99070087APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY , Nm rJ A 2 `IP
#� CITY DF CUPERTINO BUILDING -ELECTRICAL
PERMIT .
BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL.
BUILDINGPROJECI' IDENTIFICAmON
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BUILDING ADDRESS: -
SANITARY NO.
APPLICATION SUBMITTAL DATE
0 DfAIV2A
3 o
OWNER'S NAME: PHONE:
CO TRACTOR'S NAME: LIC NO:
6 -
/C
CONTROL#
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RCHITECr/ENGINEER: \ LIC NO:
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CONTACT: \ PHONE:
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❑ CO tn[ a al DaliCatli(tn is
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BUILDING PERMIT INFO,
BLDG ELECT . PLUMB MEECCH
LJ 'CJCTi2MB'21CH
LICENSED CONTRACTOR'S DECLARATION
I hereby atnrm that I am littnsed under provisions ofCh.Pter 9 (commencing
QTY. ELECTRIC PERMIT FEE
_
SOB DESCRIPTION
Z with Section9GW)or Divi ion3oftheliminessand Professions d gpd mylicense is
in fall force and effect a�C� /�
J ' `^JN\YY
RESIDENTIAL;
11SFDWL [I KITCHEN REMODEL
PERMIT ISSUANCE
APPLIANCES - RESIDENTIAL
J License Class Lie # �—
*I Date
El ADDITION El PLUMBING RE -PIPE
❑STRUCRAL
❑MOLT] -UNIT N
MODIFICATION
El INTERIOR [I CHIMNEY REPAIR
IMPROVEMENT E] SWIMMING POOLS
❑ BATH REMODEL/REPAIR ❑ DEMOLITION
❑OTHER
DECLARATION
h ARCHITECTT'SSDECLARATION
Tom. ]understand my plans shall be used as public records \
\
OI
Licensed Pmd,,mnal \\
OWNER -BUILDER m the CoATION
I hereby affirm that I am exempt from the 0ontrns Co License law fort \ v
Business and Professions Code: Any city or rounty
F following reason. (Section ] construct,
which requires a permit to nmswch aper, improve, demolish, or repair any swmure
PANELS
UPT0200AMPS
201-IMOAMPS
OVER IOW AMPS
\ SIGNS ELECTRICAL
--------
SPECIAL CIRCUIT/MISC.
�' prior to its issuance, also requires the applicant for such permit o file a signed statement
that he is licensed pamuant w the pumiumis m m, Comrmtoex License Law (Chepta 9
O (commencing with Section TOM) of Dwislet 3 of lie Business and Professions Crxet) in
TEMP METER OR POLE INST.
COMMERCIAL:
r� that he is exempt triumphant and the basis fur the alleged exemption. Any violation of
❑ NEW BLDG/ADDITION ❑ DEMOLITION
x -
P WER DEVICES
{l• Section 7031.5 by any applicant for a Permit subjects the appEeannn a civil penalty of
H
6 not more than rise hundred dollars ($5W).
[:)I, as owneroT the property. or myempinyees with wages as their Hole cnmpensntinn,
❑ will do the work, and the structure is not ivtendedoroffered for sale (Sec.]044,Business
TENANT ❑ FOOD SERVICE
PROVEMENT
❑OTHER
SWI ING POOL ELECTRIC
OUTLE-SWITCt1ES-PIXTURP.S
m and Professions Code ped Contractor's license Lew does not apply to an owner of
.r
r
property who M1uilds or improves ]hereon, and who does such work himself or through
his awn employees, provided that such improvements are not intended or offered for
sale If, however, the building or improvement is sold within one yearofcompletion,the
Her -builder will have the human of proving that he did not build or improve for pt«-
NEW REST NTIAL ELECTR SQ FT.
SQ. FT FLOOR AREA
$/SQ. FT
.
\
pore of sale.).
❑ I, as owner of the property, am exclusively convecting with licensed contractors In
TOTAL'
,
oesimct the project (Sec. 7044, Business and Professions Code) The Corrector's Li-
.,
cause Law does not apply to an owner of property who builds or improves thereon, and
QTY PLUMBI G PERMIT FEE
who contracts for such projects with a contrvmor(s) licensed pursuant «, the Cnntmctia,
PERMIT ISSUANCE
License Law.
❑ I am exempt under Sec. . B & P C for this reason
Owner Vele
ALTER-DRAIN&VENT- TEREA)
VALUATION
WORKER'S COMPENSATION DECLARATION
BACK FLOW PROTECT. DEVICk�
1 hereby affirm under penalty of perjury one of the following declarations:
DRAINS- FLOOR, ROOF, AREA, C D.
I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
salon, as provided for by Section 37W o1'the Labor Code, for the performance of me
STORIES
TYPF; CONSTRUCTION
work for which mis permit is issued.
FIXTURES - PER TRAP
Fl I have and will maintain Workers Compensation Insurance, as required by Section
30Wof the Labor Code, for the perforicaviceof the work for whichthispy ,icy®.
My Worker' us 'o nce rainier ad Policy nu boa
GAS- EA. SYSTEM I INCA OUTLETS
OCC. GROUP
APN
Cartier: Policy No.:
GAS - EA. SYSTEM -OVER 4(P.A)
CERTIFICATE OF EXEMPTION FRO WORKERS'
COMPENSATION INSURANCE
(This section need cot be completed if rho pormhis Forane hantlretl dollars ($IW)
or less.)
GREASNINDUSTRL WASTE INTERCEPTOR
%
e BUILDING' DIVISION FE "
GREASETRAP
PLANCHECK FEE
I ceaify that in theperforarectfthe work for which this permit is issued, i shall
not employ any person in any manner so as to become subject m the Worker,'Cornier-
SEWER -SANITARY -STORM EA. 2W FT
ENERGY FEE
K sntion Laws of California. Date
D Applicant
WATER EcFermit
GRADING FEE
tiNOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject m the Worker's Compensation provisions of the Lshor Code, you must
tiforthwith comply with such provisions or this permit shall be deemed revoked.
' CONSTRUCTION LENDING
them isaconsumerism lentlan. agency for the performance ofUvoijunsibility
ti Ihereby which this
the work far which this permit is issued (Seo 3(19]. Civ. C.)
WATE SYSTEM RFA'I'ING
WATER
NEWR B. cep
Inppa
tl
AILS FEE
a Receipt#
Lenders Name
Lender9Address
�n
TOTAL:
y 1 certify that I have read this application and state that the above information is
BUILD\G FEE
n emrom. l agree m comply with all city and county oNinnnces and sate laws retain, to
building mnswction. and hereby authorize representatives orthis city m enter upon the
QTY A FEE
SEISMIC E
shove -mentioned pfnpeny for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
PERMIT ISSUANCE
ELECTRIC FE
ALTS TO MECH.
PLUMBING HE
liabilities,judgmenq costs and expenses which may in any way marine against said City
in consequence of the,mrieg of this permit.
AIRHANDLINGUNIT (TO 10.
MECHANICAL FEE
APPLICANT UNDO 'TAN AND ILL COMPL WITH ALL NON -POINT
SOURCE RE UI 1 ]. ^
�rJVER I pW C
EXHAUST HOOD (W
CONSTRUCTION TAX
-Signature of Applieay mancmr Dote
F AZARDOUS MATERIALS SCLOSURE
HOUSING MITIGATION FE
HEA
Will the applicant or furore building c t daminhandle maroons material
e
as refund by the Cuperino Municipal C hap cr 9.12, and the Health and Safety
Code, Section 25532m)?
HEATING UNIT (OVER 100,000 BTU)
E] yes r-1 No
PAID
Dam Receipt#
VENTILATION PAN (SINGLE RBSID)
Will the applicant or future building occupant use equipment or devices which
it hazardous air contaminants as defined by the Bay Area Air Quality Management
stria I
]] Yes �No
BOILER - COMP (3HP OR I W,f1o0 BTU)
TOTAL:
BOILER -COMP (OVER 100,000 BTU)
AIR CONDITIONER
1 basement the hazvdnas materials reyairart an under Chapter fi to of the Calle
fomin Health at Safety Code, Sections 25505, 5533 and 25534. I understand Nat if the
building duos Homo yhaveate an. thud emy responsibility to notify the occupant
ISSUANCE DATE
3
NEW RESIDENTIAL MECH. SQ. FT.
TOTAL.
of therequirc tent use et prior suancamitlerifcateof4`ne^�`,
/V
ISSUED BY:
Owner or out adz em Dole
OFFICE
E
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: chrl5tya
Sec: Twp: Rng: Sub: Blk: Lat:32633113.00
INVOICE DATE......: 07/30/1999
REFERENCE ID # ...: 99070087
SITE ADDRESS .....: 10355 N DE ANZA BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: VIDOVICH-CUPERTINO LIMITED PAR
ADDRESS ..........:
CITY/STATE/ZIP ...: SUNNYVALE CA, CA 94087
is I
CONTRACTOR .......: LIC
#
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ... ,
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE
PAID -TO -DATE BALANCE DUE
--------------- ------------
BTEMPPERM P 200.00
------------
-----------
0.00 200.00
---------
200.00
------------
-----------
0.00 200.00
VOICE ID
DESCRIPTION
VOICE
ID DESCRIPTION
TION
102
PIERS
UFER
UFER
104
REHAR
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
508
FINAL MECHANICAL
509
FINAL GRADE
510
FINAL PLANNING
514
FINAL PUBLIC WORKS
is I
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: christya
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:32633113.00
DATE ISSUED.......: 07/30/1999
RECEIPT q.........: 9673
REFERENCE IO N ...: 99070087
SITE ADDRESS .....: 10355 N DE ANZA BLVD
SUBDIVISION ......:
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: VIDOVICH-CUPERTINO LIMITED PAR
ADDRESS ..........:
CITY/STATE/ZIP ...: SUNNYVALE CA, CA 94087
RECEIVED FROM ....: TIM
CONTRACTOR .......: LIC N
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE ID UNIT
QUANTITY
AMOUNT PD -TO -DT
THIS REC
NEW SAL
__________ _____________
BTEMPPERM FLAT RATE
__________
1.00
____________________
200.00 0.00
__________
200.00
__________
0.00
__________
TO PERMIT
__________ __________
200.00 0.00
__________
200.00
0.00
Mdk OF PAYMENT
AMOUNT
NUMBER
___________ ____________
CHECK
200.00
__________________
1452
TOTAL RECEIPT
6.
200.00
0 CITY OF CUPERTINO
Item 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: chrietya
COPY N : 1
Sec: Twp: RnS: Sub: Elk: Lot:32633113.00
DATE ISSUED.......: 07/30/1999
RECEIPT R.........: 9673
REFERENCE ID M ...: 99070087
SITE ADDRESS .....: 10355 N DE ANZA BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: VIDOVICH-CUPERTINO LIMITED PAR
ADDRESS ..........:
CITY/STATE/ZIP ...: SUNNYVALE CA, CA 94087
RECEIVED FROM ....:.TIM
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS RECNEW BAL
--------------------- -------------------- -------------------- ------
V ID DESCRIPTION
.. ...... . ..........
101 FOUNDATION
103 UFER
105 ANCHOR BOLTS
202 UNDERFLOOR PLUMBING
204 UNDERFLOOR FRAME
301 ROUGH PLUMBING
303 ROUGH MECHANICAL
305 FRAME
307 INSULATION
309 EXTERIOR LATH
311 SCRATCH COAT
501 FINAL ELECTRICAL ENERGY
503 FINAL MECHANICAL ENERGY
505 FINAL ELECTRICAL
507 FINAL PLUMBING
0
VOICE ID, DESCRIPTION
102
PIERS
104
REBAR
106
SEWER & WATER
203
UNDERFLOOR MECHANICAL
205
UNDERFLOOR INSULATION
302
TUB & OR SHOWER
304
ROUGH ELECTRICAL
306
HOLDOWNS
308
SHEETROCK
310
INTERIOR LATH
313
ROOF NAIL
502
FINAL PLUMBING ENERGY
504
FINAL BUILDING ENERGY
506
GAS TEST
508
FINAL MECHANICAL