99090183 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CI TY OF CUPERTINO BUILDING-ELECTRICAL PE TN
BUILDING DIVISION APPLICATION/PERMIT PLUMBINGROJEC7 MECHANICAL
'� 7i$..'tlUIDDING PROJECTiIPENTIFICATION.$.i:
BUILDING A)PRESS: SANITARY NO. APPLICATION SUBMITlAI.PATE
W 5-a `T3fK-n v'►'('�t- lrt L - 2 8 - 9 j
WN NAI'HON �T (hY'f ACID NA E:(5 ' yI�NLt.� FEE CONTROL#
ARCHITECTX51GINEER: LIC NO. foRR85$r• Ain ss W lle CA—
CONTACT:
� ❑
CONTACT: PHONE: 9977 1ILL�' Si-sJ �f.{[ ) r sI;={� i';r7.,•6gILDINGPERMITINPOf
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ ❑
LICENSED CONTRACTORS DLCLARATIONQTY'r Jt '( ELECTRICPERMI'1)t' 1
I hereby affirm that 1 am licensed u de preI.' i Chapter 9 perform. g , , +, i + _ _.zt k ,tt JOB DESCRIPTION
oaz ith Sedmn]OW)nfD nsmn3 hfthe Bos adPn fe ons Cody andmy l' ace tc T
m O C p PERMfT ISSUANCE
Fp�W fidlforceand �> LJ1. SFDWL Ll KITCHEN REMODEL
QUU, license Iss Lm# ✓ APPLIANCES RESIDENTIAL ❑ADDITION [I PLUMBING RE-PIPE
Pzw Dam Conuador
F7w ARCHITECT'SDECLARAT ON PANELS ❑MULTI-UNIT L1 STRUCTURAL
z O y z� 1 mderstand my plans shall be used as puM1lic records MODIFICATION
oz- UP Q TO 200 AMPS El INTERIOR ❑CHIMNEY REPAIR
F4t
Licensed Professional - 20I-I0OOAMP9 IMPROVEMENT SWIMMING POOLS
� a`? OWNER-BUILDER DECLARATION OVER f000AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION
I hereby affirm that 1 am exempt from the Commetor's License Law far Ins r��l(
MU following reason.(Section 7031.5.Business and Professions Code:Any civersatility SIGNS ELECTRICAL OTHER
3 L h which q' p it t t t alt p d A ep" ny swcmroCAP OP <«
F'WOe
prar to its issuance.also requiresth applicant fh permit toFile a silted statement SPECIAL CIRCUILMISC.
�IDy hath licensedpursuant
the of the Contractor'
License Law(Chnpter9 -
,y : (cormmenuag with Scratch 70(0)of Division 3tf the Btdanwl, adPrf Vona Code) TEMP METER OR POLE INST. COMMERCIAL;
d ethat he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDGIADDITION ❑DEMOLITION
Section]0315 by any applicant fill or permit subjedsthe appliwntlm a penalty of POWER DEVICES []TENANT [I FOOD SERVICE
W not more than five hundred dchars(5500).
FZY '
6 (]I,as ownerofhe propeny,nr my employeeswith wages a..theirsnle cempensation, SWIMMING POOLELECTRIC IMPROVEMENT
will do the work,and the swnureia not intended orrofferod for safe(Shat. Business El OTHER
Yl and Prot'naslors Cade:The Contractors License Law dew not apply to an miner of 'OUTLETS-SWITCHES-FIXTURES"
propeny win builds or improves themen,and who dues such wed himself onhrough
his own employees,provided that each improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ
sale.If,however,the building err omprovermat is sold within one year efcompletlon,the SQ.Fp.FLOOR AREA $/SQ.FT.
wnar-boulder will have the burden of proving that he did not build or improve Far part
's,
rpur-
pose cars.)
90,
❑1,as owner of the properly,am exclusively contracting with licensed contrnemrs to A
onswct he pro)er,(Sees.7044 Bfirirt,,and P fe .C da)]fie Comrade 1 . i,• _ - - 1
se Law does net apply t fn pe tr n m int m mpmvea mern d 9TY.la, y-PLUMBING PERMIT, I� $ ; /( ' •f'
who commas for such projects with a cenhaettro)Icen.W pursuant to the Characters
License Law. FERMI r ISSUANCE
❑I am exempt under Sec B&P C for his reason
ALTER-DRAIN&VENT-WATER(EA) VALUATION
comer odor 1
WORKER'S COMPENSATION DECLARATION BACK PLOW PROTECT.DEVICE �/� •�
1 herebyaffirmmilder penaltyte Perjury one ofthe following decker'.a .t J
❑..,as and will fainmmaCee370eof thnsentt.Chile,for the Workedc Compere DRAINS-FLOOR,ROOF,AREA,COND. STORIES TYPE CONSTRUCTION
satihn,ver provldod far by Section 3]00 of the Lahnr Code,for the per[omtmce at he
Kw k for which this permh is issued FIXTURES-PER TRAP
K"
have and will maintain Worker's Compensation Insurance,as required by Section _
3 of the Labor Codwfonhe performance of the word Por which thin permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC,GROUP APN
MyWorker' oro a Incur Ice cartiel and Policyµµnn IF GAS
—
Cartler:�PolicyN:cy/� l?' &g S�L.Y^,, OA8-EA.SYSTEM-OVER - p
r I ICA OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASEANDUSTRL WASTE INTERCEPTOR B f I DIYISIQ FFES -y
(Thin seeder need oar be enmpleterlif hepemti...fbnmehuadreddmlime($100) GREASETRAP
orless.) PLANCHECK FEE
Icenify mat in he performance of the work for which thin permit ie isawdishag SEWER-SANITARY-STORM EA.200 FT
not employ any person in any manner ao as m herome subject m the Wooers'Compel- ENERGY FEE
0 z .codon Laws of Californis.Dam r WATER HEATER W/VEN9'/ELECTR
z Applicant GRADING FEE
ti
y NOTICE TO APPLICANT:If,aNer mukhm this Certificate of Exemption,yen thould WATER SYSTEMUREATING
(� become W subject in the Worker's Compensation,Compensation,pmvislons of the Labor Cede,you most SOILS FEB ti forthwith comply with such Wmviaimmmthis permiLchall be deemed revoked. WATER SERVICE -
aQ
UO CONSTRUCTION LENDING
ngAGENCY
agony t NEW RESIDENTiALPLMB. SQ.IT. PAID Date Receipt#
1 hereby affirm that here Is sed( .construction0 lending agency for me performance of
i-•i the work for which this permit is issued(Sec.309],Civ,CJ
>0 U Lender's Name TOTAL:
U Lender's Address 'TOTAL:
" a BUILDING FEB
I certify that i have read s application and state that the b absorption
h -
V1 corer 1 agree to courtly with all city and county infiltrates and tate law,hearing t QTY' t q `-MECHANICALtPFRMIT +'F�.eErt t t
U Z building construction,and hereby amhorde representatives of ms city to enter alms the {: ' trvw •:' SEISMIC FEE
aMwe-mentioned propeny for inspection purposes. PERMIT ISSUANCE
(We)agree to save,indemnify and keep harmless the City of Cammunm agalart ELECTRIC PEE
ti 1labilitiae.judgments,oats and expenses which may In any way acrue against said City ALTER OR ADDTO MECH.
In Ch
nrequence of the gmntiag at this permit. PLUMBING PEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT _ AIR HANDLING UNIT(TO 10,000CFM)
SOURCE REG �AT S. MECHANICAL FEE
/^T n��/—pC AIR HANDLING UNI T(OVER 10,00)CFM) CONSTRUCTION TAX
Signamm A,,licmWConm�w...r Y -LI roam (/ EXHAUST HOOD(WNUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material DEAD NO UNIT(TO I Trott)BTU)
ac defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety -
Chile,Section 25532(a)? HEATING UNIT(OVER 100,000 BTU)
❑Yes ❑No
' VENTILATION FAN SINGLE RESIU) PAID -
Re i
Will the applicant or entre bonding occupant are equipment or devices which Date
mill
Districts
us air conmminmts as defineA by mM
the Arca Air Quality Management BOILER-COMP(3HP OR 100,000 BTU)
Districts
� ❑Yes E]Ed BOILER-COME(OVER 100,000 BTU)
I have read the h;nrdousmaterials requirements under Chapter 6,95 of the Cali- AIRCONDITIONER ISSUAN
Items Health&Safety Code,Sections 25505,25533 and 25534.1 understand that of the NEW RESIDENTIAL SUCH. SQ.Fm
buildingdces amt lenity have atenana the it is my renpunnibdhylono ify the occupam ...9
oft ich most rte met prior m issuance of a Cenif at f Occupy
O echoozedageat TOTAL ISSUED BY.
OFFICE
• CITY OF CUPERTINO
Item 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:36615041.00
DATE ISSUED....... : 09/29/1999
RECEIPT #......... : 10194
REFERENCE ID # ...: 99090183
SITE ADDRESS .... . : 7450 BARNHART PL
SUBDIVISION ...... .
CITY ... . . ........: CUPERTINO
IMPACT AREA . . . ....
OWNER ............ .. PING CHEN
ADDRESS . . . .......:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-5208
RECEIVED FROM ....:, TIM
CONTRACTOR .......: MCGEE, PAT LIC # 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 REC NEW HAL
B-�---E------ ------------- ---------- ---------- ---------- ---------- ----------
ATER PER HEATER 1.00 9.99 0.00 9.99 0.00
ITFEE FLAT RATE 1.00 -- 35.52 - 0.00 - 35.52 - -0.00
TOTAL PERMIT 45.51 0.00 45.51 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 45.51 2146
TOTAL RECEIPT . 45.51
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ........ .---------------------------
502
ee........................502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•