99110135 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY / Q 3�
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO
BUHA9INGDIVISION APPI.ICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENT11FICA1'ION'
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
OWNS AME: PHONE: CONTRACTOR'S NAME: LIC NO: �^�
NIC CONTROL is
AIIIIIIIIII, A;'t 11 (.44— Its Lb
ARCHI FECTIENGINEER: LIC NO'. ADDRESS, ❑
CON'I'AC'I. PHONE: BUI ING PERMITINFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG E ECT PCU I M C
El 'ULfhI
LICENSED CONTRACTORS DECLARATION Q'TY ELECTRIC PERMIT FEE
I hereby.fthm that 1 am licensed ander prwislom of chapter 9(commencing JOB D-SCRIPTION
OZZ with Semon 7000)of Division 3oftheUasinessand Pedroiuns Code.and my license is RESIDENTIAL
WOO PERMIT ISSUANCE
CLLF in full force and eRe LAk < `, ❑SFDWI. ❑KITCHEN REMODEL
QUV Licen.wE-ZED __Cy'yz Conor tel` C-] APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
\R RECTS DECLARATION ❑MULTI-UNIT [I STRUCTURAL
Z p H Z I umdemmtd my plans shall be used as public ore ds PANELS MODIFICATION
OZ—O UP TO 210 AMPS El INTERIOR El CHIMNEY REPAIR
(•-�,E.,W Licensed Poic,sional 201-1100AMPS IMPROVEMENT - C]SWIMMING POOLS
Q " OWNER-BUILDER DECLARATION
C W'X. J OVER 1000 AMPS [-1 BATH REMQB VREPAIR ❑DEMOLITION
Q I hereby uRmn 0aI 1 am exempt front ate Couu'uctur'e License Law tin the
O y U fidlowiog mama.. IS...ion 9031.5,Brnino,,,nd Prum,,iom'Calc:Any city or munly SIGNS ELECTRICAL ❑ HER
W 3 LL y which,ego lis,a pennim m commam,min,,improve,demolish,or mpaia any sfiven
FLL06 pdono Els issuance.alsoregaire,lbeappficam tbrsuch"pri,to me a signed waemrnt SPECIAL CIRCUFUMISC.
F os ohm he i.,licensed pursnam m da, ovi000,ifthe Contractor's license Law(Ch..ptu9
(rommercingwith Se,niun 7000)of Division Sof Ne Business and Profess ions Coda m TEMP.METER OR POLE INST. COMMERCIAL:
Y C e ow but he is caemp therefrom and the basis mor the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
Wna' Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of POWER DEVICES ❑TPNANT ❑FOODSERVICE
had mom than five hundred dollars(Syed). IMPROVFJrt6•NT
f=� ❑I.as owner of the property,or my employees with wages as their oke compensation. SWIMMING POOL ELECTRIC t 4^
F. will do the work.and theswcmre is not intended or offered for sale(Sec.EDW,Business ❑�QTHER �•.�
a3 and Proles.ions Care:The Corbel License Law does not apply to an owner of OUTLETS-SWITCHES-FLITURES •�
pro,cny who builds or improve,thereon,and who does such work himself or through
his own employees,provided that such hopowcruents am not intended or offered for NEW RESIDENTIAL ELECB 5
le.If.however.the building or inrpraventnn i.,soldwhhi,oncycm.fcomple.ion,the
uS el'.FLOOR AREA SISQ ff.Iaildcr will bum:the burdam of pnvmg that he did not build or impmvc far pur-
❑ L un owner of the property,am exclusively contracting with licensed contractors to TOTAL:
construct the poise(Sec.70a,L 9,sina,s and Professions Code:)'Me Commetor's Li-
seUs.does mol apply to anowner,ofpropcny who .ild,o,impmvc,therenq and QTY. PLUMBING PERMIT FEE
who commas far tech projects with s o maao7s)licensed pursmnt m the Co arimba s
Liccmc I . PERMIT ISSUANCE
❑1 am encesempt under Sm. .B 8 PC for this ream,
ALTER-DRAIN Ar VENT-WATER(EA) VALUATION
Owner Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
1 hereby affirm node,pemlty of perjuryane of the following declaration O�
�w .us provided f
I have and will maintain a Cerihcate of Consent to self-insure for Worker's Co.,.- , URAINS-FLOOR.ROOF AR A,GGND' STORIES TYPE CONSTRUCTION
an Im by Section 39(61 of the Lubar Calc,for the performance of the
ark Iia which dsi,petmn m issued FIXTURES-PER TRAP
and will muinmin Workers Cn u,mmion In... r,as required by Section
3901 tat the isobar .Cnde.for 01...ou'un,c of the work l'nrwhidnhis snail In tenant. GAS-IEA.SYSTEM-1 INC.4 OUTLE I'S OCC.GROUP MIN
My Wm cFZi CnJypvnc 'on tint'n� c,Noy mmher arc: C— GAS-BA.SYSTEM-OVER 4(HA)
Carrier: _ policy FROM
C-RYIFICATE OF EX:h 'ION PROM WOR E GNLASFIINDUSTRL WASTE IM'ERCEPIDR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(This section need not bo completed if the peril is for one hundred dollars ISIDO) GREASE TRAP
or las.) PLANCfiIECK 14iE
I ecoifythzl in the piffermmeraf the work forwhich this permit is issued,l shall SEWER-SANITARY-STORM EA.20)F..
not employany person in any manner se o us somfor subject to the Worker:Cooper- ENERGY FEE
OZ satin.Inws of Culifnmia.DaT/
Date WATER HEATER WNENF.LECUR GRADING REE
ZO Applicant
h NOIICH'IO APPLICANT:If.after nmking this Cmihcac of Exemption,you shoulJ WATER SYSTEMoUREATING
Fhcmna subject to the Worker's Compensation provisions of the Labor Code,you must SOILS ITE
WIbrthwilh comply w hhwch provisions or this permit shall he deemed revoked. WATER SERVICE
� z NENI'IALPLMIL SQ. AID Dm. Receipt#
CONSTRUCTION LENDING AGE NIEW RESII
U O I hcrebyaffrm thm,sre is,,up,b iiuu lemdlmgageney fins, if nnanecof
W (, the work lir which In,permit is issued(Sec.3099,Cil.CJ
TOTAL.
O U lenders Name
Lcndcr's Address TOTAL:
} 0. I certify that 1 have read this application and stela that the above information is BUILDING FEE
.F., (n correct l agreem comply with all city and county orshispe.s and state laws relating to QTY. MECHANICAL PERMIT I FEE S':ISMIC PtiE
U Z building construction,and hereby authorim represenmtives of this city to enter upon the
ihwumeminral property rorinspcction purposes. FIAI.TERORADDTOMECH:
SUANCE F�PCIfRIC FEE�U U 111
(Wc)agree to save,indemnify and keep hornless the City of Cupertino against
Iiuhilitics.judgments.costs and apenscs which may in any way same again"said CityADDTOMECH: PLU RINin.,,sequence of the granting ofthis permit.APPLIC NTUNDERSTANDS AND WILL COMPLY WITH ALL NON.POINTLING UNIT(TO Iq(M)CFM) ESOl C [I FLAT'IONS.
� IRHAHOOD NI'I'IOVF.R IB,lp1lCPM) STRUCTION TAXSignra of Al ant&ommetur Dere HWD(W/DUCT) O .SING M ITIGATION FCEHAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupainoom nr handle haaaNnus mmeriatUNIT(TO 100.(0(1 BTU)
defined by the Cupenioo h1umcipal Cola Chapter 9.12,and the Health and SafetyCode,Section 255321 )7 UNIT(OVER 100.00 BTU)
ElYcs Ems ' VENTILATION FAN(SINGLE RPSID) PAID Da¢ Receipts
Will the applicant or future building occupant use equipment or devices which BOILER-COMP DRIP OR 100.100 BTU)
mit hmmdous air contaminants a defnN by the Bay Arca Ar Quality Managemem TOTAL:
10001E BOILER-COMP(OVER[00.000BTU)
❑Yes ;eels.
AIR CONDITIONER
it Ithe h d t `t y t: d Chapter 695 (the CuT 155 ANCE DATE
rim` ILulth K Sit)Code.Scnoro 25505 25533and25534 1 paidersiond the Tithe Nbed RESIDENTIAL MECI I. SQ.LT. //11
bnildl I' Bvhavea mon,dont y':1 'bltyl ify the ncwpwn ��s- �/'-��
aft msntsw Lh tet st Fe ncl priono s"ttnsof.Co t IO.upaey
Owner ter uwbm tad..gem Vee' 'I OTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: yvonnek
•
' Sec: Twp: Rng: Sub: Blk: Lot:32652019.00 '
INVOICE DATE. . . . . . : 11/19/1999
REFERENCE ID # . . . : 99110135
SITE ADDRESS ..... : 10353 MARY AV
SUBDIVISION . ..... .
CITY ..... . . . . . . ..: CUPERTINO
IMPACT AREA . . . . . . .
OWNER .. . . . . . . . . . . : SCHWAB CHRISTOPHER M
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1340
CONTRACTOR . . . . . . . : TRILLO, KELLY LIC # 4269
COMPANY ........ . . : ATLAS HEATING
ADDRESS ....... . . . : 155 SAN LAZARO AVE
CITY/STATE/ZIP ... : SUNNYVALE, CA 94086
TELEPHONE ....... . : (40B)939-0516
NOTE: THE FEES LISTED AAE ONLY THOSE DUE BEFORE PERMIT PRINTING
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- -----------' -
BPVENT P 8.33 0.00 8.33
BREMAIRHAN P 8.33 0.00 8.33
BREMHEAT P 6.11 0.00 6.11
BREMMISC P 25.53 0.00 25.53
EPERMITFEE P 35.52 0.00 35.52
ITFEE P 35.52 0.00 35.52
ITFEE P 35.52 0.00 35.52
--------- --- -----------
154.86 0.00 154.86
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ...........----:............ .:______ ___..............
'--------__
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
509 FINAL PLUMBING 508 FINAL MECHANICAL
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