99110061 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY L UU
CITY OF CUPERTINO BUILDING-ELEC'i'RICAi, PERMIT NO.
BUILDING DIVISION APPLICA'FION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJBCT IDFN'I'IFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL FAT
Z35ZP� Oft ✓/a U EV p
qiH:AV is ex �� I'4 Nii: (� / CO A QN'S�'.A 1jQ N
eVMI► ']pA�1 4 NIC CO!YfROLx
AfWIRWY.L.WENGINEEWLICN .? ADIg9S S• U1�J 16(-, S� ❑ �! Z
IIILES (14
CONTACT. • 1/'11100/ry."y�.: (�beR/ BUILDING PERMIT INFO
�ti\ ^ I �' ,� a LR e V 'U ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
uV (�l "w )Lj � ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC'PERMIT FEE
1 hereby ntrna that I am licensed under provMlous of Chapter 9(commitments JOB DESCRIPTION
�O'Z with.Section]000)of Divtston 3 Off.Buslncssand 11 test.. Co e.and mylicense is RESIDENTIAL'
WOO PERMIT'ISSUANCE EI
61�F in full force and tlfect �! ' ❑SFDWL ❑KITCHIeN REMODEL
QUU Liccnx C); J Lica APPLIANCF'_S-RESIDENIAL - El ADDITION ❑PLUMBING RE-PIPS
yQC Dam C vacua ❑MULTIUNIT ❑STRUCTURAL
ARC .DE LAR TION
F.7m ` I PANELS MODIFICATION
OO_Z IunJe mY Plains useda pU mcords
2 UPT020N1AMP5 ❑INTERIOR ❑CHIMNEY REPAIR
O
ul Licensed Prdcsmmral 201-I000AMPS IMPROVEMENT WIMMINGPOOIS
C al — 1 amid, affimt thWN anile 111.iI frmn the CER manume,Lie use Low for the OVI7R 1000AMPS El BATH RF.MODEIJIgEPA1R DIiMO1.ITI0N
y Q
x O d U following recon.IScnlnn]113 L5.Buslmss unJ Pmfnaxinnx Cnde ny city ur county SIGNS Ill.EC'I'ItICAL C]OTHER
LL 3 LL N which requires a pcnni'to anrswct,ahcq improve,JemnlieM1, rery'tr any strvcmre
Prior lin its issuance.also requires the applicvnl for wd,pcnni IileueigneJ sm¢nlcm SPECIAL CIHCUITIMISC.
f'�} that he is licensed punuanun the provixians of the Comr lis License land(ChaDter9 COMMERCIAL'
�fG�p (commencingwilh Seelon7(M))ofl)ivinion3ofthe nim..and Pmfc,uoU,Gnle)or TEMP.METER OR POLE INST.
L X e�, the he is exempt therefrom and the basis for th egeJ exemption.Any violation of [I NEW BLDGIADDITION [I DEMOLITION
_ Secllnn]II3LS by any applicant for alvrmi jecls the nPplicnmmll civil penalty of POWER DEVICES []TENANT El FOOD SERVICE
ON
not more than five IT
dollars($5
-FsSQ Luc owner of
,lin IMPROVEMENT
O pery,onny ployeos with wages ns their tole compemation SWIMMING POOL ELECTRIC ❑OT ,H
CF. willdulbe wtak.andthe amcmm of imm�dedontfemJ for wle(Sea.]f1W.Business OUTLETS-SWITCHES-FI%TURFS
W aad I'rofcoinm C.de The Co nmmr's Liccme Law Joes not apply ,,an owner of
a 3— propety who builds or imp es thereon,and who dues such work himself or through
his own cntployeec,pnwl J thus such improvements am not intended or offered for NEN'RCSIDENfIAL ELECTR Q FT.
sale.lC btmvever.the but Ing or improvement ismld within one yearofcomplction,the SQ.Fr.FLOOR AREA $/$Q.FT.
er-huiWer will hu the nurdun of proving that he aim not nulla or improve for our- SSS
pose of Jr.),sa
❑1,Uc c property,a culusively conte¢ting with licensed combs r,so TO'
unsttvct the lett(Sec 7(W.nosiness and Professions Code:)The Contractor's Li.
ocrIc Law do not apply to an Owner of propcoy who builds or imbrues thereon.and QTY. PLUMBING PERMIT
who contracts for such projects with a contmctims)licensed pursuant ill the Contractor's
Liceme Law. ` P17RNIIT ISSUANCE
el 1 am esempt under Sec. .If 6 PC for this reason
ALTER-DRAIN A VENT-NATER(EA) VALUATION
Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE
1 hereh,affirm under penalty or perjury one of the following dedLiaLme:
❑I have and will maintain a Ccnificam of Consent tosellinsum for WoAer's Cooper- DRAINS-FLOOR.ROOF.AREA,COND. STORIES 'TYPE CONS'I'HQGTID!
ration,as provided bor for by Suction 3710 of the LaCode,tar the perhatuarc.of the
work for which this pcnni'is blood. FIXTURES-PER TRAP
have and will maintain Worker's Compemation Insurance,as required by Section
t of the LnMm Code,for the Performance af'he wad for which this penni'is issued. GAS-IiA.SYSTIiM-I INC.d OIf11.E1'S OCC.GROUT' [J' tPN
My Wtrkcrs Co� - o 1.1D d Policy y - 7( G
Corrie, g��ul Policy No: -1— GAS-CA.SYSI'IiM-OVIiHJ(EA) (�
CEIITII ICA1'MPE COMPENSATIPI ION ON
dAN (lH - S,4MGREASE/INDUS'1'RL WAST Ii IM'I3RCEITOR J ES
CObfl'IieSAT1ON INSURANCE .•tt,, BUILDING DIVISION FtiIS
I (This sectiontoodoor he u,mplmW It the Panni'is faonU hundred dollars($Iyh GREASE TRAP
or less.) PLANCIIECK TEF:
I ccml'y In.,inthel Til antanccufthc work for which mispermit is i...ed,Lshall SIiWI!R-SANITARY-STORM EA.100 FI'.
not employ any Person in any manner so as to become subject to the Worker.'G,mpen, ENERGY FEE
ZZ satio.Lows of Callforniu.Dmc WATI7R HEATER W/VEN DELEC R GRADING FEE
O APPlicant
h NOTICE*10 APPLICAN I.If,afmr making OUT Ceniticme of Esemprioq you should WATER SYSTEM?REATING
h' become subject to the Worme,;Compti
etnmiom Provisions of the Lan Cnde,YOU Most SOILS FEE
lonhwith amn,In,w,III eachp—ilium or this penial hallh deemed revoked WATER SERVICE
Q
7z CONSTRUCTION iNDINGAGENCY NEW RESIDENTIALPLMB. SQ.FT. PAID Date Rcecipta
U I hereby affirm thin there isaem. coon leadingogency far the l,cnornmaccof
� n 11,—A for which tpc
his rmin is icsuc Sot 1091,Civ.C.)
FU Lender's Namic TOTAL:
TOTAL:
Lender's Address
>ay I cenify that I have read is application and sin¢that the above Information Is BUILDING FEE
FN correct.I agree to comply wit all city and county Ordinances and state laws relating to QTY, MECHANICAL PERMIT FEE SEISMIC HE
U Z buildingeomtrvetion.and It coy aan,oriv.e repro-olaavesolthis city[center Upon the
above mentioned proprt or inspection purposes. PERMIT ISSUANCE ELECTRIC FEE
(We)agree Ursa .,indemnify and keep ham less the City of Capetian against
calb lies.judgmenu. inm
.usandespc swhi< my in' yway carve agusaid City ALTERORADDTOMECH. PLUMBING FEE
rnnccyoenee of the ran'it I
APPLICANT D!RST D DWI , CO LY WITH ALL NON-POINT AIR HANDLING UNIT(TO to."CPM) MECHANICAL FEE
SOURCFTION.
' r O/allAIR HANDLING UNIT(OVER 10,00(i Cl CONSTRUCTION TAX
SignatureO ppliceMComm or am EXfiAUST HOW(W/UUCP) HOUSING MITIGATION FEE
HAZARD USA A'I'FRIAIS DISCLOSURE
Will theapplicamorfm - ding Occupant sine or handle bamrdous mammal HEATING UNI'p OX)I WT,S B'I'Of
defined by the Cupcni no Municipal Cnd,Chapter 9.12,and the Health and Sal cryAWL' I
dc.Section 25532(0)] HEATING UNIT(OVIiR I W,omo B'TU)
ol Yes VEN'TILAl10NpAN151NCLERESIDI PAID Date Receipt
Will the opplicmU or lutum building On'cupont Use c,an,nmm nr Jeviocs which BOILER-COMP(3111-OR 100.0mil BRH
min hamrdous of,eumnntin....as defined by the Bay Area Air Quality Management u 'p 1,:
Dimrmt'I k
Ycs BOILER-COMP(OVER Ig1.OW BTU]
1 have real the hm:Wscs m 'els requimments under Chapter 6.95 ti the Cali-
AIR CONDITIONER ISSUANCE DATE
fomialle X. fety COd -n 25 05,2. 33 and 25531.1 Understand that If'he NEW RESIDENTIAL.MECH. SQ.FT. /
butldiacs mcuacnII a tenant, tat it inymsponsibilaytonlai Ymeoccupant
oI'IT� Uaa,w ' ben confit t Cts
��
Ow hall imd agent ITan ITOTAL ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Elk: Lot:34257016.00
INVOICE DATE......: 12/15/1999
REFERENCE ID # ...: 99110061
SITE ADDRESS .....: 23564 OAK VALLEY ROAD
SUBDIVISION .......
CITY .. . ..........: CUPERTINO
IMPACT AREA .......
OWNER ...... . .....: WALKER
ADDRESS .... . . ....:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR . . .....: LIC N
COMPANY ... . . .....:
ADDRESS .... ......:
CITY/STATE/ZIP ....
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ___ ___-__-----
BENERGY A 92.10 92.10 0.00
BPBACKFLOW P 9.99 9.99 0.00
BPERMFEE F 307.00 307.00 0.00
BPLMC14K A 260.95 260.95 0.00 ,
I*AT P 6.11 6.11 0.00
ICRE P 2.50 2.50 0.00
BSWIM P 75.00 75.00 0.00
EPERMITFEE P 35.52 35.52 0.00
PPERMITFEE P 35.52 35.52 0.00
--------- ------------ -----------
824.69 824.69 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------e- ------------------- .tee--e=- ------tee==--=-----------e--e
103 UFER 104 REBAR
107 POOL/BONDING 301 ROUGH PLUMBING
304 ROUGH ELECTRICAL 502 FINAL PLUMBING ENERGY
503 FINAL MECHANICAL ENERGY 506 GAS TEST
510 FINAL PLANNING 511 FINAL POOL
516 FINAL BUILDING