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00030086 CITY OF CUPERTINO PewMrr No. BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDINGADDRESS: - I� /err I D 3(J`••] TOKH F��a^I 1�(A{.�N+VJt�'IU YJ � r� SANITARYNO. APPLICATION SUBMITTAL DATE OWNS . A �/ I�J��rh N/C CONTROLM PHO 3 Jbi1 ,//7s • r , •❑ ARCHITECT/ENGINE � — "A BI1LOlNq PBRMITINFO mtz �Z N66 Z O H LICENSED CONTRACTORS o LA O - O 1 hereby 0)thio I am licensed....i rnvisions of Chapter 9(cotmmminis Job Description �; wine Smtion]Otp)of Divicion3o(da Business std Profession,Code.and my licen is fps n a O E in full force and cR Lic:ti �'ee 61,0-", (AJ 1� / ,,3 9'e4P", /J, WO mos la >pi e,p F Dete Convaclar �k�C� ARCHITECTS DECLARATION I p�j. .�Q11i�lgdaf9�plena h:aedu public records 0 uadrsW PyglgfatW ( s y s�P st-3 , OWNER- RDE CLARATION / r" 16ertby ethm Inn exempt I em exempt from the Conon,Coulw An,s Law for the G following naso..(Bodian 7031.5,Betimes and vc,&Profession,Cade:Any city m munry mM which its issuance, i s a a permit m ceras the alter,impasse,dnermit t m mash any tared urn - S Ft. Floor Area Valuation thelhe fits issunnm,sun ment in the trivili icaof tet smhpemdtroices.le a gaedamtemem - tl• Nminumcm widpursuam in the pro visions 3da eDeal to and Profession. (CTapref9 5 that he is ingwiNSenfromirst su0l theof Division for ofmeBminexeandon.Animalation r Occup% cy Type Nn io is exempt any appli and Ne basis far be elkged exemption.Any violation of APN Numberrs�Y -red Section man by anyapplicantdeur for a 00). bjmtr da applicant to a civil Pendry of / 3'O U f Ae r. not more Nen five hundred dollars(3300). -� LJ y Dl,as owns of me properly,mmy employms with wagesu Meir sole compemanov, Required Inspections will dome work andtheavuclu a is net inandedmoReted ferrule(So.7044,Business and Pmfauam'Code:The Contranm's Limner law 4.am apply a.we owner of property who builds or improves thereon,and who does each work himself or through - - 4 his We employees.Provided that such imp rveremts arc not intended or oRcmd for - - sale.If,arnimss,the building or improvement is sold within one year of mmpletir,,the mer-builder will have me burden a proving that he did not Wild or improve for for- ,,ex,.) 1,as owner of the property,am exclusively contracting with licenced'contractors of consouct the project(Sm.7W4,Business and Prokaaiona Cade:)The Contracmrs U. - cense LOW dens not apply to an owner of property who build%or improves Hereon,end who contracts for each Pmjects with a contractor(s)licensed pureaant to the Contractors ('; License Law. ' r ❑tem exempt under Sec. ',B&PC for Wsrauon 1 ' Owner Deer ` J_ WORKER'S COMPENSATION DECLARATION `Ver✓ Ihanwaffirm under pemllyof lteisf0inety raof if-insse owior chic,nWorkers Co I i, a and fide maintain oSomis.37W ofm a Laborrn to osis,four for Workers ce of the , mpon- tion,as provided for mi Section 3]00 of Ne Labor Code,fm.the petfomuane of the Work for which ills perms is issued. )"YI have and will maintun Worker's C.old.is Insurance,h i.iM by gado. 3y of me LCo for des c err tfhework fmwhich mispermitisissued. , . an Wo Co motion Inmran putt end POI1cYanpyberme, Ceriec ` 4-L PoIicY Na.Iv ERT GATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This rection m a d nm be complered if me permit is fm me hued dollars($100) or lac.) I,any that in is my performance as to be .which this parrot is ins'C ishan , sell employ any Amon in any menmr m m to become subject th<Woelnn'Compen-. r Applicant NOTICE of California,Dna - APPlicant s - NOTICE TO APPLICANT:If,after trading this Cmlficare of Exemption,you should - become mbjacna the Wor me.Compensation provision.of me Labor Code,you mus, -(onhwim comply with such providans err this permluhelf be domed rooked, CONSTRUCTION LENDING AGENCY p • IbertbywTlim ateterti>acs.,=donlendingagencyfmthepeffurmameof rthe Work for Which this p Hnul 161ssued(Sac.3037,Civ.C.) (� wr Lenders Name ya > lander:Address GT7 Q 1 moil"dust I have rend this application and spite that the above information is eeeq....., correct.i agree to comply with all city and county umbers...and spite laws¢eating I. U 0 building construction.and hereby su umes rtprcsmativea of this city to enter upon me _ W above-mentioned property for inspection purposes. [... • (We)agree to save,indemnify and keep ham leas the City of Cupertino against 4 f , Q U luxulitiea,judgmema,costs and expenur which may in any way x1m1 Ismat said City in conumusec of me granting of this permit t E+ a' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT f..l z SOURCEREGULATIONS. Signatumuf Applicaut Courector Date HAZARDOUS MATERIALS DISCLOSURE oi>ale aV 7 Will dieeppeicaut or fumrt Wilding oxcupani sloven,handle hamdom material e- —9(S ' as defined by the Cupertino Municipal Cade,Chapter 9.12,atm the Heald and Safety Code,Section 255.32(a)9 Type of Roof ❑Yes Will me applicant or future building occupon use wuipmen,or davima which All roofs shall be inspected prior to any roofing material being , emit harardour a4 contaminants as defaced by me Bay Arca Ab Quality Management installed. If a roof is Installed without £first obtaining an inspection District? ❑Yea W - - I agree to remove all new materials for inspection. Applicant ` I have reed me hmsrdme matenda ni,dromamx mdc,Chager 6.95 of d¢Cali understands and will comply with all non point source regulations. (sortie Health&Sefety Code,Serums 25505;25533 and 25534.1 mMerstt d that if the Wn c have a boon,mat it is my responsibility In wily Oa ettupant ' of is,m t 1 1 poorto issmme of a Cenili cu OwSignature of Applicant " Date Data All roof coverings to be Class"B"or better OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: katenb • Sec: Twp: Rng: Sub: Blk: Lot:31630105.00 INVOICE DATE......: 03/14/2000 REFERENCE ID # ...: 00030086 SITE ADDRESS .....: 10540 N BLANEY AV SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER ............: NOLAN KATHERINE M ADDRESS :.........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2455 CONTRACTOR .......: ANDERSON, WILLIAM LIC # 5573 COMPANY ..........: DAHL PLUMBING CO, JOHN F ADDRESS ..........: 329 ALMA ST CITY/STATE/ZIP ...: PALO ALTO, CA 94301 TELEPHONE ........: 14151321-5500 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- _ BREMAIRRAN P 8.33 0.00 8.33 BREMFURNOV P 14.43 0.00 14.43 BREMRECEPT P 1.11 0.00 1.11 EPERMITFEE P 35.52 0.00 35.52 MPERMITFEE P 35.52 0.00 35.52 --------- ------------ ----------- 94.91 0.00 94.91 ve ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ -------- ......------------......---- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL • REiMACOVER JACUNIT >IGCOCCF%l INIEC-ANICAL • mJ\ 119REMVENSYS BREMAIRHAN JA/C UNITS <= 10,00CCFM IMECHANICAL SRENIFURN RELOCATION OF FURNACE MECHANICAL . BREMFURNOV IRELO FURNACE > 1CK BTU IMEC4ANICALBREMINH000 INSTALLATION OF HOOD MECHANICAL BREMRELOCA RELOCATION OF HOOD NIECHANICALBREMREPALT REPAIR/ALTER HEATINGMECHANICAL IVENTILAT10N SYSTEMS MECHANICAL PPERMITFEE JPLUMBNG PERMIT ISSUE IPLUMBING 2MSNUMULTI NEW MULIFAMILY RES IPLUMBING BNUSFD NEW SINGLEFAMILY RES PLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING BPCESSPOOL CESSPOOL PLUMBING BPFIXTURE PBLG FIXTURE PLUMBING BPGAS GAS PIPING SYSTEM FEE PLUMBING BPINTERCEP IND WASTE INTERCEPTOR PLUMBING BPREPIPE IREPIPE OF FIXTURES PLUMBING SPSEWAGE ISEWAGE DISPOSAL PLUMBING BPSEWER SEWERS PLUMBING BPSPRINK LAWN SPRINKLERIBACKFLO PLUMBING BPSTORM STORM/RAIN WATER PLUMBING BPTRAP KITCHEN TRAP IPLUMBING BPVENT ALT OF DRAIN &VENT PLUMBING BPWATER INSTALL/ALTER WATERPIP PLUMBING BPWHEATER WATER HEATER/VENT PLUMBING • BPWSVCS MAIN WATER SERVICE PLUMBING ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING ZDIRTM DIR TENT MAP PLANNING ZFULLHR FULLAPPLBASE+HR PLANNING ZFULLTM FULL APPL TENT MAP PLANNING ZFULLUP FULL APPL USE PERMIT PLANNING ZFULLZONE FULLAPPLZONING PLANNING ZGPAMEND GENERAL PLAN AMEND PLANNING ZLIMAMENO LIMITED AMEND PLANNING ZLIMTM LIMITED TENT MAP PLANNING ZLIMUP LIMITED APPL USE FERMI PLANNING ZMATEMPUP IMIN AMEND TEMP USEPERM PLANNING ZMINHILLEX' MINOR APPL HILL EXC PLANNING ZMINSIGNEX M'SC SIGN EXCEPTION PLANNING ZMINTM MINOR APP TENT MAP PLANNING ZMINUP MINOR APPL USE PERMIT PLANNING ZMISCASA MI ARCH S PLANNING ZMISC MISC AND UP PLANNIN ZMIS FENCE MISC FENCE EXCEPTION PLANNING ' ZMISCGEN MISCELLAPPLGENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING ZSIGN SIGN PERMI PLANNING ZTEMPSIGN TEMPORARY SIGN PLANNING VARIANCE DIRECTOR VARIAN PLANNING • 2 oC2 . Re+itad Ll099 Dry. i/ Applicable Fee ID Fee Description Fee Group ISPERbIFEE BLDG PERMIT FEES BUILDING IBCONSTAX 1CONSTRUCTION TAX ISUILDING jBENERGY JENERGY BUILDING ISENERGYAOD ENERGY A00 MULTI BUILDING 1BOVERTIME INSPECTION OVERTIME BUILDING BTEMPPERM TEMPORARY BLDG PERMIT BUILDING BMITIGAT HOUSING MITIGATION FEE BUILDING JBPLANCHK PLAN CHECK FEE BUILDING BPLANCKADO PLAN CHECK ADD MULTI BUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSCBLVD SCS SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING BSEISMICRE SEISMIC FEE RES BUILDING ESPECIAL SPECIAL INSPECTION IBUILDING BSWIM SWIMMING POOL BUILDING ZAODCHG ADDRESS CHANGE SUILOING EPERMITFEE ELEC PERMIT ISSUANCE ELECTRICAL BELEC1000 ELEC 600V <=1000A ELECTRICAL BELEC1001 ELEC 600V>1000A ELECTRICAL BELEC200 ELECT SVCS 600V c=200A ELECTRICAL BNEWMULTI MULTIFAMILY RES ELECTRICAL BREMBUSWAY REMODEL BUSWAYS ELECTRICAL MBR EMFIXT LIGHTING FIXTURES ELECTRICAL EMMISC MISC APPARATUS ELECTRICAL o EMNRAPP REM NON-RES APPLIANCE ELECTRICAL EMPOLE POLEIPLATFORM FIXTURE ELECTRICAL EMPOWER POWER OEVICEIAPPARATUS ELECTRICAL EMRECEPT RCPTL, SWITCH &OUTLETSELECTRICAL EMRESAPP REMODEL RES APPLIANCE ELECTRICAL EMSIGNAD RMOL SIGNS ADO BRANCH ELECTRICAL EMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL EMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL F&2FAM SINGLE&2 FAMILYELECTRICAL EMp TEMPORARY POWER ELECTRICAL BTEMPSVCS ITEMP DIST SVCS ELECTRICAL MPERMITFEE MECH PERMIT ISSUANCE MECHANICAL BAPPLOTHER OTHER APPLIANCES MECHANICAL BBOILERI BOILER� 100,000 BTL IMECHANICAL BBOILER2 BOILER>t00KTO500KBTU MMECIMICALAL BBOILER3 BOILER>500K TO 1M BTU CAL BBOILER4 BOILER>1M TO 1.75M BTU CALBROILERS BOILER> 1.75M BTU CALBREMAPPU APPLIANCE INSTALL CAL H INS ALLATION CALBREMVENFAN VENT FAN SINGLE DUCT CALBMNEWMULTI NEW MULTI-FAMILY RES CALBMNEWSF&2F NEW SF&2F RES SLOGS CAL t oft s..I..a ulo�ss