00010090APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY-yl—j 00-Q I QO
CITY OF CUPERTINO BUILDING - PILECPRICAI.
PE N
BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL
" 1' ' 18111.DINGI'ROJEC9'IDFNB'IFICATION!(i� `h'I?
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SANITARY NO.
APPLICATION SUBMI'FPAI, DATE
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❑
CONfROLM
�RLRiI'1 ECI'IENGINf;IeR; LIC NO,
N)DRES /I�
VA/
CONTACT': PHONE:
-01
Ifi1l '_ ; 'BUILDING' PERMIT INFO ,',{' .
BLLDDG/ ELECT PLUMB
M,EECCH11
❑ Consultant Fees that yAp liras Tn. ial)
/
fG ❑ W LK
LICENSED CONTRAM OR'S DECLARATION
1 nerebraffirmmal I amlicensedunderproo,won.of Chapte. 9(mmmendng
QT,Y ELECTRIC PE12b1ITfl��ll..�tl(%I'ilI�PEE %;Ijt
_ :•v. .t .u.; .I,_.. I. '. r.:i>J
JOB DESCRIPTION
wins Senion7a)(donTDivi Sof the Hoiness.int,f s d7liocrecis
in full baccand eKeet. s �N e/ /
Lieenst, Llu,p !
Dae nntranor
ARCHIT SDECLARATI
1 w .sand y shall ,a blic records
Ism
RESIDENTIAL:
❑SHWL El KITCHEN REMODEL
[]ADDITION❑PLUMBING RE -PIPE
DMULTI-UNIT DSTRUCTURAL
MODIFICATION
pERMI'1'ISSUANCE
APPI.IANCIS -RESIDEN'T'IAL
PANUS
!
UP TO 200 AMPS
D INTERIOR D CHIMNEY REPAIR
IMPROVEMENT E) SWIMMING POOLS
Lt en.veJ m(essionnl
2201-10(s)AMPS
OWNER-BUILDI?RDERA'HON
I hercM1y off fins thnt I em exempt from the Contractors license Less for the
following reason, (Section 0031,5. Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve dental ish, or repair any suucture
OVER IIXNI AMPS
a4irlIffH REMODF.IIREPAIR E3 DEMOLITION
❑ OTHER
SIGNS ELECTRICAL
SPECIAL CWCUUUMISC.
prambf,sBsaaace, aleoreitures the npplwitin far such Ovar o file v sign.damemeat
That he is I lecnsedlno,na T,,ther,mokioro, of the Cmannemr'. Licence Low(Chapter 9
TEM f1iR OR POLEWST
COMMERCIAL:
(conununcingwhh Srcdon9000) of Division 3orme R.oarecsaud Professions Code) or
met he is exempt therefrom and the basis for the alleged exemption. Any violation of
D NEW BLDG/ADDITION D DEMOLITION
Section]031.5 by any applicant for a permit subjects the applicant. a civil penalty f
a.t mom than five bushed dollars (8501.
01. as owner of the property. or my employers with wages as their sole conpevsatio.
will do the work, and the structure is not Intended orotffered hrr+ale T oe. 0 1I. Katrina+
'l
I
I I'. RI
El TENANT DFOOD SERVICE
0TITERIMPROP.MF?NT
❑ OTHER
9
and Pmfesions Code: '[be Continents License Law does nnl ePPIY to an awner of
esu if' T 'I R
property vino M1Ailds nr improves Ihere.n, mrd vino does sacs work himself of through
hi+own employees, provided .hat such impnwemenu am nm imendeJ or olTered for
NE ' UF. r
sale.If. hmvever,me buildin,moripmvenern is sold within oneyearof completion,the
SQ. FT. FLOOR AREA
SISQ, PT
rte, hinider will have the harden of peeving that hedld not mild or improve for puo-
).
owner of the protmoriTi sard esJusively contracting Ill I' d t m'a
as, n the project (Scc 9M4 B d P f :Cod :) TI C 1 1[ s L
uLa d t pplyt n fp pent h h'Ids v : th n. an
who tracts for such p tette with a commetugc)Icenscd pursuant to the Contrattor
-
e
Q -I� I r 8R IT 1�1 -I �3 lei I FE&fele'
PERMIT ISSUANCE.
License latw.
❑ I not cxem Ander B & P ,tar ti nr non
ALTER- DRAIN&VENT-WATER(E
Owver C Date
WORKER'SCOMPENSATION 'LARATION :unuons
I hereby affirm under penally o(perju so, the bellowing d
VALUATION
0 r�
U
BACK FLAW PROTECr. DEVICE.
DRAINS- FLOOR, ROOF. AREA, COND.
I have and will maintain a Crmife hrofConsent toself-'moan for Work,,', Compere
cant a, movided for by Semon 37000 mnr
e mbo,Code, for the perfnanec of the
STORKS
'I'YPHCONS'I'ELECTION
12, FIXTURES - PER TRAP
work for which this permit is Lssaed.
❑ 1 have and will maintain Worker's Compensation Insurance, as requited by Section
390ofthr LxborCut for be perfommnecofthe work In, whichmis panni, is issued.
My Workers Compensation 1ncune
rue mrriu and Policy somber are:
Currier: P.licy Na:
CEIV IVICAI'E OF EXEMP'r10N FROM WORKERS'
GAS - EA. SYSTEM -I INC. 4 OIITLFTS
OCC.GROUP
APN
3 O
CAS - EA SYSTEM-OVI?R 4 (P.A)
COMPENSATION INSURANCE.'
pemn
indiscretion decd ml M compined iDhetis for nue hundred dollar,
ar lest
GRHASFJINDUSTRL WASTE INTERCEPTOR
BUILDING DIVISION ITES -
GREASETRAP
YIANCHECK HE
SEWER - SANT '1'ARY-STORM EA. IO FT
ccrtifythdidthe Harreadeofine work for which this permit is isued, Ishn11
not amply any pue.nin anymm� rte' bjeel mlhe Wurkma'Contpen-
s7f�i
ENERGY FEE
WATER 11HATER W/VENrI/ELECTS
talent Laws nyr�ahfornia. Uma �Nw f -'Is
Appliram l 1,.O - + L` } —
GRADING FEE
NOTICE TO APPLI N is If, after making this Ce bane o Zemp—i)^ ptum, you should
become subject to the Worker's Compensation provisions of the Lalwar Code, you mus.
WATER SYS'MM/fREATING
SOILS HE
WATER S17RVICE
forthwith comply with such provisions or this permit shall he deemed revoked.
NEW RESIDENTIAL PLNIB. SQ. IT.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a constmction lending agency for me performance of
PAID
Data Racip,X
.he work for which mis lirook i+ issued (See. 309, Gtr. C)
TOTAL:
Lender's Name
'TOTAL:
Leader's Address
BUILDING FEE
I nuitythtI Last, readtl ditan andat F,1 (he Moo information is
commit, l a,.,. p1y .In11 en, md,omm, J d oam I It it
building construction. and hereby authofm mpresen.aties of this city to enter upon the
Ips.'it r sl.
QTY. MECHANICAL PERMITf FEE-,
r I.ti 1. t
SFI$MICF£Fr,
above-mentioned property for inspection purpeas.
(We) agree to +act, indemnify and keep harnlesx the City of Cupertino against
PERMI"I' ISSUANCE
-.
EL rRIC FEE Irl
livbllhies.judgments, atsisand expenwewhich muymuny way accmeagninst evil City
In onnmyuc 'stns. gmming of talc l>LnnL
ACCER (lIi ADD TO MIiCII.-
PL] DING PET: I, -f
In
AIR HANDLING UNIT TO 10,0(10 CF%u
M . AN E
APPLICA UNDER, TANDS AND WILL COMPLY WITH ALL NON- INT
SOU E SGULAT S.
AIR HANDLING UNIT LOVER 10,00 CPM)
/ /11
C STRULTION I'AX
SignmmAol Appl'evn/Cnmmdnr Uum
HAZARDOUS MA'1 [TRIALS 1W.1 ISURG
EXHAUS' I' HOOD(WIDUM)
IOf]S�NG MITIGATION PEE
HEATING UNIT (To I(N)0(NI BTU)
Will meappheran nr future Imandil...ntstoreor handle hma.Jnus material
as droned by the Cupertino Municipal Ode. Chapter 9. 12, read The Ilealth and Safety
-
Code. Section 25532(x)? a/o
HEATING UNIT (OVER I0,IKK1 BTU)
❑Yes �N
Will the applicant or future building meupxnt use equipment ordevicea which
.it hasnrdous air i an inum en, as defined by the Bay Arca Air Quality Management
umm?
E] Yes X.
PAID
VENTIIA'1'ION FAN SNOUT RI? )
Dmc Realp.d
BOILER (3HP OR I BTU)
TOTAL:
BOILER - COMP (OVER 1 .Of10BTU)
AIR CONDI I ONER
er Chapter 6 95tof
i have read melcn5o5
Health &Sturdy Code,eetion,250.2553aOi25.534.1unamatifam
lid g does not camntly havananL that it is my respmshiltymnndiflae acupn,
/ ISSUANCE DATE
— (,VO�
_N
NEW RGSIDTIAL ECii$QC.
nl
oremat lwmmenrmoftneeofaCemiG.nmoffOccupancy.
ISSUED BY:
Ownenm amhonood agan -' I a
TOTAL:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: kacenb
Sec: Twp: Rng: Sub: Blk: Lot:31630004.00
INVOICE DATE......: 01/19/2000
REFERENCE ID # ...: 00010090
SITE ADDRESS .....: 10461 BAYWOOD DR
SUBDIVISION ......:
CITY .......... ...: CUPERTINO
IMPACT AREA .......
OWNER ............: STAUFENBIEL LEROY AND CELIA D
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2309
CONTRACTOR .......: LIC 4
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ....
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE
--------""'---
PAID -TO -DATE BALANCE DUE
BENERGY
--- ---------
A
38.10
------------
-----------
0.00 38.10
BPERMPEE
P
127.00
0.00 127.00
BPFIXTURE P
8.33
0.00 8.33
BREMVENFAN P
41.63
0.00 41.63
BUSLIC
P
90.00
0.00 90.00
.MITFEE P
35.52
0,00 35.52
340.58
------
0.00 340.58
VOICE ID
DESCRIPTION
VOICE
ID DESCRIPTION
........
101
............................
FOUNDATION
........
102
.....................
PIERS
' 103
UFER
104
REBAR
105
ANCHOR BOLTS
106
SEWER & WATER
202
UNDERFLOOR PLUMBING
203
UNDERFLOOR MECHANICAL
204
UNDERFLOOR FRAME
205
UNDERFLOOR INSULATION
301
ROUGH PLUMBING
302
TUB & OR SHOWER
303
ROUGH MECHANICAL
304
ROUGH ELECTRICAL
305
FRAME
306
HOLDOWNS
307
INSULATION
308
SHEETROCK
309
EXTERIOR LATH
310
INTERIOR LATH
311
SCRATCH COAT
313
ROOF NAIL
501
FINAL ELECTRICAL ENERGY
502
FINAL PLUMBING ENERGY
503
FINAL MECHANICAL ENERGY
504
FINAL BUILDING ENERGY
505
FINAL ELECTRICAL
506
GAS TEST
507
FINAL PLUMBING
508
FINAL MECHANICAL
509
FINAL ORADE
510
FINAL PLANNING
514
FINAL PUBLIC WORKS
0
n