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00010023 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PEKMG NO, BUILDING DIVISION APPLICATION/PERMIT PLUMBING"MECHANICAL _ SOoo' BUILDING.PROJECTN I IDE 'IFICATION NUILDING ADDHI!SS • rf�.�,O T 'ANI ARY NO, APP/L•ICA'I'ION tiU11�MjITIAL UA'1 ZO 41 r�� '�� •/{lifer) l/ / .- �XC O O OWN FJt:S NAMI': CW /\ � : O� C NTiACfOR'S Nq F: LIC NIC 14\S f�j V S N/C CONTROL# ARCHI I'ECI'IENGINCER; LIC NO: D 1 !'1F�r FSq:, gv '� + �A ^ . ❑ CONFACC PHONE: �#-lr� BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG F,L�ECI T//PLDA1I3 t1ECH ❑ 1 J ❑ ❑ LICENSED CONTRACTORS DECLARATIONQTY ELECTRIC PERMIT FEE I toothy arfilrn nm 1 on licensed coder residues Of chapter 9(commencing JOB DESCRIPTION �aZ with Section 7010)of Division 3 oche kaciness and Pndessians code.rad mylmcnse is RESIDENTIAL: won PERMIT ISSUANCE. 04-1, Liao�rock3,red cfft� O Lia a 3� 7- C STOW], C KITCHEN REMODEI 6_u APPLIANCES-RESIDENTIAL CADDII'ION C PLUMBING REPIPI: h Q a Dam Cnmmclnr ARCHITECTS DECLARATION ❑MULTI-UNIT ❑STkIICTI1RAl. F.D w PANELS MODIFICATION Z p h Z undcrclmW my plane shall be need u,public rccONx OZ-� UPTO 2Ip AMPS [I INTERIOR El CHIMNEY REPAIR F..~.LL Licensed Pnsrmsioval 201-100DAKIPS IMPROVEMENT USWIMMING POOLS 0. CLARATION -' uW�1 Q nonny aflimt thx�I am x!mp EGnmEme Canvas or's Licence Ww for me OVER IWK)AMPS C BATH REMODELIREPAIR C DEMOLI HON X 3 6 U following ma,on.(Section 7030 5,B-itic vnd Professions Calc:Any city-amply SIGNS ELL'CI'kICAL ❑O'I'IIEk U LL h which requires a permit to construct,alter.improve,demolish,or repair any structure k^muo prior toils is-mee,al.m requires theappliaum for etch pemtil to Glc a signed statement SPECIAL CIRCUIT/M ISC, that he k licenced pursuant u)the provisions of the Contrvctnls Licens Law(Chapter 9 LJIIan7010)rlDM,ion 3 of he Bnsima,md POJ r,la.s Co,N)or 'PEMP.METER OR POLE INST. COMMERCIAL �p0 (commenting with Sc[ ' LJ E c C that he is exempt therefrom and the basis for the alleged exemption.Any violation of C NEW BLDG/ADDITION C DEMOLITION XmLL Scotian 703 5byany upplicamIbr aIandit suM1Jects the opplirmom a civil penalty of POWER DEVICES uJ"tn ❑TENANT ❑FOODSERVICE 04Z nor more than five hundred dollars S500).Y IMPROVEMENT EMI N'T_ =6 ❑Lac owner of the pmpeny.onny entployres with wages uc nc�innle cmnpensmion. SWIMMING POOLELECTRIC F'p.� wink.and Castle aContra,mamstotmwnded orow does apply Business TITER W-w and Professions Curie:The Contrucwrs Licence Low dcee not apply to an owner of OUTLETS-SWITCHES-FIXTURES or property who builds or improves thereon,and who docs such work himself or Ihnegh his own employees.provided that such improvements m,not intended or offered for NEW RESIDENTIAL F"LECFR SO sole.IL however. of bending Orimprovcmcm isodd wohiaone year of completion.'he O. IT.FLOOR AREA $ISO.Pp. Pp. will have the burden of proving that he did not build or improve far per pose of mle.0. ❑1,as m Owner of the ppenml y,am exclusively cnrracling with licensed contractors u, TOTAL: e mvarct thepmjen(Sec 7044,Business and Professbac Cede:)The Conunetors Li. crave Law docs tat apply to an owner of progeny who buihk or improveslhereon.and QTY. PLUMBING PERMIT FEE who amlmas 1'or such pmjens with a ennuaemr(s)licensed pursuant to Ibe Conuamora Licence Law. PERMITISSUANCE ❑I am exempt under See .R&P C Or this resort •Owner Date ALTER-DRAIN&VENT-WATER(EA) VALUATION WORKER S COMPENSSI']ON DECLARXI ION BACK FLOW PROTECT,DEVICE 1 hereby mHrm under Penalty of perjury one of the following declarations: I have and will maintain a Cenificate ofCouseed to self-insure for Worker's Compen- DRAINS-FLOOR.ROOF AREA,COND. xmion,as provided far by Section 3700 of Na Labor Code,Gu he perfinmvnec Of'heSIORIES TYPE CONSTRl1LTl( work for which tris permit is issued. FIXTURES-PER TRAP ❑I have and will variant.W..ker'c Comptmylio.Insaranc.,ad rv,mooJ by Stenon 3700 oftfie Wbor Cade.far he perfrinoweof the work for whichrhis permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP AI' C War c' c"py ti lyyryu ce cnnicr;mJ Policy. O y � Cortico f4V bY� Policy No.:�I GAS-EA.SYSTEM-OVER 4(EA) CIiRTIP1CA'IT:OF EXIiMPI'[ON FROM WORK13k5' 'V 39 COMPENSATION INSURANCE GREASEANDUSTRL WASTE INTERCEPTOR (r his section need not be unopened if permit Ire is Income hundred dollars(5100) BUILDING DIVISION RESor lens.) GRGASGTRAP PLANCIIECK FEE Loy any that in the performmcmfthc work for whichthisi,, issued.I fall SEWER-SANITARY-STORM EA.200 FT not employ any pcnnn in any manner m ns m become euM1jca lr Ibe Wodcri Compcn- ENERGY FELr Z our.Laws of Califnmiu.Doc Q WATER HEATER W/VF.NT/ELF,CI'k Z INDU am F[[ NOTICE"TO APPLICANT:If,after makingthis provisions of Exemption,you should WgTlik SVSTIiM?RGAI'ING .�' bcu.ne scoop m the Worker's visions or this pmvisians of the Labor Code,you most SOILS PI3G - forthwith comply with such provisions or this pemtif shall be deemed revoked. WATER SERVICE � "" i t r N Q 0 CCONSTRUCTION LENDING AGENCY NEW kLSI1lGNT1ALPI,MB. SQ,FT PAID U 0 k for hick his permit i ii a ed(Sec.30 len ding agency for the perfarmaruce rf ' -` Ddtc -�� Raeipl# F the wad for whist This pertnil is iesuW(Seo 1097,Civ.CJ U Lenders Name `n s 2 L: Lenders Addross TOFAL: Fr" y 1 certify Ihat I have read do,application and seta the the above infnmmtion is BUILDING I� U!) cooed.1 agree w comply with all city ant]county ordinances and swat laws adding in QTY. MECHANICAL PERMIT FEE V Z building mnslmninn,and hereby authoriec repreunmtives ofnis city to enmrugm the SEISMIC FEE / almvcnemianre 1.ertyter,for admunmtionpueep ha. PERMIT ISSUANCE s (N'c)agree m save,indemnify an,]keep harmless the City of Cnpcnina agoiml 17"EC FF"li inenillequenc of egra and expenseswhich may in any way acerae againm sail Gly ALTERORADDTOMECO ^ seyucncc of he gmndng of this permit. I'LUMBWG ITE ' APP fIVTU 'DERSI'ANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLINGUNIT(T010,1100CFMt SOU] "H REC .AFIONS. MECHANICAL FEE Ae1 AIR HANDLING ON]F(OVER I WSW CIM) CONSTRUCTION*1'AS Signature dApp icanVComwcmr ' Doc EXHAUST HOOD(WIUULT) HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEE: 00it he applicant or future building ovepont store or handle hmardons material 11I7ATIN'G UNH'(TO 100.1100 ETU) as defined by the Cupertino Municipal Code,Chapter 9.12 and the Health and Safety Gds Nation 25532(a)7 1117ATING UNIT'(OVER 100,000 BU) El Yes ❑No VENTI LAI]ON PAN(SINGLE RES I D) PAID Will the applicant or future building cecupam use equipment or devices which Uma Receipt# emit hamrdrus air contaminants as defined by the Bay Arty An Codify Monvganent BOILI!R-COMP(91IPOR 100.000ITID D.gdm9 I OIAI.: L]Yet r-1 No BOILER-COMP(OVER 100.000BTU) I have read the dons nationals requirements under Chapter 6.95 of the Cali- A I R CONDI'1'IONER zur' ISSUANCE DATE C> fomia Hcallh& 'stet)Gdc.ea oo .that i 25533 and 25534.1 to nemtand Thal if the NL'w RESIDENTIAL MECH. SO.FL offficonng o�: rcon n1lyhaveale..t that it is my responsibility ui nvJimnatify the occupant /.,_ / Z, Ohne ngny-tneroo etch moa lc met pdromismmnm ora(If�Er�w oylbapaner. Y Owner or vo orize agent 1 1/Dam TOTAL: ISSUED BY. _ OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: nancyc Sec: Twp: Rng: Sub: Blk: Lot:30942039.00 INVOICE DATE..... . : 01/06/2000 REFERENCE ID # ... : 00010023 SITE ADDRESS .... . : 20441 E HOMESTEAD RD SUBDIVISION .... . . . CITY .... . . . . ..... : CUPERTINO IMPACT AREA . . . .... OWNER CUPERTINO DE ORO CLUB INC ADDRESS .. . . . . .. .. : CITY/STATE/ZIP . ..: CUPERTINO CA, 95014 CONTRACTOR ..... . . : LIC # COMPANY ....... . . . : ADDRESS ....... . . . . CITY/STATE/ZIP ... . TELEPHONE . . . ..... : FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ------___-- BELEC1000 P 44.40 0.00 44.40 BUSLIC P 90.00 0.00 90.00 EPERMITFEE P 35.52 0.00 35.52 169 92 0.00 169.92 E ID .... --DESCRI PION ... .... VOICE ID . ....DESCRIPTION ...._ ................. 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • CITY OF CUPERTINO • 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot:30942039.00 DATE ISSUED. . .. . ..: 01/06/2000 RECEIPT p. . . . . . .. . : 11097 REFERENCE ID 4 .. .: 00010023 SITE ADDRESS ..... : 20441 E HOMESTEAD RD SUBDIVISION ...... . CITY . ...... . .. . .. : CUPERTINO IMPACT AREA . .. . ... OWNER .. ......... . : CUPERTINO DE ORO CLUB INC ADDRESS .. ........ : CITY/STATE/ZIP ... : CUPERTINO CA, 95014 RECEIVED FROM . ...: TIM CONTRACTOR . . .. .. .. LIC 0 COMPANY .. ........ : ADDRESS ... . ... ... : CITY/STATE/ZIP . . . . TELEPHONE ........ : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL __________ _____________ _______,___ ---------- ---------- ---------- __---..__- BELEC1000 METERS 1.00 44.40 0.00 44.40 0.00 BUSLIC FLAT RATE 1.00 90.00 0.00 90.00 0.00 U4ITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 ..+L PERMIT 169.92 0.00 169.92 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ __________________ CHECK 169.92 1951 ...... TOTAL RECEIPT 169.92 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ............................ 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL Oty. if Applicable Fee ID Fee Description Fee Group �SPERNIFEE JBLDG PERMIT FEES (BUILDING • I IBCONSTAX (CONSTRUCTION TAX ISUILDING IBENERGY (ENERGY SUILOING SENERGYADO (ENERGY ADD MULTI IBUILDING BOVERTIME INSPECTION OVERTIME (BUILDING BTEibIPPERM ITEMPORARY BLDG PERMIT IBUILDING 6MITIGAT IHOUSING MITIGATION FEE ISUILDING BPLANCHK IPLAN CHECK FEE IBUILDING BPLANCKADD PLAN CHECK ADD MULTI BUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSCBLVD SCS SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING BSEISMICRE SEISMIC FEE RES BUILDING BSPECIAL SPECIAL INSPECTION BUILDING BSWIM SWIMMING POOL BUILDING ZAODCHG JADDRESS CHANGE BUILDING EPERMITFEE JELEC PERMIT ISSUANCE ELECTRICAL BELEC1000 ELEC 600V<=1000A ELECTRICAL BELEC1001 ELEC 600V>1000A ELECTRICAL BELEC200 ELECT SVCS 600V ­200A ELECTRICAL BNEWMULTI MULTIFAMILY RES ELECTRICAL BREMBUSWAY REMODELBUSWAYS ELECTRICAL • BREMFIXT LIGHTING FIXTURES ELECTRICAL BREMMISC MISC APPARATUS ELECTRICAL BREMNRAPP REM NON-RES APPLIANCE ELECTRICAL BREMPOLE POLEIPLATFORM FIXTURE ELECTRICAL BREMPOWER POWER DEVICE/APPARATUS ELECTRICAL BREMRECEPT RCPTL, SWITCH &OUTLETS ELECTRICAL SREMRESAPP REMODEL RES APPLIANCE ELECTRICAL BREMSIGNAD RMDL SIGNS ADD BRANCH ELECTRICAL BREMSIGNS REMODEL SIGNS. MARQUEE ELECTRICAL BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL SSF&2FAM SINGLE&2 FAMILY ELECTRICAL BTEMP TEMPORARY POWER ELECTRICAL BTEMPSVCS TEMP DIST SVCS ELECTRICAL MPERMITFEE MECH PERMIT ISSUANCE MECHANICAL BAPPLOTHER OTHER APPLIANCES MECHANICAL SBOILERI BOILER <= 100,000 BTU MECHANICAL SBOILER2 BOILER>100KTO500K BTU MECHANICAL BBOILER3 130ILER>500KTO IM BTU MECHANICAL SBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL BBOILERS BOILER > 1.75M BTU MECHANICAL BREMAPPLI APPLIANCE INSTALL MECHANICAL BREMHEAT HEATER INSTALLATION MECHANICAL BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL BMNEWMULTI NEW MULTI-FAMILY RES IMECHANICAL • BMNEWSF&2F NEW SF&2F RES SLOGS MECHANICAL 1 oft Revised 91ION9 v 9RESIACOVER ]AC UNIT >IOGOGCFNI INtECHANICAL JBREMAIRHAN JA/C UNITS <= 10.OGCCF,,,I IMEC,HANICAL IBREMFURN RELOCATION OF FURNACE (MECHANICAL • BRENIFURNOV RELO FURNACE > ICK STU MECHANICAL BREMINHOOD INSTALLATION OF HOOD MECHANICAL BREiNIRELOCA IRELOCATION OF HOOD INIECHANCAL BREMREPALT REPAIR/ALTER HEATING MECHANICAL BREMVENSYS IVENTILATION SYSTEMS MECHANICAL PPERMITFEE JPLUMBNG PERMIT ISSUE PLUMBING BNUMULTI NEW MULIFAMILY RES PLUMBING BNUSFD NEW SINGLEFAMILY RES IPLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING BPCESSPOOL CESSPOOL PLUMBING BPFIXTURE PBLG FIXTURE PLUMBING BPGAS GAS PIPING SYSTEM FEE PLUMBING BPINTERCEP IND WASTE INTERCEPTOR PLUMBING BPREPIPE REPIPE OF FIXTURES PLUMBING SPSEWAGE SEWAGE DISPOSAL PLUMBING SPSEWER SEWERS PLUMBING BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING BPSTORM STORWRAIN WATER PLUMBING BPTRAP KITCHEN TRAP PLUMBING BPVENT ALT OF DRAIN &VENT PLUMBING BPWATER INSTALUALTER WATERPIP PLUMBING BPWHEATER WATER HEATERIVENT PLUMBING BPWSVCS MAIN WATER SERVICE PLUMBING . ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING ZDIRTM OIR TENT MAP PLANNING ZFULLHR FULL APPL BASE+HR PLANNING ZFULLTM FULL APPL TENT MAP PLANNING ZFULLUP FULL APPL USE PERMIT PLANNING ZFULLZONE FULL APPL ZONING PLANNING ZGPAMEND GENERAL PLAN AMEND PLANNING ZLIMAMEND LIMITED AMEND PLANNING ZLIMTM LIMITED TENT MAP PLANNING ZLIMUP UMITED APPL USE PERMI PLANNING ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING ZMINHILLEX MINOR APPL HILL EXC PLANNING ZMINSIGNEX MISC SIGN EXCEPTION PLANNING ZMINTM MINOR APP TENT MAP PLANNING ZMINUP MINOR APPL USE PERMIT PLANNING ZMISCASA MISC ARCH SITE PLANNING ZMISCEXT MISC TM AND UP EXT PLANNING. ZMISCFENCE MISC FENCE EXCEPTION PLANNING ZMISCGEN MISCELL APPL GENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING ZSIGN SIGN PERM( PLANNING ZTEMPSIGN TEMPORARY SIGN PLANNING ZVARIANCE DIRECTOR VARIANCE PLANNING 2 of 2 • Revised 9/[0/99