00090172 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY bQ1 C9
CITY OF CUPERTINO BUILDING.-ELECTRICAL p' M
BUILDING DIVISION APPLICATIONA'ERMIT PLUMBING-MECHANICAL.
BUILDING PROJECT'IDENTIFICATION
BUILDING ADDRIJN SANITARY NO. APPLICA'T'ION SUB At,DATE
OW:�E SyAME; PHONE: CON CI 'SN LIC NO:
N/C CONTROL#
�ARCHUECUENGINEER: LIC NO: AU DS: J �V � ❑
CONTACT': PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLU ELECTPLUMB MECH
❑ ❑ ❑
LICENSED CONI OR ander,DECLARATION Chap QTY. ELECTRIC PERMIT FF;E
1 nereny:auh,n mal f ntlt fiaeltxed under proyismns nfchapmr (entmnenains JOB DESCRIPTION
Woo af.Scetinn.7,OV( IDmts1 3ofIoe Bromessu i Is dossiom Cade,nod my,feense is R I F TI
O PERMIT ISSUANCE
F-,a_ an full force' i �-�
C•+•� ❑SFDWL ❑KITCHEN REMODEL
,ZyM license Class LIc,N APPLIANCES-RESIDENTIAL []ADDITION ❑PLUMBING RE-PIPIT
v QC IJwc TS Df?��
ARCHITECTED Y El MULTI-UNIT ❑STRUCTURAL
ZOyZ I understand my plam'hdl famed as puhli,m1.wJ�W-4Pir7 PANELS MODIFICATION
O Z L C UP 10 200AMPS ❑INTERIORIMNEY REPAIR
[ 4 F'W Licensed ProfcsvunA 201-10MAMPS IMPROVEMENT LMh11NG POOL S
7 OWNER-BUILDER DECLARATION
C C Q 1 hereby affirm that 1 am exempt from the Contractor's License Law'rnr,he OVER I"AMPS C1 BATH REh10DE1/REPAI DEMOLITION
XOdU I ollnwing it(Section9031.5,B—moss and Ponc,mrs Code.Any city or county SIGNS ELECTRICAL DOTTER
'L LL N which rcquius a Penni,m consumer,uhee impose,demolish,or repair any structure
F=AI prim tofu issuance.at-acquire,heapplicant for such pevortl,,fleasigned watemem SPIiC1AL CIRCUITOR IMISC.
,hm he is licensed pmsmnnode pmvlsionsof the Cort,mnr''1.icenw Law(Chapmr 9 COMMERCIAL
(cmnmend ng w hh Section 7(XXlf of Di vision 3 ofthc Business and Professions Care)or TF,MP.METER ..'' INET'+
a a c s that her,exempt therefrom and the basis for the olleged exemption.Any vimlwion of 'EW BLDWADDITION ❑DEMOLITION
XmL
Section]031.5 by anyapplicant for v permit subjects the applicant to u civil penalty of POWER DI?VICES
m
tw- TENANT I ❑FOODSERVICE
mol metre Innis rive hundred dollar y empl. IMPROVEMENT
WSn ❑Lasoc .,k,me property.or my employsnsoitaTted!os,ale(Ssole compcnvtion, SWIMMING POOL ELECTRIC
b.- will eom,ine,ands wConaisnoti Lifan, Laos,does axle(lsABW,Bore,of OTHER
3 m and eny who
Cndc:'Ire Cons memr's L nd w Luo docs not apply s if nwncr of 011'I'LI:TS-SWITCHES-FIXTt1R1iS
his own who builds or Improvers tM1crenn,unit who does such work deed or nr mnmgn
his own employse provided rm such improvements am not intended m of pleced for NEN'RESIDENTIAL BLECTR SQ FT.
swm ll dficr ill h nullthe bur en ol'provia issold
he within h year improve
IM1e SQ FT FLOORAREA 5/SQ.TTI'.
nen sade.)r will have the hnNcn of proving mm Oc Jie not butte nr inlpmve❑m pur-
0 1 of sale.).
I,as owner of e, Sec.pro,icn,,um exclusively contracting Cita licensed Camtman,s i- TOTAL:
me,LawM e,no,,apply
]IU4.owner
exit Pmfchs a hard,in c The Cummeror, dd
wrc Leweoeenotnpplyman own actranardsUirememant tothe bannConcea,onJ QTY PLUMBING PERMIT FEE
oo comma for such projects with acmntmnor(s)IicenseJ pursuant mthe Conuazmrs
Berme law. PERMIT ISSUANCE
LI um exenap,under See ,H&P C for this reason
Owner Date AL'11iR-DRAIN&VENT-WATER(EA) VALUATION
WORKER'S COMPENSATION DECLARATION BACK PLOW PROI'F.C'r.DF,VICI!
I hereby alfirm under penally of porjury one of the follnwing declarations:
I have and will maintain a Cerificam of Coawnuoself-insure for Workers Compcm- DRAINS-FLOOR.ROOR AREA.GOND. ISTORIES T't'PE CONSTRUCTION
'min as provided for by Section 3900 of the Labor Codc,for the performed of the
for which This"coni,is is'.sued. FIXTURES-1117R TRAP
and will maintain Workers Compensation Insurance,as required by Section
100 m dm labor Code,forthe erforanscofthewmk forwhich this permit is issued, GAS-EA.SYSTEM-1 INC.4 OUTOCC.GROUP APH
MyWnr eppg{ya,��Jy� cnrae Potty Nrny nu pg[� �'1 GAS-F.A.SysrEN-OVER4(EA)
H OF
Carrier:� lll��CC lllV������� T
CERfIF1C OMPEN%EMOTION PRAN ORKERS'
COMPENSATION INSURANCE GRIiASFJINUUSTRL WASTE INTERCEPTOR
(Thin ncctim,need not cnmplattt Rthe pcnniGn PonnehuWaA dollars(EI(Nl) BUILDING DIVISION PEES
GREASETRAP
or less J PLANCHF.CK FEE
Ioymny that in the efforany,ne net ofthe toto internrk for which reit)permithe W rkers'issued lsnall S13WTiR-SANITARY-STORA1 ITA.2(X)IT.
nnI employ way person in any Innnner sex us w M1ecunm subject ua the WndurC Gmapen- ENERGY PEE
ZZ cation Laws of California.Pte WATER HEATER Wfsv N /ELECTR
O Applicant GRADING FEE
h NOTICE TO APPLICANT:If,after making this Qnti r.re of Exemption,you should WNIUR SYSTEM/TRI!Ar1NG
heroine ab'Im, ,,the Workers Co...coal provisions of the Labor Code,yor am
t , SOILS FEE
forthwith comply with mhprovisions or this permit shall be deemed revoker. WATER SERVICE
a �
U Z CONS T'RUCT'[ON LENDING
e,dl,AGENCY NEW RESIDIiMI'IAL I'LMB SQ F1'. T�------ VAID'- -
U T much,irfirm issued((Sec.3097.
agency for the penDrmunce of /,,\ Dam I I Rec^Ip N
1"' the work for whish mis permit is issued lS«.3097.Co.iv.C.) , Zl- u �.
O U Lender's Name I ,'OTAI,:
W LmWcr s Address TOTAL:
Fp• 1 certify that I have read this applicmi ae and>utte flaw the above information is D .E o0
to ormica.I agree m comply with all city and county ordinances ane sum laws relating 1. QTY, MECHANICAL PERMIT
U Z building mnewction,and berchynntherve mprescnbaives uftbism,y lu enmropon the SEISMIC FEE
admve-men,iencd property for inxpeetmn larmsn-
(We)agree m save,indemnify wait keep hamilcss me City of Cupcnin.again,, PERMIT ISSUANCE ELECTRIC FEE
Iiahilitien.judgmetns.costs and expenses which may in any way accom against 4d City
ALTER OR ADD TO MECH. Zs'
nscgacnc egmmmg of 11,xper,it 'J-P4yMBLNGR66
APPLIC 'U as STANDS A ILL COMPLY WITH ALL (ON-PO T AIR HARDLINE UNIT(TO 10.000 CFM)
SOUR F T MECHANICALFEE
AIRIIANDLINGUNI'1'(OVER 14g)ICFM) CONSTRUCTION TAX
Si,scomenfApplicarrWontrarnjil Phate EXHAUST HOOD(W/DUCT) ROUSING MITIGATION FEE
HAZARD( )' ATERIALS DISCLOSURE
Will mcupplicant nr Tore..buBdingoccapan,sure or handle hvnuJous nwmdul HEATING UNI'I'G-0100AXI BTU)
as defined by the Cupertino Manicipnl Code,Chapter 212,and the Health and Safety
Cade,Section 25532(ml? HEATING UNIT'(OVER 100,000 BTU)
❑
YO, PAID
VF.N'1'l1.AT10N FAN(SINGLE RESIU) Date Rareop,n
Will me applianm 'more b'IJing occupant use equipment or devices which HQILIiR-COMP(dTTP OR 100,0!111 BTU)
emit hemrdous air a a inanm: defined by the Hay Area Air Qualify Management TO'IAI.
oisviaff BOILER-COMP(OVER 100.000 BTU)
❑Ycx t a D
Ihuvcrwalthch' aidou nawriale raartcmcnts under,Chat re95 oflhe Cali- AIR CONDITIONER
Pu ISSUANCE DATE
Gamin H- &Safct Cale,Secllons 255115,25533 and 25534.1 understand mat i'he NEW RESIDENTIAL MECH. SQ.t C
buil - g ere otemseedyhzve res,arrid cyto ifyth 1 -2- 4-111"- 2-6 -01-0
of a prior m issue,,. nfv Cc 'E r(
awhmi gent Date an TOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Blk: Lot:35926023.00
INVOICE DATE...... : 01/24/2000
REFERENCE ID N ... : 00010112
Ss' -
SITE ADDRESS .....: 7515 DE LA FARGE DR
SUBDIVISION .......
CITY ..... ........: CUPERTINO
IMPACT AREA .......
OWNER ............: CHEN
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4360
CONTRACTOR .......: GERE, BOB LIC # 20766
COMPANY ..... ...... BOB GERE MASONRY
ADDRESS ..........: 480 CROSSLEES DR
CITY/STATE/ZIP ...: SAN JOSE, CA 95111
TELEPHONE ....... .: (408)972-1285
FEB DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ --- --------- ------------
BPERMFEE P 117.00 0.00 117.00
BSEISMICRE P 0.60 0.00 0.60
117.60 0.00 117.60
VOCE IDDESCRIPTIONVOICE ID DESCRIPTION
t... .. .....-- ......- . -__- ....... -------------
...e.......
01 FOUNDATION 312 CHIMNEY REBAR 6 STRAPS
514 FINAL PUBLIC WORKS
0.�
3:Y.^ �'Ii