99120137 I I
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY / 2 Q I
Cil
ITY OF,CUPERTINO BUILDING-ELECTRICAL �p.� PERMIT NO.
BUILDING DIVISION APPLICATIONIPERMIT PLUFIBING-FIECIIANICAL \
BUILDING.PROJECT IDFNTIFICATION
N U:.DING ADURI!SS', SANITARY NO. APPLICATION SUBMITTAL DATE
20 8/ bvvzm D L' Tivo , SO/ 2-
NERS NAF"& 'HONE CONTRACTOR'S NAME LIC NO:
NS ( �i O <11A,` N STV / ,r► N/C CONROI.
NCHI T 'NGGINEER ` -/ .IC NO: ADDRESS: ❑
A HV
COYLAC I: /5,aAl /7 ZNC - PHONL BUILDING PERMIT INFO
yE ���� n��, /D ❑ Consullanl Fees Paid by Appllcma(Initial) Bu)G ELE R.U❑MB MOEt
LICENSF,D CONTRACTOR'S DECLARATION (Ja QTy ' ELECI'RIC PERMIT IEE
I Iscrvhy afenn Nm 1 a...rtr.cd and«nroda�co of Cham"9(n,tm.:neing __ _ JOB DESCRIPTION
O Z dtSeyum70XB.I Di,kon3ofthc Buvil rmI Pmb,,oc sCAk.ubdu111mnsic - R SIDENTIAL:
4100 wi PERM1IRISSUANCF,
��� infullf«ccmdeff-I ❑SEOWE ❑KITCIIINREEI0DEL
IaI.....V�j Linve ClssLic.X nPPL1ANCFS-NFSIDPMIAL ❑ADDITION 0M.UMBI6G RF.-PIPE
Fly Date /J ARCHRLCPStDECLARATION PANELS ❑MULTI-UNIT MODIFICATION
Z 01uNsoamal my plans steal lk used as Public tecad.
OZ-Q U11 TO 4(10 AMPS ❑ EN TRIOR [I CHIMNEY REPAIR
1:a.v1 t:W Llcnsasl Pmfi,ysional 201-1000AMPS IMI'NOVEMENSWIMMING POOLS
CY OWNER-BUILDER DECLARATION OVER I0MAMPS ❑BATHRINIODELREPAIR ❑DEMOLITION
6 I hacM1y.(firm Nat l 1. cBusin from Nc Cmttxtors Lccnsc luso fa Ite ❑OTHER
K
O6E` wirihfollowing leaon.Permit
an cum
u I.S.Btnircss end Pr c1comiu Cade:Any city or county SIGNS ELECfRICAI.
s] {L wmKh rtt(w2.G pRmit In CMIMry[I,,liI imfmnsu dercWEm, file
rtBLg lrly aVe,mem
F'�0 prit ficisa iuuaregnlwrl toga hevlpionsnlf«C(,n(r, Tom Lccn signed]
w(g lmml SPECIAL CIRNITMISC.
CQ� (hal be ix lkcnwd patsuvm mlEC pnrvismnc of the Canlrxvire Gccnm law(CTmDa9
FMC (mmncncing wish ScNm 90IX)of Dlvlsmn 3ofthc Nusinass and Pror—loo,C«tc)nr 'I'EA1 P.M1fER3R OR POLE INST. COMMERCIAL
a d tNt M is exempt Ibaefmm send the tvau far llx WkIFd esempum.nny violminn of ❑NIiW'NIDWAUDRION ❑DEMOLITION
Section 7031.5 by wy"licenl for a pcmdl subjnu the i,dicam to a civil psmaky M POWER DEVICES TENANT❑FOODSERVICE
�yy rn vwm Wnfae buchu ddwe(5300). Ip1PR 'EMEN'
0 01.as war of flue propcmy.«my. emM3ee,with w om ss their sole conycnrmiva. SWIMMING POOL ELECTRIC
will do the wmk,ad dues.bbc is m imem[d-offered!fa sale(Sc.9044,Bmirres
L a.9 and Pmfcubuo,Cde:The Conti Linen.¢law ccs not apply to no owner of OUTLETS,—SWITCHES-Fl%TURES
Properly wts hulldx or impmven(herrn,and whor
o dies such wk himself-tltrm,h -
his own ,n emplujec provided that such Improvetrent arse rR imetdd«offered iso NEW RFSIDENIAL ELECfR SQ FT
sale.If,how'ew+.the Wilding«inupnsnw
vecnt is dwithln.,.ofcomplelkn.the SQ.FT.FLWRANEik USQ.FT.
sorer-builder will bass,the,hu thu rf Brost,teal he did not build re impmce for par-
ryuc a rale.).
C]L u owner of the progeny,em esclmivcly..,in,wdnt
with lio-scontractors to TOTAL
nnaNel IhC pri(Sea 9(1W,11osirroa vnd Prnfos:ms Cumc)The Cmlmevlx Li-
sclAwdssnor aWlymantoncr of prsgcny who bund.or tmryovec theran,and QTY, PLC MBING PERMIT FEE
wtw,.tracts f«such project with a cmo,wrous)licensed puroarl to the Conmeclor's
Liana Iavw. PERMIT ISSUANCE
I von exempt undo Sec. .B&P C fur This rescan
AI.TF.R-DRAIN&VITT-WATER EPA) VALUATION
De¢
err WORKER'S COM PIiNSATION DECIA RATION BACK FLOW PROTECT DEVICE D
I lerchRmdtr
y armpeb:dty of fwT.,cmc of lbc fol Irwin,tkulu nticns:
❑I have and will maintain a CeniGnvta of Comment to mlf-imam for WotkNs Comprn DRAINS-FLOOR,ROOF,AREA.COND. STO41ES TYPEC(1NsTRUCION
swion,as povvible!for by Section 3900 M the Editor Cce for the Perf.c of the
soak for which this pernul is isunl. EU TURES-PER TRAP
n 1 base and will maimain WarkeYs C«npcnwiao brobabse,m requird by Section
3900.(the Lha Code.firi Perfomtarceofthc work forwhicb this Bernd is ixsucd. GAS-EA.SY.STEM-I INC.3OUTI.P OCC.GROUP
My W rker's Ctxnpen®tiro Insuramc carrier end Policy number ate:
Carr, Polley Nr.: GAS-EA.SYSTFM-OVI!R 0(HN r
CERTIFICATE OP EXEMPTION FROM WORKERS' GREASFM'DUSTRL WASTE INTERCEPTORCOMPINSATION INSURANCE; BUILDING UIVLS NFEES
(This senitn Dad Trot t cumplced iflhe pemut ief«or formed"hus(SIM) GREASETRAP
or Ecu) - PIANCHECK FEE
I cent fy tlwt in the pedanurc of Nc work for which this Bernd is issttN,ISMII SEWER-SANITARY-SORM 11.-200 FT
not employ:mY Basun in any nwnrcr w os m hecourc xuhjm to the Wakmi Cumirn- EIS
IFF,
OZ vNm laws orcaloornia.Umo WATER HEA'117R WNEWTTECIR
O Applicant GRADING Ip'J:
71 z
NOTICE TO APPLICANT:IL dtm making This Cemiftoac of E emporn,ymt shond WATER SYSTEM/TREATING
I-' bccmie subject to ftWorker's Compensation Provisions of the factor Cute,Y.oma SOILS TLE
7 fsalhwith occultly with such ros'i,iom m this Permit shall nd stcmel resulted, WATER SERVICE.
D Q
iU. z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ,FT PAID Date Rccetpl M
LL IMr by which atrium lherrmt i is oord Sectirm len ding agcrcY Oe,the per4mrmc of
0 Le work Na which this permit is iewcl(Sc.JfYJ9.Civ.Cd TOTAL:
O VLender's Name TOTAL
Ierler.ndNea
y I crnifY tem 1 have sed Ibis vlglk-eliao ad stwc that do abase infwnaim kc BUILDING FTE
IA cocci l agree,.comply sigh all city ed county aslitamcs and stale laws relating to QTY MECHANICAL PERMIT FEE
U ,Z building emanation.and herebyomhorice firm oc
ldcory
fthis city to emerum the SEI5F11C FEE
ahavcmmrlirnd pnulcmy for Inspsilral p«pura'. PERMIT ISSUANCE _
(We)a,,-to save.Imknmlnd cry ukeep humtleaa da:City of CuNmmI al-mi ELEC11 IN(FEE
babilities,juJgmens,cos4 sod eapereuwtich may in any way--cmc agaim' t City ALTER OR ADD TO MECIL I IN res II PLUMBING_FEE I I n
in ember,xrce of d,e,martin,a(Nis Permit. 1
APPLICANT UNDERS PNUS ND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT CFO 10,000 CFFD I I V/ ANICAL FSE II
SOURCE It
s _ AIR HANDLING UNIT(OVER 10,000 CFM) C U
Sigralu mmcmra « rdks
DvIs EXHAUST HOOD(WIDUCI) I HOUSING MITIGATION IrEl
FiA eirfal US MATERIALS DISCLOSURE I IDV
Will the aPplicevlafulure Wilding occuryr nehahwnbus ial HER
TREATING UNIT 100.100.000, 0 BTU7 r J
C defml by the Clslcnim Municipal Code.Ctuplm H.13,and da IIea1N and Safety -��
Ctdc.Section 255331,)^ `, HIiATNG UNIT(OVER 100.000 BTU)
--------
E:1Ye, No PAID
dJf VENTILATION I AN(SINGLE RFSHU Uric RncipM
Wdthe firc iaorfsort Wflims,«solumyAea use Air Quak,Mineswhich
emit hau,sma fir cmlmllanla u deftrcd by the Bay Arra Air lTrality Maagcmrnt BOILER-NMP(,IIP OR II0.00011Tll) TOTAL
Dori BOILER-COMP(OVER 100.000 BTU)
0YeaSI/1 No
I Buse oust!the hazvdou.s mmtcriab. is under CTaptcr M1.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
scywrm o
fumia Ileelth K Safety Cde,SalirLs 255(15,23533 uu12S5}1.I uttrmmW Thal if the NEW RIMDIMI'IAL MECH. SQ.Cr 1 ( 9
building lkses not cu lylvtvuamtacuLlhmhfsntynsryxuibiliry et raifytW ixcurynt ( 1/ -
ofUrh v -« mc
Ioi.suaaafa Cenif acofaca
Own '1I. TOTAL ISSUEDBY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
. BUILDING PERMIT INVOICE OPERATOR: chrlstya
Sec: Tp: Rug: Sub: Blk: LOt:32609005.00
INVOICE DATE...... : 12/27/1999
REFERENCE ID N . . . : 99120137
SITE ADDRESS .....: 20819 GREENLEAF DRIVE
SUBDIVISION .......
CITY .. . . .........: CUPERTINO
IMPACT AREA .......
OWNER ...... . . . ...:
ADDRESS .... . .....
:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR . . .....: LIC N
COMPANY ... . . .....:
ADDRESS .... . . ....:
CITY/STATE/ZIP ....
TELEPHONE . . . . ....:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ _---__-----
BPERMFEE P 207100 0.00 207.00
BPLANCHK A 175.95 0.00 175.95
BSEISMICRE P 1.50 0.00 1.50
--------- ------------ -----------
394.45 0.00 384.45
Y