99080216 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY - 9 O O�
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO
BUILDING DIVISION APPLICATION/lIERNIFF PLUMBING-MECHANICAL.
t BUILDING PROJiEC .IDF.NI'LFICATION' !ti/"'HI+,f•
RESS
Btill/l9-7l9-1g//� � �(� �/��4�y/ 11 r,1'���np��c�y, 0 /� SANITARY NO. APPLICATION SUB�./Yg DAT[
OW p'AMf::I.'h-T �J V�T%1\GNI 1'rLI,T �i� '1[ )ry l'LCr) '. M �S �r/' I.IC -7 q NIC C0��' Y�
CHIIECCTIENGINEEiR: LIC N(1: a `! IVw IWR'IiS:' 4In S� ❑
�`j'o .M vs'rVu h CA-
COACT PRONE: a;•t',rr+";' iBUILDINGPERMIT INFO; •,j!`t:
RJI �J IIQ`I IC•'(`\/ pt/" 13l)-S'/ Yl-b ❑
� � Cnnsul[an[Fees Paid by Applicanl(Inilial) BLDG ELECT' PLUM MF:CH
7 ❑ ❑ ❑
LICENSID CON FBACTOR'S DECL1RV'ION QTy 'It - CLECTRIC PERMIT � I l2rl. -1a+:FLE I�x
Osy Ih by aH (hilt I licensed ad p ofChapter9t s . -- , r-.nr JOB DESCRIPTION
I. t . r
�� a IIS 1 II00) rD+v"}W 3o1 da B,...re cardlmf 1mo,G Itylw RP.S(y DRN['IA4
� in[ullrmc unJ eBec.t.G'Cb 3�`IS Pliltn111 ISSUANCE ❑SFDWL ❑KITCHEN REMODEL
QUV License Cla J Lica APPLIANCES-REST DINT IAL ❑ADDITION C)PLUMBING RE-PIPE
3,1 6�nmaar<s,
h a Date
H-'n
ARCHITECT"S DECLARATION PANELS ❑MULTI-UNfT ❑51RUCI'URAI.
0zbZ`E- lundcrewnd my pions shall be axed ua Public records MODIPICA'1'ION
Qp4t:a seUP TU 200 nMPti [I INTERIOR El CHIMNEY REPAIR
f-�F-W Licensed Professional 201-100DAMPS IMPROVEMENT SN'IMMINGPOOIS
kf�
OWNER BUILDER DECLARATION OV17R IWO AMPS ATH REMODEUREPAIR [I DEMOLITION
y�LV Q I hereby affrm Ilial 1 am excngn from Lha Cunrtemur'u License how fnr the
X M U following reason.(Sectimt 7031.5.Basin.,and Professions Code.Any onyor county SIGNS ELECTRICAL HER al
W IL N which requires a penal a+eonumct.site,,impro s,demolish,nr repair any arucwre
I" �Q prim to its issuance,also requires theupplicLm for such moral to file a signed Istrumet S PECIAL CIRCUIUMISC.
><
J I but he 1111111sedpalnand m the pnrvinomofrheCammdurx License Law(Chapter9
T.+L 020 (notmencing with SectionAX10)of Division Sot tiro Business and Professions Code) THNP ME'll?R OR FILE EST. COMMERCIAL'
a tY a 15 that he is exempt therefrom and the basis for the alleged overturned.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
k m_n- Section 70315 by any applicant for a permit subjects the applicant to a civil Penalty of POWER DEVICES
oaf mare than five hundncJ Aran 65tND. ❑TENANT (D 1700D SERVICE
C�'Q D Las owner of the pmpeny,or my employee"with wimps mlhcirroleamtprtu'alias. SWIMMING POOL EI.EC'I'RIC
IMPROVEMENT
F- %'i 11 do the work.and the structure,our imanded or offered for sale(Swu7n II.Bmnotc, ❑OTHER
ad 3 m and Profession,Cade:The Contractors License Law does not apply to an owner of OUTLIT S-SNITCHES-FIXTURES
.....lady who hold.or mr'oves Ourram,and who does such v o k hlmmllor through
his own empbrycer, I tell that such ratio nraas are no Inaroded no ol@tN fat NEW RESIDENTIAL ELECI R SQ
India.IC however.the building or improvement is old within one year nonfiction,the SO PK FLOOR AREA s/SQ-FT.
owner %ill have the burden of poring that he did nor build or improve for pur-
P�corsale').
❑ I,us owne,of do,pnga rly,atm anlmsively oule,r a will leen,ced contractors a: T
contract the Pngrst ce 7044 Buouncs,andfull . 'C I )The C banner, r +
se law m.n+ot applyt fp peal m b 'Id. p h dQTY PLUMBING PERMIT 55(t
who commit,touch project,will a rat trai llumsedpursuanunmma
,,he Cors ' - rt'f+ "•t ', �'I�
Limnxe Law. I'F:NMI'I'ISSUANCE
❑ I in.exemia ander Smr
. ,It&P C an hits reason -,
Date N:I 17R-DRAIN&VENT-NATER(EA) VALUATION
tunes
WONKIiRS COh11'1,NSATION DECLARATION HACK FLAW PROI'F:C'I'.DEVICE
1 hreFy ulbmt under penalty rat perjury one nl'the fnllnwing Aeclunrtlons:
I have and will maintain a Certificate of Consent in self-insure for Workers Cooper- DRAINS-FLOOR,ROOF.AREA.COND. STORIES 'TYPE CONSTRUCTION
satin.,as Provided for Cy Section 3000 of the Latin Cade,for the performance m the
link for which do,Permit soloed. FIXTURES-PER TRAP
have and will maintain Walk,,,Cnmpenxulion Insunmcc,na...mated by Section
Xlofthe Laammm-CCeed,Rome
�ApD"erformere ofthe work for which this permit is issued- GAS-EA.SYSOEM-I INCAOU'DRIS OCC,GROUT' ARN
My
Carrier:r l�
CERTIFICATE O1 1i%I MI'TFairly iiION PROM� K_T�e-RS' '--•--- GAS-EA.SYSTENT OVER 4(CA) 39S l�OS�
COMPENSATION INSURANCE GRI
ASFJINDIIS'I'til.WAS'T'E IN'1'IhiCIi1TOR
(Thie somion need stn he completed if the Permit is for one hundred dollars(41IXB p BUILDING DIVISION PEES
ales) GRE ASETRAP
PLANCH[CK FEE
Iccrlily that in the lxrinnnunaul the work for
..Rpench hi,,the nt W.ke's Id Island MWFR_SANITARY-STORM EA.21XI FT
not employ any person in any manses v+m m becanne sohjecr m the Wnrkcts'Cnmpen- ENERGY P1317
Z sminn Iaxs of Califomia.Dare WATER HEATER WINEY'U,LEC R
Applicant GRADING PEE,
y NOTICE Or APPLICANT It,aper.raking this Cenifczm of Exemption,you should WATER SYSI ENULREA'I'INC.
a ; become whjceh(,,,he Worker's Cominnsalf.Provisions.li the Labor Code,yon mull SOILS PEE
fonhwith comply with such procisionn or this Permit shall he deemed related. WAUIR SERVICE
Q
O CONSTRUCThurt,
aON1-ENDINGAGHNCY NIiW RPSIUHNTIAh PLMH. SQ.FL PAIL'
I holif,, hi hien Ind i iso ca (Sol.on lending agency lbr the Performance nl Dana Receipt N
F
the work for which this permit is issued(Sol.3W7,Cr,CJ
O U Lenders Name 'IYITAL:
Lender I Addrr_sr TOTAL:
f I ,, col' Ith' III t l it that0 'b ton e . t 'O f "/ ( i 1�EPt' INILDINGIEh:
Ill) correct.1 g,e t plyslid,' 11 'y d Y d' ' Let l lou
gm 'QTY ' Vi AL PERtvIIT}r II �ijf .
U ,Z building construction.and hereby awbnnce representatives of this city to enter upon the .'7 t }.. SEISMIC II'1:
ahnve-mentioned Romany for inrPection purryno.
(We)agree to atmc,radian y tad keep humlle,the City of Cupertino against PERMIT ISSUANCE ELECTRIC PEE.
liabilities,judgmems,costsand e,,nov, bichrnay imamywry a mmcrl,muo,lrid City ALI IS OR ADD TO MICH,
con-equencc of the gaming of this permit PLUMBING IEE
APPLICAN'r UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO TO,=)CPM) MECHANICAL FEE
SOURCE RFCtJI. ONS. )/
4/3//C� AIR HANDLING UNI T(OVER rNX)CTNE CONSTRUCT ION TAX
Signature of Applrcano/Comerctor {, ate EXHAUST HOOD(W/DUCT) HOUSING MITIGATION IEE
HAZARDOUS MATERIALS DISCLOSURE
Wdlrbcm,hrunlorfWer,holding occupunl sone air handle hazardousoloariul THA'I'ING UNI T'('I'O 100,000 BTU)
;is defined by the CuNrflnn Municipal Code,Chapter 9.12,and the Health and Safety
Csale.Section 25532(a)'! HEA'T'ING UNIT(OVER 1ORDDO BTU)
❑Yes ❑No VENTILATION FAN(SINGLE RF.SID) PAID
Dane Reeuipllt
Will The applicant nn future handing by he Has
use equipment or AMma which BOILER-COMP(3HP OR 1(X1.000 BTU)
nit hamdnux air a+maminams as defied by the Roy Area Air Quality Managemnn TOTAL:
Fl Yes E]Nu BOILER-COhIP(OVER 100.0INI RTU)
I have read the hvardoov mamriAs requimnten¢under Chapter 6,95 ofthe Cali- AIR CONDITIONER ISSUANCE DATE
forest Henllh&Safery Cade,Sections 25505.25533 and 25534.1 understand that if the NEW RESIDEiNT1AL MECH. SQ.FT,
building dile eptly have a tenant,tilt sinmy topnmibllaym uncityteocenpunt
nl Ther hich roust be ueI'mar toissulmce of o Ce drf aleof 7
enpm5"
Ov.nefor oullamoM agent I Doc f TOTALISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Blk: Lot:37517054.00
INVOICE DATE...... : 08/31/1999
REFERENCE ID # ... : 99080216
SITE ADDRESS .....: 18781 BARNHART AVE
SUBDIVISION .. .. . . .
CITY ............. : CUPERTINO
IMPACT AREA ...... .
OWNER ............ : VISNAN, BRENDA
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR ....... : MCGEE, PAT LIC # 18986
COMPANY .......... : WATER HEATERS ONLY
ADDRESS ..........: 500 AIRPORT BLV
CITY/STATE/ZIP . . . : BURLINGAME, CA 94010
TELEPHONE ... . . . . . : (415)349-3747
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ ___----__--
BPWHEATER P 9.99 0.00 9.99
PPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
45.51 0.00 45.51
ID DESCRIPTIONVOICE ID DESCRIPTION
... �___=.OEv ._____- ........ ---...........e...____�...._
SEWER S WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF CUPERTINO
I• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: christya
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:37517054.00
DATE ISSUED....... : 08/31/1999
RECEIPT #...... . . . : 9936
REFERENCE ID N . . . : 99080216
SITE ADDRESS . . . . . : 18781 13ARNHART AVE
SUBDIVISION . . . . . . .
CITY ............. : CUPERTINO
IMPACT AREA .......
i
OWNER ............: VISNAN, BRENDA
ADDRESS ..........:
CITY/STATE/ZIP . .. : CUPERTINO, CA 95014
RECEIVED FROM ....: TIM 0
CONTRACTOR .......: MCGEE, PAT LIC M 18986
COMPANY . . . . . . . . . . . WATER HEATERS ONLY
ADDRESS .......... : 500 AIRPORT BLV
CITY/STATE/ZIP ... : BURLINGAME, CA 94010
TELEPHONE ........ : (415)349-3747
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REG NEW SAL
---------- ------------- ---------- --------- __ ---------- ____-----_
BPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00
PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
---------- ---------- ---------- ----------
TO
---------
T PERMIT : 45.51 0.00 45.51 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 45.51 46320
TOTAL RECEIPT a 45.51
VOICE ID DESCRIPTION VOICE IO DESCRIPTION
-------- _._----ee____aa..-_= ----- -----=== ------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
1 507 FINAL PLUMBING
i