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99080078
APPLICANTTP FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OCU RTINO BUILDING-ELECTRICAL BUI�p :CC DIVISION APPIACATION/PERMIT PI-UMBING-MECHANICAL BUILDING PROJECT IDRNTIFICATION BUILDING ADDRESS: j� SANITARY NO. APPLICATION SUBMITTAL DATE WNAME UOWUNTRACfO 'SLIC NO: 4M �tl / NIC CONTROL of 7—ARCHITECTiENGINEER: LIC NOADDRESS: C ❑ONTACT: PHONE: BUILUI ' PERMITINFO A �pConsultant Fees Paid by Applicant(Initial) BLDG LECf PLUMB MECH i7i 'I S- ❑ ❑ ❑LICENSED CONTRACTOR'S DECLARATIONI herebyinfirm that I am licensed under previsions of Chapter 9(commencing QELECTRIC PERMIT FEE oth Section](NgryafDivlsinn3ofthe BuslJ P1.fv,i.nsCOde,and my licenscis ]OB DESCRIPTION full force and effect. PERMIT ISSUANCE RESIDENTIAL XU, License Class Lich ❑SHEWL ❑KITCHEN REMODEL yQL Oma Connector APPLIANCES-RESIDENTIAL ❑ADDITION C1 PLUMBING RE-PIPE py_ RDECLARATION I understand my pinhall Wmrdanale .ad PANELS 13 MULTI-UNIT 13 STRUCTURAL UP N3 200 AMPS MODIFICATION W Lmensed Profauawl El INTERIOR 11 CHIMNEY REPAIR OWNER-BUILDER DECLARATION 201.100AMPS IMPROVEMENT El SWIMMING POOLS C)W I hereby affirm that 1 nm Islorm from the Commdor's License Law for the OVER Ii(s)AMPS ❑ H REMODF.1/REPAIR D LITI N t3 W F following—a(Scam.]031.5,Business said Pmfessioes code:Any city or county SIGNS ELECTRICAL OTHER r u which requires a permit to construct,alter,improve,demolish,or repair say stmcturt w Jd prior to its issuance,also requires the applicant for such pero itto file a signed statement SPECIAL CIRCUCOMISC. er Qhdheislicamedp.rs.zm m he previsions Of the Contractors License Law(Chapttt9 log (cotnmeociog with Section 7")of Division 3 of the Business and Professions Code)mr TEMP.METER OR INST. rnmu CQMMER m the he is exempt therefrom and the basis for the alleged eacmplim..Any sm1admn of a, Smoon]031.5 by ny applicant for a permit subjcu the applicnt m a civil penahy of POWER DEVIC ❑NEW BLDG/ADDITION ElDEMOLITION F Z;,. not more than five hundred d.11.($500). - T AB9B6R ICE aI-•m13Las owner ol'the prOPcny,or my employees with wages as their sole compensatimn, SWIMMIN OOLFLECTRIC I ROVr_ will do the wok,and the stmcmre is not intended orolfered formle(Sm.704a,Business ER S 3.. and Professions Code:Tho Convector's License law does not apply to an owner of OUTL -SWITCHES-FIXTURES Property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for N3A RESIDENTIAL ELECTS SQ FT. sale.If.however the building or improvement is sold within one year of completion,in tJ, SQ.FT.FLOOR ARS owner-builder will have the burden of proving that he did not(wild or improve for put- SQ'FT. pox mf sale.). ❑ 1,as owner of the pmpertg am exclusively connecting with licensed contractors to TOTAL: ry construct the project(Sec.7044,Rusiness and Prolbssiom Crude:)The Commamrs Li- �gy cnsc Law does not apply to on owner of property who builds or improve,,thereon,and QTY, PLUMBING PERMIT FE who contracts for such Projects with a commcrog0 licensed pursuant o the Cotttraeor's License Law. ❑lamexcmptunder Sec. ,B&PCfothisrearrn PERMIT ISSUANCE ( Owner Date ALI Ilk-DRAIN&VENT-WATER EA) VALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE I hereby of irm under penally of perjury one of the following declarations: ❑I have and will maintain aCluifiemeof Consent to self-imus,far Workers Compen- DRAINS-FLOOR,BOOR AREA,GOND `•/v `� aDak i7 as provided for pi Section,isu3]fl of the labor CMe,for the performance of the STORIES TYPE C UCITON work for which this pemai Ls issued. FIXTURES-PER TRAP ❑I have wd will meinmin Worker's Compensaimn Insurance,as required by Section 370of the labor Code,for the performance of the work far which this permit is issued. GAS-EA.SYSTEM.I INC.40 us Workers Cotnpensatippn lnsum se currier and Policy nun are OCC.GROUP APN miev`F'`1fg:.X'JNS �-_.a�P icy No.: � -� GAS-FA.SYSTEMOVER FA) ' ♦ '` C[RTIFICATE OF F.A 1PTION FROM WORKERS' /Yi/s COMPL'NSATION INSURANCE GREASE/INDUSTRL W TE INTERCEPTOR (This section need not becomPleted if the permit is forme hundreddollars($IIXB BUILDING DI -ION FEW tar less.) GREASE TRAP 1 certify that in the performance of the work for which thispennit is issuN,I shall PLANCHECK FEE .at employ ny person in any mannerm aembecmme subject to the Wokers'Compen- SEWER-SAN RY-STORM EA.200 FT. O ton Laws of Cali 'a.l ENERGY FEE z APPBn01 WATIiR H' F.R WIVENT/ELECI'R OTICE TOA PIJCANT.IL efmr making this Cenifcae of Exemption,you shmulJ GRADING FEE become subject mthe Workers Compensation provisilns of the Laor Code,you must WATFi YSTEM/IREATING {i7 Innhwith romPly wih such Pnrvisimns onhis permit shello JameO rtvokW, W ER SERVICE SOILS FEE a � Z) z CONSTRUCTION LENDING AGENCY EW RESIDENTIAL PLMB. SQ.FT. PAID J O Thereby addu�lhat there is a conslmctin lendingagency for the Peofformnceof Date R,ceiptM l f+ the work for which this N-11 is board(Sec.3097.Civ.C.) U Lenders Name „�+ yLender's Address TOTAL. I certify that I have read this application it star that the move information is TOTAL:nveBUILDING FEE y correct.1 agree m comply with all city and county ordinances and state laws relating to QTY MECHANICAL PERMIT g .� building coction,and hereby authorize representatives of this city to enter upon the SEISMIC FEE move-mentioned property for inspection W.,. (We)agn.mauve,indemnify and keep harmless the City of Criterion against PERMIT ISSUANCE ELECTRIC FEE liabilitiesjudgmeno.costs and expenses which may in any way accrue against mid City ALTERORADOTOMECH. in consequence of the granting of this permit PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO to,IXO CFM) OU ATIONS, MECHANICAL FEE S — AIR HANDLING UNIT(OVER 10, FM) CONSTRUCTION TAX .W. re ofAppBn Cmmmcmr Dm, EXHAUST HOOD OVEGUCO HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEE Will the applicant or future building Occupant store or handle co/rooma material HEATING UNIT(TO IW, TU) ' as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety Code,Section 25532(a)? HEATING UNIT(OVE 00,1000 BTU) ❑Yes E]No VENTILATION F (SINGLE RESIDE PAID Will the applicant or future building ceemmat use equipment or devices which Date ReaiptN emit bouldme,air commeninuma as dethad by the Bay Arco Air Quality Management BOILER-CO (311P OR]hit,”BTU) Disport? QYa nNo BOILER OMP(OVER 100,001TU) I have read he humame,tnudals requlremctns under Chapter 6.95 cilia Cali- AIR NDITIONER fomia Health&Safety Code.Sections 25505,25533 and 25534.1 understand that if the I NCE DATE ha' log does not Currently have tenant,hat it is my rcsponotility to notify the rommant RESIDENTIAL MECH. SQ.FT. fµhe �which ustomet prim t0 issuance ofaCrniOcate of Occupancyustomet prim to issuance ofaCrnifcate of Occupancy. emacto agent Date TOTAL: ISSUED BY: OFFICE INVOFCR/ INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE ' CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: karenb - Sec: Twp: Rng: Sub: Blk: LOt:35617076.00 INVOICE DATE......: 08/11/1999 REFERENCE ID # ...: 99080076 - SITE ADDRESS .....: 11101 CHADWICK PL SUBDIVISION ....... CITY .. . . .........: CUPERTINO - IMPACT AREA ...... . OWNER . ........... : DAVID KRAMER ADDRESS .......... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4705 CONTRACTOR .......: LIC # COMPANY ..........: . ADDRESS .......... : CITY/STATE/ZIP ... . , TELEPHONE ........ : FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- ___ _________ ____________ _--_---_--- BPERMFEE P 77.00 0.00 77.00 BPLANCHK A 62.25 0.00 62.25 --------- I------------ ----------- 139.25 0.00 139.25 "OICE ID ..DESCRIPTION... =DBm CR2vc1ON= ==-=___= VOICE IO DESCRIPTION ok.,-�303= ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL 1 r-� . if Applicable Fee ID Fee Description Fee Group BPERMFEE BLDG PERMIT FEES BUILDING BCONSTAX CONSTRUCTION TAX BUILDING ' BENERGY ENERGY BUILDING BENERGYADD ENERGY ADD MULTI BUILDING BOVERTIME INSPECTION OVERTIME BUILDING BTEMPPERM TEMPORARY BLDG PERMIT BUILDING BMITIGAT HOUSING MITIGATION FEE BUILDING BPLANCHK PLAN CHECK FEE BUILDING BPLANCKADD PLAN CHECK ADD MULTI BUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSCBLVD SCB SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING BSEISMICRE SEISMIC FEE RES BUILDING BSPECIAL SPECIAL INSPECTION BUILDING BSWIM SWIMMING POOL BUILDING ZADDCHG ADDRESS CHANGE BUILDING EPERMITFEE ELEC PERMIT ISSUANCE ELECTRICAL BELEC1000 ELEC 600V <=1000A ELECTRICAL BELEC1001 ELEC 600V >1000A ELECTRICAL BELEC200 ELECT SVCS 600V<=200A ELECTRICAL BNEWMULTI MULTIFAMILY RES ELECTRICAL BREMBUSWAY REMODEL BUSWAYS ELECTRICAL BREMFIXT LIGHTING FIXTURES ELECTRICAL BREMMISC MISC APPARATUS ELECTRICAL BREMNRAPP REM NON-RES APPLIANCE ELECTRICAL BREMPOLE POLE/PLATFORM FIXTURE ELECTRICAL BREMPOWER POWER DEVICE/APPARATUS ELECTRICAL BREMRECEPT RCPTL, SWITCH &OUTLETS ELECTRICAL ' BREMRESAPP REMODEL RES APPLIANCE ELECTRICAL BREMSIGNAD RMDL SIGNS ADD BRANCH ELECTRICAL BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL BSF&2FAM SINGLE &2 FAMILY JELECTRICAL BTEMP TEMPORARY POWER ELECTRICAL BTEMPSVCS TEMP DIST SVCS JELECTRICAL MPERMITFEE IMECH PERMIT ISSUANCE IMECHANICAY N PPLOTHER OTHER APPLIANCES MECHANICAL OILERI BOILER <= 100,000 BTU MECHANICAL OILER2 BOILER >100KTO500KBTUOILER3 BOILER >500KTO 1M BTU MECHANICAL OILER4 BOILER>1M TO 1.75M BTU MECHANICAL OILER5 BOILER > 1.75M BTU MECHANICAL EMAPPLI APPLIANCE INSTALL MECHANICAL • BREMHEAT HEAT ER INSTALLATION MECHANICAL BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL BMNEWSF&2F NEW SF&2F RES BLDGS MECHANICAL 1 of 2 Revised 6/10/99 ' CITY OF CUPERTINO Item 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb COPY # 1 Sec: Twp: Rng: Sub: Elk: 1,11:35617076.00 DATE ISSUED....... : OB/11/1999 RECEIPT #.........: 9787 REFERENCE ID # . ..: 99080078 SITE ADDRESS . . . . . : 11101 CHADWICK PL SUBDIVISION ...... . CITY CUPERTINO IMPACT AREA .. . . ... OWNER DAVID KRAMER ADDRESS CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4705 RECEIVED FROM .... : JOE S CONTRACTOR LIC # COMPANY ..........: ADDRESS ......... . : CITY/STATE/ZIP .... TELEPHONE ....... . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL __________ _____________ __________ __________ __________ __________ __________ BPERMFEE VALUATION 3,000.00 77.00 0.00 77.00 0.00 BPLANCHK PERMIT FEE 1.00 62.25 0.00 62.25 0.00 TOTAL PERMIT 139.25 0.00 139.25 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ __________________ CHECK 139.25 3293 TOTAL RECEIPT .. .. 139.25 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ............................ 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL - - - - - - `- - P - - - - - - - --' - - _ _ - - - . _ - _ - - - _ _-L. 1 _` - - -'t - - - - - - _ - - - t.. -_ _ - _ _ {:`3' mob- _3 .; - _ _ . 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