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99120151�,APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY `A `7 1 Zo os CITY OF CUPERTINO BUU.DING . BLECfalcAl. BUILDING DIVISION APPLICATIONTPERMIT PLUMBING - MECHANICAL tlU1LDING PROJECT IDEN'TIF'ICATION f,PERMIT NO. siftwN BUILDING ADDRESS I(A91-7 RE *2S7 SANITARY NO, APPLICATION SUHMITTAL DATE OWNER" 11) PHONE: CO Cy'ORSN^FB_ fY LIC ti'(): NIC CO.NTROI.a Is U+ I J ❑ RCHITECDENGINEER: -LC NU. ADORES o' I`otV ` �U�\/�l,t/�Se I CONTAPHONE: CT': BUILDING PERMIT IN PO ❑ Consultant Peace; Paid by Applicant (Initial) BO ELI':Cf / PLU❑MB MECH LICENSED CONTRACTORS DECLARATION I hereby of nd, mal I am licenced under maisiors of chapter 9 (commencing QTY. ELECTRIC PERMIT FEE JOB DESCRIPTION 1'17RMIT ISSUANCE with Station 700(a of Division 3 of the Business and P... soors Codgand my lleenseis in full Tons unJ cRcd. x'1 License Glaass/-aF�--lie k 2 sl / 1 Dur. 1 o,F-e / / ate— Conlmaor RESIDENTIAL' ❑SFDWL Ll KITCHEN REMODEL ❑AUDITION El PLUMBING RE -PIPE [IMULTIUNIT []STRUCTURAL MODIFICATION El INT [I CHIMNEY REPAIR IMPROVEMENT L]SWIMMING POOLS ❑ BATH REMODEUREPALR El DEMOLITION ❑ OTHER -- 0 / APPLIANCES - RILSIDF.NTIAL j f ARCHITECT'S DECLARA9'ION understand my ph er,hull ba coed as public records 1 Licensed Pmm,,inno s OWNER -BUILDER DECLARATION 1 therebyoflion that 1 um exempt from the Cnmractars License Law for The 1 following reason. (Section 7031.5, Business and Professions Code: Any city o1 county j which requires a pcntdl to construct. alter, improve, demolish, or repair any structure PANELS Oil TO 200 AMPS 201-IOWAMPS OVER That AMP'S SIGNS ELECTRICAL SPECIAL CIRCUIT/MISC. 9 jprior to its issuance, also requires the applicant for such pernat to file a signed statement That he is licensed pursuant o the provisions ofthe Contractors License Law (Chapter 9 (commencing with Seation7W0 of Division 3 of The Business and Prefeisinns Cale) or that he is exempt therefrom and me Thesis for the alleged exemption. Any violation of 'TEMP. METER OR POLE INST. 1 [I NEW HhDG/ADDITION ❑DEMOLITION Section 9031.5 by any applicantfor a permit sabjems The applicant to a civil penalty of not more Thu. five hundred dollars WITH. ❑ I, as owner of the property, or my employees with wages as their sole compensation. will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Corle: The Convector's License Law Ams not apply m an owner of POWER DEVICCS []TENANT ❑ FOOD SERVICE IMPROVEMENT ❑OTHER SWIMMING PO01• ELECTRIC OUTLETS -SWH'CITES -FIXTURES property who build,,,,, improves Thereon, and who doea.aah work himself it, Thrmgh his own employees, provided that such improvement arc not intended m offeaJ I'., sale. If. however, the building or improvement is sold within one year of completion, the NEW REMORSE TIAL ELECTR SQ SQ. FT FLOOR AREA S/SQ. FT owner -builder will have the home. of putting than he did not build or improve for Pur- TOTA pou of evleJ. 1, as owner of The property, am exclusively contracting with licensed contractors To construct the project (Sea 7044, Business and Professions Code:) The Contractor's Ta- uilds or improves thea.,nnd cerise Law docs not apply manowner of property who hr QTY. PLUMBING PERMIT F who eontmet farsuch projects with a con meor(s) licensed pm'yuanl To the Contractors PERMIT ISSUANCE License Law. Ism exempt under Sec. . B & P C fortis reason at Owner Dan— ALTER - DRAIN & VENT- WATER (EA) VALUATION U WORKER I S WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT. DEVICE: 1 hereby off rut under penalty orpajury nnc of fhc following Jeelarmiam: I have:mJ will maintain a Cenilicum of Consenl In xlf-insure for Worker's Comped- ,an... as provided for by Section 3701 of the Labor Code, for the performance of the DRAINS- FLOOR, ROOF, AREA, COND, STORIES TYPE CONSTRUCTION work for which this permit is issued. FIXTURES - PER TRAP i-1 I have and will maintain Workers Compensation Insurance, as required by Section 37011 ofthe labor Code, for the performance ofthe work for which this permit is issued. GAS- EA. SYSTEM. I INC. 4 OUTLETS OCC. GROUP /� APN3 /1 �C/ GAS - EA. SYSTEM -OVER 4(EA) My Worke{y.�Wgp ior�yur_ ffamerand Policy .LW� Cnnier:_rw {�'� Policy N..:_[I -q CERTIFICATE 017 EXEMPTION FROM WORKERS' INSURANCE ( GREASF/INDUSTRI. WASTE INTERCEPTORCOMPENSATION BUILDING. DIVISION FEES _ (This section nnal not M completed if The permit is for one hundred dollars IS 100) m less.? GREASETRAP PLANCIIECK FEE SEWER -SANITARY- STORM EA. 3110 FT. ENERGY TEE I codify that in the performance ofthe work for which This permit is issued, Ishall not employ nner su yecgrµ igyc.io The Wurkeri Comped- WATER HF.ATIiR WIVENTIELECTR GRADING PEE cation Laws nl�dtf �," I L'F i "I or i Applicant ",' 1,r ! 1 NOTICE TO APPLICANT IL alter making this C.difiane of Exemption, you should become subject to the Workers Compensation provisions of the Lothar Code, you mud WATER SYST[?M/TREATING SOILS FEE forthwith comply with such provisions or this permit shall he deemed revaknl. WATER SERVICE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for performance of + the work for which This permit is issued (Sec. 309'7. Civ, C.) Lender's Name _^I PAID I^• O1 f acceipTh I I n �I� ate r --et �11— NEW RESIDENTIAL PLMB. SQ. FC 14 TOTAL: 11 m TOTAL: Lender's Address BUIL. LNG FE ,19 99 111/1 1 cenify that 1 have mad this application and state that the above information is corect.I agree to, comply with all city and county ordinances and start laws mlmingm building cientruction, and hereby authored representatives of this city To enter upon the QTY. MECHANICAL PERMIT FEE I xi SEES41C FEE 1+ PERMIT ISSUANCE BE, ,ItIC�F.EE above-mentioned property for inspection purposes. (Wu) nprec m cove, indemnify mA keep harndexe the City of Cupaninn chat PLUMBING IEE hahilities,judgments. costs and oxpenses which may in any way accuse against said City in consequence of the gmming of this permit. ALTERORADDTOMECH. AIR HANDLING UNITC70 10.000CFM) MECHANICAL FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH At.). NON -POINT SOURCE REGULATIONS. ' AIR HANDLING UNIT (OVER I0,000 CFM) CONSTRUCTION TAX Signature of ApplicmmVCommemr Dale EXHAUST HOOT)(WIDUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE I HEATING ON] '1'(TO End," BTU) uldingcupica,a ar handle hazardous material Will theafrideam ceramic hmle as defined by the CLpedinn Municipal Code, Chapter 9.12. and The Health and Safety Cade, Section 255320)? HEATING UNIT (OVER 100.000 BTU) VENTILATION PAN (SINGLE REST DI C Yr, No PAID Date RttroiptN BOILER -COMP (3HPOR 10),R) BI U) Will the applicant or future building ocrapain use equipment or devices which mit mansions ons air concomitants as defined by the Buy Area Air Quality Management a TOTA isuiem+ C] Yea QNo BOILER - COMP (OVER 100.0010 BTU) AIR CONDITIONER I have a:Mme huzamnus mammals requirement under Chapter 6.95 of the Cali- fomia Health As Safety Cale, Sections M05,25533 and 25534. I understand that if the xmteumtlyhuv(i building comate to mot ccu cupunl myresofu ISSUANCE DATE / 'j L NEW RESIDENT [Al. MECH. SQ. ET. Carly nicipfiortni,mancefaCeliTycateof Occupancy. ofthe rey u which naveh.mmpriorm is / ISSUED BY: TOTAL: Owner m umhmized agent Dale OFFICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: chriatya • Sec: Twp: Rng: Sub: Elk: Lot:36906008.00 INVOICE DATE......: 12/29/1999 REFERENCE ID # ...: 99120152 SITE ADDRESS .....: 19760 STEVENS CREEK BLVD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: EVERSHINE GROUP ADDRESS ..........: CITY/STATE/ZIP .... CA CONTRACTOR .......: LIC R COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... TELEPHONE ........: VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ 101 ............................ FOUNDATION ........ 102 ............................ PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER S WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB k OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS INSULATION 308 SHEETROCK 16 EXTERIOR LATH 310 INTERIOR LATH 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