamn is
0. correct. I agree to comply with all city and county ordinances and state laws mining m PERMIT ISSUANCE MECHANICAL FEE
Lo) building construction,andhereby audience represenntivesoftiscity to emerupon the
U ,2 above-mentioned property for inspection purposes. ACI'ER OR ADD TO MECH. CONSTRUCTION TAX
(We)agree m save,Indeready and keep harmless the City of Cupertino against
Imbilities,judgumals,costs laid expenses which may in any way accmeagaiut soil City AIR HANDLING UNIT(TO 10,01u)CFM)
in cu yue the ting of����IIII Pennt
is ���� AIR TANGLING UNIT JOY GR 10,0(g)CFM)
Siin'at&of eplicanpComrncror Dae EXUAUST HOOD(W/DUCI)
PAID
HAZARDOUS MATERIALS DISCLOSURE (BATING UNIT TO 100,000 BTU) Data Receipt.
Will the applicant or future building Occupant store or handle incautious material BEATING UNIT(OVER 100,000 69L) TOTAL:
as defined by the Capetian Municipal Cole,Chapter 9.12.and the 11.11h and Safety
Cade,Section a)? VENTILATION FAN(SINGLE RMID)
Yes
13 Yet,
El NO
BOILER-COMP ONE OR FIX,"BTU) ISSUANCE DATE
Will the npplicanmrfuwrcbuilding«cupant useequipmem ordevicee which emit BOILER
/{
p I p0
hazardous air conhtminnnts as defined by the Buy Arca Air Quality Management BOILER-COMP(OVER 100,000 BTU)
Disrrict?
❑Yes ❑No NEW RESIDFNB'IAL MECH. SQ.FT.
I have read the haverdous material,requirements under Chapter 6.95 of to FEB 16 1995
California Ilealnh&Safety Code,Sections 25505,25533 and 25534.1 understand that
if the building does not currently have a tenant,tat it is my responsibility to notify the CI17 UI VVI tan (r
occupant of the requirements which nine be met prior to issuance of a Certilicam of
Occupancy.
Owner or aathons of agent Data TOTAL: ISSUED BY:
OFFICE
OciLVOf
Citperthio
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
11111 Santa Teresa Drive
Cupertino, CA 95014
Subject: 11111 Santa Teresa Drive, Permit#27466 -Waterheater
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
Printed on Pecyclad Paper