00010177Amo1 !CAHTTO cu I IN INFORMATIDN WITHIN RED LINES -USE BALL POINT PEN ONLY 4 Vv01 0 19
CITY OF CUPERTINO BUILDING - ELECIRICAL
BUII,UING DIVISION APPLICATION)TERMIT PLUMBING - MECHANICAL
BUILDING PROJECT IDENTIFICATION
PERMIT NO.
Qft�ff am
BUILDING DRGSS'�
<r�� s . �-3�z py. G� �t,yc c -1IX_3�-�0C
SANITARY NO.
APPLICATION SUBMITTAL DA'
OW ER'. NAME: / iONE� L
V IY.&16
CO I'R 'S NAM& (7` �, LIC NO:
NIC
❑
CON [RULp
'ARCIITECT/IiNGINEER: LIC NO
ADDRESS:
CONTACT: PHONE:
ati� /6 L (J X)-O
❑Consultant Fees Pail by Applicant (Initial)
BUILDING PEfi MIT INFO
BLDG- -ELECT PhUMH, M[❑CH
�c-1�
LICENSED C 'TRACTOR'S DECLARATION
I bercby affirm that 1 am Iia sed under provisions of Chapter 9 (commencing
ions Cale, and my license in
in full force and affer.
with Section 7000) on Division 3of the\DPCATION
License Gloss
Dntc
ARCHITE
1 understand my plansshall hely
1 Licensed Professional
OWNER" exemptBUILDER DECe Conte
C I hereby .(Bran Inas 1 1. ,Bonne Brom the Conions License c Law for the
) following roman. (Section 703 1.5. Business and Professions C Any city or county
which reyulres u permit to anstmcl, aRur, iinpnrve. JemoliIn nr r n any sfinemrc
prior In is issuance. also Inquiries the applicant for such Permit file a.! ncdslamnawm
than he is licensed pcolonuo the prismomof the Contractor's License (Chapme9
(commencing with Section 7000) of Division lot the Business and Pmfeui sCodO or
'hat he is exempt therefrom and the basis for the alleged exemption. Any vi Linn of
Section 70315 by any applicant for a prook sunjecs file applicant m u civil Po lfyof
not mane thea five hundred dollar 55001.
Q I, as owner nl the propcny. or my employees will wagesas theireole compcmau
I will do the work, and the notion, is not intended or offered forsale(Sec.]D1q Busine"A
c and Professions Code Hie Contractor's License Law does not apply to an caner of
property who bui Id—r impmvcs daemon. and who does such work hlmmlf unhmugl
vemcnts rt not intended or offered for
his own employees, provided that such impna
cele. If.however, We budding or improvement is sold within one year ofcompledom, theSQ.
wner-rLnui�lder will have the burden of proving that be did not build or improve for pvr-
pi
own,r of the prripenY• um escbnivuly mnumming will licensed contractorsm
.,.,.at the project (Sce. 904, Liminess and Professions Cade:) The Coruscates L.
cameLaw does not apply to an owrerof,noNny who builds or improves thereon. and
who contracts for such projects with a wmlmda(s) licensed masuanuo the Contmaor's
Lm°roe Law.
lou r-or,aundat'$Cc,/ /7 .I1&1'C fo Lkne."m
QTY ELECTRIC PERMIT FEE
JOB DESCRIPTION
RESIDENTIAL,
❑A D TTI C1 KITCHEN RF.h10UE1
[]ADDITION C4i'C4MBING RI; -PIPE
❑STRUCTURAL
MODIFICATION
C1 INTERIOR ❑CHIMNEY RITAIR
IMPROVEMENT []SWIMMING POOLS
❑ MITT REMODI?L/RITAIR ❑ DEMOLITION
❑OTHER
PERMIT ISSiIANCP.
APPIJANCES- HESIDENIIAI.
PANCS❑MULTI-UNIT
UP T02(XIAMPS
201-I(X)PAMRS
OVER I000 AMPS
SIGNS ELECTRICAL
SPF.CIALCIRCUIT/MISC.
TIiMP. MISIVR UH POLE INST.
COMMERCIAL:
Q NEW BIDC/ADDITION ❑ DEMOLITION
❑TENANT ❑ FOOD SERVICE
IMPROVEMENTC
❑OTHER
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETS SWITCHES - FIXTURES
B L4.
NEW RESIDENTIAL ECSQ
FI'. FLOOR AREA
$RQ. FT
'TOTAL:
QTY PLUMBING PE IT FEE
PERMIT ISS NCE
ALTER -DRAIN VENT-WAT- (EA)
(Iwnc- Dale
VALUATION
J
OR KIeR'S COM PENSA'1'ION DECLARATION
1 hereby train under penalty of perjury rime of the following declarations:
❑ I have and will maintain a Cenifcnte of Consenno-self-insure for'll-W sCompell-DRAINS-PLOOR.
sation. as provided for by Section 3700 of are Labor Code, for the performance of the
work lir which flus permit is issued.
1 have and will maintain Worker's Compensation Ism uranin, us rationed by Section
3700ot the Labor Cedc, forthe peromanceofthe work for which this permit is msueJ,
My Worker's Cooperation Insurance carrierand Policy mother arc:
Carrier, Policy No.:
Clik'I'IFICATE OF E'XEMPT'ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need no be completed if the permit is tritium hmMrcd dollars IS 100)
or le".)
Ilecnifythairidapefformanse.fine work for which this ry'rtnil is iswal,luhall
col employ uny p,rnin in onY mannut m as of become subject to the Workers' Compcn-
- s,am Lmv,of C.ffsmi. Date
1 At,lsunt I
BACK FLOW PRO)"I•. D E,--1
ROO kEA,C
S RIES
OCC GROUT'
PG CONSTR11Cfl(
7 G y
b
FIXTURF_S - PF.R I RAP
GAS -EA. SYSTEM -1 INC.40 FTS
GAS -EA. SYSTEM -OVER J (EA)
GREASMINDUSTRI. .TH INT 'ERCE OR
IlU1LUING DI VISION FF.6
GREASE TRAP
PLANCHECK FEE
SEWER-SANITAkY-S" ,,u,,,.
s ERGY FEE
WATER HBATIiR WNENT/ELECT
i NOTICE TO APPLICANT: If, after nmking this Cena"ne of Escanial m, you should
' become subject to the Worker's Compensation provisions of the labor Code, yea masa
fmlhwith comply with such proviuiomor this permit xhall M deemed revoked.
CONSTRUCTION LENDING AGENCY
j Iherchy alum Thai lhecisn annelmdinn lending agency for ihu perfnmrvnce of
' the work for which this pernit is issued (Sec. 3097, Civ. C.)
Isndrea Name
Lenders Address
WATER SYSTEMORRATING
SOLI".
WATER SERVICE
PAID
NEW RESIDENTIAL PLMB. S . FTFit
Data Receipt#
TOTAL
'DOTAL:
I
I lenity that 1 have read This application and sale That the above inforn tion in
i .erect. I ngrce tu comply with All city and county nrdi.naer_a and stale laws fuming to
building contraction. and hereby authorize repreamadveunfthis city loenerupon the
aswennrofionedproperty for inspevinat unace,
(W) .,me toe' indemnify aadk ph' dessthaCty of Cupenno gain.0
liub'IT. ju lg ,nesse .l. J panus which 'y many wnyaectueagonat said City
scgerenceofihegrmiimgotihispcmnit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1. NON -POINT
SOURCE REGIJ TI S.
is ti
QTY. MECHANICAL. PERM .E
I�.SEISM
_
r,Fi,�
PERMIT ISSUANCE I
ELECTRIC iE I
U PL
ALTER OR ADDU METH.
AIR HANDLING UNI F(1'0111,0(X1 C.`
'I{ANICAI. PE
AIR HANDLING UNIT' (OVER IB.IIOU CFM7
.C'ONSTRUCTIQN TAX
g IAppl /C D
HAZARDOUS MATERIALS DISCLOSURE
Will the upplicamor nature huilding tweepin slomorhandle bavudous material
as defncd by the Cupenino Munieiyal Code, Chapter 911, and the Health and Safety
Cao. Section 25532(a)]
❑Yea ❑No
Will the applicant or future building occupant use equipment or devices which
•mil h...Nnes ai..tm.aminates as claimed bythe Bay Arca Air Qualify Mawgun:etl
'in ... it,,
El Y,, E]Nu
quircme"
I have read the haeMaus materials m e, under Chapter 6.95 of the Cali-
fom a Health & Safny Cade. Sectioro 25505, 25533 and 25534.1 nndanmnd Thal if the
huilding does nos clumally have a[crwt, that it is my responsibility [it notify are occupant
u(I ulphennelif he in mcotx Ccnific:ue .1 Oc.upanc,
E%I{RUST HOOD(W/Dl]C'I)
,vUSINO MI'CIGATION 113
HIiATING UNIT ITO 100.000 BTU)
HEATING UNIT (OVER 100,(X)0 WITH
PAID
VENTILATION PAN (SINGLP. RF,SID)
Date Rtteipl #
BOILER- COMP (31 IP OR 1011,0011 BTU)
TOTAL:
BOBER- COM P(OVER I Wirth B' TO)
AIR CONDITIONER
ISSUANCE DATE
/' D
3 /•- z�O
ISSUED BY: 7-C-2
NEW RE_SIDENU IAL MECH. SQ. FT.
uthodzed agent Dane
TOTAL:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
•
BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Elk: Lot:36924009.00
INVOICE DATE......: 01/31/2000
REFERENCE ID k ...: 00010177
SITE ADDRESS .....: 870 E ESTATES DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: LEE KENNETH K AND CECILIA 0
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4560
CONTRACTOR .......: LIC # -OWNER-
COMPANY ..........: LEE KENNETH K AND CECILIA 0
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4560
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE
_______________ ___
PAID -TO -DATE BALANCE DUE
BENERGY
_________
A
35.10
____________
___________
0.00 35.10
BPERMFEE
P
117.00
0.00 117.00
BPFIXTURE P
8.33
0.00 8.33
BREMMISC
P
25.53
0.00 25.53
EPERMITFEE P
35.52
0.00 35.52
PPERMITFEE P
35.52
0.00 35.52
•
______
257.00
__________
0.00 257.00
VOICE ID
--------
DESCRIPTION
----------------------------
VOICE
ID DESCRIPTION
101
FOUNDATION
--------
102
---------------------
PIERS
103
UFER
104
REHAB
105
ANCHOR BOLTS
106
SEWER 8 WATER
202
UNDERFLOOR PLUMBING
203
UNDERFLDOR 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
SHEETROCX
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
50B
FINAL MECHANICAL
509
FINAL GRADE
510
FINAL PLANNING
514
FINAL PUBLIC WORKS
0
J