27640 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO BUILDING-ELECTRICAL PERMI'I'NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 2 7 6 /I
BUILDING PROJECTIDENTIFICATRIS G 64
BUIIL/DDIING�AAiyURES/S: Q a{7
S //]J/��� SANI'PARY NO. APPLICA'I[OOIIN SUBMITTAL DATE
P�O / ✓t.CJG�/Ci avlNIT0 LOTH
O SNAME: PJ{ONE: 015 CONTRA IOR'SNAME: LIC MORA4 NA` CONTROI.p
AR(',IJIINF. LIC NO: ADDRr S: -
4 TCT/IiN K," El t14 0 e Mdi l 401 El
4"COSPLACT:ft
PHONE DUILDING PCRMIT INPO
qrYPERMIT ISSUAN ELRIC PCRMIT FEEPLUMB MECII❑ ❑ ❑NSED CONTRACTOR'S DECLARATION APPLIANCES-RISIDENTIAL JOB UISCRIPI'ION
WQWZOO IhGomli0.BainderndPoransafCTapter9(commccensewith /^q Is100 5emiohtI=lce Rosiness and Professions Cule,vWmmenemeeis inwith PANELS
�C J
y. ��.... fullforccanAcf m 5g0g Conc./ef�r. .2Q
<FZW License'kip,
LIC.g UP TO 20t)AMPS
mQy Dule�Canlreelrr 201-UWO AMPS
70D ARCHITECTS DECI. ON OVER ILtlO AMPS SQ.PIT.FLOOR AREA $/SQ.FT.
OZ—tm�]J Iundcrsmndnsyplansshnll bunscdaspWliemenls.
SIGNS ELECTRICAL
Q Licensed Pmfensinnul
ty tuYIQ
OWNER-BUILDER DECLARATION SPI°CTAT.CIRCUIT''/MISC.
OOy I hereby affirm tion I not exempt from the Contractors License Lew for We
30„ oullovwhich
nquires a, ermtionmuL5,n.altess and,impime,de ons Cade:Anyepoinay structure TEMP,METNR OR POLE INST.
�mM which reyuimnperoso requires tepplicimprove,demolish,or rcpatr anyytatemere
�<O Priorto,licensed pals.m nth the applicant forsuchCortamon emdur Lfile icense
La statement POWER DEVICES
_MpK Thalmhe is licensed with Ssction70T.Huta,sot the Ce Budoma Llcense Lsion,Cpmr
a off, 9(commencing with Seainn]1M0)of Division3rf the Business and lhofessiom Cade) SWIMMING POOL ELECTRIC VALUATION
y _y or Wal he is exempt therefrom and the basis for the alleged exemption.Any violafionof OUTLETS-SWITCIJFS- 990
3< Section 7031.5 by any applicant for apermitsubjeets the applicant loacivil penalty of FIXT Es / /
Onot roma thea five hundred dollars(S500).
❑ I,;tx nwnensftheprnreny,onnyentployecswithwmges us lhcirsnlecnmpensmion, NEWRISIDENT1ALEL8 _SQ.FT. STORIES TYPECONSTRUMION
will Jolhework,erd the sauuureisnm intended orofferul Intrude(Sm.]U44,Business
and Professions Code:The Comtradors License Law does not apply to an owner of
property who builds nr improves thcteon and who does such work himself or through his
employcen,pnrvidulth�t Hoch impmvwname oro nm intenledoro[fercA[orsule.If, OCC,GROUP RES.UNITS
however,the building orimprovement is sold within oneyearofcompletion,the owner.
builder will have the burden of proving that initial nm build or improve for purpose of
sale.). QTY. PLUMB :RMIT FEE IS,OOD ZONE APN
❑ Las ow cull,(Set. 0FI,Business
Prof ssio,with sed The Contraorsto
mnswm We pmjnot(Sec..an.Business and Professions Cade:) we Contractor's
License Law dfr not appjects wow aminumopenywhosed ds pummumto the
PF.RMIT'ISSUANCF,
whence Lits for such projemxwithecommnor(s)IicenseJ pursuannothe Commmols ALTER-DRAIN&VENT-WATR
License Law. FEE SUMMARY
❑ 1 um exempt under Sec. ,0&PC for this reason BACK FLOW PROTECT. :VECE OUTSIDE FI:S
SANITARY YN
Owner Date DRAINS-FLOOR.ROOF,A FA,COND. RF F.IPI'p
WORKMAN GOMPENSA'f10NURCLARATION SCHOOLTAX Y N
Thereby affirm th:nlhave ucenifcam of conecnuo self-insum,oro certificate of FIXTURES-PERTRAI' C.IFI'N
olein'Compensation lrssumnce ora cenifieJ copy We¢of(Sec.3tlW,Leb CJ which PARK THE ry
covers all ensployec'S,upder� p RECEIPT.
Policp (p7N�7 N'sG 4'��475' �� GAS-IiA.SYSTLM-I IN .40 S
Y _DI GDIVISIO EES
Company 'Ig 9b 9rn .
�7 Certified coy r�� q GAS-EA.SYSTGM-O rRJ(GA) PLANCIIECK
I� py is hereby with
I[,,cry
Certified ropy is tiled with the city inspection division. GREASfA1NDU5TRL WAS"INTCRCE GRADIN
CERTIFICATE OF EXEMPT[ON FROM WORKERS' GREASJ3TRAP S G .I',
COMPENSATION INSURANCE
(This section need not be completed Film pemtit in forme hundrl dollars SIM) SEWER SANITARY-STORM EA.21NS.,
or lean)
I certify that in performance of the work for which this permit is issued,l shall WATER HEA'1'ER W/VENT/ELECTR
not employ any person in any m as m become subject to the Workers' PAID
Z Compensation Lawsof California. Date w WATER SYSTEMTRHATING D e Receipt It
O O NOTICm
Z become subject
the Worker's
Ctormnsation prvisiinsofof Exemption,e,you mull NEW RESIDENTIALI'LMB. SQ.Ff. 'fOTAI.:
F y hceomesuhjecunlhe roushp a Cnmpenr,hi,provisions be eLabormcaeil must
fnnhwifh comply with such provisions or this per shall be JeemM invoked. BUILDINGill
LSI Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
Thereby affirm thanhem is it construction lending agency traffic performmneeaf
V O the work for whi Ihiv pe it is iytuedd Gee.309],Civ.C.) TOTAL: ELECTRIC FE)
de
Lenr's Name CJ
Lenders Addre / �p QTY. MECHANICAL PERMIT FEE PLUMBING FBA
V I minifyWm 1 have read his application and slam that the alawe information is
�" LI correct. I agree o comply with all city and county ordinances and state laws inlating toPERMIT ISSUANCE MECHANICALFEL
F ,p) building construction,and hereby authnrim representatives of this city to enter upon the CONSTRUCTION TA
V Z above-memioned properly for immation purposes. ALTER OR ADD TO MECH.
TWO agree to save.indemnify and keep harrnless the City of Cupertino against
iuhilitics,judgments,costs and expenses which may in any wayaceme against,id City AIR HANDLING UNIT(TO 10,000 CFM)
f We gremin 9Nispnmit. /
/ AIR HANDLING UNIT(OVER 10,000 CFM)
Seto n Dem - EXHAUST HOOD(W/DUCD PAID
Yom" HAZARDOUS MATERIALS DISCLOSURE: I[BATING UNIT(TO 100,0911 BTU) Date Rasiptp
Will the applicam or future building occupant store or handle hamrdoes material HEATING UNIT(OVER IIX1,000 BTU) TOTAL:
as defined by the Cupeninn Mno clpnl Code,Chapter 9.12,and the Health and Safety
Cade,Secdoor O Y 5s32(a)9 VENTILATION FAN(SINGLE REBID) p
Will he applicammfmu n fusee qui tardeviaawhichemit BOILER-COMP(311P OR 1(10,0(10 BTU) ISS AN DA'I'S
goccupan y poen
ill b ccardaus or contaminanu as Refuel by the Bay Area Air Quality Managemepl BOILER-COMP(OVER 1111,000 BTU) 'JAN 19 1995_
District? r�t��� �
❑Ye, a� NEW RESIDENTIAL MECH. SQ,IT.
I have read the hazardous materials require encs under Chapter 6.95 of the CITY Uf UUI'EkI INN
Carposer a Health&Sabi Cade,Sections 25505,25533 and 25534.1 undenfand that -
ifthehuildi doe.nmcurenfly wveafenunt.thatitismyre.sponsihilit t minify
acupanI he requimnems ch must be met roar to ismence V Hifi of
Occup
(J oriycd agent —Q
as 'TOTAL: ISSUED BY:�
OFFICE
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Resident
21875 Stevens Creek Boulevard
Cupertino, CA 95014
Subject: 21875 Stevens Creek Boulevard, Permit#27640 - Concrete Wall
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 Tone 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, C
City of Cupertino
Prcfeo on RacycleJ POOL/