00020131 FAPPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY - O Z
CITY OF CUPE RTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
BUILD INNGA��5, - _ zs �^ 1 ^ ' ^O O , SANITARY NO. APPLICATION SUBMITTAL DATE
OWN NA //I �J•(,'J PHONE � IIJ. TR9N 3R$N9ME_ tink LIC NO: V� �V�
rKrf/•W—W-.T. a (IYl /1E., NIC
CONTROLp
RCHITECIVENGINMR: LIC NO: ADDRESS: ^If� `` ❑
fi/1. i Cs
CONTACT, PHONE: BUDDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT P ECH
El ❑ JI
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
1 hereby a0irm mme
that 1 am licensed under provisions of Chapter 9(concing JOB DESC
wR[ ION
o, with Souhm7MTn(Division 3afthe Bouromand Professions GdeaL:nd my licenmis R CID NTIA
WOO PERMIT ISSUANCE
F W F Li full force and ede 1l) 4 1 ❑SFDWL ❑KITCHEN REMODEL
�UzU Lironse � O LIC.M APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
rF6 W� Dela Lic. r
FOw ARCHI'TECT'S DECLARATION-' PANELS [D MULTI-UNIT ❑STRUCTURAL
z O rn z 1 uodmilund my plums shall he used as public records MODIFICATION
O z UP TO 200 AMPS [I INTERIOR El CHIMNEY REPAIR
W Licensed[imfesximed 2!11.10 DAMPS IMPROVEMENT ❑SWIMMING POOLS
�Y4J OWNER BUILDER DECLARATION inOVER I(100AMPS El REM EIAIR DEMOLITION
CC OO�CC 6 1 hereby aftren that I am exempt from the Canna is License Lew for the fir( I
fa�SOyV m1having..at.(Section 7031.5,Busessand Professions Cade:Any city or county SIGNS ELECTRICAL yYOTHER
W 3 LL F" which requires a permit to consumer,alter,improve,demolish.or repair any stmeture
f"E:O prior to its issuance,also requires the applicant for such permit to file a signed statement SPECIAL CIRCUIT/MISC.
F y
that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9
�y'oo (commencingwirh Sermon7ll )O(Division3oflhe Businessand Rofemions Code)or TEMP.METER OR POLE INSL COMMERCIAL:
0.2. IY Bud he is exempt therefrom and the basis for the alleged exemption.Any violation of [INEW BLDG/ADDCHON E3DEMOLITION
rn Section 7031.5 by any applicant for a proper subjects the applicant to a civil Penalty of POWER DEVICES O TENANT ❑FOOD SERVICE
nor mom Than five hundred dollars(5500).
F Z} IMPROVEMENT
❑Lo the work,the property,mmyemployees d with wages azelei((Sec.
compensation, SWIMMING POOL ELECTRIC
andwildo work,and e:The mm is not e&License o w doexical not apply to an Business []OTHER
6,�jrm pro Profusions Code:The eves thereon License Law dces not appy to if rowner Brought ht OVfLFTS-SWITCHES-Fl%TURES
properly,who builds or improves thereon,and who dors such work himself ut th d for
his own employees,provided that such improvements ore not intended m offered for NEW RESIDENTIAL ELECTR SQ IT.
sale.IL hswveverthe building or improvement is sold within one year of completion,the 1SQrFE,FLO0RAREA SISQ.PT.
worm,builder will hoop the burden of proving that he did not build or improve for put. D Q
,n,c nt sale.).
El 1,as owner of the property,am exclusively contracting with licensed Contra tars to TAL: f}
construct the project(Sec.70a14,Business and Professions Code,)true Contractor's Li. OJT
cerise Law does not apply to an owner o(propery who builds or improves thereon,and QTY. PLUMBING FEE
who contracts fill such projects with.emarramr(s)licensed pursuom m the Captracnr's B d.7 6 2O
License Law. PERMIT ISSUANCE I! 00
❑ I.m exempt under Seo. .B&P C for This rtazon
ALTER-DRAIN&VENT-WATER(EA 1' VALUATION
Dale J_
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
I hereby affirm under penalty,of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Concerto self-insure for Workers Camper- DRAINS-FLOOR.ROOF.AREA,GOND. STORIES GO STRUCTION
sadmi.as provided for by Section 3700 of the Libor Code,for the performance of the
w A for which this permit is issued. FIXTURES-PER TRAP /
I have end will maintain Workers Compensation Insurance,as required by Sarum
I'M of Me LutwrCode,far the performance of Be,work for which this permit is issued. GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN
Myhpr.T CQtpp�Bf II lnsumnce cartierand Polity ryryibr y�y.W3- S? GAS-EA.SYSTEM-OVER 4(EA)
Comer. If IV !'u Policy NelAll.1JC
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASEIINDUSTRL WASTE INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION FEES
(This section need not he completed if the permit is for one hundred dollars 1$l BILL GREASETRAP
or lust PLANCHECK FEE
I certify that in the performance o0he work for which this permit is issued,Isholl SEWER-SANITARY-STORM EA.200 FT.
n u employ any I cram in any manner so as to become subject to the Workers'Compen. ENERGY FEE
z sudon Luws ill Culifnntia,Mare WATER HEATER WNENTIELECTR
700 Applicata GRADING FEE
q r~Ni NOTICE TO APPLICANT:IL ofnr making this Cenificme of Exemption,you should WATER SYSTEMrTREATING SOILS FEE
(~ become-auhJem m the Worker's Compensation provisions of the Labor Code,you must
W - forthwith comply with such provisions or this permit hall W deemed revoked. WATERSERVICE
7 z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID Date Receipt p
V 0 1 hereby affirm that there is a contact lending agency for the performance of
Ne work for which this permit is issued(Sec.3097,Civ.CJ
0 F Under,Name TOTAL:
1 Lenders Address TOTAL: BUILDING FEE .
I certify that I have read this application and state Nal the above information is
FN correct.I agree to comply with all city and muntyurdfnanms and care laws relating to QTY. MECHANICAL PERMIT FEE
V z building comouction,and hereby authorize represearives ofthis city to enter upon the SEISMIC FEE
m
above-mentioned pmpeny for inspection purposes. PERMIT ISSUANCE ELECTRIC FEE
(We)agree In save,indemnify end keep harmless the City of Calvert.againm
liabilities,judgments.costs and expenses which may in any way theme against said City ALTER OR ADD TO MECH. PLUMBING FEE
in comsequence of the greming of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM) MECHANICAL FEE
SOUR?E ATIONS.
l D ,`/Q, AIR HANDLING UNIT(OVER IB,OOIICFM) CONSTRUCTION TAX
Signature of plica o/Cnnwcmr Uric EXHAUST HOOD(W/DUCD HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material ' HEATING UNIT TO 100,000 BTU)
ua defined by the Cupedinn Municipal Cade.Chapter 9.12,and the Health and Safety
Cale,Section 25532(.)! HEATING UNIT(OVER 100,000 BTU)
❑Yes ON. VENTILATION FAN(SINGLE RESID) PAID -
Dane, Receipt g
Will the applicant or future building mcupant a.equipmern or devices which
,mit haoodous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(JHPOR IW,gq BTU) IOTA :
Dimdm^
I [I Yes ❑No BOILER-COMP(OVER IW,000BTI17
I have read the Incumbents materials rcquimments under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUAN A
humin Health&Safety Code.Sections 25505,25533 atd 25534.I understand thin if the NEW RESIDENTIAL MECH. SQ.ET.
Wilding dnec not currently have a terms,that it is my responsibility to notify Ne occupant
of the requimmenta which must W met prim to issuance of a Certificate of Occupancy.
Owner or authorized agent Date TOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: christya
Seo: Twp: Rng: Sub: Elk: Lot:31623040.00
INVOICE DATE......: 02/16/2000
REFERENCE ID # ...: 00020131
SITE ADDRESS .....: 10169 N BLANEY AV
SUBDIVISION .......
CITY ............. : CUPERTINO
IMPACT AREA ...... .
OWNER .... ........: BROWN
ADDRESS ..........:
CITY/STATS/ZIP ...: CUPERTINO CA, CA 95014-2329
CONTRACTOR ....... : MARK BEECH LIC # 21644
COMPANY ..........: UNITED AIR COMFORT
ADDRESS ..........: 5819 N ANDREWS WAY
CITY/STATE/ZIP ...: FT LAUDERDALE, FL 33309
TELEPHONE ........: (408)771-8967
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BREMACOVER P 14.43 0.00 14.43
BREMHEAT P 6.11 0.00 6.11
MPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
5
�� 6.06 0.00 56.06
�ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
204 UNDERFLOOR FRAME 301 ROUGH PLUMBING
303 .ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
50B FINAL MECHANICAL 514 FINAL PUBLIC WORKS