27981 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO EmL)INU-ELEUrRIC PERMIT NO.
APPLICATION/PERMIT PLIPUING-MECHANICAL.
BUILDING.DIVISION HULLOING PRO.IECI'IDEN'I'IFICAY'ION 27981
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAIS
OTM
OW�RSN M@ CONTNACfOR'S NAME: LIC NO: aas�_`IC6;
N/C CONTR� OLg
�ANGI II'1'E 1'BiNGINE-ER: LIC NO: ADDRESS: , ❑
V
CONTACT: PHONE: Q4 xgd #i, .ELEC'TRICrPERM IT PCG xs BUILDING PERMIT INFO
BLDG ELFiCT PLUMB MECII
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL LOB DESCRIPTION
Coxz I limby affirm that l ore licensed underpmvisions of Chapter9(commencingwiN
POO Section 1001 Division 3 ofthe Business and Pmfessioes Code,and my license is in PANELS '
fullforenandeffor.
F2W License Class Lic.k UP TO 200 AMPS
tiF-Qy Date Con,m, ' 201-I"AMPS
Z.O vi Z.-1 ARCHITECTS DECLARATION OVER IOOOAMPS
SQ.FT.FLOOR AR[iA 5/SQ.FT.
O Z—O 1 understand my plans shall be used ss public records.
M,,F Ia SIGNS ELECTRICAL
Lic sal Professional
OWNHR.BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
�aaddOyF 1 hereby uffirtn that 1 ren exempt from the Contractor's License law for to
tsl3 u.rn following reason.(Section]031.5,Business and Professions Cale:Any citycr county TEMP.METER OR POLE INST.
`�tS rnS which requires a permit to coreamct.alter,improve.demolish.or repair any swetum
ren} prior 10 is issamer,alsn require theapplicamfar such perming fileasignadstmament POWER DEVICES
Kip that he is licensed pursuant to the Provisions of the Contractors License Law(Chapter
ddo� 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION
µ�_rn or that he is exempt hcmfmm and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIXTURES
�Z4 Section 00315 by any applicant for a permit subjects the applicant to..vilpenahy of
r�0 not mart than five hundred dollars(85(10). NEW RESIDENTIAL ELECTR S
3Fo ❑ I,nsownernfthepmlxny,ormyemployeeawith wagesas theirsolecompcnsation, Q.FG STORIES TYPECONSTRUCIION
willdo the work,and the structure amid intended or offered for sale(Sa.7044,Business
and Prefessios Code:The Contractor's License law does not apply to an owner of
pmpeny who builds or improves thereon,and whodo o,such work himselfor through his
own employees,p whed that suchimprovemenls menet imendedarofferadforsale.If, OCC.GROUP RISS.UNI'lS
however,the buildingor improvement is sold within one yearofcompletion,the owner-
builder will have the burden of proving that he did net huild or improve for purpose of
sale.).
❑ I,as ownerofthe pmpeny,ameaclusively contracting with licensed contractors to QTY, PLUMBING PERMIT ,FEE FLOODZO L APN
maract the prajeel(Sao.7(44,Business and Profwslons CW O The Contractive,
Lianx Law Jncsnm opplym anowncrofpropeny whohuildsw impmvea Merton,and
PERM]]'ISSUANCE
whocnntmets fooauch projects with acontmemr(s)licensed pursuant to the Cunractoes ALTER NA fT:E SUMMARY
Lhum,c Law. (. 7
❑ 1 am exempt under Sec. ,B&PC for this reasonD:pF
BACK FLOW PROTECT.DEVICE SANITARY YN
Owner Data DRAINS-FLOOR,RtPOP,ANI:A,GOND. RECEIPTM
WORKMANOOMPENSATIONDECLARATION SCHOOLTAX Y_N
❑ Thereby ufOrm rhmihaveucenifica¢ofrowenun selbinsum,ornceni0eme of FIXTURES-PER TRAP RECF.IPTIf
Workers Compenxtion Insurance or o certified copy flereof(See.38M.lab C.)which PARK FEE Y_N
covasallempbyecsuMer this permit. GAS-EA.SYSIE•M-1 INC.40UTLETS RxCEII'1'p
Policy M BUILDING DIVISION FEES
Company
❑ Carl copy is hereby famished. OAS-HA.SYSTEM-OVER 4(HA) PLANCHECK FEE
❑ Ccnifiedcopyx Bled with lheciry inspexamodivisina GREASIpINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP
COMPENSATION INSURANCE SOILS FEE
(This section need not becompleted ifthe penton is for One hundred dollars($100) SEWER-SANITARY-STORM G.2WFT. ENERGY FEE
or less.)
I cenifythat inthe performance of the work far which this perant is issued,)shall WATER IIF TFR W/VENT/ELECTR
not employ any person in any mmmer so as to become subject to the Workers' PAID
CamNensutiunlawsaf Califomia. Data WATER SYSTEMnREATING
Data Receiptp
Z Applicmn
Z 0 NOTICE TO APPLICANT.1LaRa making this Certifinte of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
t-+ V) luteoma subject 1.the Worker's Compensation provisions of the Labor Cale,you..at
lR' 7 fonhwih comply wi th such provisions or this permit shall be deemed revoked. BUILDING FEE
a [� CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z I heachy affirm thin there is a consvuctiom tending agency for to performanca of
J C) the work far which this pemtit is issued(Sao.3097,Civ.C.) TOTAL: ELECTRIC FEE
7. r.t IsnMrs Names
a _
.J U Lenders Address QTY. MECHANICAL PI312MPP FEE PLUMBING FEH
N I certify that 1 have read this application end state that the above information is
e
meat.lugrocmcomply withal)cityindraunty ardinnncesand stmt laws relating to PERMIT ISSUANCE MECHANICAL FEE
D,I building emumry me,und hembyauthodze rtprexnmtivesofthisciry menterupnn the CONSTRUCTION TAX
j Z above-mentioned property for inspection purposes. ALTERORADDTOMECH.
(we)agree m save,indemnify and keep harmless the City of Culsmino against
liabilities,jud cuts,costs and expenses which may in any waywcmeagei set said City AIR HANDLING UNIT(TO 10.0,30 CFM)
in aortae. the, at of th' permit.
AIR HANDLING UNIT(OVER IO.WO CFM)
tgnatere of Applicant r ter Y ate EXHAUST FOOD(WMUCn
PAID
HAZARDOUS MATERIALS DISCLOSURE. HEATING UNIT EO Bid."BTU) Data Receiptp
Will the applicam or future building occupant store or handle hazardous rudedal
w defined by ilia Curynino Municipal Cod,Chapter 9.12,and the Heahh it Safety I IEATI NO UNIT(OVER 100.000 BTU) AI,;
Cod<,Section 25532(a)P
11 yas 11 No VENTILATION FAN(SINGLE RESID)
BOILER-COMP(JHPOR 100,(Np RTU) ISSUAts( iDATE
Will Me eOmbemrsturs s building by the Bay equip men Quality
es Management P.Y All)
ha,arc,? air contaminants as JefincA by the Day Arca Air Quality Management BOILER-COMP(OVER 100,000 BTU) �Y
Uistrictl
❑Yes ❑No NEW RESIDENTIAL MECH, SQ.IT, p
PR 25 ,
1 have reed the hazardous mmerials requirements under Chapter 6.95 of the aa,
California Health&Safety Code,Sections 25505.25533 add 25534.1 understand that C/Ty()FGUN' W
if the bulldinur
gdrrcs nal current 11 have a tenant,that it is my responsibility m notify the la
exc Loom of Ne nopno comas which most be met prior to issuance of a Cenifiwte of
Occupancy, 29
Owner or authorized agent Date TOTAL: ISSUED BY:
CILv of
Cl1per tll10
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
903 South Stelling Road
Cupertino, CA 95014
Subject:903 South Stelling Road, Permit# 27981 - Spa- Electric
Dear Resident,
According to our records the above mentioned permit has never been fmaled by a
City Building Inspector. A permit is considered to be valid only six months from its
• las4 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, 1
City of Cupertino
44
Prinrea on Fecvcled Paper