99070059APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -.OSE BALL POINT PEN ONLY , / L%([ d7 D,9,!)Q
CITY. OF CUPERTINO BUILDING - ELECTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL
'BUILDING PROJECr IDENTIFICATION
PERMIT NDj
S0001 'IR'!T''Q'TxJ �f
J
BUILDING4DDRESS:
SANHARYNO.
APPLICATION SUBMITTAL DATE
N R'SNA 11PHONIir
4 -31
CONTRACTOR'S NAME LIC NO:
')• rY /.aOC
/
❑
CONTROL#
RCHITECTIENG EER: LIC NO:
ADDRESS:11(pq R 'O i
R .`t
CONTACT: PHONE:
❑ Consultant Fees Paid by Applicant(Initial)
BUILDING PERMIT INFO
BIAG ELIiC'I', PLUMB MHCII
❑ ❑ ❑
LICENSED CONTRACT'OR'S DECLARATION
1 hereby abler that I am liecrsed under Provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions GNe, and my license is
a fu111afceand eRc
Livens Lida "r (
J Date. Come ly ` F
QTY ELECTRIC PERMIT . PEE
JOB DESCRIPTION
RESIDENTIAL:
❑ SFDWL ❑ KITCHEN REMODEL
[]ADDITION El PLUMBING RE -PIPE
❑MUCTLUNIT ❑STRUCTURAL
MODIFICATION
❑INTIiRIOR ❑CHIMNIiY REPAIR
IMPBOVEMENT L] SWIMMING POOLS
❑BATH REMODEUBfiPAIR ❑DEMOLITION
❑ OI'I lliR / ��
�
PERMIT ISSUANCE.
7 APPLIANCHS-RESIDENTIAL.
j ARCHITECT "S DECLARATION
1 understand my plans shall be used as public records
J
J Licensed Professi�nal
J OWNER -GUILDER mDECLARATION
J
f 1 ad.. .(Sinn that I am exam t (num the Contract. C'x license Law far the
r p
J following reason. (Section omel Business and 14ofespons Code-: Any city s county
W requiais a e.h. ra commie, pilar, improve, demolish. in e. sigany naiewrc
prior to its lase.nee. okso requires he applicant lbr such permit to life. aNtemm�t
the he is licensed pursuant m the limlisiam.f the ConuueoPs license Law (Chains, 9
(commencing with Section 700a of Division 3 afthe Business and Professions Code) or
- that he is exempt therefrom and the basis far the alleged exemption. Any violation of
' Section 7031.5 by any applicant for a pemrit subjects the applicant to a civil penalty of
not mire Nan five handled props dollars y employees
mpl
❑Lasownerrd'thend themply,mmy nnatenhaswiNwagesm their sale compensation.
will Jothewnrk. Co the hd CmeIxint, Licensor offeredsersulc1,ly 9(144, Buuincss
and Professions Gs of improves
oyes dean's License Law does eat apply s if owner of
property who builds it improves thereon, and who rices such work himself or am
his o
his own employeesprovided than such improvements arc not intender or pleated for
mlc.If. howeventhe buildingoded of Falling
is at hewithindione tbuild or improve for
owner -Wilder will have the burden of proving that he did not build or improve for par
pee of salad.
❑ sinu owner or the property, am exclusively contracting withlicensed)Thecontractors it)
maaict the project (See. 9044, Buxinoss and Professions Cndep The Contractor's Li-
cameLawdoesnotapplymanownerofprupenywhobuildsorimprovesthermn,and
who contracts for such project, with a lantmcmrcs) licensed pursuant a the Contractor's
License Law.
❑ IamexemptunderSa. ,B&PCfurthisreasan
PANELS
UP TO 200 AMPS
201-Io0(IAMPS
OVER PXX) AMPSELEC
SIGNS ELECI'RICA1.
RIC
SPECIAL CIRCUIT/MISC.
LJHG'!/...!%
TEMP. MIUTR OR POLE INST.
COMMERCIAL:
0 NEW BLDG/ADDITION ❑ DEMOLH'[ON
❑TfiNANT C) FOOD SERVICE
IMPROVEMENT
DTIII?R
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETS-SWITCHES-FIX'TIIRES
NEW RESIDENTIAL ELECTR SQ FT.
00
SQ. FT. FLOOR ARRA
5/SQ. Ff.
.
TOTAL'
QTY. PLUMBINGPERMIT F
t
PERMIT ISSUANCE
ALTER- DRAIN & VENT- WATER LEA)
BACK PLOW PROTECT. DEVICE
Owner Data
,l VALUATION .
_7{y'K' � OLD
WORKER'S COMPENSATION DECLARATION -
endue arlb,sll inn main, Penalty al'ofCoyoneofthe imatm, arWng ker'sons:
are and will merrymaieCeei37M of the sent toLabor
self-Code,for the performance
.aloe, as provided liu by Section 3900 of the I<bor Cade, for the performance of the
k far which this parentis issued.
haveve addwill maintain Workers Compensationrkfor shrequired by Section
of Ne Labor Code. for performance of the work for which this Permit is issued.
My Work9{ L tq�g}�}wq�{ �y and Policy 1�� pry. n
Cortices' o1y�/(G (jJLD)1 �onle Polley No.:(�ly- LoorJ101 rI
CERTIFICATE OF EXEM VGON FROM WORKERS'
COMPENSATION INSURANCE
(This waliin need not be completed if the permit is foranehundred dollars (SIM)
ar less.)
1 minty that in the performance of the work forwhich this permit is issued, I shall
not employ any person in any ancon y w to the WmAds'Com
I� �� =s y{
xatiin is C. n D t "-(7�
�'''
Appllcom S
DRAINS - IO.00R, ROOF. AREA, COND.
STORIES
TYPE CONST RUCTION
FIXTfIREg - PER TRAP
GAS - EA. SYSTEM -I INC. 4OUTLETS
OCC. GROUT'
, ANN
_
GAS' EA. SYSTEM -OVER 4(EA)
GREASIYINDUSTRLWASTE INTERCEPTOR
BUILDING DIVISION FEES
GREASE TRAP
PLANCI ECK FEE
gENTR-SANITARY-STORM EA. lT.
ENERGY FEE
WATER HfiATER WNENT/ELECI'R
GRADING FEE
NOTICE TO APPLICANT. If, alter making this Cenific:ie n1' Exemption, you should
become subject to the Workers Compensation previsions of the Labor Cade, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
T hereby nRnmhm there isacomwaion leering agency fnr the performance of
the work for which this permit is issued (Sec 3099, Civ. C.)
Laren',, Name
WATER SYS11PALTRF.ATING
SOILS FEE
WATER SERVICE
PAID
NEW RESIDENTIAL PLMB. SQ, FT
Data Receipt#
TOTAL:
Lender's Address
TOTAL:
1 certify that 1 have mad this application and state that the above infoenation is
comet, l agree to comply with all city and county ordinances and state laws relating to
building construction. and hereby authorize rep «ntativesofthis city toen¢rupin the
above-mentioned property for inspection purposes.
(We).9. to love, indemnify and keep handless; the City of Cupertino ag.ion
liabilitiesjudgments, costs and expenses which may in any way accmc against said City
a. mst,darre of the painting mind, permit
APPLICANT UNDERSTANDS AND WILL COMPLY WI PC ALL NON -POINT
SOURCE REOULAr10NS. '
BUILDING PEE
- -
QTY, MECHANICAL PERMIT FEE
SEISMIC PER
PERMIT ISSUANCE
ELECI FEE
ALTERORADD'I'OMECH.
PLUMBING HE
AIR HANDLING UNIT (TO 10.000) CPM)
MECHANICAL PEG
AIR HANDLING UNIT (OVER 10.0Q) CFM)
CONSTRUCTION TAX
Signature of Applican/Contrecmr Date
MATERIALS DISCLOSURE
Win theupplicum orUndo, building occupamstnrenr handle It ... Won, ma,,W
as defined by Ito Cupartln l Munlcipul Cada. Chapter 9.12, and Tho Hwlth. ,I Safety
Cede, Section 25532(0)'1
❑Yes ldNo
•Y�
Will the applicant or furor, building occupant use equipment air devices which
knit hazardous air contaminants as defined by the Bay Area Air Quality Management
�isaid9
C] yes 1 �Jo
quiremen p
(have result (azardnus matsrbl requirements Chapter fl95 of the Coli
humin Health & S y eines 25 05, 2553 d 25534. I understand Nat if Ne
buildingdces bar atcnant, miY nsibilitymn notify the occupant
.find en u ¢In so facartificaleLfJge(yyW y
EXHAUST HOOD(W/DUCI
HOUSING MITIGATION FEE
HEATING ON[ '1'(TO W,O(10 It'I'll)
HEATING UNIT (OVER 100,000 BTIT) -
LAID
Data Receipt #
,
—
VENTILATION PAN (SINGLE RMID)
BOILER - COMP (7HP OR I W,IKKI H'fU)
TOTAL:
BOILER - COMP(OVER 100,000 BTU)
AIR CON DI'I'IONIiR
ISSUANCE DATE ,.r
�T /T /y
L// /S
ISSUED by.
NEW RESIDENTIAL MECH. SQ. ET.
O ramharf agent
TOTAL:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
• CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: nancyc
Sec: Twp: Rug: Sub: Blk: Lot:34212088:00
INVOICE DATE......: 07/23/1999
REFERENCE ID q ...: 99070039
SITE ADDRESS .....: 10200 BYERLY CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ......:
OWNER ............: BRAND RONALD A AND MAXINE
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-5647
CONTRACTOR .......: GILROY, JOHN LIC # 15128
COMPANY ..........: JUST WATER HEATERS INC
ADDRESS ..........: 1764 NATIONAL AVE
CITY/STATE/ZIP ...: HAYWARD, CA 94545
TELEPHONE ........: (510)293-9901
FEE DESCRIPTION CHK TOTAL FEE
_______________ --- _________
BPWHEATER P 9.9E
PPERMITFEE P 35.52
45.50
VOICE ID DESCRIPTION
............................
FINAL PLUMBING ENERGY
7 FINAL PLUMBING
PAID -TO -DATE BALANCE DUE
____________ -----------
0.00 9.98
0.00 35.52
____________ -----------
0.00 45.50
VOICE ID DESCRIPTION
........ ............................
506 GAS TEST
5