90080196 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY C
CITY CUPERTINOBUILDING ELECTRICAL PERMIT N
.R ITN
BUILDING DIVISION APPLICATION/PERMIT PLUMBING
-MECHANICA
BUILDING PROECT IDENTIFICATION
'
BUILDINGADDRESS', SANITARY NO. APPLICATION SUBMITTAL DATE
io334 rli v/r /� R� 4ox/q f- 2_ -7 -q9
AME
WNE��7Ai� �y� ZS�� CONTRC'If3RMN�. GOQ LIC NO: �r
,v Lr ACI 4RS NIC CONTROL
Add qP .iCHITE 3NGINEER: LIC NO: ADDRESS: ❑
-ViCK C 06e 441" N4c
CONTACT: PHONE: BUILDING PERMIT INFO
�,-4�ov 4-'q,' '4rx —7yo-S/2 EDConsultantFees Paid y Applicant(Initial) BLDG ELECT PLUMB MECH
7 ❑ ,�,/` ❑ El
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE �
I herehy nffvm Ibcl I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
WaWOZ with Scefmn 70UI1)ofDlvisianJof theBminas endP Coda,endo Ileemnas
ADO W PERMIT ISSUANCE RESIDENTLIL:
�F UU' 'iec, Rolando!ellen Ave/ 0STOWE C KITCHIiN REMODI'L
UzU License Cly LICK APPLIANCES-RESIDEN PIAL CADDITION ❑PLUMBING RF_PIPE
h Q L Dine 7S`DFlu
A C111'TECT'S DECLARATION G CMULTI-UNIT CSTRUCTURAL
PANELS
ZOyZ lunderetan my plans shall he useJ ns public records MODIFICATION
UP10201AMPS [I INTERIOR C CI'IIMNEY REPAIR
F 22 S�".tW Licensed Professional 211 bIfklfIAMPS IMPROVEMENT
Y 5,',,I OWNER-BUILDER DECLARATION
SWIMMING POOLS
M
Zw Q 1 hereby affirm that 1 am exempt from the Cammcmr.s License Law for the OVER!"AMPS C BATH REMODEL/REPAIR C DEMOLITION
3 U following mason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL C OTHER
gai
tL which requites o permit m camtma,alter,improve,demolish,or repair ed tamnur, f
F,°IO pdormiuceusedpurmintto the thovisioso for such Petors icesfiled,Law(Chapter
SPECIALCIRCUIT/MISC. /� � LIP
f (coheenlicensed pnruant to the provisions of theContractorsLicense law(Chapter9 L
(commencing with Seaton 7010)of Division 3of the Business and Profmsiom CMe)or TEMP.MfCI'F.R OR POLE INST. COMMERCIAL:
0.a e M That he is cacmpm therefrom amt the basis for me alleged exemption.Any violation of C NEW BLDG/ADDITION C DEMOLITION
Section 7031.5 by any applicant for a Permit subjects the applicant m a civil penalty of POWER DEVICES
stn CIMPROV [I FOOD SERVICE
F Z>,sot mate as owner
file hundred dolours y employees
IMPROVEMENT
Lo(he war ,relf the rminic or myyemntended with Bred fowages r
their(See
reorientation,Busen, SWIMMING POOL ELECTRIC
Cao will dobuewous Code:
The Cureisnots License Law do tome apply town owner
[]OTHER
3 m and Pmlmnnns Cts]e:TLe noes a etc License Law saes not apply s if owner of OUTLP.TS-SWITCHES-FIXTURES
property,won hurl,,or impmven thereon,Hero who does such wad himself or though
his own.c,,c,,the p ildor, nit.such mem bask!
a are not Intend,m offered for NEW RESIDENTIAL BLECfR SQ IT.
...ml•baweregohave be
improvement ithat he dbuin on wild tT improvetFa the SQ,PT.FLOOR AREA $ISQ,FT.
er-builder soil l have the huNan of proving that he did nm build or improve Farm-
TOTAL xto of sale.).
❑ 1,an owner I me praPeTls.nm e,elo,imly tuntravaiall with licemed cammemte It, Tm'nL:
punt the pried fScc.7194,Business and Proftessbn,Codr:)ram CovrnumT's Li-
,,mic Law(]ties our apply to un(wner of properly who builds or improves themon,und QTY. PLUMBING PERMIT FEE
who contacts forsuch projects with a conuacmrtsJ licensed pursuant to Ibc Conmaumu',
Licenm Law. PERMIT ISSUANCE
I am exempt under Sec. ,B&P C for this reason
Dam ALTER-DRAIN&VENT-WATER(EA) VALUATION
mer
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
all 1 hereby affirm under penalty of perjury one of the following deolmminn,:
C l have and will maintain a Certificate of Consent o self-insure for Worker's Comber. DRAINS-FLOOR,ROOF.AREA,COND.
cation,as provided fm by St37M of the Labor Code,for the performance ii STORIES TYPE CONSTRUCTION
work for which this permit is issued. Iq STORES-PER TRAP
C 1 have and will maintain W'orker's Compensation Insurance,as required by Second
3700afthe"Isfe Code,fanhe Perfamemeeof Ne work firo hieh this permit is issued. GAS-PA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN
My Worker's Compensation Insurance eerier and Policy number arc: �/
Cortin: Policy Nn.:
GAS-PA.SYSTEM OVER 4IEA) I O
CERi'iFICATE OF EXEMPTION FROM WORKERS' (D-2—
COMPENSATION INSURANCE GRHASFANDUSTRL WASTE INTERCEPTOR
(This section ace l not be completed if the permit is foram,hundred dol has L$1011) BUILDING L51VI510N FEESnr
le".)(nil TRAP PLANCHECK P13E
I certify that in the performance of the work for which this permit in issue,],l shall SEWER-SANITARY-STORM EA.200 FE
not employ any person in any manner sous to become subject m the Waders'Compel)- ENERGY FEE
O Z cation Laws o]Cnlil'ornia.Ilam WA'I'1iR 1111MER WNENT/ELECTR
4,Q Applarm, GRADING FEE
G y NOTICE TG APPLICANT:11,suer nmk'og this Ceniliwle of Exemption,you shaulA Wq'THR SYS"TEMrTREATING
F'! become subject to the Worker's Compensation provisions of the Labor Cee,you must SOILS FEE
7WL forthwith comply with such pmvisiom m this permit shall be deemed revoke, WATER SERVICE
Q
IDz CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB, SQ.14. PAI FGa,
U O thereby affirm that there is u construction lending agency for the performance of
LL. F' the work for which this Permit is issued(Sec.3057,Civ.C.)
O V Lenders Name U TOTAL:
Lenders Address TOTAL:
F0. 1 certify that I have read this application and stam bum the above information is RUI DI G FEF G 1
Tq correct.i agree to comply with all city and county ordinances and state laws minting to QTY, MECHANICAL PERMIT FEF.
U z building conmm�ion,and hereby debutante representatives of this city to enter upon the SED NVCFEE
dboverientioned pmpany for inspemicn purposes. FERMI I'ISSUANCE
(we)agree reeve,indemnify and keep humorless
the City of Cupertino against ELE Mij6FEE
liabilities,judgments,costs unit expenses which nay in day way asecmueagaina said City ACERB OR ADD TO MECH. -•—'
in consequence of the granting of This permit. PLIIMBINGFEE•--'�•'—�-� M
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1,NON-POINT AIR HANDLING UNIT(TO 10,000 CPM)
SOURCE REGULATIONS. MECHANICALFEE
AIR HANDLING UNIT(OVER DI.O(111 CFM)
�1'eI CONSTRUCTION TAX
bpi
too an m HXUAUS'fHOOD(W/DUCT) HOUSING MITIGATION FEE
OUS M .RIALS DIS OSURI:
WIIl thenppliwm art fuutre hl Jing ecenptmm or hnnJle hxzurdnusmmoriul 110A'fING I1NIT(Tl)100'001 BTU)
us,dined by the Cupcnino Mumici tel ter 9.12,and the Health and Safety
Coda,Section 25532(x)^ _ / 111?A'IING UNU(OVER 100'0008'Dl)
C Ycs 1-/�1�` VENTILATION PAN(SINGLE RESID) PAID
Date Recelon#
Will the air contaminants
m future building occupant use equipment Or devices which
Droitict? us air conmminumsm,ding by Ne Bay Area Air Quality Management BOILER-COMP(JHP OR 1fp,000 BTU) 1OTAL. ,O
2—
District?
r)Y<s _ / BOILM-COMP(OVER 100,04)0 BTU)
/�ry�j
I have read the hm:INoun morins requimmde
ents under Chapter 6.95 of Ne Cali AIR CONDITIONER ISSUANCE DATE
forma Health&Safety Code,Sections 15505.25533 an,and rabil 1 understand bum if the NEW RESIDENTIAL MECH. SQ.FT. �^ l7
of th,ngdtam no aveamnam,t it is my asp fitcelirymnodfy the cecapam C(,,1
a(the rtyuirem ns run bey}em pd cote CcmXitk'� of Ott �nc.
caner or mdbonz225_< Ute TOTAL: ISSUED BY:
OFFICE
CITY OF CUPERTINO
I� 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: chrietya
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:35702021.00
DATE ISSUED.......: 08/27/1999
RECEIPT q.........: 9917
REFERENCE ID # ...: 99080196
SITE ADDRESS ... ..: 10334 MIRA VISTA AV
SUBDIVISION .. . ... .
CITY ......... .. ..: CUPERTINO
IMPACT AREA .......
OWNER ..... .. . . . ..: RANG, MARTHA
ADDRESS
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-2745
RECEIVED FROM . ...: DAVE S
• CONTRACTOR ... . . . . : LIC %
COMPANY ......... . :
ADDRESS .......... :
CITY/STATE/ZIP ... . ,
TELEPHONE ........ :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BTEMP FLAT RATE 1.00 57.50 0.00 57.50 0.00
EfITFEE FLAT RATE 1.00 -35.52 0.00 -- 35.52 0.00
T PERMIT 93.02 0.00 93.02 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 93.02 412
...
TOTAL RECEIPT 93.02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
•