00010168 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY Q C--?O / O If
CITY OF+CUPERTINO BUILDING-ELEC'RICAL PERMIT NO
CITY
BUIE ING DIVISION APPLICATION)PERMIT PLUMBING-MECHANICAL. S
BUILDING PROJECT IDENTIFICATION
BUILDING DDRE.SS; SANITARY NO. APPLICATION SUBMITTAL DAT
OWNER'AML.-MaS NAME - PH E: CO TRACE R', N MF;'. LIC
Z
�,. / _ NIC CONTROLp
CHITECT/EiNCINEER: LIC NO: RES ❑
o� 4
CON'I'AQ': PHONE: BUILDING PERMIT INFO
❑ COnfaullanl Fees Paid by Applicant(Initial) BLDG IiLLCI' PL�U�M(g MECH
❑ ❑ �[ ❑
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT Fll
1 hereby amrti+that late Iiren.ed ander pmvixlona ofchapmr 9(eomin,harm, JOB DESCRIPTION
woz with Scnion J(loo)of Divisiun3of We Business and Profess twCore.an ylicensel.
m O PERMIT ISSUANCE RESIDENTIAL,
1-.I F in full force and effect. ❑SFDWL ❑KITCHEN REMODEL
U U Lice ahe Lic.N
Nae Dam Commetor APPLIANCES-RESIDENTIAL ❑ADDITION El PLUMBING RE-PIPE
ARCHITECTS DECLARATION PANELS ❑MULTLUNIT El STRUCTURAL
Z p y Z 1 understood my plans shall be used as public records MODIFICATION
O Z—_n UP TO Zoo AMPS ❑INTERIOR El CHIMNEY REPAIR
Far. `W Linmwd Prot—inoal
C 201-If1DBAMPS IMPROVEMENT
M Y f'1 OWNER-BUILDER DECLARATION C1 SWIMMING POOLS
p5 Q 1 hereby affirm that 1 am exempt from the Contractors LicenseLaw for the OVER IBrlo AMPS El BATH REMODEUREPAIR El DEMOLITION
yj 3 W F following reason.(Section 9031.5.Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER
w which require,a permit m co®muet,alter,improve,demolish,or repair any stmaure
; prior o nes isxuance.allo requires the applicant ler Such permit to rile a signed stromwet SPECI AL CIRCUIT/MISC.
}Q shat he is I Icetised pursuanun the Provisions of the Conmacmle License Law(Chapter 9
W5,Zp (commencing with Section TKild of Division 3 of the Business and Professions Code)or TEMP.M61'ER OR POLE INST, COMMERCIAL'
Ii 6 e C that he is exempt therefore and Nes basis for the alleged exemption.Any violation of El NEW BLDG/AUDITION El DEMOLITION
IS, Section 703 L5 by anyap,l,camfor.permitsubJects dre.,llcient to a civil penalty of POWER DEVICES []TENANT ❑FOOD SERVICE
net more'ban five hundeed dollars(5500). -
_�
El 1,as owner of the property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
dsbo will do the work,and the smachmv is not intended orortered for vale(Sec.70Ff.Business ❑OTHER
413�o and Professions Code T'he ComrucmdS Liecnso Law docs not apply to on owner of OUTLETS-SWITCHES-FIXTURES
L
property who Wilds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR
sale.IL savior,the huildingor imprcvement is sold withinone yearefo+mpletion.the SQ. FLOOR AREA $1SQ,ET.
tier-Wuilder will have the burden of proving that he did not build car improve for pur-
pose of sale.)
1,as owner of'M1c property,am eulusivdy nmtracting with licensed cons tors m TOTAL: -
consumer the protect(Sec.90.00,Business and Profio sxons Codes:)The Centretlnr's Li-
seI.aw docs nor apply In an owe"id pnipeny who builds or improves therum,and QTY PLUMBING PERMIT PEE
who contracts for such priests with a commcmgs)licensed pursuant to the Contmcmd
License Law. PERMIT ISSUANCE
❑ I um exemptundcr Sec.- ,B&PCfor this. on
Owner Date ALTER-DRAIN&VENT-WA'1'f7RFAO VALUATION
WORKER'SCOMPENSAary h DECLARATION RACK FLOW PROTECT.DEVICE.
1 hcrcby aRrm under penalty of pe jury he as the following declarations: W
I have unit will encinoln a Certificate of Consent o self-insure for Worker's Camper- DRAINS-FLOOR,ROOF.AREA,CON..
'ion,as provided far by Section 370 of the Lber Cole,for the performance of the STORKS TYPE CONSTRUCTIOI
r
(or which this permit is Issued, FIXTORES-PER TRAP
have and will maintain Workers Compensation Insurance,as required by Section
37M of the Labor Code,for the performance of he work fieryrwt{hiich this permit is i//sw�((e��d GAS-EA.SYSTEM-]INC.4 OUTLETS OCC.GROUP APN
Cy Work dj?yi n.urance carrier oand Policy ypi �tel_,n'LYJ GAS-EA.SYSTEM OVER 4(LA)
' r P1 FROM
�7O/ 3JW ll0/�
CERT IFIC O OF COMPENSATION
INN FROM WORKF,RS'
COMPENSATION hVSURANCE GRFASF/INDUSTRL WASTE INTERCEPTOR
(This sec0nn nerd not be completed file,po.ir is finene hundred dollars(8100) BUILDING DIVISION FEES
nr lc>.) CREASE TRAP PLANCHECK FEE
Loy any whohin the performmeso as toWnnork er Subjectch to the Wrks,,' d.l,halfper- SEWER-SANITARY-STORM F.A.2011 IT
not employ any person in any manner so as m bewmc subject m the Waders'Cnmprn- ENERGY FEE
O Z sauna Laws of California.Dam WATER HEATER WJVENT/GLECTR
Z O Applicant GRADING FEE
e, NOTICE TO APPLICANT:IL after making this Certificate of Exemprom.you should WATER SYSTEMO`REATING
> become subject to the Workers Compensanen provisions of the Lahr Core,you must SOILS FEE
W forthwith comply with such provisions or this Mrshil shall be deemed revoked. WATER SERVICE
p O
U z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMN. SQ.FT. PAID
V QIforewhicht ilhauhe¢issuerr(See,onlonJing agency fur'he performnnm of Date Raeiprp
the work for which this permit i.issued(Sec.3092 Civ.C.)
Lemke,Name
O V Lender's Address TOTAL: TOTAL:
Fy I certify that 1 have read this application and stare that the above information is BUILDING FEE
V] corren.I agree as comply with ml oily and county ordinances andaate laws helaling to QTY. MECHANICAL PERMIT
U Z building construction,and hereby amhonze representatives of this city to enter upon me FEE SEISMIC FEE
alwve-mentioned pmKby for impeaion purposes. I'ERML'I'ISSUANCE
(We)agree masa,indeormly and keep mentleas the City ot'Cupertion against ELECTRIC FEE
Iiabilirics,jedgmenrs cos¢and expenses which may in any way accrue against said City ALTER OR ADD TO MECH.
in nxquence of the granting of this permit. PLUMBING FEE
APPLICANT' lDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT 10,000 CFM)
SOURCE RE ATIONS. MECHANICAL FEE
INL u(/�/O yy/S AIR HANDLING HIT I'(OVER W."CPM)
//YfV 7r V r0 ✓(/ CONSTRUCTION TAX
Signamtt ofd Lic manr Uwe 17XHAUST HOOD(W/DUCT)
AZARI)OUS MATERIALS DISCLOSURE HOUSING MITIGATION FEE
Will the applicant or future building wcipam store or handle Wharf material HEATING UNIT(TO 100,OBl)BFU)
as def tied by the Cupertino Municipal Core.Chapter,9.12,and the Health and Safely
Cole.Section 25532m)? HEATING UNIT(OVER 100,000 BTU)
El Yes We
Tut' VENTILATION PAN(SINGLE RESID) PAID
Will the applicant orantra building riuse equipment or devices which Die Receipt N
haenrdnuS air contaminants m ,he Bay Area Air Quality Management ROILGH-COMP(3HP OR I fIQq(XI RTU) 44
V
staid^
❑Yes Ry(Jo TOILER-COl1P(OVF.R 100.000 BTU) TOTAL: �a
I have read Ue M1uaNuus mamrials teyuimmcnu under Chapter 6.95 of rhe Cali- AIR CONDITIONER
L.cro,
h&Safe v Code.Sections 25505,25533 and 25514.1 nnderstonJ Ihnt it the ISSUANCE DATE
snor cu ally hovcurewmnhm it i.my rcxponsihililymnmily Ne occupant NEW RIiSIDENTIAI,MECH. SQ.FT.
em t. mW nor c met
prior m issuance of a CeniOeam of Occupancy.
Stthonze Dam TOTAL: ISSUED HY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: chri.tya
Sec: Twp: Rug: Sub: Blk: Lot:35611014.00
INVOICE DATE.... . .: 01/28/2000
REFERENCE ID k . . .: 00010168
SITE ADDRESS ... .. : 8107 HYANNISPORT DR
SUBDIVISION . .. ....
CITY ........ . . . ..: CUPERTINO
IMPACT AREA .......
OWNER ... .. .......: WILLIAMS PHYLLIS
ADDRESS . .........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4063
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
ID DESCRIPTION VOICE ID =DESCRIPTIO ...
...... .............. ........ -------
SEWER
..SEWER S WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB h OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING