99090037 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PENONLY
CITY OF CUPERTINO BUILDING-EIACTRICAL �� PERMITNO.
NUILDING DIVISION APPLICATION/PERMIT PLUMBING-MF•6HANICAL - �
BUILDING PROJECT IIIENTIFICATION
BUILDINGADDRFSS: SANITARY NO. APPLICATION SUBMITTAL DAT(
!l?a6 MT CR&sT ail G�f T1 vo
tWNER'S NAME: PHONE: / CONE RACI'OR'S NAME: LIC NO:
'/ CNA NIC CONTROL,#
CUE'I'ECT/ENGINEER: LIC NO: ADDRESS'. ❑ //
CONTACT': PHONEILDING PERMIT INTO
L ANNI� q3? GGA ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
trt
LIC17NSED CONTRACTOR'S DECLARATIONQTY. ELECTRIC PERMIT FEE
i hereby arm.that 1 ata limmeed note,provi.doreof Chapter 9(commenting JOB DESCRIPTION
DMZ with Sc,,nm7(Xn0)ufDi,,uma 3othe Fm-e..and ProfeWom Cow,anti in,license is RESIDENTIAL:
I'IiRMTf ISSUANCE
F�2 In lull loins and cRed ❑SPDWL [I KITCHEN REMODEI.
�UV I-kraw Class Lick APPLIANCES-RESIDENTIAL ❑ADDITION L1 PLUMBING RI-PIPE
Fezw Dote
vp.s,6u,aw Commcmr
ARCIITILTl DECLARATION
ARATION
[I MULTI-UNIT []STRUCTURAL
1ANI .S
MODIFICATION
ZOto Z 1 understand m)'plann shall be used az Public records
Z'%)Q UP lU 2(I(IAMPS [I INTERIOR El CHIMNEY REPAIR
I:.H F-)y Licensed Pmfessi...I 201-1000AMPS IMPROVEMENT WIMMING POOLS
OWNER-BUILDER DECLARATION OVER 1000 AMPS ❑BATH REMODEIIREPAIR IOLFHON
C C Q I hereby anlrm that 1 am exempt from the Contractor's LicenseLaw for the
X W F fallowing,cosh#(Section 90315,I3mine,and Profi ssians CWu:Any city or county SIGNS ELECTRICAL ❑OTHER
on which minims a p,mait to summer,data improve,de mol., or mind,any structure
d snore#its issmnu,a6u requires the applicant fmoeh permit,,file asignadmammem SPECIAL CIRCUIT/MISC,
mmmisllcensed purmon,rudm,anlvlons ofthe Contrunm's Liscnsc l,uw(Couple,9
W X0 (comancrucing with Section 9mXBof Division Sof the Businae, nd l'nffesslons CodgEMI
or 'I' R M ETER OR POLE I NST. COMMERCIAL
0 :
a a e C (bar he is exempt Iherefmm and the basis for the alleged exemption.Any viulaion of ❑NEW BLDG/ADDITION ❑DEMOLITION
X-y Section 9031.5 by any applicant for a senior subjects the applicant o a civil penalty of POWER DEVICES ❑TENANT ❑FOODSERVICE
n mare than five hundred dollars(45(X8. IMPROVEMENT
=0 ❑Lexnamerofthepmpeny,o0^yemployeeswimwagesmmeir sale rompensaicn. SWIMMING POOL ELECTRIC \
El OTTER
p. will do the work.and the structure at riot interned waoRered for sale(See 70,L4.Business
i 3 and Profemions Code Me Contractor's License Law dues not m
apply an ow act of OUTLETS-SWITCHES-FIXTURES
property who builds or improves thereon,and who does such work himself or through
his awn employees,provided mut such improvements are nor intended or oflered for NEW RESIDENTIAL ELECUR
sal (,',however,the buildlmgor in,rovenient'is roll within one year ofcompletimt the SO IT.FLOOR AREA 5/SQ.I'E
e
cmbullder will have the nurden of proving(het he did not bnlld or improve far pur-
,ac ol'salcl.
El 1,a.w owner of the property,am exclusively contracting with licensed contractors to TOTA .
mmvet the prajem ISec.9IIm,Boone,w and Professions CWc:)for,Contractor's L,
cen,e Law does not apply to an owner of progeny who builds or improves thereon.and QTY. PLUMBING PERMIT •:E
who commits for such projects with a counteracts)licensed pursuant the Contractor's
License Law. PERMIT ISSUANCE
❑1 am exempt under Sec. .11.@ P C for this reason
ALTER-DRAIN A,VENT'-WATER(EA) VALUATION
net RKER'S COMPENSATION DECLARATION RACK FLOW PROTECT.DEVICE I O .LV�Y1
I herchy infirm under penally of perjury oncof the Rsllawing deelimilem.'. ` coo
I have and will mainminn Ccnlficateof Consent mwif-nsurc lar Workerb Compen- DRAINS-FLOOR,ROOP,AREA.CON D. STORIES TY PE CONSTR UC 1101,
nation,as provided for by Section 391X)of the Lahor Code,for the performance of the
work far which this permit is issued. FI%'TURES-PER TRAP
1 have and will maintain Workers Compensation Insurance,a.rtyuired by Section
3900 of the labor Code,far the perhame ,afthe work for which this permit is iswW. GAS-F:A.SYSTEM-1 INC.]OUTLBTS OCC GROUP Low 1W
My Wmkdw Compensation Insurance carrier and Policy number art:
Carrier Policy No.: GAS-EA.SYSTEM-OVER 4 TA) I_
CERTIFICAT E OF:EX EM"ION FROM WORKERS' OR[iASU1NWSTRI,W'ASTB INTERCEPTOR V
74
COMPIiNSATIONINSURANCIi BUILDING DIV( ION FEES
)Thin section acedernM:canrpincA it the pomait is lar onchundmd Jallurs f3l W) GREASE'TRAP
or PfANCHECK FEElas)
Icenlfy lhalmncc pemammaceollbe work farwhich his permit is issued,ishall FEWER-SANITARY-STORM PA.200IT.
nal vmploy any person in umy mmnner sit.,,a Fav mc,.oect nI the Worker.'Catalan- ENERGY FEE
O z cation Laws of Colifamia Dae _ WATER HEATER WNENT/ELECfR GRADING F"
Z O Applicant
NOTICE*10 APPLICANT:If,veer making this Cemncae of Exemption.you should WATER SYSTEMITREATING
(— ? heconrk
m object to the Woer'x Cumpeneaion provisions of the Labor Code,you most
SOILS FEE
Wforthwith comply with such prownions or this permit shall be decrmJ revoked. WATER SERVICE
az CONSTRUCTION LENDING AGENCY NEWRESIDENTIALPLMB, SQ PT. PAID Dam Receipt#
U O I hereby affirm shot here is o tan,mcume lending agency fon he performance.(
F In.work Ln which mis....it is Issued(Sec.3097.Co.C.)
O TOTAL:
U Led,,Name
r Ct7 I,cndcr's AJdms TOTAL:
y 1 certify that I have reed thin application and slam mal the above information is HUIBt)ING FE'
siren.I agree wimall city and county ordinances and smm laws.1.1m,g lu QTY. MECHANICAL PERMIT
aand hPBE [r--
U z Wildingc.nmcthm, embyaumtrize msmsenmtives ofthi,citywcmcr upon the a SEISM�C HE U
renree m
above-mentioned progeny for inspection purposes. PERMIT ISSUANCE I I., nn ELECTRI FEE
(We)agree to wave,indemmify and keep hornless the City of Cupertino against ( V V
liobilines,judgmempe
s.costs and exnses whichmaymany way accrue against said City AIT ER OR ADD TO MECH, PLUMBING rr..PZI
In e,,mcquence of Inc granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING ON]1('1010,0IXICFM) MECHANICAL ITE
SOURCE REGULATIONS.
A1I2 HANDLING UNIT(OVER I d IX)B CFM) �wL— CONSTRION'IAX
Slgnvwm oFA count/Comirsonr Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FELE,
HAZ RIN)US MATERIALS DISCLOSURE
Willme applicant orfumrt hulldni,oveu,scal,nremhanJle hanodmis manrial HEATING UNIT CFO IME(loO BTU)
as defined by the Cupertino Municipal Code.Chapter 9.12,audit,Health and Safely I I'
Cads,.Section 25532m)? HEATING UNIT(OVER IM.IIOD OTU) �r ��� y •�r�as
❑Yes ❑No vENTI1.Af10N FAN SINGLE RPSIU) PAID U I S9
Un¢ Receipt#
Will nl Inc applicant or future building occupant use equipment or devices which
mit harndnw vii cenmminWb vs JclineJ M1y the Be,BArca Air Quulhy Manogmnent TOILER-COMP(JHP OR IIXLINX)N'fll)
Disnivrl' n 9'OTAI:
0 Yes �No
11011.IeR-COMPfOViiR IlX1.I11X)li'I'U)
I have read the hauudous materials reyoirements under Chapter 695 algae Cali AIR CONDH IONF,R Q r ISSU CED
Tomo#Health&Safety Cote,Saloons 25505.25533 and 2553],1 uMcrsmnJ that if meNEW RESIDENTIAL MECII. SO.
building docs not cumardly have a tenant.that it is my resrymsibility to notify the occupard 1 �J
of the m nine b hi must be mel prior to issuance of rtiP of Os, p
own or amhonzeda
Danz TOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
eBUILDING PERMIT INVOICE OPERATOR: kar b
Sec: Twp: Rng: Sub: Blk: LOC:35626016.00
INVOICE DATE...... : 09/07/1999
REFERENCE ID # ...: 99090037
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
CONTRACTOR . . ..... : LIC k
COMPANY .. . . . ..... :
ADDRESS ... . . .....:
CITY/STATE/ZIP . ...
TELEPHONE .... ....:
NOTE: THE FEES LISTED ARE ONLY THOSE DUE AT PERMIT APPLICATION
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ --- --------- ------------ -----.-----
BPERMFEE P 157.00 0.00 0.00
BPLAN[CHK A 124.95 0.00 124.95
--------- ------------ -----------
0 281.95 0.00 124.95
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb
COPY 9 1
Sec: Twp: Rng: Sub: Blk: Lot:35626016.00
DATE ISSUED... . .. .: 10/06/1999
RECEIPT k......... : 10248
REFERENCE ID k :.. : 99090037
SITE ADDRESS . . . . . : 11206 MT CREST DR
SUBDIVISION . . . . . ..
CITY . . . ... . . . . . . .: CUPERTINO
IMPACT AREA ... . . ..
OWNER . . ........ .. : CHAM KIT M AND NG SAO L
ADDRESS ......... . :
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-9755
RECEIVED FROM . ...: TIM
CONTRACTOR . . . . . ..: LIC 8
COMPANY .. . . . . . . ..:
ADDRESS ...... . . . .:
CITY/STATE/ZIP . ... ,
TELEPHONE ..... . . .:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
HPERMFEE VALUATION 10,000.00 157.00 0.00 0.00 157.00
BPLANCHK PERMIT FEE 157.00 124.95 0.00 124.95 0.00
PERMIT -_" 281.95 0.00_ ___129 95 ----15] 00
-NOTE-: THIS RECEIPT HAS FEE CREDITS TOTALING: B.50
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ __________________
CHECK 124.95 518
------------
TOTAL RECEIPT 124.95