00010066 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY DO
CITY OF CUPFRTINO BUILDING-ELECTRICAL. PERMIT NO
BUILDING nrvIsroN APPLICATION/PERMIT r1.uMBwc-MECHANICAL SOooI
BUILDING PROJECT IDENTIFICATION
BUILUIN DDRESS; SANITARY NO. APPLICATION SUBMITTAL DATE
OWNERS NAME: HON CONTRACTOR'S N LI NO:
it N/C CONTROL It
RCHITECT/E GI E LC O: ADDRESS:
NTAC U. PHONE: /��/ C BUILDING PERMIT INFO
�, z �"'N ❑ ConsBIta 9Yeld y 14W,ial) BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE ❑ ❑
I hereby nrarm that Tom licensed under prnviamna orchapmr 9 Terming Ing JOB DESCRIPTION
F��2 wllh Semitn 7")of Divisiei3afthe Business and Professions Code,and my license is ESIDENTIAL:
O in full forecxndeff t PERMIT ISSUANCE
W U ❑SFDW I. 0 KITCHEN REMODEL
U U Llce re Class Lie.M
rF�W Orae Contractor �� APPLIANCES-RESIDENTIAL. ❑ADDITION ❑PLUMBING RE-PIPE
Fly
ARCHITECT'S DECLARATION PANELS ❑MULTI-UNIT [-]STRUCTURAL
OZ-� '•z lunderstand my plans shall be used as public..ads MODIFICATION
UP TO 200AMPS
401 Lmensed Professional ❑INTERIOR ❑CHIMNEY REPAIR
OWNER-BUILDER DECLARATION
2111-1000 G
AMPS IMPROVEMENT SWIMMING POOLS
OVER IWO AMPS O BATH REMODELREPAIR [I DEMOLITION
W I hereby.(bene that 1 am exempt from the Contractor's License Law co the
040 whichmimde,afollowing (tectum 2onsu Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER
O whmh requires n permit re consumer,apes Improves demolish, file
repair,any ammeters
prior mits smance.also requires the applicant for such permit mEleasigned.[moment SPECIAL CIRCUITIMISC. T✓
that he 1s 11cens d pursuant m the provisions of the Connector's License Law(Chapter 9
mJ00 (crmmendrg with5ecdon90IXgnf Division 3oflhe Buslness and Professions Codc'm TEMP.METER OR POLE INST. COMMERCIAL:
4 c 4r that he is exempt therefrom and the basis for the alleged exemption.Any violation of E3 NEW BLDG/ADDITION ❑DEMOLITION
h• Sciion 7031.5 by any appliean for a pentrowIjecls theappliramma civil penalty of PO EVICES
m notmare than Five hundred dollars($500). El TENANT ❑FOOD SERVICE
^' Q [1 1,as Owner of the property,Or my employees with wages as their sole compensation, SWIAPING POOL ELECLRIC IMPROVEMENT
oval do the work,and the structure is not intended or offered I'nr wale f$ec.7044,Business DOTTER
m call Professions Code:The Contractor's License Law does not apply to an own ofT TS-SWITC S-FI ORES
property who hrildx or improves thereon,anJ who aces such work himself or thrnu
it
his two employees,provided that with improvements are not intended or offered for RESIDENT LE R SQ FT
site.If,however.the huilding mon,ovememiscnldwithin meyearof cum stir rhe SQ.FT FLOOR AREA SISQ.ET.
err-builder will have the burden of proving that he did not build nr inaprm I r p -
pose of sale.).
0 1,as.tuner of the property,am exclusively contracting with livens comm M to TOTAL'
construct the project(Sec.]M4,Business and Professions Code:)The onlrano Li-
cenu Law does not apply to an owner of property who builds or improv thereon, d TY, P MBING PERMIT FEE
whocontrtets forsuchprojems with occuations)licensed pmsmnuoth Cerhneror'
License Law. c PERMIT IS ANCE
O l am exempt under Seo. ,B A,PC to this reason
ALTER RAIN A,VENT-WATER(EA) VALUATION
Owner are
WORKERS COMPENSATION DZ
AT BAC FLOW PROTECT.DEVICE OO
I hereby affirm under penalty of perjury one ofllowing umrin s:
(have and will maintain aCeniOcute of Cnnsentm sure for Wnr SC pen- D INS-FLOOR,ROOF,ARBA.CONU. STORIES TYPE.CONSTRUCTION
Orion,as provided for by Section 3"100 of the Labor EO the perfotmn f the
work for which this Noun,is issued. (STORES-PER TRAP
0 1 have and will maintain Worker's Cumpe stion Insurance,as required by Section
3900ofthe Labor Coe Ih yfor.Once he
work
for
which this permit is issuca. GAS-EA.SYSTEM-I INC.4OUTLETS
My Worker rat cc ar' and Policy n OCG GROUP APN
Cooper: PolicyNo.: W GAS-EA.SYSTEM-OVER4(FAT 62iody�
CERTIFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASE%INDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES
(This section need nut be completed iflha Permit is brume hundred dollars($1
or less.) CREASE TRAP PLANCHECK FEE
I certify that in the performance afthe work for which ma prnnllisisctcd.l all SEWER-SANITARY-STORM EAZT�AL:200 FT
not employ any person in any manner sur as to become subject m the Wrrkcrs'Co pen- ENERGY FEE
,Z scion Laws of CalifomiO.Dare
O WATER HEATER WNENT/ELEC'T
Q
Applicant t GRADING PEE
i NOTICE TO APPLICANT.If,after making Ilii.Cenificute of Exemption, a should WATER SYS'I'EMOREATING
abemme.cubjen m the Worker's Compensation prnvisoms of the Labor Co you must SOILS FEE
{>a forthwith comply with such provisions or this permit shall he deemed rev e . WATER SERVICE
Q Q
z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. PAID
C) O Thereby affirm that there is a combeelan lending agency for c andommnreof Dam Receipt#
", P the work for which this permit is issued(Ser.3097,Civ.C.)
Lender's Name TOTAL:
> a Lenders Address
I certify Out 1 have rend this Oppl kation and stem Lha he ahrve information is BUILDING PEE
F' 01 correct.I agree In comply with all city area Aunty oMinnnc,and state hvesrelaling to QTY. MECHANICAL PERMIT FEE
V^ SEISMIC FEE
thes'ngmrstmctiogard horanTscrhorirzrepresenhuive of this nirymmner upon the
nlwve-mentioned properly for Inspection puHmsee. PERMIT ISSUANCE
(We)agree m save,indemnify and keeph urnt s the City of Crpenlu0 against ELECTRIC FBP.
Int ilines,jal,nartns,costa and expenses whithmny' anyway acerae against said City ALTER OR ADIYf0 MECH. PLUMBING PGE
in oMeyuence Of the graining of this permi[.
APPLICANT UNDERSTANDS AND WI LL OMPLY WITH ALL NON POINT AIR HANDLING UNIT(TO 10,0(1(1 CFM)
SOURCE REGULATIONS. - MECHANICAL FEE
AIR HANDLING UNIT(OVER fithim CPM) CONSTRUCTION TAX
Signature c Applicant/Contracnor Dole EXHAUST HOOD(W/DUCT) HOUSING MI'I[CATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the apploormor future building occupantslore or handle hrranlous material HEATING UNIT(TO 100,1X0 BTU)
as defined by the Cupertino Municipal Coda,Chapter 9.12,and the Health and Safety
Cade,Section 25532(a)? HEATING UNIT(OVER 100,000 BTU)
❑Yes GNo VENTILATION PAN(SINGLE RESID) PAID —'
Date Receipt#
Willtheapplmllii Poturo building occupant use en AirQuordevices which yOILER-COMP(3HPOR W,OfN)BTU)
-MIT
harmdnu.c air comaminams as defined by the Bay Amt Air Quality Manugemen[ TOTAL:
lislrict^.
❑Yes F-1 No BOILER-COMP(OVER 100,000 BTU)
I have read the hazardousntamriaLuequiwmems under Chapter,695 n1the Coli- AIR CONDITIONER ISSUANCE:DATE
forma Health h Safety Cade,Sections 25505,25533 and 25534.I understand that if the NEW RESIDENTIAL MECH. SQ.Fp
huilding aces not cumenlly have a Mount,that it Is my respmsihilily to notify the ecenpanl
of the requirements which must be met prior to iesi ance of a Cenifiemeof Occupancy,
Owner or authorized rgcar Date TOTAL; ISSUED BY
OFFICE
INVOICE INVOICE v3=ICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
• CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: chrietya
Sec: Twp: Rng: Sub: Elk: Lot:36210047.00
INVOICE DATE......: 01/28/2000
REFERENCE ID # ...: 00010137
SITE ADDRESS .....: 7842 BELKNAP DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: PIYUSH GUPTA
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4906
CONTRACTOR ....... : GUSLANI, CHRIS LIC # 21311
COMPANY .......... : HOT WATER INC
ADDRESS .......... : 2531 GRACELAND AVE
CITY/STATE/ZIP ... : SAN CARLOS, CA 94070
TELEPHONE ........: (650)298-8494
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
t ID DESCRIPTION.... .. VOICE ID ........
.S DESCRIPTION
106 S SEWER & WATEES
R Sm202 SS UNDERFLOOR PLUMBING
S6C9996i9
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
1)TRN.10.2000 10 37RM {NETCLERK jtiC 697 Fp'.10
CITY OF CUPERTINO
BUILDING PERMITAPPLICATION
10300 Ter7e Ave• CUPOMtto,Ca 95014
' (408)777.1228
PROJECT ADDR888:7647 BBLmw DR BLDG S�
su►rErAPrx,_
PROPHRTY OWNER CONTRACTOR
EAMMAIUNGADD
E: pIYUBH OUPTA NAME hat esyr hIC+409Gb7011
E9S�11Boutw OR MAILINGADDP: CUPERTINO Oraeelalld AN, san�bmCq W070
0)1633090 RAKAm ( RAYpft f &54709.849788: g.MAILwDORESS:
1p0aenf®eet.aam
!� 2- 0 BUSINSSSLICENSE* 21311
B12L VN a'ORK TO 88?Ewr0Rz,=: RBPLACB WATER HEATER
BUu.Dfaac[; ELSCTASCAL:
N3CVAMCAL� PLVMMO.
12ROOP: VA2A0OU4RREAIDLk Y89— NOS wUMS ROF>Q07Tw ROOFCOV);R MIa
TTPS oFaxle:na0leooFeov9)lara:
NUEdeSlOF810S1MOROOFOOvaItA081tE1dOV8D 0 FROPOWROOF tovE&wQj .._
NUUM OF 3XISTDIFIG.RM COVRRDM UTADiM 0
=VMS LC.aa RPPO7tTNO, VALVATTON. 00)00
• IMPORTANT NOTICES NOTION TO APPL1CIRM
APPLICANTS CERMIwATION 1 Mleby WM uldarwne6y(t<peluy am of the fallowing deoerafbne,
ABOVE
IFYTHATfNFORM TIAv1 READ THIS APPIJCATIDN AND STATE THAT THE ( l L IMnend v,al a amvan[eaaWrour■brwnicna•aepl,
FOR THEINPORMAT)ON IS CORRECT•i AGREE THAT IF A PBRMT IS 18• peres0 u prey e0d 6y aeedan a7ee d ae Labor pada,ar ma peRarmame
SUEDSIONSO THEPERMI DESCRIED IS THIS APPLICATION,ALLTHB aroo'"a*�+W■pannlits�
PROVISIONS OF THE PERMIT AND ALL LAWS AND ORDINANCES
THERTO WILL BE COMpLIBO WITH. (d/L I haw ed adI Remain rormea• W041108,ad raclared by Bae
pGm 3704 Or Me Luba Code.1m ae aapmrnenaa d the y,*far vhlch MIR
HOLD HARMLESS CLAUSE.The perm6ea(a)by 90o80bana of the pannlL bareR I'�'boAura'oonw�e+gan mavrana atria and poliq Raaf
&VOW)a md"PIMf a rtd hold hamnot dn,CrWel euperOrm froMand L71re °�>und
st"I'M any eW all derma,dMlanda and 8etkm for domap s rmuldap Spm
oporeeons under tbd0 Pem%%f"afdb u of neplrpenps data Cq of CWwrdne "Number 1548386
49010,W such Nebre,demands or adl0le, [ ) N Ina ose d11ewa sem a 4100 areas.
In
WhrN CM�leenta LlpnadBadlon 3600 of the Labor Caesdthe ( ) N Ioeay der in the wwmaw cox". kfarwhlen Na Pont Isisarad.I
applloant Shan leveM.Coverage M undo ov,I 0s dM*oke andr=V:parrnl IR arty Renmr as is a beoama s
Ifaledhow ver W ash I ch su Rama(Ilp.m st b a M,"ehem h a*the e, ars ew of"st'tl■.I kVO4faamrrowladoe that srg;;
Rhaalwritam M e chastised ham(11Q must 68 eheobad as w4.Hak iM set m Me arum IMe I mhoue bamma:
eppraprlafa method of ompllanee. BoNerus of Ma Labor CC40 of atyea a Me�iY•for�6r�with
praLlona d8eten saw oftta Vitee"C da ,OW r"I fall the Pwft hvvfn aXftd kr
LIC6N96D CONTRUMmoR9 DapLARATN)N ahal be loaned rawmed.
alaiI I1�mebyv�AllIm esti ams aaerid Oared"am efchwworo1eRaRmr�e%ft
fowl dol ldorsuae&WPMud plc ibeCos w ow mane4ln b4 am 11 K IgNy u4e Gamer(a do 4110111 IN ee am"met in the Pffftm mdfhe
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Llama Clw m Bar 06/31x2001 R11h00wwks amsnank we en aoen p�hams
who,whin W torn.
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PAYMIENT
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