99080031 1 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 00-0 1
/ CITY OF CUP!,;RTINO BUILDING-ELECTRICAL PE
BUILDINGDIVISION• APPLICATIONIPERMIT I'UUMBING MECHANICAL
BUILDING PRfIJ I:CT IUEN'I'14'[CATION
/ BUILDING ADDRESS: SANITARY NO. APPLICA'I'[ON SUBMITTAL DATI
OWNI,,RXNAME: Plfl li: CONTNAC—)R;S NAME: LIC NO:
0 h) L -- 'C I NO, DD I i v 3 L' NIC CON/TItUL q
RCIIITECI'/ENGINEER: LIC NO, ADDRESS ❑ g5(0J
:ON'I'AC'P ' PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELLE L ICI' - PLUMB MIiCH
❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY. F,LECTRICPERMIT FEE
]herehy ar[ro that I ant licensed under pmvlot is of Chnpmr 9 0wmntencing JOB DESCRIPTION
WoZ mSteai.n7000ptrnlvidonlonhe Bucinesa and rroression.ante,and my manse is ESILR RESIDENTIAL,
W O PERMIT ISSUANCE
F�� in tali fame ante ca. ❑SFDWL ❑KITCHEN REMODEL
QUV License Cl LCine t sK APPLIANCILS-RESIDENTIAL
F z W []ADDITION [I PLUMBING RE-PIPE
Dale — ontractor
tn2y ❑MULTI-UNIT ❑STRUCTURAL.
ARC]111'PCIS DECLARAI'[ON
zb,/Z undersrns my plumshall Be used-public records PANELS MODIFICATION'- UP TO 2M AMPS
oz-a El INTERIOR D CHIMNEY REPAIR
PQat-w Licened Professional 201-1000AMPS IMPROVEMENT SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER]big)AMPS ElBATH REMODEIIREPAIR ❑DEMOLITION
C d 1 hereby effum that I nm exempt from❑m Cunvaanr'e I,-nw,Law fa Nc
X
ow
U following reason,(Section 7031.5.Business and Pr lesions Cade:Any city or county SIGNS ELECTRICAL
41 LL h which requires a Permit to construct,alter,improve,demolish,or repair any structure !•7
0 J prior its issuance.also requires the afflicamfar such permit no file o signet statement SPECIAL CIRCUIT/MISC. f' N ,
that he is l teemed purmam to the provisions of the Contractor s Lwcnw Law(Chapter 9 f '
(connnc..air,with Station 700houl Dickman Sol he Haveemund Prmresxcm,Code)no, TEMP.MET ER OR POLE INST. CC) FOAL
a a c C that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDI"PION ❑DEMOLITION
��a Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
of mom than five hundred dollars($5000. IMPROVEMENT
FSC ❑ Las owner of the property.or my cntployees with wages es thei...lecompensation, SWIMMING POOL ELECTRIC
wilitho hawork,ant theWruelmeit not intended n oncred linsale(Sec.9044.lbal,ness 1
yl C m and Prolusions Cade: Hot Comment's Littnse Law Jas not apply m an owner of OUTLL' -SW I'C
6 property who builds or improves thea..,and who deux such work himself or Ihmugb
dad that such iso t art not intended or offered for NEW R ALE FT FL )R AREA E/SQ.FT.
his own however.
the
provi proveold z
sale.IT,hewer will
have
buildingh or improvement A Arman is sold within one year of completion,the
cr-milder will hove 0c burse.nfproving that he Aid not bnllA or improve for pur-
pose nl ante.). T.T.
❑ h as owner of the prrpeny,am exclusively contracting with licensed contructnts to t
contruca the project(Sec.7141.Business and Pmfesslon Code:)The Co.oanor'I Li-
xLawdoesnotapplytoanowner-of property whit builds or improves thereon,and QTY. PLUMBING PERMIT FEE
who anonels for Such pr jets with u a.nraemr(s)licensed pursnnntto the Contractile
License Law, PERMH ISSUANCE
E]land exempt under tiff. ,B&P C for this reason
ALTER-DRAIN&VENT-WA ) VALUATION
[)are
WOR KERS COMI'IINSATION DECLARAI IOION BACK FLOW PROTECT.UIiVICE r1
(hereby aflirm underpenalty nl perjury aneuf the following Acc]ormion,v: �d UI V
Ihme and will maintain a Ceni&ate of Consent losclf-insure far Worker's Com pen- DRAINS-FLOOR,ROOF.AREA,CONT. STORI TYPE CONSTRUCTION
as Provided for by Section 3710 of Ne LyMn Code,for the performance of the
rk for which this Kninit snootiest FIXTURES-PEk TRAP
❑ I have and will maintain Workers Compensndon Insurance,as required by Section
3700of the labor Code.knia,pert.nnunce of the work Lavinia,[,ispermit ix i...ed GAS-EA.SYSTEM-I INC.4 OLD EI'S OCC.CROUP AP
My Worker's Computation lnwrance caner and Policy number are: /G
Cartier Policy No.: GAS-PA.SYSTEM OVER 4(EA)
CERI'IFICATEOFEXEMPT10N FROMWORKERS' 3 Z
COMPENSATION INSURANCE GREASUINDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES
(fhis-s"lauwad n llc,cwtPlcmJ it'the, it ix for ouch—earddollarx IS 100) GREASE'fRAP
nr less.) 1'LANCIIIiCK TEE
I cenifythen in thcperfort.ntt.ftne work fnwhich ahispetmit is issued.)shall SEWER-SANITARY-STORM EA.200 FT.
not employ any person in any manner so as to become wtt
bjeco the Workeri Compen. ENERGY FEE
Z lotion Laws of Cub rmiu am WATER I ENIER WNENT/ELECTR
Z O Ap,fikatri�/C mom/ GRADING EEE
NOTICE'1'O APPLANT:If,after making Nis Ccniliwm of Lxcmption,you should NATER 51'STEM/TREATING
VillSOILS FEE
F becntM subject notion,Wildcat's Compensation provisions of the Labor Code,you must
forthwith comply with such provision or this permit shall be deemed revoked. WATER S17RVICE
Q
Z) CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLM(; SQ.PC PAID —Um -Rcecipt
L)O thereby anion that there is a construction lending agency for the Performance of
U. F-' the work for which This permit is issued(Sec.307,Civ.C.) u
Q U Lender's Name a d
Lender's Address TOTAL:
r d¢nlfy that 1 have rutd this upNicmion and same that'he above infonnatbnt is BU L)NO PEE
Ncomer'.I agree to comply am all city and evenly ordinances and some .. re]atingm QTY. MECHANICAL PERMI'P FEF. SEISMIC FEE
U Z building construction.and hereby authorize representatives of this city to enter upon the
.hove-mentioned propcny for inspection pur ares. PERMIT ISSUANCE
(We)agree to save,indemnity and keep hurmleos the City or Cupertino ugaita
Iiubilines.judgmcros,"I'w ons expenses such may inmty way accrue against will City ALTER ORADD'1'0 ME 1]
PLUMBING FEE
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM) MECHANICAL FEE
SOURCE REGULATIONS.
AIR HANDLING ON[((OVER I0.0s)CFM) CONSTRUCTION TAX
:'gummul ApplicanVComorcon J JDate EXHAUSTHUUD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or mum Wilding occupant store or handl hazardous material HEATING UNIT(TO 1(X1,000 BTU)
as returned by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety
Codc,Section 255321aT1 HEATING UNIT(OVER 1003,000 BTU)
❑Yes 0N VE,,"LAI'ION FAN(SINGLE RESID) PAID Dam Rec - te
Will the applicant or future building occupant use equipment or devices whichr
hardwnairnnnumann¢as felines by the Bay Area Air Quality'Management BOILEk-COMP(3HP OR[00.000 BTU(
cv
riot BOII,I!R-COMP(OVBR 10.100 R'ITI)
❑Yes I]No
I have read the hazardous materials tequiremenn under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DA
f.mia Health&Safety Code,Station.25505,2550 and 25534.1 ondersnded that it the NEW RESIDENTIAL MECH. SQ.ET.
bullmng fres ma,, rcnly have it meant,that It is my msponsihllhy nr notify the tracpana
([1e yuiremems whichumna Wnatapriormisxoanec aft Cethia'mDe ofo loolspaneylilloo, G (T
Ulm TOTAL: V!
Owner or authoriuJ agent ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
_ CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Elk: Lot:31646032.00
INVOICE DATE...... : 08/04/1999
REFERENCE ID # .. . : 99080031
SITE ADDRESS . ....: 10293 MINER PL
SUBDIVISION . . . . . . .
CITY . . ...... .. . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . ......... . : LEE KON K AND VICTORIA Y
ADDRESS . . . . ...... :
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-2012
CONTRACTOR .... . ..: MATTHEWS, GERALD R LIC 4 19281
COMPANY ..... . . . ..: ACTION AWNING
ADDRESS ....... . . . : 439 FIELDCREST DR
CITY/STATE/ZIP . ..: SAN JOSE, CA 95123
TELEPHONE ... . . . ..: (408)629-8007
FEE DESCRIPTION CHK TOTAL FEE 'PAID-TO-DATE BALANCE DUE
. --------------- --- --------- ------------ -----------
BENERGY A 38.10 0.00 38.10
BPERMFEE P 127.00 0.00 127.00
BPLANCHK A 107.95 0.00 107.95
BREMMISC P 25.53 0.00 25.53
B RECEPT P 1.11 0.00 1.11
IE P 0.70 0.00 0.70
i .TFEFEE P 35.52 0.00 35.52
335 91 0.00 335.91
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
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 L 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
5D5 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
CITHADDROSS:
INO.. . ER "N
BUON
BUILDING PROJECT IDENTIFICATION
B1111. SANITARY NO. APPI.ICAI'ION SUBMr I.[)At
/
" OIWfNlilt'.tiNM1C: P I1NIC'. CON'1'NACIpH:S NnMI?: LICNO
..{'S ✓::.:N '/ _ L/C y NIC CONI It01,p
-11111:(171: w LIC NO. AIA)Rl.SS: v ❑
BUILDING PERMIT INFO
INSPECTIONS DATE INSPEC ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑' E2" ❑ ❑
FOUNDATION/PIERS/H.D.S. INSPECTION RECORD
JOB DESCRIPTION
UFER GROUND NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL
PAD/SETBACK-CERT SHALL BE INSTALLED TO COMPLY WITH ❑SFDWI. ❑KITCHEN REMODEL
THE APPROVED PLANS AND CITY OF ❑ADDIMON ❑m.umnlNG RE-PIPE.
GARAGE:SLABS/PREGUNITE CUPERTINO STANDARDS. ❑muixi UNIT ❑STRUCTURAL.
MODIFICATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED TO ARRANGE INSPECTION ❑INTERIOR ❑CHIMNEY REPAIR
UNDERGROUND/SLAB CALL. AF'TI?RN DONS lL•1111 PM1I - 4:311 I'M) Im PROVIiMEN'1' 0 SWIMMING I'(A)I.S
❑..A'1'II REMODELIki;yAIR ❑DI!MOI.II'ION
PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE-
F-1_ECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS DOTOM fi!
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED AND PERMIT#ARE NEEDED WHEN PHONING.
COMMERCIAL{
PLUMBING ATTENTION CONTRACTORS: ❑NEWBI.DGrnuuHION ❑DIHMUIrnoN
NO PERSON(S)SHALL PERFORM WORK ON ❑'ranANr ❑FWD SERVICE
MECHANICALTHIS J013 SITE WI'T'HOUT BEING IN COM- ImPRovl MervT
ELECFRICAI_ PLIANCE WI"FH WORKERS'COMPI'sNSAI'ION �onusk
FRAMING VENTS INSURANCE REQUIREMENTS.
INSULA'T'ION
wsvec'noN SPECIAL INSPECTION REQUIRED ❑ DATE INSP
PLACE NO SUBFLOOR UNTILABOVE HAS BEEN SIGNED
ROOF SHEATH/DIAPHRAM
PLUMBING
TUBS&SHOWER PAN I
MECHANICAL
,I;CTRICAIJPOOL 13OND
.<AMING/S'T'AIRS/E.EGRESS
I NSUI_AI'ION/VENTILATION
COVER NO WORK UNTIL.ABOVE HAS BEEN SIGNED
EXTERIAL SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SI]171—rWROCK/SHEI:I'ROCK SHEAR
EXTERIOR LATH/W-SCREED
SHOWER LA'I'R
NO TAPE OR PLASTER UNTILABOVE HAS BEEN SIGNED
SCRATCI I COAT'
SEWER/WATER
TEMPORARY APPROVALS
OCCUPANCY
ELECTRICAL
GAS
FINALS .....__._...__..._._.._
GAS"I'FS'f
GRADIS
FIRE �•_ —
99 ' '+
HANDICAI'
ELECTRICAL
PLUMBING _.
ECHANICAL
.4ERGY
-VISUAL FINAL ONLY ICERTIFICATEOF OCCUPANCY El
BUILDING IMPORTANT: ISSUANCE D�7S
OCCUPANCY OF BUILDING ISN TP R ITT PLFAS13 READ REVERSE SIDE BEFORE �.�'
UNTIL BUILDING FINAL IS SIGNED BY BUILDING CALLING POR FINAL INSPECTION!!
INSPECTOR. Issuul ay:
APM ICANT'R POSTING COPY