Loading...
99090101 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PER BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL BUILDING PROJECT IDENTIFICATION HUILDING ADDRESS: ^ SANITARY NO. APPLICATION SUBMITTAL DATE 00/0 1 43 `�I ONE L R CfOR' AM N U Y A OrW (3 © ,f LIC 3 N/C CONTROL p CHITECT(ENGINEER: 1_K LIC NO: ADDRESS: ❑ CONTACT: PHONE;:- BUILDING PERMIT INTO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH ❑ ❑ aK ❑ LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE A I hereby effum that l am licensed under provisions a]Chapter 9(commencing JOB DESCRIPTION �aZ with Section 7000)ofDivision 3 efne Btasmessuod Profession,Cade.and my license is WOO PERMIT ISSUANCE RESIDENTIAL: H IyF in full force unJ efl'cctG 7 O-3 ❑SFDWL El KITCHEN REMODEL �UU License Clnn, Lic.# I-72 Datc Grmtmcmr APPLIANCES-RESIDENTIAL El ADDITION ❑PLUMBING RE-PIPE ¢LLLL ARCHITECT S DECLARATION ❑MULTI-UNIT ❑STRUCTURAL F'/Orz Iunderstandm lansshall hinted as Public records PANELS MODIFICATION Oz�` YV UP TO 700 AMPS El INTERIOR [I CHIMNEY REPAIR F��LLQI Licensed Pnlesa moul 201-1000AMPS IMPROVEMENT E]SWIMMING POOLS �cgw, OWNER Bl1ILDER DECfARATION OVER IWAMPS ❑BATH REMODEL(REPAIR ❑DEMOLITION a a 6 1 hereby aRrm that 1 am exempt from the Contract License Law for the x1 O L U following reason.(Section 7031.5.Business and Professions Code:Any city or county SIGNS ELECTRICAL f�TfHER a=l 3{L f" which requires a permit to construct,alter,improve,demolish,or repair any swaurc y 2=0� prior to its issuance.alsorequirc.dieapplicunt fmrweh permit...Fit easigned statement SPECIAL CIRCUIT/MISC. �y that he is licensed nurutmnt to the provisions of the Contractor's License Law(Chapter 9 COMMERCIAL: r1 410 (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or TEMP.METER OR POLE INST. 0`,HC In., xe he is empr therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION [I DEMOLITION 4. Section 7031.5 by any applicant for a permit subjects rhe applicant to a civil penult,of POWER DEVICES W�'m ❑IMPROV ❑FOODSERVICE not moa than five hundred property, inrs y em). t�6 ., Lotoe vvwk,the pe,mictnr mow ployeeswith Bred as theirole 04,L Bu inion. SWIMMING POOL ELECTRIC IMPROVEMENT and do the wons end c:The Cum now s Licerve Law does not a(Seeapply to an owner of ❑OTHER _ and Professions Cade:The Convenor,License Law does not apply s if owner of OUTLETS-SWITCHES-PI%TIIRF.S property who huilds or improv..thereon,and who dcex such work himself or through his own employees,Provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECT' SQ IT. sale.If,however,the building or improvement is sold within one year of completion,the SQ.FT.FLOOR AREA SISQ.FT. ,Work,,will have the home.of proving that he did nm build or improve far pur- P.w of sale.). Q 1 ❑1,as owner of the property,am exclusively contracting win licensed contractors to cooswn the protect(Sec.7M4,Business and Professions Cadeq The Comtmcmd Li. I cru law docs rot apply 10 an owner of properly who huilds or improves dramon,and QTY PLUMBING PERMIT EE 1 who contracts for such pmjecu winaconaeaor(s)IicenseJ purtuanna the Cnmmenrzx SEP + �99 License Law. II ❑I am exempt under Sec. .H&P C for this reason PERMIT ISSUANCE , y ALTER-DRAIN&VENT-WATER HIO VALUATION i( Date WORKER'S COMPENSATION IIECLARATION BACK FLOW PROTECT.DEVICE Y �fly I hereby elTrm under penes,of perjury one of the following dcdarmions: ❑I have and will maintain a Certificate of Consent it)self insure for Worker's Compw- DRAINS-FLOOR.ROOF,AREA,COND, sation,as provided for by Section 37M of the Labor Cure,for the performance of rte STORIES TYPE CONSTRUCTION work for which this permit is issued. FIXTURES-PER TRAP ,yyy 1 have and will maintain Workers Compensation Insurance.as requirei by Section l'lMl of the Labor CNe.for the performance of the work for which this permit is issued GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN� My Workers Co nsyY� �Ins�ya nd Policynu 'j� q Cartier ����PIa nee carrier dh,y Nod� 02-b S/� GAS-FA.SYSTEM-OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASFANDUSTRL WASTE INTERCEPTOR (This section need oat be completed if the permit is forone hundreddollars($100) BUILDING DIVISION PEES or less) GREASE.TRAP PLANCHECK HE I eenify oat in rte pedinmsomid'the work for which this permit is issued,(shall SEWER-SANITARY-STORM EA.200 FT. not enmploy any person in any manner w as to become subject to the Workeri Compere ENERGY FEF. Z inion Laws of California.Date WATER HEATER WNENT/ELECTR Z Applicant GRADING FEE r+ ^ NOTICE TO APPLICANT.If,after making this Certificate of Ewmptinn,you should WATER SYSTEyff-r 'TING a , home subject to the Work c's Co nscrowion provisions of the Labor Code,you must SOUS FEE ee foMwith comply withsuch provisions or this permit shall be decreed revoked WATER SERVICE O CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID Date Ruch I hereby affirm that there is a construction lending agency for rte performance of IL rthe work for which this permit is issued(Su.UN7.Civ.C) !-' Lenders Name T AL. Lenders Address TOTAL: 1 certify that 1 have read this application and swat that the above information is BUILDING FEE TSA correct.l agree to comply with all city and county ordinances and suite laws relating to QTY, MECHANICAL PERMIT FEE. U ,Z building construction,and hereby authorize representatives of this city to enter upon the SEISMIC FEE above-mentioned pmpeny for inspection purposes. PERMIT ISSUANCE mm (We)agree to save,indemnify and keep halest the City of Cupertino against ELECTRIC PEG liabilitiesJudgments,costs and expense,which may In any way accrue against said City ALTER OR AILD TO MECH. in rotimspume of the granting of this pewit. PLUMBING FEE APPLICANT DF, STANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT 90 IBM CFM) MECHANICAL FEE SOUR['MM S. p lS-( 7 AIR HANDLING UNIT(OVER IQ000 CFM) CONSTRUCTION TAX Siltation.of Applicanth7comctm Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE. Willtheapplicantor future hi ildingecergant storm handle houndmismaterial HEATING UNIT TO 101F000 BTU) as defined by the Cupertino Municipal Cude.Chapter 9.12,and the Health and Safety Code.Section 25532(a)? HEATING UNIT(OVER 100,000 BTU) ❑Yn ❑No VENTILATION FAN(SINGLE RFSID) PAID Date Receipt# Will[lie applicant or B fulmoccupant building equipment terdevices which BOILER-COMP(3HP OR 100,(00 BTU) emit huzardmus air contaminants as dcfncd by the Pay Area Air Quality Management TOTAL Ditvict? P E]Y" ❑No BOILER-COMP(OVER 100.000 BTU) AIR CONDITIONER 1 1 have re of 0th hazardous materials 5,2553 a under Chapter ma of the Cad. ISSUANCE DATE fomia Health Cale,ea Iium25505,25533and25534.1 to notify th nmifthe NIiW RESIDENTIAL MECH. SQ.PT { ¢ / building no urrently huveatutwm,thathis my responsibiirymnoi fy the cecupant afahw a which must he met prior to issuance of ficate�=gypancy. /�w/O�_ ' authorized agcut 6at� TOTAL: ISSUED BY:✓UeQJ`->,,>A-Cl-t• OFFICE CITY OF CUPERTINO 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: christya COPY # 1 Sec: Twp: RnS: Sub: Blk: Lot:35930003.00 DATE ISSUED.......: 09/15/1999 RECEIPT #.........: 10090 REFERENCE ID # ... : 99090101 1 SITE ADDRESS .....: 1043 COLONY HILLS LA SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: DODSWORTH BARBARA A ADDRESS ..........: % CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-5801 . RECEIVED FROM ....: TIM CONTRACTOR ....... : MCGEE, PAT LIC # 18986 COMPANY .......... : WATER HEATERS ONLY ADDRESS .......... : 500 AIRPORT BLV CITY/STATE/ZIP ... : BURLINGAME, CA 94010 TELEPHONE ........ : (415)349-3747 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL ---------- ------------- ---------- ---------- ___ BPLSGFEE FLAT RATE 35.52 35.52 0.00 0.00 35.52 B EATEA PER HEATER 1.00 9.99 0.009.99 0.00 ---- PERMIT 45.51 0.00 9.99 35.52 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ __________________ CHECK 9.99 7507 ...`• TOTAL RECEIPT 9.99 VICE ID DESCRIPTION VOICE ID DESCRIPTION ...,..... ............................ ........ ............................ 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER V502 FINAL PLUMBING ENERGY 506 GAS TEST ' 507 FINAL PLUMBING •