99090170 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 041 Q Jr7 /
CITY OF CUPERTINO BUILDING-ELFICTRICAI. P
ERMT�;NO
BALDING DIVISION APPLICATION/PERMIT PI,GMBING-MFCUENTIngNICAI.
IIUILDING PR(IJECT IFIL'AT]ON
"'DING ADDRESS: SANITARY NO. APPLICATION SUBMI'FI DAH
,?/// ` yy �P"'- z / qr
^WNER'S NAME: PHONE: CONTRACTOR'S NAME: LIC NU'
�# NIC CONTROLX
CI IITECTIENGINIE?R', LIC NO AUURESS: ❑ �f �^
G-al 3 D a sto— l J
CONTACT: PHONE. EUILUING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECTPLUMY MECH
Z S'st,o LTJ' 2- Q E�
LICENSED CONTRACT'OR'S DECI.ARATION QTY ELECTRIC PERMIT FEE
I hereby affirm that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
Z with Scaion 20M0 of DivisinnJ of the Business vnJ Professions CtNe.and mylicensc is RESIDENTIAL:
W O p PERMIT ISSUANCE
CWF In full lune and cheat. ❑SCOWL ❑KITCHEN REMODEL.
QUU Lica COayk�r�Lic.p APPLIANCES—RESIDENTIAL DADUITION [I PLUMBING RE-PITT:
f�anW Dae tl/ '�—/ TSDE L ❑MULTIUNIT El STRUCTURAL
F D m law
rill
DECLARATION PANELS
H Z I unJarawW nmy Plans.hull be used as puhlic rttvNs MODIFICATION
0.y°:� UP TUNNIAMPS ❑INTERIOR ❑CHIMNEY REPAIR
[—NEW Licensed Professional 201-1000AMPS IMPROVEMENT ❑SWIMMING POOIS
pC C t'yx�¢ DECLAATIN
I hereby affirm Oat am UTIMexxemprffrrom the Can ractor's License Law for the OVER IOW AMPS [IBATH REMODEUREPAIR [IDEMOLITION
X OLO fulloon,oluin.(Seen 70315.Ba,inam,ard Prole—or,Code:Any city nr umuor, SIGNS I?LECfRIC ❑OTHER
W 3 W l- which requires a Permit In construct.aper,improve,demolish.or repair any umcture
OQ
pride its issuance,also requires me applicant for such penNtto Filcasigned statement S"E=R
UIT'/MI.
that he is licensed pursuant to the provisions of the Commcmfs License law(Chapter9
W�b�O (aouncncing wirah Section 2(HHp of D'olden5 of the Rosi ties%anti Professions Cac)or TOR POI.F.INSKv_ COMMERCIAL:
a a e C that he is exempt therefrom and the bads for the allcgW eaempdom Any violation of W BLDG/ADOI'UON ❑DENTO[JUION
W-m Section 7031.5 by any applicant for a penman subjects applicant a civil penalty of PES NT FOOD SERVICE
p-y} notmom than Five hundred dollars(E5W), IMP ' TENT
=opt.as owner of the pruNny.or my employcn with wages as their sale compensation. SOL ELECTRIC
$�+N willdo the worlsaad mr,trucmre is not inwndedo—namd unsulc(Sat.2Nd,Rusmncss '/T
Date{y w and Ihotessionz Calc The Contractor's I.namoe Law does not apply to an owner of OIT"IIiS—FIXTURES
d 3 Mwi ny who builds or improves thereon,and who does such work himself or through
his own employees.provided that such improvements are not intended or opened for NTIAL ELECTR S' Ff.
sale.ILhnwevel Ombmilding or inn"ostncn issold within one year of completion.the S FT.FLOO ftEA E/SQ.FT.
ownermilder will have the burden ofinnving that he did net build or improve I'm puT-
"m of sele).
I,as owner of the progeny.am exclusivity contracting with licensed contractors to TOTAL:
construct the Project(Sec.2194,Rovinc%%and Professions Cme:)The Connactar's at-
sel.awdoe nm opd,to anowmaot pnpcny who haildsor resolves mere on,and QTY. ' PLUMBING PERMIT FEE
whit contracts far such projects with a cnnmacturV)licensed pursuant to the Contractors
License Law. R IS
1 am exempt under Sec. .B&P C for this Mason it
VALUATION
Date
WORKERS COMPENSATION DECI.ARA'T10N C P D ,(1
I hereby umrm under Penalty'of Perjury one of the fallowing dedara'ion
❑ I have and will main Win uCenificnteef Consent ran self for Wnrker'x Compen- AINS l- D. STORIES TYPE CONSTRUCTION
smimn.as spiraled fnr by Sccl o 320(1 of the Labor Code,for the perfnmwnce of me
wnrkfmwhichlhispamnisissued. TUR '1'
El 1 have and will maintain Worker's Compensation Insarmce,as required by Section
1701 of the Luer Coi for the performance of she work for Which'M1ispcmmit is issued. GAS—I..A.SYSTEM-I INC OUTLETS OCC.GROUP N
My Win 's Cnnmpc -anti Insurance aorr, oil Polity nnmbcr,m' 6 ��
Cartier: Policy No.:Ll Y iM- ll3 .y
CERTIFICATE OP EXI7MPT10N PROM H'(I iRi S' L
COMPENSA'1'IONINSURANCE 1 R BUILDING DIVISION FEES
1'mis nealian need not he cmmplmcJ if'hc pcnnil is Toone hnndrW Anllars(EI(MB GREASIi TRAP
or lc,,) PLANCIIECK FEE
I cenify that in the Performance ofthe work for which thispennit isismed,I shall SEWER—SANITARY—STORM EA.200 11'.
not employ any person in any manner to m er } .,he Worker'Coaxial SEWER FEE
mZm .ambo laws of Culifomla,Due ��be '/u_�
zO APplicunt r Will]Ek HEATER W/vENTkiL1iC1'R GRADING FEE
h NCICE TO '1':11.after making this Ceni5cate of Exernption,you should WAT12R SYSTEM/TREATING
7 become subject to me Workers Compeo,own prav cions of the Labor Code.You mus' SOIIS FEE
W fnnbwith comply with such provisions or this panni'shall be deemed revoked WATER SERVICE
Q
CONSTRUCTION LENDING AGENCY NEW RIESIDFN'I'IAI.PhMB. SQ,IT PAID
U0 IherebY uffmmthmthereis:mcumwnion lendingagencylonhe perfonnancemf DateRecciPlq --.�"—
V. E" the work for which this permit is issued(Sec.3092.Civ.C) / \
Lender's Name TOTAL
U Lander,Address 'TOTAL:
1 1 caddy that I have mad this application and state mat the above Infontiation is BUILDING 121E
'� rn correct l agree to comply with all city and county ordinances and state laws relating to QTY MECHANICAL PERMIT FEE rp III
f) Z buildingconstructamounts,consction.unit hereby amounts,representatives of this city wenmrupo
n me s
SEISMIC '11
above-mentioned property fnba,in%pelion purposes. PERMU ISSUANCE ELECTRImNEE
(We)agree to save,indemnify and keep M1arndes,the Ci[y it Cupertinn against J
liabilitier.judgments.costs and expenses which may in any way seem'atuiniclud Col. ALTER OR ADD TO MECH. PLUMBI s FEE ,
in consequence of the growing of this permit. _
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,M)CFM) MECHANGAbFRE--
SOURCEREGULATIONS.
AIR HANDLING UNIT(OV13R 10."CFM) CONSIRUCTIONTAX
Signa .ppf actor c EXHAUST HOOD(N'NUCf) HOUSING MITIGATION FEE
HAZARDOUS NINUiRIAI ti DISCLOSURE
Will their,iAnamor home buildingeccupmnmwe mhoulb,huamNonsmawram HCATINGUNI'1'fC(l IIH1,UWl1'1'U)
as JeOncd by the Caucasian Municipal Code.Chapter 9.12.and the Heahh and Safety
Code.Section 25532(x)2 HEATING UNIT(OVER 100.0011 BTU)
p Yes ❑No VEN'UI,AUONFAN(SINGLERESID) PAID r
Will he applicant or future building occupant useequipmentor devices which
mi'bozardou%aircnaeminants a%Jcfnad bribe Ray Arca Air Quality Management BOILER—CONI'(3NP OR 100.001)BTU) Do, ReceiptM TOTAL:
D'utdctl BOILER—COMP(OVER 101.(H)(t)BTU)
F7 Yes 0 N
Iha'e read the hvallous mamriuls rtyuimnwms u'mMr Ouprer 6.95 of the Cali- AIR CONDITIONER �k ISSUANCEE.m
bane Health&Safu'y Code,Sections 25505.25533 and 25514.1 understand that Units,Units, NEW RESIDENTIAL MECH. SQ.ET. 2-97 �7J
huilding duos num cuncnlly have a terrain, it is my mslxmsibility to notary'he ( I
n(Ibc nce of a Ccn��Ts ' Pancy.
Ouncr ur vu dugcm Dan,/ TOTAL: ISSUED BY: ^�
OFFICE
CITY OF CUPERTINO
I� 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: chzietya
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:31607042.00
DATE ISSUED.......: 09/28/1999
RECEIPT N. . . ...... : 10178
REFERENCE ID # ... : 99090170
SITE ADDRESS .....: 19111 PRUNERIDGE AV/B
SUBDIVISION .......
CITY ......... . . ..: CUPERTINO
IMPACT AREA . . . ....
OWNER ........ . . . . : HEWLETT-PACKARD
ADDRESS ........ . . :
• CITY/STATE/ZIP . .. : PALO ALTO CA, 94303
RECEIVED FROM .... : TIM
CONTRACTOR ....... : SCATTS, LLOYD LIC # 21007
COMPANY . . . ....... : SCATES CONSTRUCTION INC
ADDRESS . . ........ : 3350 SCOTT BLV
CITY/STATE/ZIP ... : SANTA CLARA, CA 95054.
TELEPHONE . ....... : 4082358500
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__ _ __ --------- ---------- ---- _
BPERMFEE VALUATION 38,000.00 404.00 0.00 404.00 0.00 .
Bo- CHK PERMIT FEE 404.00 343.40 0.00 343.40 0.00
Eq PERMIT FEE 404.00 121.20 0.00 121.20 0.00
BR CEPT NO. OUTLETS 27.00 26.89 0.00 26.89 0.00
MPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
BREMREPALT NO UNITS 6.00 73.26 0.00 73.26 0.00
BSEISMICOM VALUATION 38,000.00 7.98 0.00 7.98 0.00
EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
TOTAL PERMIT 1047.77 0.00 1047.77 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 1047.77 1171
TOTAL RECEIPT ne 1047.77
•
CITY OF CUPERTINO
Item 1 of 2 BUILDING PERMIT RECEIPT OPERATOR: christya
COPY # 1
Sec: Twp: Rug: Sub: Elk: Lot:31607042.00
DATE ISSUED... . . . .: 09/28/1999
RECEIPT #... . . . ...: 10178
REFERENCE ID # ... : 99090170
SITE ADDRESS ..... : 19111 PRUNERIDGE AV/B
SUBDIVISION ...... .
CITY . . . .......... : CUPERTINO
IMPACT AREA ...... .
OWNER ... . . . . . ....: HEWLETT-PACKARD
ADDRESS ... . ......:
CITY/STATE/ZIP ...: PALO ALTO CA, 94303
RECEIVED FROM .... : TIM
CONTRACTOR ....... : SCATTS, LLOYD LIC # 21007
COMPANY .......... : SCATES CONSTRUCTION INC
ADDRESS . . . .......: 3350 SCOTT BLV
CITY/STATE/ZIP ...: SANTA CLARA, CA 95054
TELEPHONE ........ : 408235B500
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR '
ANCHOR BOLTS 106 SEWER & WATER
UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
46 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
311 SCRATCH COAT 313 ROOF NAIL
501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY
503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
509 FINAL GRADE 510 FINAL PLANNING
514 FINAL PUBLIC WORKS