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99080155 W-.1., APPLICANT t IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CU F<fINO BUILDING-ELECTRICAL P BUILDING E (SION APPLICATION/PERMIT PLUMBING-MECHANICAL BUILDING PROJECT IDENTIFICATION BUILDINGADDR SANITARY NO. APPLICAT A DA I OWNS/tS NgME: PHONE: O RAC MS ME: LIC NO: NIC CONTROL# Cf/HHII�T`EECCT/EN'GINEER: LIC NO: ADD S: ❑ CONTACT: PHONE: BUILDING PERNUT,INFO ❑ Consultant Fees Paid by Applicant(Initial) B� ELECT PL46 61n OWMoy — UMB MECH ❑ ❑ ❑ —LICENSED CDM AETOR:S DZCLARATIOr QTY, ELECTRIC PERMIT FEE 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing - _ JOB DESCRIPTION WOOwith Section] fDry io fthe Bualness an fessiansC license RESIDENTIAL: 00 PERMIT ISSUANCE F in full force d �51yyy�. �Qfoq �U� License as -� Lic.# y ❑SFDWL -1 KITCHEN REMODEL h4i Date Contac APPLIANCES-RESIDENTIAL El ADDITION ❑PLUMBING RE-PIPE F,Dmm ARCHITELT'SU PANELS El MULTI-UNIT []STRUCTURALZ O N Z understand my plans shall be Ns used as public meet ODIFICATION OZ—O ,ii UP TO 200 AMPS El INTERIOR ,Id6ki1MNEY REPAIR Licensed Professional 201-IMAMPS IMPROVEMENT V ..1 ❑SWIMMING POOLS SyaaJ OWNER-BUILDER RDE Ce Contr ON OVER IWO AMPS ❑BATH REMODEUREPAIR El DEMOLITION G W U 1 hereby offection 1 am exempt from the ContrnsCo License Law for the K O 6 V following reason(Swoon 7031.5,Business and Professions Cade:Any city or county SIGNS ELECTRICAL ❑OTHER whirls requires n permit re construct,alma id for demolish,or repair any structure 1"'�yOylIa pnarit)itsckl issuance,also rcgoithe,m,asimaantfor sucM1pamll toicFile se La(Chapt em SPECIAL CIRCUIT/MISC. �±�G];y.•]] that mer licensed pursmnt tothep111an m,3 of Con.,mv,s License Loons Co(Chapter 1500 (wmmencing with Section]00)ofDivision3 nRhe Business and Professions Code)ar TEMP.METER OR POLE INST. COMMERCIAL: d y o eL that he is exempt therefrom and Uc basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION m Section]031.5byanyapplicantfor.permilsubjectstheepplicanttoacivilpenaltyof POWER DEVICES not more than Five hundred dollars($500), ❑TENANT [I FOOD SERVICE ESQ I,as owner of the norm to ces with wa es as theirsole cont ensation, SWIMMING POOL ELECTRIC IMPROVEMENT EFO ❑ grope Y YemP Y % P 11 do the work,and the structure is not intended oroffered for sale(Sec.](144,Business []OTHER W3 m and Professions Code.The Contractor's License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are nut intended or offered for NEW RESIDENTIAL ELECTR SQ Ff. sale.If,however,Ne building or improvement issold within one year of completion the SQ.FT.FLOOR AREA $/SQ.Fr. mer-builder will have the burden of proving that he did not build or improve for par- pm,itfsalc). El I,as owner of the property,am exclusively contracting with licensed contractors to TOTAL: construct the project(Sac.](144.Business and Professions Code:)The Convamar's Li- s ase Law does not apply m an owner of progeny who builds or iambuses thereon,and QTY. PLUMBING PERMIT - FEE who contracts forwch proJeua with a emntmctor(s)licensed Pursuant to the Contractor's License Law. PERMITISSUANCE ❑Iamexemptind"Sec. ,B&PCfofthiadafim � Owner Data ALTER-DRAIN&VENT-WATER(EA) VALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE I hereby affirm under penalty of perjury one of the fallowing declarations: / I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- DRAINS-FLOOR,ROOF,AREA.COND. sation,as provided for by Section 3900 of One Labor Code,for the Perforneave of the STORIES TYPE CONSTRUCTION Xfor which this permit is issued. FIXTURES-PER TRAP 1 have and will maintain Worker's Compensation Insurance,as required by Section ] Labor Code.for the pert mance of the work for which is GAS-EA.SYSTEM-1 INC.4OUTLETS OCC GROUP qs APN Co Work l2JIPIQjs�i u�i " TScy NoPolicY GAS-EA.SYSTEM-OVER4(EA) v O Came�{([�s//��J�� '(Jf P CERTIFICATEOF EXEMPTION FROM WORKERS'^ �yZ_ COMPENSATION INSURANCE GREASUINDUSTRL WASTE INTERCEPTOR F�* $_HECK FEE DING DIVISION V,, _a.4 (This section need GREASE TRAP d not be completed ifthepermit is In dollars($I W) � or less.) PLANCHBCK PEE Ioy day thatinthe perany ormance mannero the work for as this Permit theWorkes'Campr- SEWER-SANITARY-STORM EA.200 FT. ,I shall not employ tory person is any manner so as to became subject m the Workers'Camper- ENERGY FEE D ,z plLaws ol'Cabfornia.Date Applicant /V WATER HEATER WENT/ELECTR z O Applcant GRADING FEE V] NOTICE TO APPLICANT:If,after making this Cisions of of Exemption,dyou should WATER SYSTEMl1'REATING ai � become subject y the Worker's Compensation provisions of the Labor Code,you must SOILS FEE (11 forthwith comply with such provisions or permit shell be deemed revoked. WATER SERVICE Q 7 z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ,ET. PAID U O l hereby affirm that there is a construction lending agency for the performance of Data Reee t " ti the work for which this p dunite,issued(Sce.3097,Co,C.) 0 U Lenders Name OTAL: WLender's Address TOTAL: I certify that 1 have read this application and state that the above information is BUILDING FEE V Ps l agree to comply with all city and county ordinances and state laws cultivator QTY. MECHANICAL PERMIT FEE U z. building construction,and hereby nuthmizerepresentativesofthis city to wtumpov the SEISMIC FEE .hove-mentioned property for inspection purposes. PERMITISSUANCE At cc m save,indemnify and keep hurmlese the City of Cupertino against ELECTRIC PEE lims,costs and expenses which may inany way a.e.,ain,t said City ALTER ORADDTO MECH. thc gran' it.ATA S AND WILL PLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IQIIW CFM) MECHANICAL FEE AIR HANDLING UNIT(OVER HLOW CFM) CONSTRUCTION TAX nmre Ofpp VCOntra or me EXHAUST HOOD(W/DUCq HOUSING MITIGATION PEE it OUS MATERIALS DISCLOSURE Will the applicant or futirc budding occupant nmre or handle haxallous material HEATING UNIT(TO IW,WO BTU) as defined by the Cupertino pal Coda ChaFmr 9.12,and the Hwlth and Safety Code,Section 25532(a). HEATING UNIT(OVER 10.000 BTU) ❑Yes VENTILATION PAN(SINGLE RESID) PAID Data Receipt Willme applicant or(umre building Oecupam use eyuipmem or devices which BOILER-COMP(3HP OR IW,f011 BTU I h reardOns air command efned by t Bay Area Air Quality Management ) T strict^ BOILER-COMP(OVER I W,B00 BTU) Yes a read the hazardous mamdalsrequirements under Chap¢r6.95 mme Cali- AIR CONDITIONER ISSUANCE DATE to He a &Safety Code, it...25505,25533 and 25534.1 understan at if the NEW RESIDENTIAL SUCH SQ.EL (� E ce, card,that R's my responsibilto notify pant d h at Prior m i carevi to of ncy. Owner mr oath ized age Dale TOTAL: ISSUED BY. tri OFFICE CITY OF CUPERTINO 1 0£ 1 BUILDING PERMIT RECEIPT OPERATOR: kaTenb COPY 4 1 Sec: Twp: Rng: Sub: Blk: Lot:36909032.00 DATE ISSUED.......: 08/23/1999 RECEIPT N.........: 9875 REFERENCE ID .q ...: 99080155 SITE ADDRESS .....: 10298 COLD HARBOR AV SUBDIVISION . .... . . - CITY ............. : CUPERTINO IMPACT AREA ...... . OWNER ............ : WEST PAUL E AND SCHWARTZ-WEST ADDRESS .......... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-3328 ' RECEIVED FROM ....: TIM CONTRACTOR .......: GERE, BOB LIC N 20766 COMPANY .. . .......: BOB GERE MASONRY ADDRESS ..........: 480 CROSSLEES DR CITY/STATE/ZIP ...: SAN JOSE, CA 95111 TELEPHONE ... . ....: (408)972-1285 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL BPERMFEE VALUATION 2,000.00 77.00 0.00 77.00 ' 0.00 _________ __________ PERMIT : 77.00 0.00 77.00 0.00 OD OF PAYMENT AMOUNT NUMBER , ___________ ____________ __________________ CHECK 77.00 12628 TOTAL RECEIPT =S6Ev6i 777.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION .....>.> .......»>.................. .....m.. m........................... 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 514 FINAL PUBLIC WORKS • I INVOICE INVOIJ INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: kaYenb Sec: TwP: Rng: Sub: Blk: Lot:36909032.00 INVOICE DATE...... : 08/23/1999 REFERENCE ID # ... : 99090155 SITE ADDRESS ..... : 10298 COLD HARBOR AV SUBDIVISION ...... . CITY ............. : CUPERTINO IMPACT AREA ....... OWNER ............: WEST PAUL E AND SCHWARTZ-WEST ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-3328 CONTRACTOR ....... : GERE, BOB LIC # 20766 COMPANY ..........: BOB GERE MASONRY ADDRESS . .........: 480 CROSSLEES OR CITY/STATE/ZIP ...: SAN JOSE, CA 95111 TELEPHONE ........ : (408)972-1285 FEE DESCRIPTION CNK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BPERMFEE P 77.00 0.00 77.00 --------- ------------ ----------- 77.00 0.00 77.00 04 VOICE ID .- DESCRIPTION'._....-- VOICE ID _-6 DESCRIPTION .. ..... ...... ........ ..... .............. FOUNDATION 312 CH INII4EY REBAR & STRAPS FINAL PUBLIC WORKS •