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99080112 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY - Q I I L/` CITY OF CUPERTINO BUILDING-ELECTRICAL nITN BUILDING DIVISION APPLICATION/PERMITPLUMBING.MECHANICAL ,BUILDING PROJECT IDENTIFICATION BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE ` 1)206 MOUAT cResT Zwwe ( G 4 OWNER'S NAME: PHONE: CONTRACPOR'S NAME: LIC NO: K/T CIArn NIC CONTROL4 NITECT/f?NGINEER: LIC NO: ADDRESS: ❑ AsH!ipOa A )Ames CHI-IJ CONTACT: PHONE: BUILDING PERMIT INFO (AIVA1 #33 661 � ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT _,PLUMB MECH ❑ Lfd— ❑ ❑ LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE 1 hereby arrrm that I am licensed under provisions of enabler 9(commencing - _ JOB DESCRIPTION X00eiz with Ssaim.700)mf Drvrium 3mfthe Breinesxand Professions Code,andmy licensers RESIDENTIAL: 1y 00 in full force and effect. PERMIT ISSUANCE F W F ❑SFDWL El KITCHEN REMODEL �UZU Dow Class Contract., y6G Date Commcmr APPLIANCES-RESIDENTIAL ❑ADDITION [I PLUMBING RE-PIPE I„p rn ARCHITECT'S DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL ,Z p ra z I understand my plans shall be used as public records MODIFICATION OZ 400 UPT02MAMPS [I INTERIOR El CHIMNEY REPAIR r,4t:zJ Licensed Professional 201-1000AMPS IMPROVEMENT E]SWIMMING POOLS 9� OWNER-BUILDER DECLARATION OVER 100 AMPS ❑BATH REMODEUREPAIR Q DEMOLITION C I hereby affirm that 1 1. exempt from the Cssuar, o License Law for the O y U following reason.(Section]03 construct. Business and Professions Curie:Any city or county SIGNS ELECTRICAL []OTHER which rWuirex issuance,permit re wrewo6 aper,improve,demolish, fi repair any swemrc CSO 'hior to itst heist edportion,to the the ovisio ant forsoothe such Contractor's Lice s Law statement SPECIAL CfRCl1IT/MISC. q thmheiecang it pumuan mlhopfovisionsnf meConwnessa License Law(Chapter 9 01 (commencing with Senion]00)ofDivixion3ofine Business and Professions Code)or TEMP METER OR POLE INST. 1,2H that he is exempt merefrnm and the low,for me alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION Section 7031.5 by any applicant for o permit subjects me applicant to a civil penalty of POWER DEVICES ^y ❑TENANT [:1 FOOD SERVICE not more than❑f t hundred dollars y employees IMPROVEMENT C�Q ❑ I,as,the .,k,tad,ha sent',or myemployeeswimwages acadtheir(sole 044,Bunion, SWIMMING POOL ELECTRIC N. will dotnework,Codas xhmcmmictno,lmicense aw ed doe not apply town owner of ❑GTHER W and Professions Code:iThemp Contractor's License Law ices not apply to if owner of OUTLETS-SWITCHES-FIXTURES a' property who builds or improves thereon,and who does such work himself or through his own employees,building that such improvements are not ior offered for NEW RESIDENTIAL ELECTS SQ PT. year of sale.If,however the building orimprovement is sold within one year of completion the SQ.FT.FLOOR AREA $/SQ.FT. nwner-builder will have the burden of proving that he did not build or improve for buf- pose of snla�). E] 1,as r of the property.am exclusively contracting with licensed contractors to TOTAL: conswet the project(Sec.7044,Business and Pmfessions Cade:)TAe Conhmtar'x W- se Law does not apply to an owner of property who builds or improves thereon,and QTY, PLUMBING PE FEE. who contracts for such projects with a eonhactood licensed pursuant to the Contractor's License Law. PERMIT ISSUANCE I am exempt under Sec. ,B&PCfonhis reason Owner Dae ALTER-DRAIN&VENT-WATER(EA) VALUATION do WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE I hereby affrm ander penalty of perjuryone of the following declarations: ❑I have and will maintain a Certificate ofconsent in self-insure for Worker's Compen- DRAINS-FLOOR,ROOF,AREA,COND. STORIES TYPE CONSTRUCTION ,mimic o,provided for by by Section 3]00 of the Lobar Code,far the performance of the work for which this permit is issued. FIXTURES-PER TRAP ❑I have and will maintain Worke's Compensation Insurance,as unsuited by Section 370 of the Labor Code,for the part orman..f me work for which this permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP ApN /- MyWorker'a Compensation Insurance carrier and Policy number are: GAS EA /{[_7 Carrier: Policy No.: ( ) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE. GREASE/INDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FB $ (Tmit his section need not be completed peris fomne hundred dollars(SIM) UREASE TRAP ar lase.) PLANCHECK FEE I certify that in the performance ofhe work for which this permit is issued,Ishall SEWER-SANITARY-STORM EA.200 FT. not employ any person in any mnnner so as to become subject to the Workers'Compen- ENERGY FEE cation Laws of O Callfumia.Data WATER HEATER WNENT/[LECfR Z V) Applicant "tMrtDIN9'FEE------s-..—•..� V) NOTICE TO APPLICANT:If,Co making this Cisiom;of of Exemption,you should WATER SYSTEM/fREATiNG r a; become subject the Worker'sro Compensation n prmiit hal of the Labor Code,you must LTI ti forthwith comply with such provisions or this permit shall be deemed revoked. - WATER SERVICE ) yi Q ' I CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMT SQ.FT. P�p}(� p I hereby affrm that there iso canarecomn leodingageney forme permmmnee of rECALME I's eeeipt ql! CUL the work for which this permit is issued(Sec.3097,Co.C.) 11 ;0 L) Lender's Name AL: {il Lender's Address TOTAL: yi I certify that 1 have read his application and stale that the above information is - E (n correct.)agree to comply with all city and County ordinances and state laws reining to QTY. MECHANICAL PERMIT P5 U M1uilging wmwotion.antl hereby avanrim representatives of thio city menmr upon the above-mentioned pmperty for inspection parpmms. PERMIT ISSUANCE(We)agree to save,indemnify and keep harmless the City of Cupertino aguinat ludi lilies,judgments,costs and expenses which may in any way aecme against said City ALTER OR ADD TO MECH.an ometracce of me granting aftnis permit EAPPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) LFEESOURCE REGULATIONS. AIR HANDLING UNIT(OVER 10,001 CPM) IONTAXSignature ofApplicanl/Commclor Data EXHAUST HOOD(W/DUCT) IGATIONFEE HAZARDOUS MATERIALS DISCLOSURE Will the applicantor future building rccupammme or handle hazardous mafedal HEATING"a(TO 100,001 BTU) as defined by the Cupertino Municipal Code,Chapter 9,11,and the Health and Safety Cade,Section 25532(x)7 1 HEATING UNIT(OVER 10,(00 BTI)) ❑Yes ❑Nm VENTILATION FAN(SINGLE RESID) PAID a _- Will the applicant or furore building occupant use equipment or devices which Date Receipt N emit hazardous air contaminants as defined by the Bey Area Air Quality Management BOILER-COMP(3HP OR 10,0110 BTU) A t Dishiu^ ❑Yes ❑No BOILER-COMP(OVER 100,000 BTU) 1 have read the hmardous materials requirements under Chapter 6.95 mf me Cali- AIR CONDITIONER ISSUANCE DATE forma Health&Safety Code,Sections 25505,25533 and 25534.1 understand mat if the NEW RESIDENTIAL MECH. SQ.FT. building does not currently have a tenant,that it is my responsibility to notify me occupant O •�/ (_ of the requirements ishich must he met prior to issuance of a Cer ifwte or Occupancy. Owner or authorized agent Date TOTAL: ISSUED BY: OFFICE Building Permit Fee Code Checklist Qty. if Applicable Fee ID Fee Description Fee Group BTEMPPERM TEMPORARY BLDG PERMIT BUILDING BCONSTAX CONSTRUCTION TAX BUILDING BENERGY ENERGY BUILDING BENERGYADD ENERGY ADD MULTI BUILDING BOVERTIME INSPECTION OVERTIME BUILDING BPERMFEE BLDG PERMIT FEES I BUILDING BMITIGAT HOUSING MITIGATION FEE BUILDING BPLANCHK PLAN CHECK FEE BUILDING BPLANCKADD PLAN CHECK ADD MULTI BUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSCBLVD SCB SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING BSEISMICRE SEISMIC FEE RES BUILDING BSPECIAL SPECIAL INSPECTION BUILDING BSWIM SWIMMING POOL BUILDING ZADDCHG ADDRESS CHANGE BUILDING BELEC1000 ELEC 600V <=1000A ELECTRICAL BELEC1001 ELEC 600V>1000A ELECTRICAL BELEC200 ELECT SVCS 600V <=200A ELECTRICAL BNEWMULTI MULTIFAMILY RES ELECTRICAL BREMBUSWAY REMODEL BUSWAYS ELECTRICAL BREMFIXT LIGHTING FIXTURES ELECTRICAL �• BREMMISC MISC APPARATUS ELECTRICAL BREMNRAPP REM NON-RES APPLIANCE ELECTRICAL BREMPOLE POLE/PLATFORM FIXTURE ELECTRICAL BREMPOWER POWER DEVICE/APPARATUS ELECTRICAL BREMRECEPT RCPTL, SWITCH &OUTLETS ELECTRICAL BREMRESAPP REMODEL RES APPLIANCE ELECTRICAL BREMSIGNAD RMDL SIGNS ADD BRANCH ELECTRICAL BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL BSF&2FAM SINGLE & 2 FAMILY ELECTRICAL BTEMP TEMPORARY POWER ELECTRICAL BTEMPSVCS TEMP DIST SVCS ELECTRICAL EPERMITFEE I ELEC PERMIT ISSUANCE ELECTRICAL BAPPLOTHER OTHER APPLIANCES MECHANICAL BBOILERI BOILER <= 100,000 BTU MECHANICAL BBOILER2 BOILER >100KT0500K BTU MECHANICAL BBOILER3 BOILER >500K TO 1 M BTU MECHANICAL BBOILER4 BOILER>11M TO 1.75M BTU MECHANICAL BBOILER5 BOILER > 1.75M BTU MECHANICAL BREMAPPLI APPLIANCE INSTALL MECHANICAL BREMHEAT HEATER INSTALLATION MECHANICAL BREMVENFAN - VENT FAN SINGLE DUCT MECHANICAL BMNEWMULTI' NEW MULTI-FAMILY RES MECHANICAL BMNEWSF&2F NEW SF&2F RES BLDGS MECHANICAL • BREMACOVERAC UNIT >10000CFM MECHANICAL BREMAIRHAN A/C UNITS <= 10,000CFM MECHANICAL BREMFURN I RELOCATION OF FURNACE MECHANICAL BREMFURNOV JRELOY FURNACE> 10K BTU MECHANICAL Building Permit Fee Code Checklist BREMINHOOD INSTALLATION OF HOOD MECHANICAL BREMRELOCA RELOCATION OF HOOD MECHANICAL • BREMREPALT REPAIR/ALTER HEATING MECHANICAL BREMVENSYS VENTILATION SYSTEMS MECHANICAL MPERMITFEE MECH PERMIT ISSUANCE MECHANICAL ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING ZDIRTM DIR TENT MAP PLANNING ZFULLHR FULL APPL BASE + HR PLANNING ZFULLTM FULL APPL TENT MAP PLANNING ZFULLUP FULL APPL USE PERMIT PLANNING ZFULLZONE FULL APPL ZONING PLANNING ZGPAMEND GENERAL PLAN AMEND PLANNING ZLIMAMEND LIMITED AMEND PLANNING ZLIMTM LIMITED TENT MAP PLANNING ZLIMUP LIMITED APPL USE PERMI PLANNING ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING ZMINHILLEX MINOR APPL HILL EXC PLANNING ZMINSIGNEX MISC SIGN EXCEPTION PLANNING ZMINTM MINOR APP TENT MAP PLANNING ZMINUP MINOR APPL USE PERMIT PLANNING ZMISCASA MISC ARCH SITE PLANNING ZMISCEXT MISC TM AND UP EXT PLANNING ZMISCFENCE MISC FENCE EXCEPTION PLANNING ZMISCGEN MISCELLAPPLGENERAL PLANNING r ZMISCPCINT MISC PC INTERPRETATION PLANNING • ZSIGN SIGN PERMI PLANNING ZTEMPSIGN TEMPORARY SIGN PLANNING ZVARIANCE DIRECTOR VARIANCE PLANNING PPERMITFEE !PLUMBING PERMIT ISSUE PLUMBING BNUMULTI NEW MULIFAMILY RES PLUMBING BNUSFD NEW SINGLEFAMILY RES PLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING BPCESSPOOL CESSPOOL PLUMBING BPFIXTURE PBLG FIXTURE PLUMBING BPGAS GAS PIPING SYSTEM FEE PLUMBING BPINTERCEP IND WASTE INTERCEPTOR PLUMBING BPREPIPE REPIPE OF FIXTURES PLUMBING BPSEWAGE SEWAGE DISPOSAL PLUMBING BPSEWER SEWERS PLUMBING BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING BPSTORM STORM/RAIN WATER PLUMBING BPTRAP KITCHEN TRAP PLUMBING BPVENT ALT OF DRAIN &VENT PLUMBING BPWATER INSTALL/ALTER WATERPIP PLUMBING BPWHEATER IWATER HEATER/VENT PLUMBING BPWSVCS IMAIN WATER SERVICE IPLUMBING CITY OF CUPERTINO • 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: yvonnek COPY q 1 Sea: Twp: Rng: Sub: Elk: Lot:35626016.00 DATE ISSUED....... : 08/16/1999 RECEIPT k. ........ : 9825 REFERENCE ID N ... : 99080112 SITE ADDRESS .....: 11206 MT CREST DR SUBDIVISION . . ..... CITY ... . . . . ......: CUPERTINO IMPACT AREA ....... OWNER ..... . ... ...: CRAM KIT M AND NG SAU L ADDRESS ..... . . .. .: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4755 RECEIVED FROM .... : TIM CONTRACTOR ....... : LIC H -OWNER- COMPANY ..........: CRAM KIT M AND NG BAD L ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4755 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 EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 _____ __________ __________ __________ SIL PERMIT 93.02 0.00 93.02 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ __________________ CHECK 93.02 491 TOTAL RECEIPT . 93`02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ........-----------......ae. 103 UFER 304 ROUGH ELECTRICAL • INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE + CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: yvonnek Sec: Twp: Rng: Sub: Blk: Lot:35626016.00 INVOICE DATE...... : 08/16/1999 REFERENCE ID q- ... : 99060112 SITE ADDRESS .....: 11206 MT CREST DR SUBDIVISION ......: CITY ... .......... : CUPERTINO IMPACT AREA ...... . OWNER ............ : CRAM KIT M AND NO SAD L ADDRESS .......... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4755 CONTRACTOR ....... : LIC # •OWNER- COMPANY ......... . : CRAM KIT M AND NO SAU L ADDRESS .......... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4755 TELEPHONE ........ : NOTE: THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BTEMP P $7.50 0.00 57.50 EPERMITFEE P 35.52 0.00 35.52 --------- ------------ ----------- • 93.02 0.00 93.02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ............................ 103 UFER 304 ROUGH ELECTRICAL •