99120040APPI,ICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY qq1ZoaqG
CITY OF CUPER'PINO
BUILDING, KLEICPRICAL
'PERM] PNO
PE M]PNO
BUILDING DIVISION APPLICKf1ON/PERMIT
PLUMBING MECHANICAL
. •i- BUILDING PROJECT IDEN'OF'ICATION
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RDILDINNGADDR&SSSS: R�T_1/ ice' �/yam
SANITARY NO. AI'I'L1 ATIONSUBMIrIALDATF,
W � 'S NAM/ PHONIiD�
Y
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IAL G 7
C(1CI_I]R'S NAMI'�� G�3 t��'
J�/Ifl✓ /M�-�L'�
N/C CON 'IROLp
. Cfi1T[CT/fiNGlf'EER: LIC NO:
iv
ADDR SS:
" / 7Lrlrz�4 ACE !?l cri
❑
CONTACII --
PHONE.
'. BUILDING PERMIT INFO -
'
❑ Consultant Fees
/ v
Paid by Applicant (Initial)
BILtDDIG ELEEC,T/ PLrUUM133 ME [I
Qjy ELL'CTRIC PIiRM1T 1 FEE
[sT l(X at ❑
LICENSED CONTRACTOR'S DECLARATION
I herehy affirm J under provmmnx Chapter 9 mnm(nene
I am f,he
'
JOB DESCRIPTION
M I o is
Ihllfram7nWlof DividnnJnfihe NosinessanA Pndessioos endo and my llcunseis
PERMIT ISSUANCIi
RRSIDENI'IAL,
Iu en e Cl...and dlcet.
2•
ClIJa N
❑ DWL ❑ ITH Cl REMODIET
—
Data
J Data acmr�
APPLIANCES - RESIDENT IAL
A
❑ADDITION ❑PLUMBIURAI. 'IPE
PLUMBING
j RCHI °CFS DECLARATIO
rikurs
fmy
PANELS
❑MI11.TI-UNI"f ❑STRUCTURAL.
� I unJurs plmis eM1oll be nmd ax Buhliu records
MODIFICATION
]
UI"I'O S
201-11 R
R El CHIMNEY REPAIR
F.MIiNT SWIMMING POOLS
L¢ensed Pmfnsinnel
j OWNER -BUILDER DECLARATION
t 1 hereby affirm Ihvt I am exempt from the Contractor's License Law for the
OVER PS
,MO ATIJREPAIR ❑ DEMOLITION
ti ]lowing revmn. Sorbian 7131.5. Noshes, and pm1"ess ns, C(de Any city no, Loamy
SIGNSELE ICA
❑ (Tf ,R
j which requires a prrnil er construct. alter, improve. Demolish, or repair any structure,
prinnoits issuance. atw rtyuimsthe applicant fnr maM1 perminn OlcasigneJ emmmem
SPECIALC UI'1'/ 1
Thal he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
(comnrmang wit h Section 700(hof Dlvlsioa 3 or Jor Bu,mc,, L (prof Lions Cn]a)nf
TI:MI'. MIiTl3 EIW�m
ER
that he is exempt therefrom mrd the N,k far the :JlegeJ conniption. Any violation of
❑NIiW 6LDG/ADDITION L1 DEMOLITION
• Section 7031.5h Beam fora
YanY app permit mbjeets the applicant ban penalty of
o
Po
_
. not more than five hundred dollars ($500).
❑ FOOD SERVICE
(] I, us owner of 0a pmpmy, nr my anpinyeos with wages as their soler incersmion,
SWI IN (
PN EMI±NT
will Jct the work. and the samaureis not ImmnJW oraflfmrd forxde (Sec 70yq. ❑uslness
and Professions Code: The Conuvemrs License Law Jres not apply to an owner of
/-L, OUrjLI I'S -SWITCHES -FIXTURES
pmpeny who builds of improves theram, and who fres such work himself of Ihreugh
his own employees, provide(] That such improvements are not intended or oRemd for
N13W RESIDENTIAL. ELECT R SQ EF
note, If. howcve9 the huiliingorimpmvenaent ix sold wlthln one year of conallellnn the
SQ ILK FLOOR AREA 5/SQ. FF
owner builder will have the burden of proving that he did not build or improve for prom
poseufase).
❑ 1, its owner of the prolany, am exclusively contracting with IicenseJ comractora m
TOTAL:
rr.vnenhe Ismiall (Sea 7144 B.'nes, andP f ons Code)1'hc Can ours Li-
-I
t r
'
cease Law discs not apply( an Ter ofp perry h builds or improve, Waco d
QT',Y": � PLUM BING PERMIT •#'
E•'
who contracts for such projects with a enntmmorls) licensed pursuant to the Contractors
License Law,
0 lam exetnp under Sec. ,B&PCfor Thisommar
PERMIT ISSUANCE
AL'I'Iilt- DRAIN & VENT -WATER WA)
VALUATION
oner Da
Date
WORKER'S COMPENSATION DF,CLARA'1'ION
BACK FLOW PROIECE DEVICE
_
/D bCYJ
I hereby affirm under penally of cannty one of the follow ing dcclamlmra:
I_I have and wil l mainmi a u Cerfiicma al Consent o self- insure no Worker's Confer-
DRAINS -FLOOR. ROOF A RI±A, CON D,
amiom as provided for by Section 3]1X1 of ahe Lnhor Code, far the performance aide
STORE; 'TYPE CONS'Ilt I1CTION
work for which this permit is issued.
FIXTURES-PER'IRAP
O
1 have and will maintain Worker's Compensation Insurance, as required by Section
3700ofthe Labor Coda In,dicpeffnr nanecnftbawofk for which thi,branllx mcmd.
GAS-ITA.SYS'1'I'M-IINC.JOUTLI?T.l'
My Workers Compensation Immance caner and Policy ...be, arc:
UCC. CROUP
Q
Cartier: Policy Nn:
CAS -EA. SYS TEM"OVER J EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GREASFANDUSTRL WASTE INTF.RCEPI'OR
(Thin seetima naeJ not he cnmplemJ iRhepmmit is far one hundreddnllun ($I W)
BUILDING DIVISION FIFES
nr les,,)
ONEASE TRAP
"
-
VLANCHECK Il?F:
Icerify (harmthe performance of the dnoll
not employ any person in any men as to bemmosuhJmnn the Wovkers'Cnm
Lecomewhiice, to the W.ainmedlise,
Ja+i/f pen
$EWI?R- SAN] TARY-STORM EA. 200 FT
f'j'`1
ENEI�GY_4EE
lain o Lnwe al�ai�li��/
Applicata _ / -
WNIIdRHEATI?RW/VENT'/ELELTR
WATER SYSTEM/FREAI'INC �t 1
GRADING FEE
N(TI'ICE'�IAF L�'IC N�I�Rer making this Certificate of Exemption. you should
become aunject to me Workers Compensation provisions of doe Labor coda yon mast
F�,fd�
�iCL"'E 999
forthwith amaply wish soots provision, no This pardon hall be decnred revoked
WA'I'HIT SERVICE
CONSTRUCTION LENDING AGENCYNEW
RESIDENTIAL PLMIL SQ. FT
PAID
I herehy af0lm thm there iAattmxvunion lending agency 4a the perfnnnance Pf
Date Receipt#
the work 1`4 which this pcnnh is -emord (Sec J(197, Cie. C.)
y
Leaders Name
Lander'sAddres,
TOTAL:
I amity that l have mad this application andstatethat the ls- information
rel I agre,to comply with all cityamJ my ordinances and.tt laws
t
BUILDING FEE
roclatingwo'QTY,4�MECIIANICAI.
Fa Jct' gc r'In cl"on.nJ larch, vulhn[o repose fol ves of do, myto enar upon mm
PERMIT n bHlf
i},
SEISMIC ILII
.face mentioned Drawn, fnr inspection pugmses.
'r
Wel a •
( gree m save, indemnify and keep harmless the City of Cupeninn aguinea
THESEE.
ISSUANCE
ELECT RIC FEE
Iivhilities,judglnents, costs and expenses which may in any way acetas against said City
( nt"rencc of the grinning of did, pertnit.
ALTIiR OR ADD' 10 MECIT
PLUMBING FI±I±
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
AIR HANDLING UNIT (IT) 10,1X10 CPM)
/
SOURCE RIiGIJF S.
MItC11ANICAI. FEE r
_ J
AIN HANDLING UND' (OVER 10,000 CFM)
EXHAUSTHOODDVMUCD
CONSTRUCT[ON TAX
Signmureo Applivan not o D:ne
HAZARDOUS MATE IS DISCLOSURE
HORSING MI'I'ICATION PEE
Wil ahc appGcam or furore huilAing oucupam score or handle hreco,ms material
H17A'FING UNI' I'( TO IIsyl B'Ot
its defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safely
Code, Section 25532(x)1
I II3AI'ING UNIT (OVER 1011,000 B U)
❑Yes L] Nor
VENT'ILAT'ION 17AN(SINGLE RESID)
PAID
Will the applicant future handing occupant use or Devices which
[)air RL Ll
i
emit haznNons air mnunninunts as Defined by the Iluy Arca Air Quality Munngemem
. Air Qu
BOILER -COMP OHP OR 1(111,1X10 BTIO
Uixuict?
TOTAL
❑Yc. Fl No
BOILER -CONI'(OVER IIXI,I]fXa BTU)
I hove ]rad the ha,udoox mmcliah nems trader Choler c95 of the CA,
rcquimi p
AIR CONDITIONER
ISUANCIi DAI'Ii
h abiu Heads & Safety Code. Sections 25505, 2559) 25534. I undectand thin If the
building dmvun cumnCode. See. ctions25505 spo25534fluildar,tanotifynherccupme
NEW BESIDES I(A]. MUCH. SQ. ET.
of th cost beta lificate of or,
ISSUED BY:
Dwner ow,amhnd:ed a [)AtTorrAL:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
•
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Blk: Lot:31630012.00
INVOICE DATE......: 12/06/1999
REFERENCE ID # ...: 99120040
SITE ADDRESS .....: 19835 BAYW00D DR
SUBDIVISION .......
CITY ............. : CUPERTINO
IMPACT AREA .......
OWNER ............: BROOKS STEVEN R AND CYNTHIA 0
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2311
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ,
TELEPHONE ........:
FEE DESCRIPTION CHK
TOTAL FEE
PAID -TO -DATE BALANCE DUE
--------------- ---
BENERGY A
---------
47.10
------------
---------"_
0.00 47.10
BMITIGAT P
1.00
0.00 1.00
BPERMFEE P
157.00
0.00 157.00
BPFIXTURE P
41.65
0.00 41.65
BR CEPT P
13.32
0.00 13.32
ICRE P
B&E
1.00
0.00 1.00
B. P
90.00
0.00 90.00
EPERMITFEE P
35.52
0.00 35.52
PPERMITFEE P
35.52
0.00 35.52
---------
422.11
------------
-----------
0.00 422.11
VOICE ID DESCRIPTION
VOICE
ID DESCRIPTION
101 FOUNDATION FOUNDATION
531026
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 GRADE
510
FINAL PLANNING
514 FINAL PUBLIC WORKS
0