28226APPLIeANTaI'O FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO HULLOING-KLKCTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL
BUILDING PROJECT IDEN OPICA'HDN
, a.,a ^ „a rs /N
PERMIT N028226
L yV('LJ L FV1
BUILDING ADDRESS:
SANITARY NO.
AMICATTIIONSSUBMITTALDATE
D2b0 UNIT# LOT#
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CGNTACI': PHONE:
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QTY. ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
BLDG FLE UM MOH
✓`tea 41r 549- (%:t,PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
Himcbyafim"at l am licenxdunder provisionsof Chspmr9(commencing with
APPLIANCES - RESIDENTIAL
IGH DESCRIPTION
PANELS
Swoon 7000)of lNvision 3 oftM1c Business and Professions Cob, and my license is in
full force and effw
License Gloss Lia#
UPT02W AMPS
201.1000 AMPS
Date i Cammcmr
CHITECTS DE RAD
1 undeuturd my plans,hall be mm an pu term cls.
SQ. FT. FLOOR AREA
S/SQ. FT.
OVER 1000 AMPS
SIGNS ELECTRICAL.
LittnxW Profes,ional
OWNER -exempt s,RDI?C ON
SPECIALCIRCUIT/MISC.
I hereby affirm that I um exempt from the Contmcmts
Corina Taw for the
TEMP. METER O Lfil
ciAr,e
following leesun. ISwtion 7Ull.5, Business anJ Prafcesiona Code: Any city or county
whichre9uiresapermi o, construe improve, demolish.m.,ranymunum
primmitsissuane,alaorequlr eapph mforsuchpenninofileaaignedsmcmeat
POWER DEVICES
that he is licensed pursuant the provision. of the Contractors License Lew (Chapter
9(cmmmemcingwAhS on1(gglof Divisi 3ofthe Dusinessand Professions Code)
SWIMMING .LF. C
VALUATION
orthmhcisexem crefromandthebasisfo he alleged exemption. Any violation of
Soction7031 yanyaplicantforapermits 'cnalh<eppllcanuoacivil penvlty of
/w�•
OUTLETS - SWITCHES - FI M
not an. a Eve hundred dollars (5500).
,asnwneroOhe property, ormyempNyces iNwagesastM1ei'm1mompctwtion.
NEW RESIDENTI ,E .FI'.
STORIES
TYPECONSTRUCTION
dl clothe work,endthe suucmre isnot imsidledo offered heaWe(Sm. 7044. Business
and Professions CMe: The ContmdM License w dors not apply m m owner of
s.chavokuomhmughhis
propenywhabolldsorimpro sthcoMmlf
ownemployeespinvidedthat ch oe is sotimendedoroffcredforsale. If,
!soldwiNinac
OCC. GROUP
RFS. UNITS
however.thebuiliing limp ofmmpletlondheowner.
builder w'1) have the d mg that he did uild or improve for purpose of
MJe.).
❑ La, ne fN o rsy,amexclusiv conameh gwiNlicensedmintmcm
QTY]rsto PLUMBING PERMIT FEE
FLOOD ZONE
APN
onswc ce. 7044, Busine and Professi us Code:) The Contractor's
Licer notapplytounowner properywhobuildsorimprovesthereon,mrd
PERMIT ISSUANCE
himbare for uchprojectswith onuuct Odlicensedpursuanumhe Cantracmr'°
case Law.
ALTER - DRAIN&VENT - WATER (FA)
PEE SUMMARY
1 urn exempt under Sec. , B & P C for thisrtason
BACK FLOW PROTECT. DEVICE
UTSI ,E
SANITARY YN
RECIi1PT#
Own Dam
DkA1N5-MOOR, ROOF,ARP CON
WO tAN COMPENSATION DECLARATION
SCHOOL TAX Y
❑ I rebyuffi at l have a certificate ofcansent to self -insure, ora certficare of
Workers . ation Insurance or a versified copy thereof (Sm. 38M,lab C.) which
RECEIPT#
FIXTURES - PER TRAP
PARK FEE Y N
covers all employee's under this permit
Policyp
GAS - EA. SYSTEM -1 INC. 4 OUTLETS
Rii .HT
BUILDI 1151F.S
Company
❑ wed copy is hereby furnished.
GAS - EA. SYSTEM-OVF.It 4 EA)
PLANCHECK FEE
GREASEANDUSTRL WASTE INTERCEPTOR
GRADING PEE
CrnlfiM copy is filed with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS'
GREASM. AP
SOILS FEE
COMPENSATION INSURANCE
SEWER-SANITA
FNPAGYIEL
(This section need not be cnmpleled ifthe permit is hours hundred dollars(5100)
m leu.)
WATER HEATER W/VENTJLECTR
I cenify net in the performance ofthe work for which this permit is issued, i shall
nw employ any person in any manner, so es to become subject to the Workers'
PAID
WATER SYSTEMITREA
Compensationlawsof Culifomia. Date
Receipt #
APPlicrm
NOTICE I'O APPLICANT: If, urermnking this Cenifica¢ of Exemption,you.hould
NEW RESIDENTIAL PLMB. SQ. FT.
TOTAL:
become subject o the Worker's Compensation provisions of the Labor Coder, you most
deemed revoked.
comply with such provisions or this Permit shall beeeme
BUILDING FEE
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby affiant that there is a construction lending agency for the performance of
the work for which this permXf�� a: 3x97, Civ. C.)
ELECTRIC FE
Lender's Name IVPhUMBING
QTY. MECHANICAL PERMIT FEE
E
Lenders Address
I cenify that 1 have read this application and sure that the above information is
correct. l agree to comply with all city anal county ordinances and stale laws relating to
PERMITISSUANCE
MECHANICAL FE
building ransomed., and hereby aathodsx reprremli dues of this city to enter upon the
above-mentioned property for inspection puopposes.
ALTER OR ADD TO SECT.
CONSTRUCTION TAX
(We) agree to save, indemnify and keep harmless the City of Cupertino ugainat
Iiabilities,judgmenls, cost annd expenses which may ininy weyaccruea,mast said City
AIR HANDLING UNIT (TO I 0,00k) CFM)
AIR HANDLING UNIT (OVER I0,000 CFM)
in eonsequenm of the grunting of this permit.
EXHAUST HOOD(W/DUCT)
PAID
Signature of ApplicanUContracmr Date
HBA'1'WG UNIT (TO 100,000 BTU)
OSURE
HAZARDOUS MATERIALSDISCLOSURE
Date Rana tp
HEATING UNIT (OVER 1o(1,00()BN)
T TAI:
dom I tandous lealth and material
Will thea Capertoard or Tumrcicipal Code,ng pantsmre o, hanand the
an defined by theCapertonMunicipal Code, Chapter 9.13, and the lkahh end Safety
VENTILATION FAN (SINGLE RESID)
CMe, SectiV5a32(a)1
lI��El No
ISSUANCE DA
Will the applicant orfuture buildingoccuptalusaNuipmemordevicss whichund
ROfLER- COMPpHP OR I00,01XIBTU)
BOILER - COMP (OV ER Did." BTU)
htiondous air contaminants as defined by the Buy Area Air Quality Management
District?
Ifs
PAID
O
NEW RESIDENTIAL MECH. SQ. IT.
❑ Yea ❑ No
1 have read the ha arol aterials rcquirctnems under Chapter 6.95 of the
California Health & S, t Me, corm 25505, 25533 and 23534. L understand Net
JUN 27 g�
if the building do of curtcmlyh eetenent that it is my responsibility to notify Ne
«cupant oft rest. orb ch mas met prim 10 ax ce of Cenilicate of
Occupancy
a
nNo
ISSUED BY:
Owner m authonu ant Date
TOTAL:
OFFICE
.•
J
of
10300 Torre Avenue
Cupertino, CA 95014
Cupertuio Building Division
(408)777-3228
(408) 777-3333 (fax)
April 23, 1996
Resident
10260 Bubb Road
Cupertino, CA 95014
Re: Expired permit (copy attached)
Dear Resident:
t0
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
is 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.
•1
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
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