00010156APPLICANTTO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY 00o/ O
IllON'CUPERTINO BUILDING - HLECTRICAI. PERMIT NO.
nUILDING DIVISION APPLICATION/PERMIT PLUMBING - MRCHANICAI.40
, BUILDING PROJECT IDENTIFICATIONI ..
A✓e
N.(Od11N
1 hereby aR m that 1 am licensed under provisions of Chapter 9
with Section 7BlXp of Division 9 the Business and Prnfe,,ia sCtea. an
. fill lachos dcllbct.,a ``��-�57,3
License rcess �LiC,p _S.7_
Da¢�+-/�-aOA—Cor osemr
�" , / G SIIKj ITECI"S DECLARATION
1 understand any plans xhalI he,,sal as pmal.. records
LIC
❑ Consultant Fees Paid by Applicant (Initial)
fiLECIRIC PERMIT
PERMIT ISSUANCE:
APPLIANCES - RIS IDENTIAL
PANELS
UPTO200AMPS
-'
.]
W Q
It r-
LL o N
t�t�Q
p. -4
OWNER -BUILDER DECLARATION
1 hereby aBinn that 1 um excerpt from tM10 e,ntracmds e: An c Law for the
]IDI a Business and improve, le ons Cale: Any city or county
following reason Round
which reyuires a permit In ammmct, aper, improsx, demolish, or repair any swcture
pnorm its ismitace.allo reyuires the applicant for such parchm filoasignedstmement
this he is liccnsodpursum,to the pmvisionsofthe Crmlmaofs License Law (Chader9
OVER IMO AMPS
SIGNS ELECfRICAI.
SPECIAL CIRCUIT0,11SC.
❑MULTI -UNIT
Q'S'
(,nmmencing with Section 7000)of Di,i,am 3 ofthe Brsiaess.md Pndbc,mx Code)or
,hal he is exempt Therefrom and the basis for the alleged exemption. Any violation of
TEMP. M E' BR OR POLE INST.
El INTERIOR
-- N
--,
L 3 ao
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of
et more than five hundred dollars ($510).
I,mownmofihapropm'.,,myenmloycc with wages anheir xnle comp'a'alme.
will doth, work, and the wmdrre is mat imeaded ornfiered for sale (Sec. 7044, Business
and Professions Cale: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETS -SWITCHES -FIXTURES
❑ OTHER
his own employees, provided that such improvements are not intended or oficred for
NEW RHSIDENI Al. ELEM It SQ Fr.
sale. 11, however, the building or improvement is sold within one year of completion, the
owner -builder will have the burden of proving that he did not build .r improve for pur-
pase ofssalcJ.
1, as owner nl the property, am exclusively contracting wird licen.md contractors t.
TOTAL.
mxbu(the project (Sec. 7044, Business and Professions Code;)'Ihe Comtaau.'s I.,-
aselowdoesnotapplytoonownerof property who builds or improves thereon. and
QTY' PI,UMRING,PERMIT` I
who convects for such pntjects with a commands) licensed pursuant o the Contractor's
PERMIT ISSUANCE
License Law.
❑ I am exempt under Sea. ,B&PC lot this open
ALTER - DRAIN & VENT- WATER (EA)
Dat
WORKER'S COMPENSATION DECLARATION
BACK FLOW PROTITCT. DEVICE
1 hereby affirm under penalty of perjury one of the following declarations:
DRAINS- FLOOR, ROOF, AREA, COND,
I hay.and will nminmina C,rtili.nteal Cnmsendo ulf-insure for Wmket's Comtper-
somiom, as pm,,dcd far by Section 37W of the Lahr Cale, for the performance of the
m for which This permit is issued
FIXTURES - PER TRAP
have and will maintain Workers Compensation Insurance, as rerryired by Section
3700ol he Labor Code, Earth. performmteeofma work ler whibh,hi, tis issued.
GAS -IiA. SYSTEM-] INC. 4 OUTLETS
My Wor�e(/C��o��t�Eeernls��e�''Io°°"° 1dEur nce carrier and Policy /�m5 ["{"'
Carrier.4i�JLL"J-S/� Policy vr�r"S.
GAS -IiA. SYSTEM OVER 4(EA)
RO
C13R1'((FTCATH OP EXCMI'TION FROM WORKERS'
COMPENSATION INSURANCE,
GREASEYINDUSTRI. WASTE INTERCEPTOR
[This section need not he completed if the permit is forma, hundred do][. (SIM)or Ices)
GRPASI?TRAP
SEWBR-SANI'T'ARY-STORM PA. 200 fl1
T,nhfy that in the performance of,ho work farwhich this prmtit is issued, I shall
nal employ any panes in any aumnet.so as to become subject to the Workers' Camper-
WATER HEATER W/VENI'/ELEark
ZZ
O
ration Laws of Callfornia. Disc
Applicant
y
a^
CS1
G
LJ 0
r�
0Lend,A
U
LF, lZt
NOTICE TO APPLICANT. IL afier making this CeniOeale of Exemption, you should
become subject to the Worker's Compensation provisions of the Limar Code, you must
forthwith ratably wltheuch pnrsisiansorthis permltshall be deemed revoked,
CONS '1'RUCTION LENDING AGENCY
l hereby afiinr that there is a conswaian lending agency fanhe performnnce of
the wotk f..which this permit is issued (Sec 3097, Clv. C.)
Name
WATER SYSTEM/BEATING
WATER SERVICE
NEW RGSIDGNTIAh PLMB. SQ. FT.
Lendrev Address
I certify that 1 have read this application and state that the above information is
room. I agree to comply with all city and ammy ordinances and sone laws relaling In
M1uikliltg ennstrvdinn, uoJ herchy uuthoriec presenlalivcs of Ibis city matt upon the
TOTAL:
QTY. ...MECHANICAL PERMIT •.,
PERMIT ISSUANCE
r
altos, -mentioned progeny for impaction purposes.
(We) agree m save, indemnify and keep harmless the City of Curl ageina
ALTER OR ADD TO MECH.
liabilities,judgmems, costs and expenses which may in any way accrue against said City
in .omaryence of the granting of Thi. Dermal.
AIR HANDLING ONIT'(TO lROM CFM)
APPLICANT ND ER STANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE RE r IL r1ONS.
AIR HANDLING ON I'I'(OVER 10,000 CUM)
M!f __/X
f�,
P.XHAUSTHOOD(W/DUCT)
Signature of. I'-ontmctor Dam
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT (TO 100,000 BTU)
Will The.pplircm or future bulldmi,saupimmore.r handle havardous material
as defined by the Cupallan Municipal Code, Chapter 9.12, and the Health and Safety
Coda, Section 25532(0)'1
HEATING UNIT (OVER 100,000 BTU)
'� n
❑Yes Nan
VENTILATION FAN (SINGLE RF.SI D)
Will the applicant or future building occupant use equipment (it devices which
nit hmmdous air contaminants as defiaal by the Bay Atca Air Quality Management
BOILER -COMP (3IIP OR 100.111111 RTU)
BOILER -COMP (OVER 100.00 BTU)
Disuid7 ❑Yes
AIR CON DITIONP.R
I have trod l he brain d sartetialatdlainement, un der Chapmrfig5oflhe Cali-
NEW RESIDENTIAL MECH. SQ. IT.
RuIleal & Safety Code, Sections 25505, 25533 and 25534. 1 understand that if the
building] not currently haven wrist, Nat it is my responsibility m ratify the occupant
of the rcoyl -,)I, which torn be met prior,. issuance ofa Cenifrcmeof Oceapancy,
OFFICE
'FEE_.
Z-2oo0
I�
.'BUILDING PERMTTINFO
ILDG HLECT PLUMB METH
❑ ❑ Pe ❑
JOB DESCKIP'110N
RESIDENTIAL;
❑SFDWU
❑ KITCHEN REMODEL
❑ADDITION
❑PLUMBING RE -PIPE
❑MULTI -UNIT
C3 STRUCTURAL
ENERGY FEE
MODIFICATION
El INTERIOR
El CHIMNEY REPAIR
IMPROVEMENT
0SWIMMING POOLS
❑ BATH REMODEIJREPAIR ❑ DEMOLITION
❑ OTHER
NEW BLDG/ADDITION ❑DEMOLITION
TENANT ❑ FOOD SERVICE
FT.
-1oOs
STORIES
$/SQ. ET.
PAID
Date Receipt W
BUILDING FEE
TTE ; SEISMIC FEE
ELECTRIC FEE
PLUMBING FEE
MECHANICAL HE
CONSTRUCTIONTAX
HOUSING MITIGATION FEE
PAID
Date Receiptp
ISSUANCE DATE
2� 2-- zo00
3LU - 4-1 - CGI
/ T i jBUlLDINb
DIVISION FEES
PLANCHECK FEE
ENERGY FEE
GRADING EEE
SOILS FEE
PAID
Date Receipt W
BUILDING FEE
TTE ; SEISMIC FEE
ELECTRIC FEE
PLUMBING FEE
MECHANICAL HE
CONSTRUCTIONTAX
HOUSING MITIGATION FEE
PAID
Date Receiptp
ISSUANCE DATE
2� 2-- zo00
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: christya
FEE DESCRIPTION
---------------
BPWHEATER
PPERMITFEE
Sec: Twp: RnH: Sub: Elk: Lat:35701088.00
INVOICE DATE......: 01/28/2000
REFERENCE ID N ...: 00010157
SITE ADDRESS .....: 22420 JANICE AV
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: LEUNG ANASIA S AND BILLY K
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2747
CONTRACTOR .......:
MOOSE, PAT LIC # 18986
COMPANY ..........:
WATER HEATERS ONLY
ADDRESS ..........:
500 AIRPORT BLV
CITY/STATE/ZIP ...:
BURLINGAME, CA 94010
TELEPHONE ........:
(415)349-3747
CHK
TOTAL FEE
P
9.99
P
35.52
45.51
VID . '. DESCRIPTION
106 SEWER & WATERc ......
301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
PAID -TO -DATE BALANCE DUE
------------ -------9 99
0.00
0.00 35.52
--------0.00 ------45 51
VOICE ID ._ DESCRIPTION
202 UNDERFLOOR PLUMBING
302 TUE & OR SHOWER
506 GAS TEST