The URL can be used to link to this page

00010167 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 0001D ) 11 '3= EtTY OP.CUPF,RTIN0 BUILDING-ELECTRICAL t PERMIT NO. RUII,DING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL SOOO1 BUILDING PROJECT IDKNTIFICATION I UILIDI NG ADI�� . ( I T. SANIIARYNO. APPLICATION SUHMR7ALDA' O NER'S N�ME: - HO'ry(F,((-J� Cq ACf R'S A E: - 1 ' LIC NO: 6 H C/AFI/f},AI�A NIC CONTROL% tCHITE /,NGINEER: LIC NO. R?n �/ ❑ 100ite Mg CONTACT; - PHONE: .. 13UILUING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PI,7 MECH ❑ ElQrd/ Ll LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE I hereby anirin that I me licensed under provisions of chapter 9(commencing JOB DESCRIPTION CoeOz with Section nMO)ofuidsion3oftheRmmmsaf RESIDENTIAL m full focemA eRecl. ms PERMIT ISSUANCE Lice Tan [_I SFDWL ' [I KITCHEN RFMODLI e_U APPLIANCES-RESIENTIAL ❑ADDITION ❑PLUMBING RE-PIPE iZQL FDw ARCHITECT'S UEC,ARAI[ONPANELS ❑MULTI-UNIT ❑STRUCTURAI, Z O'"Z I understand my plans.shall be u.J as Public records MODIFlGCDON OZ=� UP'10200 AMM ❑INTERIOR [I CHIMNEY REPAIR FHE W License)Professional 201-11"AMPS IMPROVEMENT I]SWIMMING POOLS �til,F.; OWNER-BUILDIiR DECLARATIONOVER Half)AMPS E3 BATH RfdMODE11REPAIR C:1 DEMOLITION C C Q' I hereby affirm that 1 am exempt from the Contractors License law for the 6040 fnllowin Seen.. Busint,wed Pridiev,.n.Code:AnY ci y t t El OTHER g reaum L or county SIGNS FT,IiCfRICAI. 3 LLvFi whim rttNires n Permit to constrict aper.Improve,demolish,or naso any mnature 0r/�Q prior to issuance,issuance,also musuch applicant for ch pmi ertmfilcasigned statement mem SPECIALCIRNIT/MISC. yg that hpursuant e is licensed pursuano the provisions of the Contractor's License Law(Chapter 9 W FCCO (commencing with Section 70D(Dof Division 3 o the Bminessand Professions Cade)or TEMP.METER OR POLE INST COMMERCIAL' 6 e Ihm he is exempt therefrom and the basis for the allugcd exmnption.Any vndation of ❑ EW BLDG/ADDHHON ❑DEMOLITION W Napplicant IS Section 3 IS by any applicant for a permit subjects the applicano a civil penalty of POWER DEVICES / TF.NANI' ❑FOOD SERVICIi nl mom man Five me lu ,c Jnllvrs(E51X7. Ih1PROVF:h1ENT _< 6.dic t, nlme property,or nryemnteadeswithwugesas n,ale mle704D,B sines SWIMMING POOL ELECTRIC SF O will do rework,ande he Contractors tors Liienso Law edl dos not applypwico an Business THBR 13th and erywhob Gde:The Comreeros License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURIiS property who builds or improves thereon,and who esw such work deed m u through pin own owever,me psvlJW Ihnl wch rent is sold w shin not intended m ptetiod for NEW RESIDENTIAL ELECT SQ PI'. sale.If,however.the building or improvement is sold within ora year of<umpletinn,me SQ.PI'.FLOOR AREA LSQ.1T ownrolmildor will have the burden of proving that he did not huild or improve for Par- Pm'of wla). ❑ 1,as owner of the propen ...d am exclusively aounec,ir,with licensed eanrs n+ TOTAL: mmmuct the project(Sec.7(00.Business and Prnfecsinm Cad,)'Me Contractors Li- cense Law does net apply toanowner ofprpenywho builds or improves thereon,and QTY. PI,UMBING PERMIT FEE who commas for such projects with a cormacmr(s)licensed pursuant to the Contractor's License law. PERMIT ISSUANCE ❑ lam exempt under Sec, ,B&P C for mi-em. - ALTER-GRAIN&V ENT-WATER(CAO VALUATION Owner UIO WORKERSmundeChy of twur,on DECLARATION BACK FLOW PROTECT.DEVICE 6-GO, /�� Ihandy affirm under Cenapyof perjuryoneof the following Worker a Co: LAA// (�� van,I have and will mai by etio ifiwaof C.nseour,Cod insure for Worker Compro- DRAINS-FLDDR,ROOP.ARBA.COND. STORIES TYPECONSTRUCTR ration,as pmviJed for by Section l]O)of the tabor,CWe,far me perf.rmmcc of me VI which Ibis porton is icmed. FIXTURES-PER TRAP w I have and will maintain Worker's Cnmpenmtican Irmem wt.as meanest by Section 3700.1 the L�uEl'y.�+,Code,for be performance ofibe work for which this permit is issued, GAS-EA.SYSTEM-]INC.1OUT'LETS OCC GROUT' AINMy Co crk/ I]&wsve camel and PolicyW 113 GAS-EA.SYSTEM-OVER J(EA) SI-z Pdicy FROM HA CERI'IPIC OMPE SATIONION FRAM WORKF,RS' COMPENSATION INSURANCE GRFASF/INUUSTRL WASTE INTERCEPTOR phis section nreA not he annple¢A it the permit is for one hundred dollars Sl(k) BUILDING DIVISION PBES or less.) GREASETRAP PLANCHECK IEE I ceni(yrat imhe perfnmmaneenfthe work fmwhmit this ,,at,is issucd,[,hull SEWER-SANITARY-STORM EA.200 F1. nal employ any person in any manner so as to become subject m the Workers'Compere- ENERGY PEE Ozsation Laws of California.Date WATER HEATER WNIiNT/IiLHCTR z 2 Applicant I GRADING PEE h NOTICE TO APPLICANT:IL afar making mix Cenifieme of Exemption,you should WATER SYSTEM/pREA'TING a ; hccome-euhject to the Workers Compensation powilion,of the Labor GNq ym nmst SOU-S PEE forthwith comply with such previsions or this permit shall be deemed revoked. WATER SFRVICF, Q 5z CONSTRUCTION LENDINGAGENCY NEW RESIDENTIALPCMB. SQ.FI'. PAID V. r. l for by whihhith Penta i is..ed( es.30 lending agency for the performance of Date Receipt# W F the work tier which this permit i,.issued(Sec.31H],Civ.C.) O Lender's Name 7UTAI,: Leader's Address '1OTAL: Fy 1 certify that I have mad this application and state that are above information is BUILDING FEE pl correct I vgra lu amply with all city and county nNinances and state laws relating to QTY. MECHANICAL PERMIT FEE L.) z building construction,and hereby authorize representatives of this city to enter upon the SEISMIC FEE abs-e-onsminnwl prpeny for inspection purpose,. PERMIT ISSUANCE. (We)agree to nave,inJemnily and keep hamdess the City of Cupertino against ELECTRIC FEE Iiabilities,judgmeno.costs and expenses which may in any way accme against said City ALTERORADDTOMECH. is cnnseJA' UNDIRSTANDS fib gmnling of this permit. PLUMBING FEE APItLICAND WILL COMPLY WITH ALLNON-POINT AIR HANDLING UNIT GO 10.(0(1 CFM) TIONS. MECHANICAL IEE 1�_I?�O AIR HANDLING UNIT(OVER 10.001 CFh) CONSTRUCTION TAX Signmtamuf nUContmemr (/e O Date EXHAUST HOOF)(W/DUCT) HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEF, Will the nPPlicum or furore building tweupunl stores,bundle h....do.,maarind HEATING UNI]'IF1(08W BTU) as define)by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety Cot,Sceti.a 25532(r)? HEATING UNIT(OVER 100.000 BTU) [D yes No Y VENTILATION FAN(SINGLE RES]D) PAID Dan Receipt# Will the applicant or future building use equipment or devices which tit hmN.ua air contaminants as by the B JefneJ by the bay Area Air Quality Alanagemem BOILER-COMP(JHP OR 100.00t)BTU) isuicR TOTAL: ❑Yes BOILER-COMP(OVER 100.000 BTU) I have rt' the haziwarials hequirtmcnrs under Cha fi95 of the tali- AIR CONDITIONER mer ISSUANCE DATE G+mia Healthgdoes b(ety Cods,Sections 25585,25533 and 255311 undersand that if the NEW RF,SIUIiN'TIAL MECH. SQ.FI'. afthehaddingdmmes i cuwhichntanhe w,mi itismommufaCerfiytonotifyme'repant Z- 2-2oa..o of the trym- m which must be ran prionu izwwtt of a Cenificam o(wmpanty. If Owner nr vu t (�� Dat TOTAL: ISSU13D BY OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: christya Sec: Twp: Rng: Sub: Elk: Lot:36923032.00 INVOICE DATE...... : 01/28/2000 REFERENCE ID # ... : 00010167 SITE ADDRESS ..... : 10793 W ESTATES DR SUBDIVISION ...... . CITY ... .......... : CUPERTINO IMPACT AREA ......: OWNER ... . . . . .....: IGNAITIS JOSEPH AND ELIZABETH ADDRESS ... .......: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4535 CONTRACTOR . . .....: WARREN, HENRY LIC # 20719 COMPANY .. ........: ABSOLUTELY WATER HEATERS ADDRESS ..........: 191 PADDON PL CITY/STATE/ZIP ...: MARINA, CA 93933 TELEPHONE .. . .....: (831)384-5133 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ -____------ BPWHEATER P 9.99 0.00 9.99 PPERMITFEE P 35.52 0.00 35:52 --------- ------------ ----------- 45.51 0.00 45.51 V ID DESCRIPTION VOICE ID DESCRIPTION SEWER I WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB 5 OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING