00010008 . APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY ��IO O� P�lrJC7
.CITY OF GUPERTINO BUILDING-ELECTRICAL. PERMII'NO.
BUILDING DIVISION APPLICATION/PERNUT PLUMBING-MECHANICAL
,BUILDING PROJECT IDENTIFICATION r 50001
-BUILDING ADDRESS: • - SANITARY NO. APPLICATION SUBMITTAL.DAI'
/.369' &4a1_8 Ll eer 7-1.vo �°/9 �5z'' _ �'�
OWNEk'S NA PHONE'. CONTRACTOR�NAME LIC NO:
l,Jf O•zL�r Lx1/ NEC CONTROL#
CHITECr/ENGINEER: LIC NO: ADDRESS: - ❑
CONTACT. PHONE: - , BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG EL�HC1'1/'/ PLUMB MECH
.. ... .. ... . . . .. ..._.. . .. t!� ❑ ❑
LICENSED CONTRACTORS DECLARATION QTY. ELECTRICPERMIT FEE
I hereby.Ilired that I licensed under p of Chapter 9(comp ins - JOB DESCRIPTION
W OC with Section 7001 D ".on 3.f the But .wand Professions Codo,and my l4dollb RESIDENTIAL'
Fad- in full force and eficar. PERMITISSUANCE ❑RESIDENTIAL
❑KITCHEN REMODEL
�VU Licensc Cluss Lar.#
5ZW pale Contmcmr. APPLIANCES-RESIDENTIAL ❑ADD]TION ❑PLUMBING RE-Pair,
py ARCHITEC'US DECLARATION ❑MULTI-UNIT ❑STRUCTURAL
1 undersand m
Z y plans shell be used as public PANELS MODIFICATION
OZ^'C UPT02MAMPS El INTERIOR El CHIMNEY REPAIR
[+�Iqq"'la) Liccnsed Pslc,mnal 201-IOOOAMPS IMPROVEMENT SWIMMING POOLS
RS d J OWNER-BUILDER DECLARATION
y W 6 I hereby affirm Thal I am excerpt from the Contractor's Licemec Law for the OVER 1000 AMPS ❑BATH REMODELBEPAIR DEMOLITION
x d U following reason.(Section 9031.5,Business and Professions Coda Any city or county SIGNS ELECTRICAL ❑OTHER
W se O E' which e, a period t construct, Ile prod dish p:i r by fracturez AVV 7, 11V
yzn
prior to itssu .also requiresthe applicantf h permitl file a signedstatermnl SPECIAL CIRCULUMISC. Y ��AA����
Y 'hath licensed p...part t thep m. fd C tr for L" La (Chapter9 P��-1,,QI/r N
A� (commencing with Sect 7100) Divisiont3 of the Business dProfessionsCodc)or I EMR METER OR TOLE INST. COMMERCIAL W�� /J „UM
d y m p� Ihat h pt mere! m d th b is f tl 11 g e exempt A y 'nm[nn of 0 NIiW BLDG/ADDITION U'F L-1 ION
W L4 Section 9031.5 by any applicant for a permit subjects theapplicnot m a civil penally of POWER DEVICES
W^m []TENANT El FOOD SF.RVICF.
�z t^�.than Evehondralperty, rrsyempl., IMPROVEMENT
0ZLo the work,theand psperty, myemntended with wages as their sole 044,Business
SWIMMING POOL ELECTRIC
_
will doth.work.Codec structureCotra mors LaversepredictedLadforxal apply to pr oscre,of
❑OTHER
d am and Professions Code:,The.p Ge,the au License Law does mol apply m un owner of OUTLETS-SWITCHES-PIXTURP.S
^ progeny who builds or Improves thenen,and who docs such isinto ded o f or through
his awn however,
the provided that inch improvements are not intended of offered the NEW kES1U(iN'f1AL ELECI'k SQ FT.
owner-builder
w,11have due bng urden of moven Thad he irhinone tbuild a improve for
SQ.FT.FLOOR AREA $ISQ.PP.
ncrbudder will have Ne burden of proving Ihel he did not build or improve for Dur- "
pare of a%rte
E]1,as rd owner of property,am exclusively contracting ,"
with licensed caner,. ,a- TOTAL
cow .
nsthe pr jcd 904
(Sec. 4,Bus and Professions,CadTh
e, e Carried,.,",Li- -
ee Law does not apply to an owner of property who builds or improves thereon,and QTY,, y' PLUMBJING PERMIT FEE
who contracts for such projects with a cmnraaods)licensed pit rsurat to the Contractors
Licensc Law. PERMIT ISSUANCE
ElI ap cxpmpt under Sas B Nc P C for his mason -
ALTER-DRAIN&VBNT-WATER(E
A.,01:4_ p. VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROI'EC'1'.DEVICE
I hereby affirm under penalty of perjury one of me following de.lambons: Cl V
41
I have and wil l maintain a Certificate of Consent In self-insure let Worker's C.mpen- DRAINS-FLOOR,RDDE IRP, CON,. STORIES TYPE CONSTRUCTION
s.tiun,as provided far by Section 37U1 ofthe Labor Code,for the performnuee of the
work for which mix permit is kared. FIXTURES-PEB'I'RAP
❑ 1 have and will maintain Worker's Compensation Insurance,as squired by Section
3900 of the Labor Code,forthc performance.1thew.rk far whichmispermlt is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC CROUP / A AP
Q
My Workers Compensation Interface,proper and Policy number are: (.R
Carrier: Policy No.i GAS-EA.SYSTEM OVER 4(EA) /
CERTIFICATE OF EXEMPTION FROM WORKERSGRCASEIINDUSTRL WASTE,INTERCEPTOR O
27
COMPENSATION INSURANCE, BUILDING DIVISION FEES
(ibis section need not be completed if the permit is for one hundred dollars($Ig) GREASE'BAP
nr leen.) PLANCHECK FEE
I certity that in We pcompau:e of the work for which ills permit is issued,label[
SEWER-SANITARY-STORM EA.NIO FT
m employ any person i e any manner as to became subject to the Workers'Compen- ENERGY NEIi
,Z Applicant
Lucas of Caifornia.Data WATER HEALER WNENT/ELECTR
yyy� � Appliwm � GRADING FF.F,
q
as, NOTICE TO APPLICANT If,after making this C p,dwae of Exemption.you shumid, WATER SYST AIGRENI ING
become subject to Lha Worker's Cou,sc,catime previsions of the Labor Code,you must SOILS PPL
t.y forthwith comply with such previsions or Ilia permit shall be deemed evoked. WATER SERVICE'" ,
zCONSTRUCTION LENDING AGENCY � NEW RESIDENTIAL PLMB. SQ,Em PAID Dere keceipr#
1 hereby affirm that there is a construction laWing agency for the pedbrmarea m'
W Q me work for which this permit i,,,,upd mor 3097,Civ.CJ i ...�_
ULender's Name -. '���"��-TO"
Lcndw'x Addnas x TOTAL:
a i ccndy'hal l h d d pplnation n l:r r thath b information re --- , - . . - i± BUILDING FEEy LZI
h
correct.1 g t ply -m all city net ly d' d store I I t g a QTg MECHANICAL PERMIT FEE iII sE s FEE '^
building construction, dM1 by' m representatives of this city to trap. the - - !
r-t abo f dproperty f p tionpurposes,
PERMIT ISSUANCE BLCCTkICFEE
di 4mrin
(We)agree to spot, ndemn fy and keep hn mess me City at Cupertna against x
liabtlitiex,judgmems,costs and expenses which may in any way accrue against said City ALIERORADETOMECH. PLUMBING FEF,
in consequence of the gmnling of this permit' ;;]]
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING ON['[ 10.000 CPM) t U
50XItCE REGULA710NS. E J MECHANICALFFL
/.//� AIR HANDLING UNIT(OVER IU,IXO CPM) CONSTRUCTION TAX -
Si m of Applicamb Comraaar Y Dam EXHAUST FOOD(W/DUC'I) HOUSING MITIGATION FEE
HAZARDOUS MAI INIALS DISCLOSURE
Will the applicant or future building occupant atom or handle hazardous marenal HEADING UNIT(TO 110,000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Houlrh and Safety
Cade,Section 25532(a)^. HEATING UNIT(OVER I00dP)0 BTU)
(]Yes F-1 No PAID -+
VEN'I'ILA'1'IONI-AN(SINGILkHSID) Data Receipt#
Will the applicant or future building occupant use equipment or devices which ROLLER COMP(3HP OR 1 W,OW BTU)'it bazdNa -
an
ns air contaminants as defined by the Bay Area Air Quality Management .IOTA
7rict^
YesNo BOILER-COME(OVER 100,000 BTU)
❑ , ❑
AIR CONDITIONER
11 mm hazardous materials 5,requirements5 Chapter 695 rfacuff Cali- ISSUANCE DATE
Tam H et IN up Safety l d Section,25505 25513 d 25594,I d .m d mat-faro NEW kESIDEN'I'IAh MECH SQ.Fp.
ding et r ulyh 1 tmtu my Ica.Ib ilyr n a mereapart
t nquircmenrswhi rose n t�pro� ancecfa Cenf� Oce
TOTAL: j
dror authorized,gem - am ISSUED BP.
OFFICE
..ly
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO*
BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Blk: Lot:31629039.00
INVOICE DATE...... : 01/04/2000
REFERENCE ID # ... : 00010008
SITE ADDRESS .....: 10366 COLBY AV
SUBDIVISION .......
CITY .... . . .. .....: CUPERTINO
IMPACT AREA .......
OWNER ............: DAVIS STERLING W AND JUANITA
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO CA, 95014-2401
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ... .......: -
CITY/STATE/ZIP ...
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BENERGY A 23.10 0.00 23.10
BPERMFEE P 77.00 0.00 77.00 -
BREMRECEPT P 2.22 0.00 2.22
BSEISMICRE P 0.50 0.00 0.50
EPERMITFEE P 35.52 0.00 35.52
138.34 0.00 138.34
VOID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 . ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
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 50B FINAL MECHANICAL
509 FINAL GRADE 510 FINAL PLANNING
514 FINAL PUBLIC WORKS .�