99070077 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY PERMITNO.
EBUILDING
OF CUPFRTINO BUILDING-M1 .PNI RICA(.
APPLICATIONA'F,RMIT PLUMBING-NIRCNANICAI.
DIVISION BUILDING PROJECT IDENTIFICATION
SANITARY NO. APPLICATION SUBMITTA, ATE
GADDRId �N�-
770 A► in/vTr o, — z `I- I'S NAME: PHONE: CONTR NAME: LIC NO: N2 CONTROL.
(,t �(a817R�� �6adc/ c ❑
.Culy;CI'/1?Ijk1INEER: LIC NQ ADDRESS:
h'Go
COM1TACI: PHONE: BUMIT INFO
ILDING PER
1,n /yt//COY 0"8/77 ;-Val y ED Consultant Few Paid by Applicant(initial) BLDG ELECT PLUMB _ MECH
El
LICENSED CON'TRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
JOB DESCRIPTION
I herby dfina that I an,licemed under provisions of Chapter 9(commencing RESIDENTIAL;
od'Z wilt Section]IMM))uf Divi.cion)of me Business send PromIlionn Crab,and my license ix PERMIT ISSUANCE �—
ulOp m ❑SFDWL ❑KITCHEN REMODEL
CWF full force and effect.
at
at—i" License Class Lm x APPLIANCES-RESIDENTIAL. ❑ADDITION ❑PLUMBING RF PIPE
I-6a DataCan ❑MULTI-UNIT ❑STRUCTURAL
ARCH((rUCPS DECLARATION PANELS MODIFICATION
ZZ 3 I undcrswnd my plan—mil be used nx Public records UP TO 200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR
O
F�Fy�j Licensed Professional 201-I000AMPS IMPROV BMENT ❑SWIMMINGPOOLS
OWNER-BUILDER DECLARATION OVER IOLITION
(M)O AMPS • ❑BATH REMODEVREPAIR ❑D M
K C Q 1 hereby affirm that 1 am exempt from the Contractors License Law far the El OTHER
Xa U fallowing rerun.(Section]03 L5,ffusincss and I'rufcsxions Code:Any city or county SIGNS ELECT'RICA1.
m 3 tL y which regnirex a perms ox cm+saue-inter.Improve.demolish,or repair any ourmiae U
mits ot he it censed p alsom,otcxlhcapimasofne Ciabano',Licuu Law(Chapter
SPECIALCIRCUIT/MISC.
❑ ffnn JJ pdnr
2 y nownwaring with
pSection 70th)of Diviaas 3me Conniness and
Proc Law(Chapmr9 /. R
LL�00 Oonnmencing with Section 91MI0)nl UivisionJ of the Business and Pmfeasiuns Code)or TF,MP.n11i 1'ER OIt POLE(NST. NEW BLDG/ADDITION 0DEhf01.1'f10N
a a c C ma he is exempt therefrom and the basis far the alleged exemption.Any violation of ❑TENANT [I FOOD SERVICE
�N or
Section 7031.5 by any applicant for a Permit subjects the applicant m a civil Penalty of POWER DEVICES
oat me flan f vc hundred dollars IMPROVEMENT
5pEl 1.wownernf The pmpedy,arny,mployex, i,h wages as lhcireole compenmtlnn, SWIMMING POOL ELECTRIC ❑OTHER
F will doth,work.and thes7metum+x nod imendedurullhrW forxale(Sca 7TKBwmc11 OUTLETS-SWITCHES-p1X'IURES
W�� and Professions Cale:The Cormatoas Lice se Lnw does not apply to an owner of
o. property,who builds or improves thereon,and who does such work himself or through
his own employees,prode,that such improvements wnot intended or offered for NEW RESIDENTIAL ELECTR SQ FT. SO.EL ELOOR AREA SISQ.FT.
sale.If,however,the building or improvement is sold within one year of completion,the
soncr-huilder will has,The harden of proving that he did not build or Improve for par-
er ul the Pmpeny,um enelusivuly conlrveling with Ilcenxul cnnuoelnrs to
consattO the project(See.96W,Business and PmRssions Code:)Me Comracou's Lb IBI P E
use law docs not apply to an owner of property who builds or improves thereon,and QTY.
who Contracts for such pmjece,with a contrnnor(s)licensed pursuant to the Common's
Licene Luw. PB T ISSUAN
0 Iamemotounder 5u+1 B 61'C for this reason I
////t✓/ _ nLT N&V '-Wh ?H(EA) VALUATION
WORKERS COMPENSATION DECLARATION BAC LOW PR1TT , 1
e I hereby affirm under penalty of perjury mm of the fallawiag declarations:
vl have and will maintain a Cenificate of Consent to lR-insure for Worker's Comped. DRAL OOP,AREA.COND. STORIES TYPE CONSTRUCTION
.dam,as pb,,dcd for by Section 3700of me Lahor Calc,for the performance of the FIXTURES-PER TRAP
work tot which this permit is ixsu,d.
❑ I have and will maintain Worker's Com sanwalon Insurance as required by Secfinn �-A
3700.f'be Latah Card"Iola,pcnormoraeol the work for which this permit is issued. GAS-EA.SYSTEM-1 INC.i OUTLETS OCC CROUP
My Worker's Compensation lnmrance carrier and Policy number ore: GAS-EA.SYSTEM-OVER d(EA) 3
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERSGREASPONDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES
COMPENSATION INSURANCE
(Ihis ti w omdnm h,..... lided ifthepeand.,foron)hwdmddollm(SI()B GREASERAP PLANCHECK FEE
or Icss.l
Ioyany thin in the any
ymannr of the work for whichthis
to the w rkera' arope0 SEWER-SANITARY-STORM EA.200 F7. FiNERGY FEE
new aiemploy any Person in any manner m as m hcnme subject to the Wnrkeri Compen-
Z ration Lows of California.Dam WATER HEATER WNENT/f:LECTIt GRADING PEE
Z
Applicant
NOTICE'10 APPLICAN P.11,after making this C)nificam of Exemption You should WATER SVS'fliM?REA""PING SOILS FEE
F-' berm..)sabot to the Wmkcrx Cmnpenxalion provisions-I mc Iatm Code,you must
U.1 babo It nply with...hpr..omms onus permit shall he deemed revoked WATER SERVICE
y � NEW RI'SIDENTIALI'LMN, SG.PT. PAID
CONSTRUCTION LENDING AGENCY Dae Rudptx
U O Ihereby affimuhat there is a construction lending agency for the performance of
me work for which this permit is i...ad(Sec.3(N7,Civ.CJ TOTAL.
OU LcnJcr'x Nunte TOTAL:
>-ILaid...Add mss BUILDING PIiE
y 1 cenily Ina 1 have mad oris application send smle that the wove Information Is FEE
Fy corms, l agree In comply with a 11 city and amav ordinances and state laws mining a+ QTY. MECHANICAL PERMIT SEISMIC ITE
L)Z buildingconarvaion.and barely onhorim mpmscntadvesaftbis city memer.pon the
a,we-mcmioned property for inspection purp+us. PERM]"1'ISSUANCE ELECTRIC FEE
(We)agree to save,indemnify and keep harmless the City of CuPenino again
hadalita.judgments,corsunit expense which nay In any way nccm)ognintsaid Cit ALT ER OR ADD TO MSCI I. PLUMBING PEE
in nnseyuence of the gunfn,of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON PONT AIR HANDLING UNIT(TU IIkfMW CPM) MECHANICAL PEE,
SO tC RBLA/TIONS. _7 nee/' AIR HANDLING UNIT(OVER 10,000CPAD CONSTRUCTION TAX
i do tlu ol'Applm 7/Cnnlra1111 �7Dom71 EXHAUST HOOD(W/DUCI) HOUSING MITIGATION FEE
I IAPARDOUS mrERIALS DISCLOSURE
Will the applicant or metre buildingswcuww,l c or handle hnaerdous maarial [BATING UNIT(TO 1011.00 BU)
as defined by the Cupenino Municipal Cadc,Chapter 9.12,and the Health and Safety HEAPING ON IT OVER 100.000 BTU)
Coda Scctm.25532(x)" PAID
❑Yc< ❑No VE.,WBATION FAN(SINGLE RESID) pate Receipt x
Will the...laim,it,lMu7e haddingoccupeol u.c e,m,aw for dcvicas which BOII,IiR-COMP(Rill OR 100.0m)BTU)
.nit LvarJon air eI m aamwns ax Jetmod by the Buy Arun Air Quality Management rOTAL 1,
District! BOILER-COMP(OVER IakWO BTU)
❑Yes ON.
AIR CONDITIONER ISSUANCE DATE
I have mad the hoommous tion2materials requirements under Chapter r-95 of the Cali- 7 — rj O
wild Ilcaltha safety C+da.Smcau 255ot it
yand255}9.1andcmm�d Ihm Ifmc NEW RESIDENTIAL MECH. SQ.Pf. C
huilJing Jcex nut cum:n0y Erna)a tenunf.Ihm n is inti t•Ponilility h+nodfy the navpum
Tc,T It sew ichow ma prior of a Croli t-oq.vni �y
Dam TOTAL: ISSUED BY:
wo emitted, gent
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Blk: Lot:375-31-036
INVOICE DATE......: 07/29/1999
REFERENCE ID # ...: 99070077
SITE ADDRESS .. . . . : 10770 MINETTE DRIVE
SUBDIVISION ...... .
CITY . . ........... : CUPERTINO
IMPACT AREA ...... .
OWNER . ...........: MIKE KURY
ADDRESS .......... : 10770 MINETTE DRIVE '
CITY/STAT£/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR ....... : LIC #
COMPANY
ADDRESS .......... :
CITY/STATE/ZIP ... . ,
TELEPHONE ........:
FEE DESCRIPTION CNK TOTAL FEE PAID-TO-DATE BALANCE DUE
___ _________ ____________ ___________
BELEC200 P 22.20 0.00 22.20
BPGAS P 4.44 0.00 4.44
EPERMITFEE P 35.52 0.00 35.52
PPERMITPEE P 35.52 0.00 35.52
""-97 68 ------------0.00 97.68
40
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ .......................=.... ........ ...................-----=...
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL