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99100098o APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING - ELECTRICAL BUILDING DIVISION APPLICATION/PERMIT PLUMBGIIROJ -,I II)EANICAL FIC PUILUINC {'ROJF.(T IDENTIFICATIO BUILDING ADDRESS: ass' ti . Alewl 61✓o. . I' NAM[. PHONE: V^ CO CfOR'S NAMES' ' LI; n/G- 2cr-T7rrn. ARC}JJICT/E 1 MR LTC LIC NO'. v 2S-30 ADDRESS CSTRUCIURAI. COF/NNTACT:: PHONE: MODIFICATION C INTERIOR 6-0-743k ❑ Consultant Fees Paid by Applicant (Initial) LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under prosuir ns of Chapter 9 (commencing Sedion](100)of Divisian3of the Business and nsfeasinns Cnde. vnAmylicaawt, in full Transition] effect I.iccnse Cho Lia.# DatC— CnnZCL QTY. ELFCTRIC FERMI P _ CIaZwith m O p F ce aUV N PERMIT ISSUANCE AI'PLIANCLS-RESIDENTIAL 0. Z O N 3 oz -Oil Q ARCIII'1'ECT:S DGCLARATION I understand my plans shall M used an public records PANELS TO 201 AMPS f-.4EW �se a (XX a ag5O0. U 3 Licensed! Professional OWNER -BUILDER DECLARATION 1 hereby of on that 1 am exempt from the Contractors License Lew for the following reason. (Section 7131.5, tlusm,st and Pmfmsianx Code: Any city or county ]111-10XIAMPS OVER 1000 AMPS SIGNS ELECTRICAL. W WO ye which requires a permit to canswd, alter, improve, demolish, or repair nny enotane prior to its issuance,also requires lheupplicamfar such peril to tileusigned statement SPECIAL CIRCUIT/MISC. } that he is licensed pursuant to the Provisions night, Contractors License Law (Chapter 9 RADING 1>Eli 'RANO, d p, M a iUCy1+N. h., Z } p�O❑I, (etmmenoing with Section 7") of Division Sof the lsosinessrmd professions Coxle7 nr Seal be is exempt ghemfmm .t the basis for the subjectsIn,l exentptinn. Any violminn of Section L5 by anY applicant fora permit subjects In, lareltyof not mom than five hundred dollars (SSW). perty, y employees with wages as their sole eonrpensaame. as ownerofthe proarm is intended (Sec.]Iky Rosiness TEMP. MI'ITtk OR FILE INST. POWER DEVICES _r _ SWIMMING POOL ELECTRIC 4 et, a m will do thework, and She swclure nor modifiedmodifiedlot sale and Professions Code: The Contractor's License law does not apply to an owner of property who builds or improves thereon, add whe docs such work himself or through his own employees, provided that such impmvemems ore not imendcd or offered for OUTLETS - SWITCHES - FIX 'I'URFS� `T _ .. NEW RESIDENTIAL. HLEC'IR " sole. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving Ihat he did nor build or improve for pun- - ". of sale.). uns to Fl I, as owner of the property, am exclusively contracting with licensed comror TOTAL oustmm the project (Sec. 7OI4, Business and Professions Cali Contractor's LI- seLaw does not apply tovnowner ofproperly who build' or improves Hereon, and QTY. PLCMBINOPERbRT who nmuams Tortoni projee¢ with a contmcand.) licereed,tormme men, Cc n one no's PERMITISSUANCE License Law, .B&PCtar thisreasonAUFLIR - DRAIN & VENT -WATER (M) ner {late BAEI t-minexerepturaderSe, WORKER'S COMPENSATION DECLARA'TION hereby affirm under penally of perjury ane of the following declaratme, hove and will maintain a Certificate of Consenuo self-insum for Worker's Compete DRAINS- FLOOR, ROOF, AREA. COND, smion, as provldcd for by Section 3700of She Labor Code, bathe performance of the work l m which this permit is issued, !!CC Iq Oft Eprior' o plan chee 1 have and will unitarian Workers Compensation Insurance, as required by Section 37W of The Labor Code, for the performance of the work for which this penal is issued. au' n �1�. µyo©Wllei GA�'n My Workers Contpensatme Insurance carrier and Policy number am: Carrier: Pal icy, No enpn Gr+GOptlIFOns ri` fortorrecti pcocn�nsi� was CERTIFICATECOMPENSATIOMPT WORKERS' OF EXE 't��1t� COM ION INSURANCE N Gr�yyFlissw, s nd W''ay#M ( tWn'#DOFVOm {iii �w��INVNNfTiI (Tak,ection rued not hcarmpleted lfthe peril is from hundred dollars (5400) -Hanmlelntml Dluu DA.+. 1 certify had in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to became subject to the Worken' Compen- ,Z VIran lawsof Cafif..aid. Date OQ Applicant s O Vl NOTICISI0 APPLICANT: II, after making this Certificate of Exemption. You should a5 become subject to the Worker'a Compensation provisions of the Labor Code, you const (a7Qforthwith comply With such provisions or this Krarit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby nation hatthem is u constmetion lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) U Lender's Name O 0 {ki Lender's Address iSt 1 certify that I have tend this application and state test thenbave inBrrmion is nFi IA core[. l agree to comply with all city and worry ordinances and some laws rotating to Q'pY. U,Z building conswction. and hereby authorize mpmscmmi vex of this city to enter upon Ne above-mentioned property no inspection poHnnea. (We) agree to save. Indemonry and keep htmntexs the Co, of Cnpenino against liabilities,judgmems, costs and expenses whlcb may in any way vccmo against said City in asequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WTI 14 ALI, NON -POINT SOURCE REGULATIONS. Signature at AppluxualtContmetor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant rte or handle hazanloox dou riul as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532m)? ❑Yes 0 N Will the applicant or future building accupam use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management Dlmrict? ❑Yes ON. I have read the hazardous materials requirements under Chapter! 95 of the Cali roundHealth & Safety Code, Scetionx 25505, 2.5533 and 25534. I understand that if die building does not currently have a lenunl. tat it is my responsibility to notify the occupant of The acquirements which must bo met poor to issmnce of a Certificate of Occupancy. WATER HEATER FI?E (J� - /'7 N/C CONTROL# 'BUILDING PERMIT INFO 3LDC. ELECT PLUMB MSCI o", ❑ ❑ ❑ JOB DESCRIPTION - RFSIDFNTIAL C SFDW I, C KITCHEN REMODEL CADDITION ❑PLUMBING ITE -PIPE C MULTI -UNIT CSTRUCIURAI. PLUMBING PEE MODIFICATION C INTERIOR 0CHIMNEY REPAIR IMPROVEMENT CSWIMMINGPOOLS C BATH RL'MODEUIUPAIR 0DFAOLITION C OTHER ly�� (����. STORIES m e 'l e t♦C C.GROL idddft C NEW BLDG/ADDITION CDEMOLITION C'I'ENAN'r ❑ FOOT) SERVICE I.MPROVEMEN'I' - COTHER F.NL'RGY EEE' $/SQ. FT. .t MECHANICAL PERMIT S1 PERMIT ISSUANCE ELECTRIC FBE ALTER OR ADD TO MECH, PLUMBING PEE FF:E MECHANICAL FF.E AIR HANDLING UNIT p(OVER to.(" CIM) CONSTRUCT IONFAX EXHAUST HOOD ONMUC I HOUSING MI'TIGA'TION FIFE SKATING UNIT (TO IOgWoIII Of STORIES m e 'l e t♦C C.GROL idddft is, TUfAL: Bun PL.ANCHTiCR PEP' -' ISSUANCE DATE F.NL'RGY EEE' A RADING 1>Eli 'RANO, ISSUED BY. " SOON 0,1._ $/SQ. FT. FUT'D GFtEtE MECHANICAL PERMIT FEF. SEISMLC PE PERMIT ISSUANCE ELECTRIC FBE ALTER OR ADD TO MECH, PLUMBING PEE AIR HANDLING UNIT GG I0,000 CFM) MECHANICAL FF.E AIR HANDLING UNIT p(OVER to.(" CIM) CONSTRUCT IONFAX EXHAUST HOOD ONMUC I HOUSING MI'TIGA'TION FIFE SKATING UNIT (TO IOgWoIII Of HEA'T'ING UNIT (OVER I00,0p) B'T'U) VENTILATION PAN (SINGLE RESIDE PAID -- Date Receipt It BOILER -COMP (3HP OR INOM B"TU) TUfAL: BOILER - COMP (OVER 1011.000 BTU) AIRCONDIITONER -' ISSUANCE DATE NEW RESIDENTIAL MCCII, SQ. FT A TOTAL: ISSUED BY. " OFFICE INVOICE• INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: yvonnek Sec: Twp: Rng: Sub: Blk: Lo[: INVOICE DATE......: 10/19/1999 REFERENCE ID # ...: 99100098 SITE ADDRESS .....: 10355 N DEANZA BLVD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: ADDRESS ..........: 10355 N DEANZA BLVD CITY/STATE/ZIP ...: CUPERTINO, CA 95014 CONTRACTOR .......: WARING, RALPH LIC # 21299 COMPANY ..........: WARING CONSTRUCTION INC ADDRESS ..........: 500 HOWLAND ST, SUITE 3 CITY/STATE/ZIP ...: REDWOOD CITY, CA 94063 TELEPHONE ........: (650)365-0181 NOTE: THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING FEE DESCRIPTION CHK TOTAL FEE PAID -TO -DATE BALANCE DUE _______________ _----------- ------------ __-__--_--- BTEMPPERM P 200.00 0.00 200.00 _________ ____________ ___________ 200.00 0.00 200.00 VOID DESCRIPTION VOICE IO DESCRIPTION ........ --------------- = --------- ........ ............................ 304 ROUGH ELECTRICAL •