99110099 APPLICAI974 TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY I I 00Q61
CITY OF CUPERTINO BUILDING-ELECTRICAL.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUII.DIN(;PROJECT,IDENTIFICATION' '
BUILDING ADDRESS. SANITARY NO. ATfON SUBMITTAL DATE
/ 8 o 0 6?2e&1_Z) 11 Pte, J' _ �7 ryq (() �- -
OWNE NAME: � �Q PHONE: C A OR' NAME: /O/ILJI- /IC /
C- N/C CO ILO
iCHITEC'I/LANOINP LIC NO: ADDRESS �� /�e ❑
CONTACT: �'VV ONE: 77 IP BUILDING PERMIT INFO ".
/,�� , _p ,(Q�r�•-Vq'�Q�� ❑ Consultant Foes Paid by Applicant(initial) HLDG ELECT PLUMB
MECH
LICENSED COMRACTORS DECLAIM[ON ` t
I h edw affirm that I r .al and p ;ons of Chapter 9(anmme n QTY.. - ELECTRIC PERMIT- I !FEE: JOB DESCRIPTION
witbS t n]I )).f Di 3 the Rusi P mCode.a Imy lice.. RESIDENTIAL
try/pppi � .. . ..
BOO iI PERMIT ISSUANCE
Y�F., "full( J i ❑SFDWL ❑KITCHEN REMODEL
QUU License Cla Ls.M AYPLIANCI3S-RESIDENTIAL ❑ADDITION I]PLUMBING RE-PIPE
Ful Ilam Contractor
0.
ARCHITECTS DECLPANELS [IMUCH-UNIT ElSTRUCTURAL
Z p h Z lenders,. tans sbail be used as public records MODIFICATION
p Z_O yp UPT02WAMPS El INTERIOR ❑CHIMNEY REPAIR
FSI❑'[[vv]] Licensed Professional 201-IgN1AM1'S IMPROVEMENT
OWNER-BUILDER DECLARATION C]SWIMMING POOLS
OL C Q 1 hereby affim rm that I aexempt from the Cnmracar's License Law for the OVER 1000 AMPS ❑BATH REMODELRtEPA1R El DEMOLITION
E6 C U following reason.(Section]0315.Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER
3 4 vFi which requires a permit m construct,alter,improve,demnli.h,or repair any structure .-
.Hnn prior to its saaance.also requires the apphear,Lou each parminofile as;gned,chenent SPECIALCIRCUn]MISC L ( d�
I y mat he is B.erscd pursaa.1 t.the pmvisiom of Cemm.mrs Lieerse Law ICnaptcr 9
�p:Q� (commencing with Seoiun 7(Xq)of Division3.f the Business and Professions Code?or 'TEMP.MEI'EROR POLE INST. COMMERCIAL:
4 pr o y that he a eaetnpt therefromoilwthe h....for the alleged exemption.Any vi.1.1mo"f ❑NEW BLDG/ADDITION ❑DEMOLITION
U'm'm
Section 7031.5 by any opplinmt he permit suhjactvthc upplicam m ut,Ml penalty of POWER DEVICES [-]TENANT ❑FOOD SERVICE
t mom than five hundred dollars 14500). IMPROVEMENT
=0 ❑Las owner offle properly,or my employ«s with wages as their sole compensation, SWIMMING POOL ELECTRIC
will do the work,and the structure is not intended oroffered for sale(Sec.7!144,Business ❑OTHER
mand Professions Code.'The Convamnr's License Law Aoex not apply m an owner of OVT1JTf5-SWITCHFiS-POST URES
properly who builds or inapeavcs thereon,and who does such work himself or through
hi.v own employees,provided that such improvements are not intended(it offered for NEW RESIDENTIAL F.LECTR SQ FT.
sale.If,however,the bui lding or improvement is sold within one year of completion,the SQ.FP.FLOORAREA $/SQ.FT.
ownr+-buildcr will have the burden ofproving that he did not bulla or Improve
pont of adeJ.
❑I,as owner of the property,am exciuvively contracting with licensed eon TOTAL:
nn,wct the project(Sec.](144,Business and Professions Code:)The Contr
can,Law does not apply to an owner of properly who builds or improves thereon,coal IN PERMM Ire• 'PEP c �
who contracts for such projects with a corrections)licensed punuam to the Camra
License Law. PERMIT I5. F.
I am exemptde
unr See ,B&PC for this
ALT VI?Mf- ) VALIIA'RON
r
Date
WORKERS COMPENSATION DECLARATION 1 )
1 hereby affima under penalty of perjuryone of the allow a,
Ihaveanl will mentainaceniticateofCoomttowir-insure for rke INS-Isle ,It •O STORIES TYPE CONSTRUCTION
smion,as Provided for by Sado.3700 of the labor Code,for IM1e perfon c he
work for which this pcmait is issued. LS R
❑1 have and will maintain Workers Compensation Insurance,as required by Section
37n0 of the Labor Code,for IM1e performance of the work for which this permit ix isvucA, G S OCG GROUP ^G�APN� �a
My Worker's Compensation...sura.[..artier and Policy number are: , /
Carrie,. Policy No.: GAS-EASYSTEh V 4
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASFII NDUSTRL WASTE INTER p ,BALED lsr DJMJIQN F13ES,
frhis rte..inn need not b<eomplmWiDhc permit is for one hundred Dollars(S 1(107 b
or less) GRGASE TRAP PLANCHECK FEL
I certify that in IM1e f2rf anmofthea nr, orwhich lhispermit isiss.ed,shall SEWER-SANITARY-STORM 13A.2W Fi'.
nut employ any Tars a ray anter so es t ¢came whjaeun the W akers'Cartier. ENERGY FEE
Z scion laynko .vJi rt e.D
ZZ Applicant / 11h WATER HEATER W/VENT/F,LECI'R GRAVING FEE
ti NOTICE f0 AN .IL ftcr mg this Cenificam of Exemption,you should WATER SYSTEMORF.ATING
a > become subject m the Worker's Compensation provisions of the Labor Code,you most SOILS FEE
forthwith comply with sueh proviai.nsor this permit shall be deemed revoked, WATER SERVICE
0. 0
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.PT. PAID
U O thereby affirm that there a aonswction lending agency for e performance of Date Reaeiptk
CL a the work for which this permit is issued(See,31X)7,Civ.C.) .�_.. /� ,_,
0 U Lender's Name TOTAL:
Lend r' Add :. TOTAL
Fa 1 cvrliy that 1 have read m s application and .te that the above information is t, . , a a --/ BUIL)IRIFEE Z_ — U
h conch g t ..ply with all city wade ty rdtam mdvlate Im"Tlnrgm QTY MBCIRANICALPP.RMIT FEEi �h
U z buildings mhumm�and hereby au@ane representatisa of this city to upon the _ SEIS FE
ahove-memioned property for inspection purposes. ME
(We)age.more.,Indemnify and keep harrelays the City of Cupertino against PERMIT ISSUANCE ELEC IC E
lishiliors,jadgment....vn and expenses whichmay in any any necmeagain.a said Ciry gL'1'ER OH ADD'ID MECH.
in narsurnce of the gaming of dais permit PLAN RING FEE
APPLICANT RNDER.WANDS AND W L COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,11(1(1 CFM) ss..
S( RE L ATI S./ / /�� MEC ANI¢AL ffiG ._. —
/w' AIR HANDLING UNIT(OVER I0.000CFM) CONSTRUCTION TAX
, gna pplicanVCom for L! are EXHAUST HOOD(W/DUC) HOUSING MITIGATION FEE
MATERIALS DISCLOSURE
Will the applicant or future holding occupant stem or handle hmanous material HBATINO UNIT('f0110,000 BTU)
as defined by the Cupenion Municipal Code.Chapter 9.12,and the Health and Safety
Cole,Section T5532(a)? HEATING UNIT(OVER 100,0010 BTU)
Vel ❑N. PAID
VENTILATION FAN(SINGLE.RESID) Data Itroulpt p
Will the applicant or future huiltling orcupum use equipment or Devices which
emit haruNouv air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP OUP OR 100,0010 BTU)
District? TO
0Y.v 0N BOILER-COMP(OVER 100,100 BTU) -
Real
rrad ds"kis
muimments under Chapter 6.95 of the Celi- AIR CONDITIONER ISSUANCE DATE
terata Hm Safe 5,in 1 and 255331 understand that if the NEW RESIDENTIAI,MECH. SQ.FT.
but d si mcu lo ismyreof.Cnle1.ase iythet cupxm �of rc em sm issuance of.Cenifeme Occu / /
TIIIrauth...ed Doerr I Vwdl TOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rug: Sub: Blk: Lot:32637053.00
INVOICE DATE... ...: 11/17/1999
REFERENCE ID M ...: 99110099
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 W
COMPANY . ...... ...:
ADDRESS .. .. .. . ... :
CITY/STATE/ZIP .. . ,
TELEPHONE ........ :
FEE DESCRIPTION CNK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- .__ --------- ------------ -",___-----
BPGAS P 4.44 0.00 4.44 (.Z^,
BUSLIC P 86.00 - 0.00 86.00 ('d Vl
PPERMITFEE P 35.52 0.00 35.52
_________ ____________ ___________
125.96 0.00 125.96
ID DESCRIPTION VOICE ID DESCRIPTION
........ ........ ............................
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING