27823 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF.RTINO ..MpCellh,TRTCA7. PEgMIT No.
APPLICATION/PERMIT PLUMBINGMF,CHANICAL
BUILDING DIVISION BUILDING PROJECT BEEN 27823
BUILDING ADDRESS: �/s ` 1 , SANITARY NO. APPLICATIONSUBMI'MALDATE
�, eT)V W UNIT# LOT Of
OWNERS N HONE: CONTR CTOR'S NAM-6 � LIC NO:
N/C ROI#
ARCHITECT/ENGINEER: LIC NO: ADDRESS: .d ❑
CONTAC]': PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
BLDG %nj, PLUMB MECH
PERMIT ISSUANCE El 17, ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRE'1'ION
OIYZ I herebyalEwthat l sin licensed underprovisionsof Chapter9(commenciagwilh
POO ZWUE Sat lore and ofetDivision3of the Business and Professions Code,and my license is in ppNBtS
r4ZW full fora and effect. UPT02WAMPS
FZW License Class Lic.p
.n=y Date Convector 201-BOB AMPS S FT.FLOOR AREA E/gQ.FT.
ZQy'� ARCHITECTS DECLARATION OVER 1000 AMPS Q
O Z_G I undemmsad my plans shall be used as public records.
SIGNS ELECTRICAL
Licensed Professional
ser
9CY OWNER-BUILDER DECLARATION SPECIAL CIRCIRT/MISC.
ap•OyU I hereby dOrn that 1 am exempt Iran the Contractor's License Law for the
W 3 a y¢ following reason.(Section 7031.5,Business and Professions Cade:Any city or county TEMP.METER OR POLE INST.PJ on J which requlrea a permit to construct.after,improve,demolish.or repair any someone
Y� prior to its issuance,alsoremixes the applicant for s.chper minoftieesignedsmtameam POWER DEVICES
p� C pK that he is licensed pursuant to the provisions of the Contracmr s License Law(Chapter gWgMMMG POOL ELECTRIC
h2�0. 9(commencing with Section]000)of Division 3 of the Business and Professions Code) VALUATION
Wim Or that be is exemptaherefrmn sand the basis for the alleged exemption.Any violation of
,ZSection]031.5 by any applicant fora pewit mbjecn the applicant has civil penalty of OUTLETS-SWITCHES-FIXTURES
vl p ❑ m . NEW RESIDENTAL ELEC T( S .FT.
STORIES TYPECONSTRUCTION
moe than five hundred dollars($500)
S o0 will dome work,tmd the svucwre is not intended offered forsde(Sec.]tX4,Business
anA Pm(essiom Calc:The Contract License w does not apply to m owner of
pro" who buil o"arpmvea the such workhimulfathrough hie
ownemployae.pr vidcdt m notintended proffered forsde.If, OCC.GROUP RES.UNITS
however,the u i pr su wuhinaneyearofcompletion,theowner- TOTAL:
huilit-will ha h mving that he did not build or improve for purpose of
le.).
❑ I,ns owntoo, proper eOWa.I"Xil m ciceet sedcontraemnro QTY. PLUMBING PERMIT FEE FLOOD ZONE nPN
answer the proja (gee.] u n ss d fessions a Convaeor's
wrione lawdoesnorapp"t. ofproperywbo build mimprovesthereon,and PERMIT ISSUANCE
whocommcn forsticmoreeb with a convac odsHicansed puts commtM1a,rnetor'e [?A ALTER-DRAINffi VENT-WATER(
License Law. ) FEE SUMMARY
❑ 1 am exempt under Sec. ,B ffi P C Por this roan BACK FLOW PROTECT.DEVICE f
SANITARY Y N
Owner Data RFCIi1PTp
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF,AREA,COND. SCHOOLTAX Y—N-
1 hinday
NTherby affum that l have a certificate ofconsent to ulf-insure,or a certificate of FIXTURES.PER TRAP RFCEIPI'#
Workers'Compcnsation hommuceora cenifiedeopy thereof(Sec.380),Lab C.)which PARK FEE Y N
covers all employer's underthis Permit. GAS-EA.SYSTEM-]INC.4 OUTLETS RECEIPT#
Policy# BUILDING DIVISION FEg
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Certifiedcapyisherebyf fished.
❑ Ca9fiedcrry ie filed withlhe city inspection division. GREASEANDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTHPIQNM OF OMPENXTIONINFROM WORKERS' GREASE TRAP. SOILS FEE
COMPENSATION INSURANCE
(This section neW not be completed if the permit is foronchwdred dollars($103) SEWER-SANITARY-STORM EA.2(0FT. ENERGY FEE
or lCaa.)
(certify that iJIM n in any performance work for which this ubjecPermit o the W.lshefl WATER HEATER WNENT/ELECTR
not employ any person li any. Date u a9 to baane subject m the Workus PAID
Compensation laws of Celifomia Date WATER SYSTEM/IRP.ATING Dare Receipt#
0 Z Applicant
z � NOTICE TOAPPLICANT:If,after mAingthis CertificamofExemption,you should NEW RESIDENTIAL PLMIL SQ.FT. TOTAL:
become subject to the Worker's Compenwitian provision of the Labor Code,you must
P , forthwith comply with such provisions Or Nis permit shall be deemed revoked. BUILDING FEE
.S z CONSTRUCTION LENDING AGENCY SEISMIC FEE
rC� 1 hereby am deal there at.constradon lending agency for the performance of
U O
,he work for which this permit is issued(Sao 3097,Civ,C.) TOTAL: ELECTRIC FEE
Lenders Name
t'a Lenders Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
U I certify that 1 have mad this application and site that the above information is MECHANICAL ME
>• Fkl torten.l agree or comply with all city and county ordinances and stem laws relating to PERMIT ISSUANCE
buildingconstruction,and hereby authorize representatives mthis city roamer upon the CONSTRUCTION TAX
UZ above-mentioned properly lot inspection purposes. ALTERORADDTOMECH.
(We)agree to save,indemnify and kap humdus the City of Cupertino.gaimt
liabilities,judgments,costs and expenses which may in my way accrue against said City AIR HANDLING UNIT(TO 10,000 CFM)
in cone a the graining pa
' NDLING UNIT(OVER 10,"CFM)
XHAU7'HO (W/ U'*nature fcant/Con for
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.000BTU) Dam Receipt#
Will the applicant or fame building=upon,smrc or handle hazardous material HEATING UNIT(OVER 100,000 BTU) TOTAL:
as defined by the Cupertino Municipal Code,Chapter 9.12,attrition Health end Safety
Cade,Section 25532(.)? VENTILATION FAN(SINGLE RESID)
❑Yes ❑No
ISSUANCE DATE
Will theapplicomorfutua buddingacupent useequipmamrdevices whichemit BOILER-COMPOIT OR 100i"BTU)
tombs air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OV M IW.M HTU) A I #.I'
ntdnT
❑Yes 0 N NEW RESIDENTIAL MECH.—SQ.FT. 9
1 have read the hazardous materials requirements under Chapter 6.95 of the ORA
n(�
California Health&Safety Cale,Sections 25505,25533 and 25534. I understand that 1995
if the building does not curtently haveatenun4 thin it is my responvibilirymnotify the VP 1.ur.
Occupant of the requirements which must he met prior to issuance of a Cenificae of Cn I l
OccuPsecy.
Owner or amhmiuA.,car Data TOTAL: ISSUED BY:
Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 29, 1995
Resident
7794 Lilac Way
Cupertino, CA 95014
Subject: 7794 Lilac Way, Permit#27792 - Bath Electric
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
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