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99110096 `I.1 ?ULC ANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY — — / 9_ Z CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT N BUILDINGDrvISIDN APPLICATION/1"FPLUMBING-MIICHANICAL 'BUILDINGPROJECT IDENTIFICATION BUILDINGADDRISS: SANITARY NO. APPLICATION SUBMITTAL DATE 8.2 d lG.;ti. ONA �f / _Q AOL /21"I NIC CONTROL M iCHITEC(ENGINEER: ff LIC NO: A DRC ' ❑ CON'I'AC'P PHONE: BUILDING PERMIT INFO, ❑ Consultant Fees Paid by Applicant(initial) BLDG ELECT PLUMB MIEECCIHH ❑ ❑ ❑ G LICENSED CON I censed under p DECLARATION of CON ELECTRIC PERMIT ' FEE. 1 hereby antrm mm I am hpenxm under provisions of Chapter 9(commencing Q 1 JOB DESCRIPTION W0Z with Section7")of Division 3 of the Business and Professions Code,and my license is RESIDENTIAL O in PVT ISSUANCE N ty full force and ellcaff .jam i 1 1 le �uU hicenxc I {••� Cm,' 'i L ❑ADITIWI, ❑PLUMBIKITCHENREMODEL hzw Dam�� � sw Com oral APPI.In ES-RIiS1UENTIAI. []ADDITION [I PLUMBING RE-PIPE ARCHI I EC'I'S DECLARA'f10N ❑MULTI-UNIT ❑STRUCTURAL a N PANHIS ZO—Z IundemanJ my plans shall he axedazpublic records MODIFICATION oz-- UP'f0 2fp AMP. W Licensed Professional [I INTERIOR El CHIMNEY REPAIR 201-H)GOAMPS IMPROVEMENT (]SWIMMING POOLS O C Oat I not exempt front The ContractRATIONor's OVER l"AMPS ❑BATH REMODELREPAIR (]DEMOLITION O I hereby uflim,that 1 em exempt from the Comrumor's License hew for the paj 3 LL F following reason.(Section 7011.5,Business and Pmfessions Code:Any city or county SIGNS ELECTRICAL. ❑OTHER W+ O y which requires a permit to construct•alter,improve,demolish,or repair any arocture qq prirnnirs issuance,also requires the applicant fncmch permitm Ele asigneJ smremem SPECIAL. C C Yt„r1y that he is liansal pursuant to provisions nl'the Contractors W�ha 9 0. W dedhe is exemitn Seneica.modJnf Division?neallegdheBmlicee t C i E COMMERCIAL, tl d G C Nm he is exempt themfmm and the basis for the alleged euro t Iasi f [I NEW BLDG/ADDITION ❑DEMOLITION X.n u• Section 9(I3L5 by any applicant for a permit suhj«ts the septic p W y ° ❑TENANT ❑FOOD SERVICE F m more than Eve hundred y,or on,om)' IMPROVEMENT aQ ❑ Lothe work,and the structure is m offerse'sxlhulreo ape P . . will Jn the work,and thexwcturc is nm intended ornlfercdfor sale(S NJ,B ❑OTHER 3 m and I'rofexsions Cwk:The Cnmmctor's License law does not apply r ..T - propcny who builds m improves thereon,and who does'ach work It tt g RIF his own employees,provided that such improvements ate nor intende e d for NEW RESIDENTIAL ELECTS FT. sale.IL hnwe'en the huildins nrimpmvcmem i'xnld wiNin one he Q.Ff.FLOOa AREA (1 $I .Fr.. ownersolder will have the burden of proving that he did not h uITT ILII posese of of ole.). D ❑ 1, owner of the property,am exclusively professions with .t r to NOWAL: constructmtheesnot (file.oan wnerof and rtywhobuidsori he sntmeturxId - r NOV 1 7 1999 Cot— come Law dtsforsch apply teas with ofpropertywhubuildeorimpro the Contractor's 'rY. PLUMBING PERMIT FEE who umrrecrs for such projects with a ronvamor(s)licensed pursuant the Contractor's License law' PERMIT ISSUANCE ❑I am exempt under Sec. ,B&P C for this reason LR-DRAIN&V HIST-WATER(EA) Owner Du e TION-- WORKER'S COMPENSATION DECLARATION PACK ' OW PROTECT.DEVICE 1 hereby affirm under penalty of perjury one of the following declamtionic J(O I have and will maintain a CeniticmcofGm'cnfmscl-insure for Worker's Compen- DRAINS OR,ROOF,AREA.GOND. STORIES IF,CONSTRUCTION sada,m provided for by Section 3900 of the labor Code,for the performance of the Crk for which this permit is issued. FIXTURES-PER AP 1 have and will maintain Workers Compensation Insurance,as required by Section "10 of the labor Code.for the rermnnance of the work for pwhich ibis permit is issued. GAS-F.A.SYSTEM-1 C.40U1LEfS OCC.GROUP My Work 'eC pen.' n/ rtran a Pol it Palle NOBS oycy4we07 GAS-hA.SYST[ OVER '.A) /y Canicr y CERTI CATS OF EXEMPTION FROM WORKERS' ` COMPENSATION INSURANCE GRF:ASMNDUS'I'RLWASTEI CEPTOR (This xaion need nor In completed if the permit is for nuc hundred dollars($100) BUILDING DIVISION PEES or ex") GREASE TRAP PhANCHECK PEE I cenRy that In the perfoummaceof the work forwhich this Permit is issued,l shall SF.WEN-SANITASY-STORM EA.200 FT. not employ any person in any manner so as m neci me subn jeco the Workers'Compen- ENERGY FEE O Z scion laws of California.Data WATER HEATER WNF.NT/LLF:CTR 0 Applicant GRADING PEE . NOTICE TO APPLICANT:If,alter among this Certificate of E.c.,ption,you Amold WATER SYSTF,MR READING becrnne xubjecr to the Worker's Compensation provisions of the Labor Core,you must SOILS FEE UJ forthwith comply with such prowWom.,this permit sha116e mrevoked.ked. WATER SERVICE 0. Q CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.PT PAID U 0 Ihcrenyallirnt thattnere is a cousoumtion tenting aguncy far theperfunnonceof Date Receipt 1L the work for which this permit is issued(See 309],Civ.C.) F0 Lender's Name TOTAL: WLender's Address TOTAL: 1 certify shut I have real this upplmmion and stare that the above information is ., BUILDING FG:E Val corect.I scree m comply wlthall plied countyordinanees and slate laws relntingm ,QTY 1 MECHANICALPERMIT FEE U Z buildho,msmactiot,and otho hefehyarire reprcsenmtives of this city to enter upon the SEISMIC FEE aMve-mentioned pmpeny for impartian putpo'cs. (We)ag.emsave,indemnify and keep harmless We City of cugainnagains PERMIT ISSUANCE ELECTRIC FEE babithno,pidgmenrs,possend expensed which may in any way acnriontinst'oid City AL'I'Fit OR ADD'I 0 MECH. consequencein of the gmmin,.1 di is permh, PLUMBING FEI3 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,(00CFM) SOUR. '..TIOF,GitA•y NS. A IV/ 1'`� CONSTRUCTION FEE (�j(�/-�NSA. � �� L AIR HANDLING UNIT(OVER 10,000 CPM) CONSTRUCf10N TAX Signamre of plicuntlGmuamor Date EXHAUST HOOD IW/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE. Will the applicant or future building nonfarm store or handle hazardous material / HEAPING UNIT(TO I W."BTU) as defined the Cupertino Municipal Cnee,Chapter 9.12,and the Health and Safety Crclq Section 255321x)? HEATING UNIT(OVER 100,000 BTU) ❑Yes F-1 No VENTILATION FAN(SINGLE RCSID) PAID -- Date Receipt at Will ms applicant in fnmm building occupant use equipment or devices which :ir buzurJou'air nmmminam'as refined by the Nay Arca Air Quality Mansgement BOILER-COMP(711P OR 100.000BTU) rsvicFl TOTAL: ❑Yes ❑No BOILER-COMP(OVER 100,000 BTU) I:have it the haisakas mareria6 requiremun ent' der Chapter 6.95of rhe Cali- AIRCONDHIONER l/l ISSUANCE DATE forma Hcuhh&Subtly Code,Secti°m 25505,25533 unit understand that if the NEW RESIDENTIAL MECH. SQ.IT. building docs not currently have it cram,that it is myresponxlhifity to notify the occupant If/ •' .�T rf Qytprluiy�effi ti which be ten prionoiamnce ofa Cenificam of y. tI 1 f Owner ar rhunmd agent D,ff TOTAL: ISSUED BY: OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: chrlstya Sec: Twp: Rng: Sub: Elk: Lot:35919042.00 INVOICE DATE. .. ...: 11/17/1999 REFERENCE ID # ...: 99110096 SITE ADDRESS .....: 820 KIM ST SUBDIVISION .... ... CITY ............. : CUPERTINO IMPACT AREA ...... . OWNER ............ : BELLEFEUILLE ROLAND E AND JEAN ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4323 CONTRACTOR ....... : LIC N COMPANY ....... . ..: ADDRESS .......... : CITY/STATE/ZIP .... , TELEPHONE ........: FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------_ BREMHEAT P 6.11 0.00 6.11 MPERMITFEE P 35.52 0.00 35.52 --------- ------------ ----------- 41.63 0.00 41.63 VOI .E ID ...®----DESCRIPT10---------. VOICE ID DESCRIPTION .. ........ ............................ UNDERFLOOR HAMS 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS •