00020193 CITY OF CUPERTINO` PERMITNO:
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS'
SANITARY NO.' APPLICATION SUBMrITALDATE
a � ���, Cdr.�h /r
} � ,Aa/ NIC CONTROLN ...
PHONC
,• Lu00 ARCHI Ct/E GINEER+ _ �h / � .. r�/ I_i�� 3 v BULOINO inifittivirr -NO ^
y - -
z FO h 3 • LICENSED CONTRACTORS DECLARATION e
O z hembY amen 0w I I c ved oder frovisions of Chapter 9(commencing t- Job Description
with Sauon](Xn)cff inaioa3ofNe B.a.mand Profermu Cade,and my Rcasn"
Y I in full fo and effec 1
7xDs
i � - r Lt nuecm�
O Q t A CHS DECLARATION if
'w ry o o 1 undenuM my piens shall be vied u pubhe records
d �✓y 0 �+ /fir ���/
Licensed Professional - . : . . ,_ _ •, .
u�1 OW NERn exempt
DECLARATION ,
C J Q 1 hereby afOw that 11. exempt f Nc Commutes e:Any
law for the
a windchfollowing Minn.(Seaton 9031 tr Beam and Profea ran Code el y city«ewnry
which acquires e Isennit w construct,alter impww,demoliN par anY'ewctwe
Sq. Ft Floor Area' / yal�a�n
prim to uiseuance.also regmrce du app&am for such pemut wfile asigned statement i
. matheslicensedpursuam tothepnvuiomofthe ,Innineas dIsrae Law(Chapter9 ."
(cat he
munint eeuen Rah basis far the
enandon.Any
Code)m I APN'Number Occu ane •ry' e
Nat he is exemptsayatherefrom and du basis for Ne alleged plicanan.Any vialehon of O +, .. P y `7 P
net Non Ina by any applicant f«a pen@ subjects Ne applicant m a civil pevlry of
not more Nen ofC finndred dollars,anall. -
O 1,-a wars,and
On ann on no,employee.wiNwgesn mei(an C.,Buedon, Required Inspections .
WE'
domewink,mode: ,wennt,acctintended,LawoffiNed dofa ,sly ea.Business '
. end Pty who
Code The Contmewfe,Nal w law does wordsply a if owner of ' )
bir wo aMo build,or tip O thereon,and who rns such tint.hinndeed or or through
for
'fir employece,pmvrded Nu such tmprowmenn arc not mreMed or oRered far •
sale ir-habl wr,dse buil ding«tmprowmeauaold did tux Wild
or complevor lan, - s
owner-builder will have Nc burden of pmvmg Net he dad nee build«unpmve for per- "
❑I,u owns of a( property,mnudusly ad worsening wird:)Tan Ccontract's to
Car-
cwha proles(Sec.]044,Business and Py who b.s Code)The Contracmi a Li-
cense law does nm apply m an owner of proanY who build,or improve dsereon,eM � s
License
ncofar ouch Ptolttu wed a contncmr(s7lkenrcdPunuant w Ore Canvactoi a '�,r
Li«nm Law. -
1 Tem cxema under Sec -' � B k P C for this
Dwyer Dean ,
WORKER'S COMPENSATION DECLARATION .T ®�� t
,. Ihereby,cormunder penalty offarjury ant,of OnfollowingRo Workeeaon, .>
Ihave ad will saamwveen..fiesse,37W of 0.Latur Cad inmmfor Wrforro Comam•
walk,r hick Oil
Foran Seen..3]00 of Ne Labor Codc,for the pesfomunce of rhe
t work for which Nie pewit n issued.
' ❑1 have and will maintain Worker's Compensa ion Insurance;m required by,Sectian+
3900ofdmlaborCode,forme performance ofthe work for whichthis pennies meed. a
MyWorkAComp ration Insurance came mid PaLcy -
Carter: Policy No -
ER CA O EMPTION MOM KE
y� . . -
lo COMPENSATION INSURANCE
1 (This sectionnecdwrbecompleted ifdcc armitis f«o«Westin dales(5100) _ -
1 certifyN na N.pert umeor Ore work f«whbj ,W On
iwuegl Nall
act pl Y eery errs' n any me« u m become Oubl«t w du Conan -action!J .afC.fifnamD.
Applicant - - Q
NOTICE TO APPLICANT If,after making this Certificate of Exemption,you should FEB (� �:2000'
become subject to On Soaka s Compo on.sounanimous of On Labor Code.you..at _ e I
forthwith comply with such pmvluons or this penult shall be decreed invoked. ,.
1 Z: '. CONSTRUCDON LENDING AGENCY -
Q 1hereby union ONOnto iseconevucuonlending agency for Onfafommraceof % By
y
On work for which this permit is issued(Sec.3099,Cis.C.) - .. It
Lenders Nemo _
Lenders Address
k: Q1 certify dor 1 have reed this applicum
n and Once Nal On above infamadon is
(L correct.)sense Nm
cnply with all city end wunty^rdmance,and cute laws relaft to
i7 Z building conswcuon and hereby vuthonac reprc,entaivu of this city to enter upon the
V'0 above-menlmad fr aany for In,i Ghon paase,.
Gin t~s 'j. `(We)agree to save.indemnify and keep harmless Ne City of Cupertino against -
U llabdi0es,judgments,c«uend..fuses which mm
ay in say way ecce against said CityIn .
,>f W ,in consequence of the granting of Nis awit.
� APPLICANTOfNDERSTANDS AND WILLCOMPI.Y WITH ALLNON-MI '
V QG SOURCE NULATIO is: I ,•,
tg rp t IIAZARact r
HAZARr am - O Tj'�--tJC+Ca
.n DOUS MATERIALS DISCLOSURE - -
Willeplwant or future Wildingatmrtar Wattle eaRe-rOOPq
as defend bythe Cun Munrepal Codn.Chapter 9.112,caNeHedlth md'Sgay
cad,Sectmtxss3xan
"
Type of Roof
W Ildwa -Lcanlarmture Wdding«cn All roofs shall be inspected.prior to any roofing,material being
emu haaadoya aroontammanu as defined byN BaysA`ea Au Query k"�ecausar installed. If ra roof is.mstalled without first obtaining an inspection
Ds"cd �;�'•- •` I agree to remove all new materials for inspection. Applicant ,
DYes �-" � o
understands and will comply with all non point.source regulation's.
I have read he Weardau material,na uircmenu abler C3upcer 6.95 of the Cali .,
forme Ha"' SafnY Cade,Sections 25505.73373 eM 25534.1 utMwaM Net if the
bmlmng d« a-tored hawatenenL Natnumyrespoml)b'Iny w rally die occupant
of Ne n whicabs nawie,wnc CeniLciecd OccuPacy. - - - -
Signature ofAppbCED - t Dale
n_ igen ate ! 1
- - •I _ All roof coverings to be Class"B"or better "
OFFICE.
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
` Z CITY OF CUPERTINO
. BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Elk: Lot:37534O49.00
INVOICE DATE......: 02/28/2000
REFERENCE ID # ... : 00020193
SITE ADDRESS .....: 10651 CARVER
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OWNER DOSHI
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR .......: LIC # -OWNER-
COMPANY DOSHI
ADDRESS .......... :
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
___ _________ ____________ ___________
BPSEWER P 19.98 0.00 19.98
PPERMITFEE P 35.52 0.00
55.50 0.00 ZPL
�CE.ID ---_-.- DESCRIPTION.---.-- - VOICE ID �.----- N
.... ........ .........
106 SEWER & WATER 202 UNDERFLG
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
DJ FEB 2 8 2000
D
b
•
BREMACOVER IAC UNIT>1CCOCCFM IMECMANICAL
' I IBREMAIRHAN IANC UNITS <= 10,00CCFM IMECHANIC?L
15RENIFURN RELOCATION OF FURNACE IMECHANICAL I
• IBREMFURNOV IRELO FURNACE > iCK STU IMECHANICAL
BREMINH000 JINSTALLATION OF HOOD IMECHANICAL
BREMRELOCA IRELOCATION OF HOOD MECHANICAL
BREMREPALT IREPAIRALTER HEATING MECHANICAL
BREMVENSYS VENTILATION SYSTEMSMECHANICAL
PPERMITFEE PLUMBNG PERMIT ISSUE PLUMBING
BNUMULTI NEW MULIFAMILY RES IPLUMBING
BNUSFD NEW SINGLEFAMILY RES PLUMBING
BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING
BPCESSPOOL CESSPOOL PLUMBING
BPFIXTUR PBLG FIXTURE PLUMBING
BPGAS GAS PIPING SYSTEM FEE PLUMBING
SPINTERCEP IND WASTE INTERCEPTOR PLUMBING
SPREPIPE REPIPE OF FIXTURES PLUMBING
BPSEWAGE SEWAGE DISPOSAL PLUMBING
BPSEWER SEWERS PLUMBING
BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING
BPSTORM STORM/RAIN WATER PLUMBING
1.BPTRAP KITCHEN TRAP PLUMBING
BPVENT ALT OF DRAIN &VENT PLUMBING
BPWATER INSTALL/ALTER WATERPIP PLUMBING
• BPWHEATER WATER HEAT VVENT PLUMBING
BPWSVCS MAIN WATER SERVIC PLUMBING
ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING
ZDIRTM DIR TENT MAP PLANNING
ZFULLHR FULLAPPL BASE+HR PLANNING
ZFULLTM FULLAPPL TENT MAP PLANNING
ULLUP FULLAPPL USE P IT PLANNING
ZFULLZONE FULLAPPLZONING PLANNING
ZGPAMEND GENERAL PLAN AMEND PLANNING
ZLIMAMEND LIMITED AMEND PLANNING
ZLIMTM LIMITED TENT MAP PLANNING
ZLIMUP LIMIT D APPL USE PERMI PLANNING
ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING
ZMINHILLEX MINOR APPL HILL EXC PLANNING
ZMINSIGN
MISC SIGN EXCEPTION PLANNING
ZMINTM MINOR APP TENT—MAP PLANNING
INUP MINOR APPLUSE PERMIT PLANNING
ZMISCASA MISC ARCH SITE PLANNING
ZMISCEXT MISC TM AND U —POUTRIN—d—
ZMISCFENCE MISC FENCE EXCEPTION PLANNING
ZMI G N MISC APPL GENERAL PLANNING
ISC CIN MISC PC INTERPRETATION PLANNING
JZSIGN S N P 1 PLANNING
IZTF-MPSIGN TEMPORARY SIGN LANNING
• IANC DIRECTOR VARIANCE PLANNING
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• a..lw rvlo9s
' I
Qty. if Applicable Fee ID Fee Description Fee Group
SBP°RMF== SLOG PERMIT FEES !BUILDING
�BCONSTAX 1CONSTRUCTION TAX ISUILOING
ISENERGY !ENERGY IBUILDING
BENERGYADD JENERGY ADD MULTI ISUILOING
ISOVERTIME INSPECTION OVERTIME ISUILDING
BTEMPPERM ITEMPORARY BLDG PERMIT BUILDING
BMITIGAT HOUSING MITIGATION FEE IBUILOING
BPLANCHK PLAN CHECK FEE IBUILDING
SPLANCKADD PLAN CHECK ADD MULTI IBUILDING
BPLANCKREP PLAN CHECK REPEAT FEE IBUILDING
BREINSPECT REINSPECTION FEE IBUILDING
BSCBLVD SCS SPECIFIC PLAN IBUILDING
BSEISMICOM SEISMIC COMMERCIAL ISUILDING
BSEISMICRE SEISMIC FEE RES 1BUILDING
BSPECIAL SPECIAL INSPECTION IBUILDING
BSWIM ISWIMMING POOL BUILDING
ZADDCHG JADDRESS CHANGE IBUILDING
EPERMITFEE ELEC PERMIT ISSUANCE ELECTRICAL
BELEC1000 ELEC 600V a=1000A IELECTRICAL
BELEC1001 ELEC 600V>1000A, JELECTRICAL
BELEC200 ELECT SVCS 600V<=200A ELECTRICAL
BNEWM IMULTIFAMILY RES ELECTRICAL
BREMBLI IREMODEL BUSWAYS ELECTRICAL
BREMF LIGHTING FIXTURES ELECTRICAL
BREMMISC MISC APPARATUS ELECTRICAL
BREMNRAPP REM NON-R S APPLIANCE ELECTRICAL
BREMPO 1POLEIPLATFORM FIXTUR ELEC ICAL
BREMPOWER POWER DEVICEIAPPARATUS ELECTRICAL
BREMRECEPT RCPTL, SWITCH&OU S ELECTRICAL
BREMRESAPP REMODEL RES APPLIANCE ELECTRICAL
BREMSIGNAD RMDL SIGNS ADO BRANCH ELECTRICAL
BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL
BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL
BSF&2FAM SINGLE&2 FAMILY ELECTRICAL
STEMP ITEMPORARY POWER ELECTRICAL
BTEMPSVCSTEMP DIST SVCS ELECTRICAL
MPERMITFEE MECH PERMIT ISSUANCE HANICAL11,
fPLOTHER OTHER APPLIANCES MECHANICAL
ILERI BOI e=100,000 BTU MECHANICAL
ILER2 BOILER>100KTO500KB MECHANICAL
BBOI BOI "OOK O 1M TU MECHANICAL
BBOT 4 BOI 2-1M O 1.75M B MECHANICAL
BBOT BOI 1. SM BTU MECHANICAL
SREMAPPU APPUANC INSTALL MECHANICAL
BREMH H IN ALLA O ME CHANICAL
BREMVEN AN VENT AN SINGLE DUCT M CHANICAL
BMNEWMULTI ILY RES MECHANICAL
BMNEWSF&2F &2F RES BLOGS MECHANICAL
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