00010013 APfICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY O O
CI YOF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
PLUMBING I
BUILDING APPLICATION,PERMIT BUILDING ROJEC7P IDENTIFICATION
50001
RUHDIN(i ADDRESS: SANITARY NU. APPLICATION SUBMITTAL DATE
c Oe?�o/
W�NIIFRSNANIe: PHONIi: �� CONTRACTOR'S N IE: LIC 7FEE
:
E NIC OL0
CHI '.CT,E?sGIN R. LICN ADDRESS: ❑
CONIACI. rV Jn�//1�A"/• ��y(� IUONE. BUILDING PERMIT INFO
❑ Consultant Foes Paid by Appticunt(initiepBLDG ELECI' - MUMB NIDCH
?o �3 ❑ � ❑ ❑
LICENSED CONTRACTOR:S DECIARA'1'ION ELECTRIC PERMIT QT'I' JOB DESCRIPTION
CZ wins=tion'nllkl)ofNiisim3ordr Busitreaul Nofeui Cod,, myhceueis RESIDENTIAL.:
IAOPERMIT ISSUANCE
F u;[[-�� infunfic aad ennnn. ❑SfUWL El KITCHEN REMODEL
-,:UV profs My Cmvano AITLIANCFS-RES11i ❑ADDITION [:1 PLUMBING RF.-PIPE
toad ❑MULTI-UNIT O sTRUC uKAL
'Don ZiL ARCHITECTS DF.CIARATIUN PANELS
ZO,nZ Imdn,aid my pk^+rlWlhc tncd is ryNic recorN MODIFICATION
DP TD 2g1AM15� C3 INTERIOR El CHIMNEY REPAIR
W ucrn Pmfrnimnl 201.1000AMPS UIPROVEMFXT C]SWIMMING POOLS
z $.,.1 OWNER-BUILDER DECLARATION OVER I(XX)AMTS ❑BATH REMODELIREPAIR ❑DEMOLITION
C w a I hereby of ora that I am exempt Britain,Contractor,Li,enr,laM w far t
L�yS C U following r=um.(Sce'ti,n 70315.Hanines,callProfcsione Castle Any city or ewnty SIGNS ELECTRICAL OT}!GR
wiry,Icyllirc,a 1r-nnit to nmaruct alter,;naMO,den clisa,oa repair nny.Vrv,one ]/ L
F.- Prinnu h,ia,wmcc,al,o quits its,,pllonl forwch'rininn filoasigwd,atamem SPECIALCIRCUU-NISC.
4 O
yny; that he 1,lin:nsedlwtont to lbe ptovisiunx ofthe CnuscuMn Licena,law(Cnaptn9
a�GO (cmmwncingwilh S=finn 90(0)of Divisioo3of11w Busiwa ail Profd'eiom CoIr)nr I RMP.MHPER OR POLE IN COMMERCIAL
a a c IY Omt Ir is na nyn Wcrcftom and arc Ansi,for th,al1<gN c,<mplior.Any violation of ❑NEW BLDGIADDITLON ❑DEMOLFFION
Way S=tionM313bymyapMl tfaalrrmituthj=I,thcepplicanttoacivd Pcoeltyof POWER DEVICES ypNT ❑FOODSERVICE
I-?Qnu antic Ilse five hutdncd dallan 15N0). lei OVI7.IFXT
❑ I.v wrtcr of the pray,-10,my empbyttr wish wage as tbeh rale coaffir—kal, SWIMMING POOL ELECDUC
�(_.� will dofib,work.Wald,wra,ran,is m inaMN nr Mfnti far mk(Saar, i,Bust. OTHEit
W
a end Prof.Cone:The Contncte(,Liceme Taw Jars mr apply to an weer of OUTIJ.7s-SWITCHES-Fl)('IURES
profeny whr builds u impmv,a tMcan.and who access wch wort:h ilea f u through
his Own empkOcat povidcd that such inn anw rcn0 art not inrn hal cr canard for NEW RESIDENTIAL R FCTR SQ PT.
•dc.ILbmvn,r.thebuiWingaiml*cwai iswMwithin erre yea of fin at,
SQ.FT.FLOOR AREA $JSQ.FT
nor-builder seal have an,btvd,n of proving that he did not tvid er innpmve Ter Ira-
pune<ofvale.).
0 I,as mwwr of the pro,,n,,an,exclusiu'<ly wnnWong with Iicenmd mnlrnelerns to TOTAL:
amnvun the project IS,701.Hr,o s and Pndemiom Castle,)Th,Conner...Li-
e ac law do„n,applye'on ownsof p,n"ywho halideor inynove,tlteann,and QTY. -
%hoamtractsfor.such pmj=rt with a contracmg,l lice tl panuunl to ac Confradrc'i
uc,m¢law. FERMI N
❑ l am exempt under S=. ,B&P C Tor this mason
ALTER-D EA VALUATION
DmC
r WORKER'S COMPENSATION DECLARATION BACK ROM' Am
Io by affirm mat pmalty of pnjury arc of tk fallowing hclemtiam: a RID
O lhneamwillmainuinaCa fimicof Conmmfodf-inwmforw'ak ,%Compen- DRAINS-MOOR.ROOF AREA,COND. STORIES TYPE CONSTRUCTION
mtkn,a Provided for by Section 3700 of th,I.aIsr Cu=e.for dtc peRonami er the
work for which this pnotil is issaM FlXTU
I hove aml will resonant WerkcF,Cmrpensauon laconsa',e,antenna!by S=lion
3100 of(bit Labor Code,for tM ptfmnarce ofdtc work few which this permit is issued. GAS- '.GROUP 2L�0 4
My Wmkcds Canpcnsnticn lirmm�a cornu vd Po iry numna m,
Ciamer: Policy Nod GAS-EA.SYSTEM-0VER Y(FA)
CERTIFlCAIEOF EXEMITION FROM WORKERS' GµIiASIIINDUSTµh WASTE INIERCEFIX)R OO
COMPENSATION INSURANCE BUILDING DIVISION FEES
llitl,wnioa mcdrirbcro,aple,ed ifthe,rmat is forum huNrcd dollar,($110) GREASE'TRAP — -
eiJ PLANCHCCK IIA?
or I
I cenify lhatin the perfwnance ofah wmk for which this permit is i,mcd.I mall SEWER-SANITARY-STURM EA.20 FT
al employ any pco sn v =
in my rant u, to home rohj=t to dr WakaV Compen- ENERGY FEE
z scion Lawn of California.Date WATER HEATER W/VEM/FJ.ECTR GRADING FEE
Z O Afro
y NOTICE TO APPLICANT IL sfar making thu Certified,of Eangak,n,you shad WATER SYSIEMa`DtEYHNG
F be,ome subject to IN,Wohela Cmryea,stion pani,iean of flue lobar Cade.you wan SOILS FEE
retMwifh carnplY witheich pro,iOarO or this permit dull h d=rool revoked. WATER SERVICE
Q
�Z
CONSTRUCTION LINIIING AGENCY NDW RFSIDFMIAL PLMB. SO FT. __ PAID Dm—R Is
C..1 O IberMyal(rm Net tlGeis e<tmrlN,liMllcrding egrncY Tor the peafomarr,nr I^ r-\ F-1
the work hr which thin pamrl rs i,wcd(S=.NAI,Cis.Cl i t 1
0 1-crasn,Nmr TOTAL:
U AL:
LtJ Icrdc,'e AMlfis
6. amS
ity Ilan I have read this application ad,al,II the aMm
wc Inforatinn is 1 BUILDING PCD
to correct. agar n.comply wim all shy aM cranny onllwnra,and,wm lawn mla0ng m QTY. MECHANICAL PERMIT aE
V Z buikm
ling,onstctirn,mol hembY autMxi.c rcpmamlVim nl lh,,oy la entcre,ca the I I M111C F,; ju
ahrvonentirmca p,npmy for inspection popows. PERMIT ISSUANCE
(W,)agr=m mare,indemnify and keep herail<u the City of Cupcnino aeunst Fl.[CTRIC FEE
IM,iifia.Itdgm,na.<osa east expense which may in my way ascot,e,,masaid City ALTER OR ADD TO MECH.
arasctltrn<,ar m,gfanang ar lain pamia Rv PLu$lelNC FtiD
APPLICAN UN ERSTANDS AND WILL COMPLY WITH ALL NON-POEN AIR HANDLING UNIT(TO 10.000 CFM) MECHANICAL Flif:
SOURCE RI G0' C�
AIR HANDLING UNIT(OVER I0X(O CFM) CONSTRUCIIONTAX
SigSig omit i FXHAU,STHOODGYMUC) HOUSING MITIGATION FEE
R IARDOUS MATERIALS DISCLOSURE
Will the,pphcantarfin.buildingfcco,ont stns or h.ndle havNatss material
HEATING UNIT(f0100.000 B'N)
ax cle inN by the Cupenino Municipal Calc,Clulr,r 9.12,and the Halth end Safety
Ctsk,Station 25532(e)'f I HHA'I'ING UNIT OVER 100,070 BTU)
�Ye A�/�C�' VCNIILAIION FAN(SINGLE RISIII) PAID Uua H=cigM
WiII Ibe amtl'tcanl u futurt hiMling murynt u.va equipment or devices which
• ,,roil ha,artI n,air eonumiv`yn,,`ac=-fated by dr Bny Ara Air Qualify Mmagenrcnt 11014.1?R-COMP(111P OR 101,0X1 BTU) TOTAL'
D'rvrkt�Yw IY No BOBLER-COMP(OVER 100,000)BTU) v
I ,w,and the taurdota armaiials Rynirtrrrnn untrr C'hspfa 695 ofd,Cali- AIR CONDITIONER ISSUANCE DATE
funk Hralfh&Winy C Ssiaa 25505,25533 oral 21514.1 tadosaah that if tk NEwr RESIDENTIAL MECH. SQ.I.T. Z (]
huildingrkrsnte t=an.that ifvmy n,spaaidlify fo tuifY the waaPw J
M dr mgli '�IaisttattR nr.CmlBar,afo,cotwaO,
\ _
(lwrcr me T(ITAI' ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO -
BUILDING PERMIT INVOICE OPERATOR: kecenb
Sec: Twp: Rng: Sub: Blk: LOC:32609005.00
INVOICE DATE. . ....: 01/05/2000
REFERENCE ID # ...: 00010013
SITE ADDRESS ..... : 20019 GREENLEAF DRIVE
SUBDIVISION ...... .
CITY ... .. ........ : CUPERTINO
IMPACT AREA . . .... .
OWNER . ..... . . . . .. : EASY FORTUNE
ADDRESS ... . . . . . .. :
CITY/STATE/ZIP . ..: CUPERTINO, CA 95019
CONTRACTOR . . . . . ..: LIC 4
COMPANY ....... . ..:
ADDRESS ...... . . . .:
CITY/STATE/ZIP . . .. ,
TELEPHONE .... . . . .:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
-TEMP P 57.50 0.00 57.50
EPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
93.02 0.00 93.02
E ID --__ ...
VOICE ID - DESCRIPTION-
-. ........ ...... ...ee...
3 UFER 309 ROUGH ELECTRICAL