99090143 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY '1 O
CITY OF CUPERTINO BUILDING-ELECTRICAL. PERM O. v
RUILDINGDIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMITTAL DATE
-4 'Rss"Cb�
OWNER'SNAME: PHONE: CONTRACTOR' AME: LIC NO:
Lr —L.> N/C /3 CONTROL
J#*'�
1.117 T/ENGINELR: LIC NO: ADDRESS: ❑ ''7�
CONTACT. Pf E: BUILDING PERMIT INFO
90 a ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT/ PLUMB MECH
tleLo-ran •13 O ❑ ❑-
LICENSED CONTRACTORS DECLARATION QTY, ELECTRIC PERMIT FEE
1 herchy of ion mat 1 am Eeer.ox ander pravishms.fchapter 9(rammearlag JOB DESCRIPTION
FC0 d'Z with Section of Division 3 of the Business and Proavdars Cards,nor my licenu is RESIDENTIAL:
C mfulifinetandeRect. PERMIT ISSUANCE
WF, - ❑SFDWL ❑KITCHEN REMODEL
�UV D.to Class C...IoaAPPLIANCES-RESIDENTIAL [I ADDITION ❑PLUMBING RE-PIPE
ZL Dme TSDECL
AHCHITF.CTS DECLARATION - ❑MULTI-UNIT El STRUCTURAL
ZFprnZ I understand my plans shall he used as public records PANELS MODIFICATION
CZ-0 UPTO200AMPS El INTERIOR [I CHIMNEY REPAIR
�4t�W Licensed Professional 2(11-Illfl(IAMPS IMPROVEMENT E]SWIMMING POOLS
�.1 'j OWNER-BUILDER DECLARATION OVER 1000 AMPS El BATH REMODEUREPAIR �DEMOLITIOK
C'd 6 I heresy affirm that I am exempt from thee CCormonnectors License Law for the
34U
following reason (Section rolls,Business and Professions code:An city or county SIGNS ELS:DUCAL p ER MOOIFICPTI.o
)
mss+
�uLLQ which requires issuance,permit re amawa,alter,improve,demolish,or repair any swaurc
-OJ that hor oslts ensedpursuart nt to theres the irsounamfor such Crium fm's Lice s Law(ed rmemem SPECIAL CIRCUIT/MISC, dNY0 p�'vA0 Ano
;!(y (cotmencing with
pSectio7000)pr�visionso of a Business License Lions haptari)Crude)or
COMMERCIAL:
W^^p0 (cat heisingwithhereiromand)ofDivisionthe
me Business endon.Any
Cwle)or TEMP.METER OR POLE INST.
Q.d oy that he is exempt therefrom and the Mitis for me allege)exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
k m W Sea, a 7031.5 y app
by any a pe
for rms subjects the apph,,tm us o csvll Wm.lty of POWER DEVICES
W^rte ❑TENANT ❑FOOD SERVICE
not mo than five hundred J911urs(5500).
F_ZY je IMPROVEMENT
6 afJfb wncrof the pro pcny,mmyemntendes oithfewd for
e(See compensation, SWIMMING POOL ELECTRIC
W�G d dotheCodec he Contractor's
Licenso Lawdos or apply 70 a4,Business 11 OTHER
W � and Professions Cale:The Confxactors Lic<nse law does nm apply n an owner of. OUTLL•TS-SWITCHES-FIXTURES
a"3^ property who builds or improves thereon,and who)hes such work himself or through
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL.ELECTR SQ
sale.If.however the building or improvement is sold within one year of completion,the SQ.FT.FLUOR AREA $ISQ.FT.
ow net buildcr will have the burden of proving that he did not build or improve for pur-
pou of mne
UjJ(5 mer or
sexclusively contracting withcontractors m
matmcnhe protect ca.7( ,Basinw an,[ licensed The Cammcnrzs Li.
c e Law des our apply toan owner of property who builds or improves
thereon,ane QTY. PI,UMDING PEPd,iv
Diverse
Law..fur suchprhjtttswithnc,,ntracmr(.)licenced pursuanuo me Commp,,rs ; )j
..
❑Ivco Lao exempt order Sa. ,B&PCfar mPERMIT ISSUANCE
isrevon �y
carer Date ALTER-DRAIN&VENT-WATER(EA) ''T VALUATION
ORKE COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE 32/ 00o
I hereby affirm under penalty of perjury one of me following declarations:
I have and will maintain u Certificate of Consent nt self-insure for Workers C.mpem DRAINS-ILOOR,ROOF,AREA,CON STORIES TYPE CONSTRUCTION
.aeon,as Provided for by Section 37W of the labor Cade,for the perman nnce of the
work for which this Permit is issued. FIXTURES-PER TRAP
I have and will atomism Wortar's Compensation Insurance,as recruited by Section
371M of me labor Code,for the perfomhnce of the work for which this permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS 0 OCC.GROUP AP
My Worker's Compensation Insurance carrier and Policy number am: 2_(P
Carrier: Policy No.: GAS-EA.SYSTEM-OVER 4IEA) �� O�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE. GREASFIINDUSgRL WASTE INTERCEPTOR BUILDING DIYISIIN FEES
(Th,wNt in readout becrmplcfed it the permit is throne hundred dallars($IW) GREASETRAP
or[coal PLANCHECK FEE
I certify that in theperrurmtmceof the work which this permit isissued,!shall SEWER-SANITARY-STORM EA.200 F`E
nut employ any person in any manner so as n become subject to me Workers'Compen- ENERGY FEE
OZ sari,,.Laws of California.Date WATER HEATER WNENT/ELECTR
Applicant i GRApWG FEH-_.._._
r2
y NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should WATER SYSTEM/TREATING
became suhjecno the Worker's Compensation provisions of the Labor Code,you mon SOILS FEh yL
forthwith comply with such previsions or this permit shall he deemed revoked, WATER SERVICE - �I
0
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID
.7 Z D6ieL�) Rc�eipt q,�
` 0 I for which
thi thatthei is..ed(Sea 30 7,Civ.
for the performance of i� J L I' �•• I,/
the wars far which this permit isissued(Sea 3097,Civ.C.)
lenders Name TOTAL:
b 0. Lender's Address TOTAL.0. I _ BUILD_LNG v FEE
1 oity mat 1 have read this and application state ear the above information is
h cnrtem.I ngrce to comply was all city and county ordinances and store laws relvingm QTY, MECHANICAL PERMIT FEE --- - ---------.---a
VZ Wildingrimmomti.n,suit hrrebyeadarixe representatives of this city to eructation the SEISMICPLE-
above-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree m save,indemnify and keep herndess the City of Cupertino again ELECTRIC FEE
liabilities.judgments,costs and expenses which may in any way accme againnsaid City ALTER OR ADD TO MECIL
in asequence of the granting of this permit. PLUMBING F
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM)
SOURCERE LAT N MECHANI AL
AIR HANDLING UNIT(OVER 10!X10 CIM) CONSTRUCT TAX
natureuf Applicant/Contmnm
Dam EXHAUST HOOD(W/DOCI HOUSING (CATION FEE
HAZARUOUS MATERIALS DISCLOSURE
Willtheapplicantor futusladldlngottupom save nr handle hazard.....venal HEATING UND(TO IO ,mh)BTU)
as defined by the Cupenino Municipal Code,Chapter 9.12,and the licalth and Safety
Cute,Section 25532(.)7 HEATING UNIT(OVER 100,1100 BTU)
E]Yes ❑No VENTILATION PAN(SINGLE RESID) PAID -
Date Receipt#
Will the applicant or future building oacupant use equipment or devices which
tit hamraon,air contvninants its defined by the Bay Area Air Quality Management BOILER-COMP 13HP OR I00JXXI BTU) TOTAL. ,OO
isn't? BOILER-COMP(OVER 1110,000 BTU)
❑Yes ❑Nn
AIR CONDITIONER
1 have reel me h ode.S s mans 25505,25533
55 5,255 3 an under Chapter h95 of the Cali- ISSUANCE DATE
fomia Hcallhn Safety Cale,Sections 255th 25531and255)4.1 to notify the
if the NEW RESIDENTIAL#BCH. SQ.FT.
building dwsno runcnth( Clamant,that it is my responsibilityfticeste.fytheoancy. 7
n
it t ental i ( �t tf[�. mtteeofu Certifcnm ofQapancy. -
net rimmarrAnsloarn Date TOTAL ISSUED BY:
OFFICE
CITY OF CUPERTINO
• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: christya
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:32637053.00
DATE ISSUED.......: 09/24/1999
RECEIPT #.........: 10150
REFERENCE ID # ...: 99090143
SITE ADDRESS .....: 10400 CAESTON DR
SUBDIVISION ....... -
CITY .............: CUPERTINO
' IMPACT AREA ...... . -
OWNER ............: OLKEIN DOUGLAS E AND ROCK KIRS
ADDRESS ..........:
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-1014
RECEIVED FROM ....: TIM
CONTRACTOR ....... . LIC #
COMPANY ..........:
ADDRESS .. ..... ... :
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
__________ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 32,000.00 356.00 0.00 356.00, 0.00
BENERGY PERMIT FEE 356.00 106.80 0.00 106.80 0.00
CHK PERMIT FEE 356.00 302.60 0.00 302.60 0.00
I TFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
B ECEPT NO. OUTLETS 24.00 24.88 0.00 24.88 0.00
BSEISMICRE VALUATION 32,000.00 3.20 0.00 3.20 0.00
__________ __________ _________
TOTAL PERMIT 829.00 0.00 829.00 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ __________________
CHECK 829.00 1011
TOTAL RECEIPT 829.00
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Blk: Lot:32637053.00
INVOICE DATE......: 09/24/1999
REFERENCE ID 8 ...: 99090143
SITE ADDRESS .....: 10400 CRESTON DR
SUBDIVISION ...... .
CITY .............: CUPERTINO
IMPACT AREA ...... .
OWNER OLKEIN DOUGLAS E AND ROCK KIRS
ADDRESS ...........
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1014
CONTRACTOR .......: LIC N
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ...
TELEPHONE ........ :
FEE DESCRIPTION CNK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- ---
--------- ------------ -----------
BENERGY A 106.80 0.00 106.80
BPERMFEE P 356.00 0.00 356.00
BPLANCHK. A 302.60 0.00 302.60
BREMAECEPT P 24.88 0.00 24.88
BSEISMICRE P 3.20 0.00 3.20
TFEE P 35.52 0.00 35.52
--------
829.00 0.00 829.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ........ ............................
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER k WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB 6 OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 30B 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 508 FINAL MECHANICAL
509 FINAL GRADE 510 FINAL PLANNING
514 FINAL PUBLIC WORKS
•