99120052 APPLICANT TO FILL IN INFORMATION WITHIN REDLINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL. RMITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDEN'T'IFICATION
BUILDING ArjDRESS: 17ililftAIWNO. APPLICATION SUBMITTAL DATE
' i00iffy /3ri5h fah /7_ 7 94
OWNER'S NAME' - - PHONE: C NT CTOR' N - - LIC NO: -
T 1 S / r JS z S / y A/ Gh ` ?r Cn� N/C CONTROL#
iR HITECMNGINEER: LIC ND. V lAi; ;V W ❑
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
& ❑ ❑
LICE .D CONTRACfO DECLARATION QTY, ELECIRICPERMIT FEE
1 hereby afro m I am heemsed arta._ onvisions of chapter 9(commencing JOB DESCRIPTION
{s�{�1Z th Section 9100) Dlvlelon3 of the Badness a Professions Coda and my license is RESIDENTIAL:
F00 W'bdI"1CO3 and PERMIT ISSUANCE
tY W r '" Q�7� ❑SFDWL [_1 KITCHEN REMODEL
aUV License Cl Lin. APPLIANCES-RESIDENTIAL []ADDITION L1 PLUMBING RE-PIPE
F.zW Date aup
CC 'ICI"5CLA ❑MULTI-UNIT ❑S'T'RUCTURAL
Z0,04 unci stand my laps shall be tee PANELS - MODIFICATION
oyo UP TO 200 AMPS ❑INTERIOR El CHIMNEY REPAIR
PFm Licensed Professional 2111-IINIIIAMPS y IMPROVEMENT (]SWIMMINGPOOLS
OWNER-BUILDER DECLARATION
1 hereby affirm that I run exempt Goo the Contractor's License Law for the OVER IOINIAMPS ❑BATH REMODEUREPAIR DEMOLITION
ip5, P.V following reason.(Section 0031.5,Business and Professions Code:Any city or county ® SIGNS ELECTRICAL if
/Q, OTHER
'+s O pFj which rcgoires a permit to construct,alter,improve,demolish,or repair any structure
yW � prinfm its lssu.are,also requires the applicant for such permit to file.signedstmement SPECIAL CIRCUIT/M ISC.
y
C� that he is licensed amount to the provisions of the Conttnctor's Uceose Law(Chapter 9
CO (commencing with Section 91100)of Division 3 of the Business and Professions Code)or TEMP.METER OR POLE INST. COMMERCIAL:
0.q e rG that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEDG/ADDITION El DEMOLITION
Section 9031.5 byy applicant tomo permitsuthe applanal ton civil penalty of POWER DEVICES sll�
not mote than five hundred dollanars(5500). AN
-1 FOOD SERVICE
Z6 D I,as owner of@e property,or my employees widt wager as theiraele compensation, SWIMMING POOL ELECTRIC PROVEMBNT
Fs will do the work,and the strucmm is not intended or offered forsale(Sec.]044,Business ER
,3 m and PmfessiensiCWe:The Contractors License Law does not apply to an owner of OUTLETS WI
property who builds or supposes thereon,and who does such work himself or through
his own employees,provided that such improvements we not intended or offered for TI SQ PI'.
sale.If.however,the building or improvement is sold within one year ofcomplatioe,the SQ.FC FLOOR AREA S/SQ.ET.
cr-builder will have the burden of proving that he did not build or improve far put-
pose wine). L.es
El I,as owner of the property,um clmovely contracting with licensed contractors to
IMID
construct me project(Sea.9044.Business and Profceslnnw Can.,The Conaaemr9 Li-
IF
ense Law'tices not apply to an owner of property who FuilJs or improves thereon,and QTY. NG ERM!
who contracts for such projects with a earthw rds)licensed pursuant to the Caricatures
License Law. PER
lomm
exeptonder Sec. ,B&P C fornames ann
Owner Date VALUATION
WORKERS COMPENSATION DECLARATION ffiBACK OWPROTECT.DEVICE / Jl a ^
I hereby arm anderpcnelty w isbirone of of the following declarmians: V l/
0 Horsetail will maintain.CeNFwlea[present to aelGlnaum for WDRAINS-FLOOR,ROOF,AREA,COND.
swarm as provided for by Section 3900 of the Labor Codperformance Code for the perfoce of the S'NRIES TYPE CONS'1'RUCt10N
ma
VExc
r which this permit is issued. FIXTURES-PER TRAP
and will maintain Workers Compensation Insurance,as required by Section
39110 of the Labor Gde,for the performance of the work for which this permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS
My Wr sCo ansa�wjpT}�rss rr'rand Policy t OCC.GROUP ,•� APIs' O
Carrico � V 1 efu Policy No.: 11 GAS-EA.SYSTEM-OVER 4(EA) -G9
CERTIFICATE OF EX� PTION FROM WOI KERS' O
COMPENSATION INSURANCE GREASMNDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES- '!p �4
(This sectio"need not be compound if the permit is for one hundred dollars(1100) GREASETRAP
or loss.)(This
FEE
Icartify thatinlheperfermanceofthe work(w,vInahthBpewU,i.esued,Lhall SEWER-SANITARY-STORM EA.200 FT.
not employ any person in any manner so as to become subject to the Workers'Compete- ENERGY FEE
,Z sation Laws of California.Date z WATER HEATER WNENT/ELECTR Q Applicant ( - - GRADING FEE
y NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should WATER SYS'TEMaREATING
h 5 become subject to the Workbes Compensation provisions of the Lubof Code,you most SOILS FEE
W Qforthwith comply with such provisions or this permit shallmed
be deerevoked. WATER SERVICE
gLi z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ,FT.
V Q I hereby affirm that there is a construction lending agency for the performance of � D�l� Race pt#
0 ti the work for which this permit is issued(Sec.3097,Civ.C.)
I•�' Lender's Name iul TOTAL.
W Lender's Address TOTAL:
LWgU I.
I certify that I have read this application and sate that the above wfommatmn is LDIN
(Al cornu.l agree to comply with all city and county ordinances and state laws relating to QTY, MECHANICAL PERMIT FEE
7
V G building conmrc0o relay amhnoc representatives of this city toe"¢_upon the MIC PEE
above-menti_ properyfrr, apecomi'srposes. PERMIT ISSUANCE
( agree to save,i nil nil toles,the City of Cupertino against RIC FEE
Iiabil" s,judgments,coss an a h' pony in any wnyaccue rains said City ALTER OR ADD TO MUCH. �'_--"•"�'"
i in nsequenceafthegran go to PLUMBING FEE
A PLICANT UNDER.'AN Dt ILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,0(10 CFM)
S URCE REGULAT S. MECHANICAL FEE
Zi 7• AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTIONTAX
SignatrerfApplicaw untranur Date EXHAUST HOOD ONMUCI) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or furore bus ing occupant store rr handle hasallous material HEATING UNIT('1'0!WAW BTU)
as defined by the Cupertino Manic' al Cede,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)P HEATING UNIT(OVER 100,1100 BTU) _
E3 Yea n
VENTILATION PAN(SINGLE RUSH)) PAID Date Rceeipt#
Will theapplicant or Pomo'buil g occupant use equipment or devices which -
emithaeardous nmminam teed by the Bay Arca Air Quality Management BOILER-COME(3HPOR 100,000 BTU)
Dia..iia?
- TOTAL
. BOILER-COMP(OVER 100.000 RTU)
(have read thchazardo mat a men's under Chapter 6.95 of me Cali- AIR CONDITIONER ISSUANCE DATF,
ria Brad
w I&Safety Code cats 50 , 5533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.ET. �T
haddimgito�snucuen0y b .t is my to
to notify the occupant / L — 7"--Q
of the rey eworm whic e of.Cori p +
Owner rauNrriudagenl u - ' Date!! ,, TOTAL: ISSUED BY:
OFFICE
A
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rog: Sub: Blk: Loo:35720025.00
INVOICE DATE. . ....: 12/07/1999
REFERENCE ID # ...: 99120052
SITE ADDRESS ..... : 10080 BUBB RD
SUBDIVISION ...... .
CITY CUPERTINO
IMPACT AREA ...... .
OWNER NET GENESIS
ADDRESS . ..... .. . . :
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS .......... :
CITY/STATE/ZIP ....
TELEPHONE ........:
FEE DESCRIPTION CNK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BENERGY A' 260.40 0.00 260.40
SPERMFEE P 868.00 0.00 868.00
SPLANCHK A 737.80 0.00 737.80
BREMRECEPT P 79.82 0.00 79.82
SSEISMICRE P 12.00 0.00 12.00
1C P 90.00 0.00 90.00
—
4ITFEE P 35.52 - -0.00 35.52
2083.54 0.00 2083.54
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER 8 WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB 6 OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION308 S14EETROCK
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