99090125 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY ZS
CITY OF CUPERTINO BUILDING-ELECTRICAL.
BUILDING DIVISION APPLICATION/PERMPfPLUMBING-MECHANICAL.
BUILDING PROJECT IDEN'I'IPICATION
BUILDING ADDRESS: A N I SANITARY NO. APPLICATION SUBMITTAL DATE
20[ 400 rf e"A ow n �� d y'-2o 9
OW NAM 0C P y1 Iz i N(r (o)fo—'3R'2 l CONI HZOR S'V O M/a.T r A 4 1 NO
NIC NIC CONTROL#
14FCHTr;C ,NGINg. LIC NQ. ADDRESS: / ❑
/yINE2'I Arecl \. ` 1-4 R� Er�'d
CONTACT: PHONE; BUILDING PERMIT INTO
ToM /iC'1if A y 3GG-39 Z / ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICIiNSEDCON'HACfO DECLARATION QTY. ELECTRIC PERMIT FEE
I[artery of....root am limned under Pr -i .of Chapter v(commencing JOB DESCRIPTION
aaX wan Sntion"!UW)of Ulvlshmanl'the Buxinessund l'st' ons Codr.andmylicenseis RESIDENTIAL'
WOO PERMIT ISSUANCE
I- in full force and effect. ❑SFDWL ❑KITCHEN REMODEL
,W=U License Class Lis.M
Q U APPLIANCES-RESIDENf1A1. []ADDITION [I PLUMBING RE-PIPE
F X W Dam Comacmr
+n6o. ❑MULTI-UNIT ❑STRUCTURAL
ARCHITECT'S DBCLARAI'IfIN
X C m X I underhand my platss shall be o.al as puhhc«crndc PANELS MODIFICATION
OX-C UP TO 200 AM PS C3 INTERIOR ❑CHIMNEYREPAIR
f-t?1:W Licensed Pmfx1,ww.l 20I4000AAIPS IMPROVEMENT SWIMMING POOLS
C C Q I R DECLARATION
hereby aftirra h�I ane crop Cfra d he C mmut, n License La m the OVER I"AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION
a O G V following rcmnn.IScnlnn 9)31.5,13ufincss and Pmfcssionu Codc:Any city ns only SIGNS EL[C'FRICAL (]OTHER
'3 W y which rtquirec a permit m constmcl,alcor,improve.Jemolisn,m npuir anY swcde
E,IL prior to its issuance,also requires the applicant for such Permit m file a signed xtaewe SPECIAL CIRCUIT/MISC.
�C} Ihathe is licensed pursuant to the prov,monsofthe Contractors License Law(Chapler9
O (commencing with Section 9000)ofDlvislon 3 ofthe Business and P-ficsions Code)or TEMP.MET ER OR POLE INST. COMMERCIAL'
d d e c
that he is uxmnpt Ihcndf i and the basis for the alleged extra (iuo Any violminn of �NEW' BLDG/ADDITION C1 DEMOLITION
N Section 70315 by any applicant for a permit subjects the applicant to a civil pamlly of POWER DEVICES plaeNANT ❑FOOD SERVICE
not more than five hundred dollars(5510). IMPROVEMENT
=O ❑I.us owner of he propcny.or my employees with wages as their Hole compensation, IMMING POOL ELECTRIC [I OTHER
N will do the work.and the structure is not intended or offered for side(See.7) ,Busint,
�3 so and Profe—ons Code:'I ire Comewo,1 icense Law docs not apply ,,an owner of OU BTS-SWITCHES-PI%T S
property who builds or Improves theram,and who does such work himself or through
his own employccs.Provided deal such improremcnLs arc Hol intended or offered for NEW R SIDENT AL ELECT 'Q Fr.
sale.If.however.the building or lmpmventent is sold within one year of completion.'he
SQ.Fr.FLOOR AREA 3/SQ.FT.
mimear-hudder will have the burden of pmving that he did not build or improve for pur-
Ease I,
si woe 1* 'TOTAL:
it
r of Elm prnpery,ctrl exclusively contracting with licensed conwnon m
.Imes the project(Sec.7001,Business and Professions Cade:)The Cwfiaetor's cenve Lew does and apply to an owner of property who builds or improves[hereon.and QTY. PLU GING PERMPE17, FEE
who contracts for such projects with a contractors)licensed pursuant to he Contractors
ElIan Law. 11IRMIT ISSUANCE
❑ con cxcmqut rRc. ,B&PC fur
s
ALTER-DRAIN&VEN -WATER(EA) VALUATION
JE��
WORKER'S COMPENSATION DEC]ARA BACK FLOW PROTECT.D. ICE �
I hereby affirm under penalty of perjury one of the following declarations:
I havcand will mninmin aCerifcamof Consdrdowif-insure fen WnrkeCs Compen- DRAINS-FLOOR,ROOF.ARI. .COND. S'[DRIES 'i'YPE CONSTRUCTION
S'alion,as provided for by Section 3700 of the Labor Crile,for the rydistmanee of the
work for which this permit is issued. FIXTURES-PER TRAP
❑1 have and will araimaia Www cA Compcnvtion Insurance,as required by Section
3701 of the LaNa Code,for the perhrnname of the work for which this permit is issued. GAS-EA.SYSTEM-I INC.4011TL S OCC.GROUP_ / APS}l�
My Worker's Compensation Insurance varier and Policy number me; f 6 .2
Caner: Policy No.: GAS-EA.SYS'I'F.M-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASF/INDUSTRL WASTE IMERCE /
COMPENSATION INSURANCE BUILDING DIVISION FEES
Tmis.sedion need not becoomic,ed ifthe pemait is forme hundred dollars(S 100 CRF,
or less.) rMit PLANCHECK FEE
I ecrifylhm inthe performonttol lhework lar which this permit vissued.I shall SE\VER-SANITARY-STORM 2W FI'.
not employ any peown in any manner so as m Execrate subject m the Worker,'Compen- f� f5 GY FEE
O ,Z s do.laws ofcarfomia.Date wATj6 apr�rd: vi:{1t
z O ApplicantP"WOW
H-t tiN01 ICE 10 APPLICANT':If,alter making this Certificate of Exemption,you should Wang ontrOQJtulan Or
> become subject to the Worker's Compensation provisions of the Labor Code,you mull v f:6 118 UUIU S Pf?L'
forhwith comply with such provisions or this perrnll shall he deemed revoked. WATIf Sjc¢j11Or EL;UII
CONSTRUCTION LENDING AGENCY Need �DDTWT�' n reviswM PAID A—
p [hereby wf..nthat there is a connruetiar lending agency for the performance of Dom REaipt
he work lin which this permit is iuued(Sec 3097,Civ.C.) m tete ate i
0 U Lender's Name 1.
Lcnder:Addtcss ermlt good or
1 certify that I have mad this application and slate that the above information is UILDING PEE
l..t to correct,l agree to comply with all city and county ordinances and.owe laws relating to QTY. MECHANICAL PER 'SE-'J z build'mgcomtmdion and hereby nnthurire mpmsenhtlives of miseily to enter upon the
aNwamentiowd proper,fnf inspect ion purposes. FEpq
RMF Ai
(W'E)agree to.Sava indemnify and keep harmless the City of Cupertino against EL[ RIC FEEIny
liabililics.judgmems,costs and expenses which may in anyway accrue against said City AMEH
m.cyuoncE of the granting of[his pem+il.
APPLICANT U NO AND WILL COMPLY WITH ALI NON 'DINT AIR HAN7)TW UNIT('TO III,000CF10I ;MECHAN 'ALI'CE
AIRH /UNIT(OVER IO.fIOO CF � TAX
a HXHAUST HOOD(WIDUCT) ING st", TION FEE
HAZARDOUS MATERIALS DISCLOSUH a
Will the applicant or future nuilding«cupam sane or handle harerdous material IMATING ON I'1('1'0 10L00 BTU)
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cede Section 255321o)9 HEATING UNIT(OVER 100.001)BTU)
0Y°s F7 No VENTILATION FAN(SINGLE RESUI) PAID
Omc dptN
Will the applicant or future hadding occupma use equipment or devices which BOILER-COMP(3HP OR 100.010 BTU[
,it harnNoas air contaminants as defined by the[lay Area Air Quality Management TOTAL:
Abduct? BOILER-COMP(OVER 101.000 BTU)
L" J"!
r7 No
ralhe hawdousmatcri:dsre tY factor Chatter 6.95 of the Cali- AIHCONIII'I'I(INER ISSUANCE DATE
mumu
Solely Csdr.Se tions 25505,25533 and 25534.1 understand[hal if the NEW RESIDENTIAL MECH. SQ.Ff.
the
ot k lsmoi.my o"awdolitymnotify the era,1
n¢which must lc mE 'or tQ�1fa or Icam tR yG4oriud agent V— ate TOTAL: LCYUEII BY:
OFFICE
INVOICE INVOICE. INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
. BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: RnB: Sub: Blk: Lot:31622018.00
INVOICE DATE... . .. : 09/20/1999
REFERENCE ID # ... : 99090125
SITE ADDRESS .....: 20400 MARIANI AV
SUBDIVISION .......
CITY ..... . . . .....: CUPERTINO
IMPACT AREA . . .....
OWNER ............ : BERG MARY A AND CARL E TRUSTEE
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
--------------- _-- --------- ------------ -----------
BTEMPPERM P 200.00 0.00 200.00
--------- ------------ ----------- .
200.00 0.00 200.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
FOUNDATION 102 PIERS
UFER 104 REBAA
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
311 SCRATCH COAT 313 ROOF NAIL
501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY
503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
509 FINAL GRADE 510 FINAL PLANNING
514 FINAL PUBLIC WORKS
.e
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: christya
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:31622018.00
DATE ISSUED.......: 09/20/1999
RECEIPT #.........: 10115
REFERENCE ID # ... : 99090125
SITE ADDRESS .....: 20400 MARIANI AV
SUBDIVISION .......
CITY ..... . .......: CUPERTINO
IMPACT AREA . ......
OWNER ...... . .....: BERG MARY A AND CARL E TRUSTEE
ADDRESS .......... :
CITY/STATE/ZIP .. . : CUPERTINO CA, 95014
RECEIVED FROM .... : TIM
CONTRACTOR ..... . . : LIC #
COMPANY ......... . :
ADDRESS ........ .. :
CITY/STATE/ZIP .. . . ,
TELEPHONE .. . ..... :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS AEC NEW SAL
BTEMPPERM FLAT RATE 1.00 200.00 0.00 200.00 0.00___
''"PERMIT 200.00 0.00 200.00 ______0 00
�
OF PAYMENT AMOUNT NUMBER
____________ __________________
CHECK 200.00 VISA
TOTAL RECEIPT •s a 200.00
CITY OF CUPERTINO
m 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: chriatya
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:31622018.00
DATE ISSUED....... : 09/20/1999
RECEIPT #.........: 10115
REFERENCE ID # ...: 99090125
SITE ADDRESS .. . . . : 20400 MARIANI AV
SUBDIVISION ... . . . .
CITY ........... .. : CUPERTINO
IMPACT AREA ...... .
OWNER .......... . . : BERG MARY A AND CARL E TRUSTEE
ADDRESS .......... :
CITY/STATE/ZIP .. . : CUPERTINO CA, 95014
RECEIVED FROM ....: TIM
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ...
TELEPHONE ........:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
ID DESCRIPTION--------- - .VOICE ID ..CRIPT ION
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
309 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
311 SCRATCH COAT 313 ROOF NAIL
501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY
503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL