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99090135SS SAI 00itaT DFN nisav P1 n /1 n n 1 71 ff, �___..__. _U".. CITY OF CUPERTINO PIJILDING-ELECTRICAL, BUILDING DIVISION APPIACATION/PERMIT PLUMBING - MECHANICAL. ,1 BUILDING PROJECT IDENTIFICATION' PE MI SANITARY NO. API'LLCATIO RMTFTAL DAL BUILDING ADDRESS: 104or. ANSoN OWNER'S NAME: -` PHONIE ,,,��///`1Q, * MR -Si , H4ncj CONTRACTOR:SNAME: LIC NO: I7 mow, NIC ❑ CDNTROLM PERMIT INFO_Q¢Io❑ ITECT/P.NGINEER: LICNO: CON,,TAPHONeBUILUINO ADDRESS: BLDG ELECI PLUMB MECfILICENSED FAVi[� Consulant Fees Paid by Applicant (Initial) CONTRACTORS DECLARATION I Lamp, atnrrn th, I a I d de Provisions fchapmr9 momma g i on]O(Ich orce and effect QTYELECTRIC PERMIT' FEE JOB DESCRIPTION RFSIDENTIAL• ❑SFDWI. ❑ KITCHEN REMODEL PERMIT ISSUANCE APPLIANCES - RESIDENTIAL License Class Llc.k Dale Cnmracmr DDITION ❑PLUMBING RE -PIPE MULTI -UNIT ❑STRUCTURAL. MODIFICATION [I INTERIOR El CHIMNEY REPAIR IMPROVEMENT []SWIMMING POOLS ❑ BATH RHMODEL/REPAIR El DEMOLITION [I OTHER ARCHITECT'S DECLARATION L understand my plans hall be used as public records PANELS 1Jl"TO HIO AMPS Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm [bat I ;no asampl from ,he Contractor" Lloausa Law for the following reason. (Section 7031.5, Business and Professions Cale: Any city rw c m ty 201-1000AMPS OVER 1000AMPS SIGNS ELECTRICAL which requires a panni, to construct. a1mr. improve, demolish, or repair any, swemre prim m hs nserner,alvo requires the applicam far,uch psnnWnfide asignednatense I that he is licensed pursmnno,he provisions of the Contractors License Law (Clasper 9 SPECIAL CIRCUI DMISC. (commencing with See, too 701MBofDivision3of,ha Business and Profession, Code) or For he is exempt thcrefram and the ba,i, forme alleged esempnion. Any violation of Section 703 LS by any applicant for a permit subjects the applicant to a civil Penalty of no, are than five handled dollars ($500), i E]1, as initial fine propcny.or,ny ontployees with wugea as lheirsolennnpemanion, will do the work, and the sw<tum is nal imm�ded nr offcad fur sale (Sec. ](H4. Business and Profesaio r Cedi The Comracarts License Law docs no, apply to an owner r TEMP. MET ER OR POLE I N ST. -OM�MFRCI'e—`I�' ❑ NEW BLDG/ADDITION ❑ DEMOLITION ❑TENANT ❑FOODSERVICE PROVE?#ENT THER POWER DEVICES If SWIMMING POOL ELECTRIC OUTLITS- SWITCHES - FIXTURES NEW RESIDENTIAL ELECTR SQ FT. + property who builds or improve, thereon, and who does,tu:h work himself or through his own employees, providN that such improvements are not intended or offered for salc.If, however the building or improvement is sold within one lemcfannpletian,the SQ. Ff. FLOOR AREA 8/SQ. FT. 0wner-builder will have the bnnlen of Joint, ,le( he did not build or improve Ito por- TOTAL: of sale.). 1 ss owner opif the pnm exd uhively contracting with licensed contrec ms to o shun the project (Sec ]044, Bmincva vad Professions Code:) The Contractor's Li- re,v: law docs no, apply to an owner of partially who builds or improves demon, and who contracts for such Immeeth whh a con0ac orts) licemal puraanm 'a 'he Contractors 4 '� -• .. I •- - QTY, PLUMBING PERMIT[', 1 i� FEE PERMIT ISSUANCE License Law. ❑Ivmeaemlounder$tee. ,B&PCEnthisreson wner Dae4 71.Aq WORKER'S CO tNSATLON DECLARATION AIA ER - DRAIN & VENT -WATER CA) BACK FLOW PROTECT. DEVICE VALUATION -2-6 J"N,e,N /� [hereby affirm under (moult perjory one of the following dedarmians: I have and will maintain a Certificate of Consenfto self -insure tin Worker's Compcn- DRAINS- FLOOR, BOOT, AREA, COND. STORIES TYPE CONSTRUCTION aurin,, as parvided for by Section 3700 of the Labor Calc Scribe performance of the work liar which ,his permit is N,riad. FIXTURES- PER TRAP ❑ I have and will mainein Worker's Compenamion Insurance, ns required by Sectio 3700 of the Labor Cale, for the performance of the work for which this permit is issurd. My Worker, Cantpen,alion Insurance curie, and Policy number are: Cortico Policy Na.: GAS - EA. SYSTEM -I INC.4 OUTLET OCC. GROUP 3 Z�APNL� GAS -EA. SYSTEM -OVER 4 (EA) GRFASE/INDIISTRI. WASTE INTERCEPTOR CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE $ a+m yBUILULNG DTVI FEES (This acction reaction hecnmple,edifnhepermitis fororehundreddollars(SRyB or less.)PLANCHF.CK GREASETRAP FEE SEWER -SANITARY -STORM EA. 200 INK ENERGY FEE I rani fy that in,be parformmnacafthe work for whivhdii, permitis issued. l shop not employ any person in any manner so as to become subject to the Workeri Compen- WATER HEATER WNENT/ELECTR GRAVING PIiE ' selion Laws of California, Date I Applicant NOTICE TO APPLICANT: If, after nuking this Certificate of Exemption, you should Lx ome subjcen to the Workers Compensation previsions of the Labor Cale, you must WATER SYSTEMaREATING SOILS FEE WAI ER SERVICE is forms (IF comply with such pro, Isioosor this permit a hal l be dernmd revoked. CONSTRUCTION LENDING AGENCY Iharehy union than there is a cotnlruchon lendiagagancy, lbr the pcdorri of PAID One R eipl# NEW RESIDENTIAL FILM R, SQ. FC 'TOTAL: the work for which this permit is i_esued (Sec. Eat Civ. C.) hander's Name 'IOTAS: Lendcr'e Adds,, BUILDING FEE 1 certify than 1 have read this application and state than the above information is j cores. I agree m comply wile all city ad may ordinances and state laws relating to ' baiktiny cmtawedo,, and hereby,mmarim representatives of this city to enter upon tile - - - ,- 'QTY' MECHANICAL PERMIT FEE-, SEISMIC FTiE PERMIT ISSUANCE, ELECTRIC FEE above-mertionW Property far inspection purposes, (We) agree to save, indemnify and keep hamdess,he City of Cupario, against ALIERORADDTOMECII. PLUMPING PEE Iiabilllies,jmhowms,etasand uspenscv which maymany wayaceme againhIwid City in tICAN tee of the of his permit. AIR HANDLING UNIT (TO 10,000 CFM) MSCI IANICAI. FF.E APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT RSTAN SQWRCE REGULATIONS. AIR HANDLING UNIT(OVER 10,0(I0CFM) CONSTRUCTION TAX R 2t - Si dT aof Applirnm/C Dom HAZARDOUS MAT ERIAI S DISCLOSURE EX FAUST 11001)(W/DUCT') HOUS ING MT' I'IGATION FEE HEATING UNIT (TO 100.000 BTU) Will The applicant or fnare building occupant Stora or handle hamadmh mammid as dcOned by hie Covert inn Munielpal Coca, Chapter 9.12, and ,he thellh and Set,,, Cod, Section 25532(a)? HPATING UNIT (OVER IM.000 BTU) VENTILATION FAN (SING LE RES] D) ❑Yes ❑No PAID "- Date Receipt# ROLLER - COMP (3HP OR IIXI,IX10 BTU) Will the applicant or future building occupant use equipment or devices which mit hazardouns air otairiarm, tis defined by the Bay Area Air Quality Management TOTAL. BOILER- COMP (OVER 100.000 BTU) District? ❑Yes ❑No AIR CON A DONER I have read be hurardoes materials requiremems under Chapter 695 of me Cali- ISSUANCE DATE NEW RESIDENTIAL. MEER. SQ. FL foods Health & Safety Code, Seed.. 25505.25533 and 25534. 1 understand Lha, if the budding dress not currently buve a tenant, that it is my responsibility,a notify the occupant p �7 _.__`7 art tie n Is whiehmm'n,a tido, 1. M.aaca of a Cami'ae afow�anay. q _ 7� To ISSUED BY: TOTAL: Owner orauthnrned agent Uatc ( OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: chrietya } Sec: Twp: Rvg: Sub: Elk: Lot:3264155.00 INVOICE DATE......: 09/21/1999 REFERENCE ID # ...: 99090135 SITE ADDRESS .....: 10406 ANSON AVENUE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: HOU ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO, CA 95014 CONTRACTOR .......: COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... TELEPHONE ........: FEE DESCRIPTION CHK TOTAL FEE _______________ -ENERGY -_- A ----_---- 92.10 BPERMFEE P 307.00 BPLANCHK A 260.95 BREMRECEPT P 23.54 BREMREPALT P 12.21 PICRE P 2.50 i TFEE P 35.52 M ITFEE P 35.52 769.34 VOICE ID DESCRIPTION .......= ...a ........................ 101 FOUNDATION 103 UFER 105 ANCHOR BOLTS 202 UNDERFLOOR PLUMBING 204 UNDERFLOOR FRAME 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 305 FRAME 307 INSULATION 309 EXTERIOR LATH 311 SCRATCH COAT 501 FINAL ELECTRICAL ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 0 LIC # PAID -TO -DATE BALANCE DUE ------------ ----------- 0.00 92.10 0.00 307.00 0.00 260.95 0.00 23.54 0.00 12.21 0.00 2.50 0.00 35.52 0.00 35.52 ------------ ----------- 0.00 769.34 VOICE ID DESCRIPTION ........ ..................... 102 PIERS 104 REBAR 106 SEWER & WATER 203 UNDERFLOOR MECHANICAL 205 UNDERFLOOR INSULATION 302 TUB & OR SHOWER 304 ROUGH ELECTRICAL 306 HOLDOWNS 308 SHEETROCX 310 INTERIOR LATH 313 ROOF NAIL 502 FINAL PLUMBING ENERGY 504 FINAL BUILDING ENERGY 506 GAS TEST CITY OF CUPERTINO 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: christya COPY # : 1 Sec: Twp: Rng: Sub: Elk: Lot:3264155.00 DATE ISSUED.......: 09/30/1999 RECEIPT #.........: 10208 REFERENCE ID # ...: 99090135 SITE ADDRESS .....: 10406 ANSON AVENUE SUBDIVISION ....... .CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: HOU ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: TIM CONTRACTOR .......: LIC # COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... TELEPHONE ........: FEE IO UNIT QUANTITY AMOUNT PD -TO -DT THIS REC _______ NEW HAL _-___----- ---------- ------------- BPERMFEE VALUATION ---- 25,000.00 ---------- 307.00 ____ 0.00 307.00 0.00 BPLANCHK PERMIT FEE 307.00 260.95 0.00 260.95 0.00 Y PERMIT FEE 307.00 92.10 0.00 92.10 0.00 CEPT NO. OUTLETS 22.00 23.54 0.00 23.54 0.00 MPERMITPEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 BREMREPALT NO UNITS 1.00 12.21 0.00 12.21 0.00 BSEISMICRE VALUATION 25,000.00 2.50 0.00 2.50 0.00 EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 ---------- 'TOTAL PERMIT ---------- 769.34 ---------- 0.00 ---------- 769.34 0.00 -METHOD OF PAYMENT AMOUNT NUMBER r_________________ ____________ __________________ CHECK 769.34 237 TOTAL RECEIPT x_6630769.34 L