99120134 J+APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 20 3
CITY OF CUPERTINO BUILDING-ELECTRICAL PERM]IN
OUII,DINL'DIVISION APPLICATION/PERMIT PLUMBING-MECIIANICAI. SOOO1
NUILDING PROJECT IDENTIFICATION
BU ILOINGADDRESG., SANITARY NO. APPLICATION SUBMITTAL DAPI
aObsq Celes-{e C i Y-r 1i e 7
OW B5 NAME I CO fRACTOR:S NAME: - LIC NO:
k c C�ODH�-�J 02S NIC CONTROL#
tCHITECGENGINEER: LI N A B)R S'. ❑
CONTACT: PHONE: IBUILDING PERMIT INFO
❑ Consultant Fres Paid by Applicant(Initial) BLDG ELECT PLUMB MEECCH
PMB
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT hili
I herchy alarm than i am licensee antler provisions of Chapter 9 ramnmenamg JOB DESCRIPTION
I"=Z with Scotia,]qgq of Divisinn7aDhe Business noti Profmslone Cotiq ane rimy licvnxv is RESIDENTIAL:
14,00 PERMIT ISSUANCB
in full farce and of fen.
nPPLIANCES-RESIDENOuuTIA
License Class Lie.#
❑SFDWI. KI'ICI{IiN ltlihlODlil.
4Dam Comruaor L. ❑ADDITION ❑PLIIMBING BE-11111F
ARCH]'IQCT'S DECLARATION ❑MULTI-UNIT ❑STRUC'IT)RN.
p,D o, PANELS
ZOm^z l understand my Finns shall he used as public records MODIFICATION
Oz�n-0 UPTO 200AMPS ❑INTERIOR ❑CHIMNEY REPAIR
1=a14 I-S Limmed pudessinnnl 2(11-IIIINIAMPS ��I�M�PqROVEMENT SWIMMING I'(JOIS
C��� OWNERtBUILDERm,hc Contractors
OVER HqO AMPS 6aKM REMODEI/REPAIR ❑DEMOLITION
1 herchy a0irm that 11. exempt tram the Cantos C s e:Any c haw for the
X 3 F following reran.(Section]IIJ LS,Business and Professions Code:Any city or courtly SIGNS ELECTRICAL OTHER
y which requires a permit to construct,alter,improve,demolish,or repair any mmnure
prior fit its issuance,also requires the applicant for such permit to file a signedstatement SPECIAL CIRCUIT/MISC.
f } that he is Received d pursuantn the unsivismarfthe Connectors License Law(Chmr9
ap
1�1�GC (commencing with Section 7")of Division 3 of the Business and Professions Code)or 'GENIP.METER OR POLE INST. COMMERCIAL:
6 K n Y that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DHMOL1'1'ION
4•
Section 7031.5 by any applicant for a prounsubjttu the applicant to a civil pcnahy of POWER DEVICES
a^m not mom than five hundred dollen($500). [-]TENANT ❑FOOD SERVICE
=SC E]1,as owner of the property,or my employees wish wages as their sole compcnsation. SWIMMING POOL FLECfRIC IMPROVEMENT
F will do the work.and thummai reis nm intended ormummi for sale(Sm.]0AL baeope>s,, ❑OTHER
and Professions Code:The Contractor's License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURFS
IY 3 property whit builds or improves thereon,and who does such work himself,;through
his own employees,provided Ort such improvements are vat intended it,alfercd for NEW RESIDENTIAL ELE 'k SQ
sale.If.however,the building or improvement is sold within one year of cmnektloq the SQ.IT.FLOOR AREA $/SQ,IT.
hf�'�11 will have the burden of proving that he did not builder inmpmva lir pm�
LM we
wm'of the pmpcnri nn;oncluaivclY evaluating with IianseA mmmnmnrx it,
construct the pmjccf(Sea.7IW4,Business and Professions CmL:)Lm CmnrautorLc Lt.
rte haw mss non apply to an owner of property who halms or improves themor,nml QTY. PLUMBINGPP.RMIT FEE
whocnntrnetsfor such projects with oxvmractor(s)licensed pursuant to Iba Comme rs
License Law. PERMIT ISSUANCE
❑ Iamcxemptinder Ses. ,B&P C mrthi.e reran
ALTER-DRAIN&VENT-WATER(EA) VALUATION
Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECf.DEVICE
I herchy affirm under penalty of perjury one of the following deelar Liam: �D f7 .
I have and xill aiand..Camficnte of Consent to self-insum for Worker's Connpen- )RAINS-FLOOR,ROOF,AREA.COND. STORIES TYPE CONSTRUCTION
satumn as provided for by Section 3]00 of the Labor Code,for the performance of The
work far which this permit is issued. FIXTURES-PER TRAP
O 1 have end will maintain Warkers Compensation Inert e,as required by Scninn
3700ofthelrMvCede,fonhe perfnerm ofthe work for which this permit is iaucd. GAS-IiA.SYSTEM-I INC.40I1TLET5 OCC.GROUP q /,I'A
My Workers Cnrnmettion I.,mance entrained Policy number arc: J /f��
Career. Policy No.: GAS-P.A.SYSTEM-OVER 41E- ) '7
CERTIFICATE OF EXEMPTION FROM WORKERS' S 0 .3
COMPENSATION INSURANCE GRL'ASEIINDUSTRL WAS'TE INTERCEPTOR
(This nation need not he completed if the permit is for one lmndmil dal las IS 100) BUILDING DIVISION FRES
nr Icw) GRHASE TRAP PLANCHECK FEF.
I middy that in the verfonnamm ofthe work forwhich this permit is issued,I,hall SEWER-SANITARY=STORM EA.2W FI'.
not employ any person In any number so as to become subject to the Warkers'Cunene ENERGY FEE
Q Z spurn Laws of California Dute WATT7R DEAFER W/VENTIP.I.FCI'R
z O APPlietmt I GRADING PEE
VVVjj�
NOTICE DO APPLICAN'1 11,alter making this Cenifiate of limon tion,you should WATER SYSTHMaREATING SOILS FAR
a [^ hceorea whim,m Lha Workers Compansate m provisions of the Labor Code,you meet
f✓a G forthwith comply with such pmvixinns or this permit shall be deemed revoked. WATER SERVICE
Q
.Uti. z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMe. SQ,I'T PAID
L)0 l herchyalfifm thhuhere issued Eme.30O,ndis.agency for the Perfnrmxnce of _ Date-�..\ ReceiP1#I
W (~ the work for which this permit is issued(Su.309],Civ.CJ I
Lender's Num. �J TOTAL:
Leader's Address TOTAL:
FG I cenify that 1 have read this application and state that the above information is - - BUR-DING EFF.
to catrcm.l egreemmmFly with all city and army oNinances and sum laws misting to QTY, MECHANICAL PERMIT IFF.
U Z hudding cnmtruaiond and hereby hushorim representatives of this city ro enter upon the SEI. 1CFE
above-memioncol propeny for inspection purposes. PERMIT ISSUANCE(We)agree m save,indemnify and keep harder she City of CLpenino against ELE IC FEE
liabilities,judgments,costs anti expenses which may in any way accrue against said City gla'ER OR ADD TO MECH.
in onscquence of the grunting of this Permit - PhU INGaFEE�
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL.NONd'OIN'T AIR HANDLING UNIT(TO IRM CF.M)
SOURCE REGULATIONS, MECH NICA11FPE
I A IR HANDLING UNIT(OVER 10,000 CFM( CONSTRUCTION TAX
rha�nlou.i
peaieanUC,desem, Drift, IIXHAUSTHOOD OVMUCD HOUSING MITIGATION FEE
I IAZARDOUS MATERIALS DISCLOSURE
Will applicant ser linure building necupunh store(it bamMous rnmcriul IIiA'fING UNIT(TO 100,000 BTU)
the Cheatham,Munlcipol Code,Chapter 9.12,and the Hadth and Safety
25532(;,)] HEATINC,UNIT(OVER 100,030 BTO)
F-1 No PAID
VENT LATION FAN(SINGLE REST[)) Date kecciptN
e applicant or future building occupant use equipment or devices which BOILER-COMP(311P OR 100,000 BTU7
s air cnnmmiams as defined by the Bay Area Air Quality Mundgemcnt TOI'A
District? i
E3 Yes nNo BOILER-COM P(OVER I WJXM BTU(
I have read the hazardous materials requirements under Chapter fi 95 of the Cali AIR CONDITIONER
9 aP ISSUANCE.DATE
tum tumbling
gdoHeales&Safety Cade,ea handed.
25505.25533 atd 25511.1 undcnftth that if the NEW RESIDENTIAL MECH. SQ.FT. / 2,-, 2 /J r if? C;1
building does not currently haveateanh that it is my responsibility mnotify the occupant L f 7
of thimmcnywhich run be met n zeta Cenifica of Oce Gi
rte or authannal ager Y+c ¢ TOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
. . BUILDING PERMIT INVOICE OPERATOR: chrietya
Sec: Twp: Rnq: Sub: Elk: Lot:32658103.00
INVOICE DATE...... : 12/27/1999
REFERENCE ID # ... : 99120134
SITE ADDRESS ... ..: 20659 CELESTE CL
SUBDIVISION ... .. ..
CITY ............. : CUPERTINO
IMPACT AREA .......
OWNER ............: LITTLE STEPHEN E AND EUNICE K
ADDRESS ..........:
CITY/STATE/ZIP . ..: CUPERTINO CA, CA 95014
CONTRACTOR .......: CARVEY, PHIL LIC q 21428
COMPANY ..........: STARBURST CONST CO
ADDRESS ..........: 1207 REDCLIFF DR
CITY/STATE/ZIP ... : SAN JOSE, CA 95118
TELEPHONE ........: (408)448-1328
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BENERGY A 186.00 0.00 186.00
BPCESSPOOL P 31.08 - 0.00 31.08
SPERMFEE P 620.00 0.00 620.00
BPFIXTURE P 49.98 0.00 49.98
BPGAS P 4.44 0.00 4.44
CNK A 527.00 0.00 527.00
CEPT P 32.25 0.00 32.25
aPALT P 12.21 0.00 12.21
BSEISMICRE P 7.00 0.00 7.00
EPERMITFEE P 35.52 0.00 35.52 .
MPERMITFEE P 35.52 0.00 35.52
PPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
1576.52 0.00 1576.52