99090040 APPLICAN7R0 FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 0100
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APAPPLICATION/PERMITPLUMBING-MECHANICAL
;RUILDINGPROJECrIDFwirFiCA'r10Nr'fff;(,ol'.(t
ILDING ADDRESS: SANITARY NO. I APPLICATION SUBMITTAL DATE
iR'SNAM' PIONC.� •� ONTRA k'S NA i1 LIC N):
N NIC CONTROL#
if 7W Nf:ER 1� LC RO. ADDRESS: ❑
OM'A47F f11D PHONE .!+,l3UILDINO'PERNIpI'i NFOSs '. •;�i
a� r I ' �.�k sY ❑ Consultant Fees Paid by Applicant(Initial) BLDG LECT PLUMB MECH
0,7
LICENSED COMRAA_CIIORS DECLARATION h✓JhVh Q .tf f {L,&RIC PLRMIT� t} ; FEE(.�t
I nerenr arrr++matln,hem+,wand Ir LE 7tt
OfCtor rn term ne g z•,Ef- ,•, t_r' ...1+ -.)Tr Ii It jt.",!1)t nl<[_ JOB DESCRIPTION
MIS:
FOz with Secuon 9lNq)ofU vrsionlofthe Husness and Pro R.sonsC fe and my' RESIDENTIAL:
O ' full rmceandeffecr I'T:RM11155UANCE
m l;, '". - ❑SFOWL EI KITCHEN RE-PIPE�UU License Class Lic.#_a App1.lANCES-RCSIDIiNTIAI. ❑AUDITION El PLUMBING RE-PIPE
yQiDateContrecor
ARCHITECTS DECLA ION ❑MULTI-UNIT ❑STRUCTURAL
,- OQ - PANELS
2O yNj Z I understand my plans shall be used as public mo,ads 1 MODIFICATION
OZ—O UP TO Nob AMPS f/ C3 INTERIOR E3 CHIMNEY REPAIR
1 4t:; Licensed Prnfossional 201-11th)AMPS IMPROVEMF El SWIMMING POOLS
C6 YE, OWNER-BUILDER DECLARA'T'ION OVER IOWAMPS El BATH 1 IIREPAIR EI DEMOLI'I ION
C C, 1 hereby o ffimt that 1 am exempt from the Contrenor's License Law for the
7p$,O LU follow ung reynn(Section)9831.5,Business and Professions Coda Any city or county SIGNS ELECTRICAL ED Up
wt 3 m�j which requires a Permit to amswim
cL cher, prove,demOBsh,Or repair any'Imurre
F-�'0g prior In its issuanceor
maims also uims the applicant for such Permit m
0 file a signed statement SPECIAL CIRCUIT/MISC. D
Y that herd licensed paramnt to the provisionsul'the COnlructnrx License Law tempter9 ALI
1i1 0 (commencing with Section 7000)of Division Sol'the Business and Professions Cwe)or 'I lvIRME'1'ERORPOLE INS'['. -
6 60 5 that he is exempt therefrom and the basis for the alleged exemption.Any violatinn of ❑NEW / ❑DEMOLITION
4• Schon 7031.5 by my appuicvn turn permit x"bjects iheapplicaut 1n a civil penalty of POWER DEVICES
ul�y NA OD SERVICE
not more man.ft hundred In"Pe dollars my
IMPROVEMI!�
~z6 (] I,asOwnernf the pmpenY•nr mY employes with wages as their sole nTmpcnsution, SWIMMING POOL ELECTRIC FQ willdu The wnrk,undone strunnrcls nal intendulnn+lTcul for sole(Sec.9044,Business ❑OTHI?R
'•m and 1'mfessions Code:The Contrector's License Law does nm apply to an owner Of 0 oupidn'S-SWTrcia"S-FIX'ITRI S C
property who builds Or improves themom,and who d«s such work himself or through
his own empluyecs,ry wided that such impmvcmems are nm Intended or offered for NEW RESIDENTIAL FLEETS SQ Fr.
sale.If.however the building or improvement is sold within one yea Ofcompletion.the SQ.Ed MOOR AREA S/SQ.Fr
insviater-laidde,woil have the burden c f proving that he did not build or im,mve fur par- r
Tawe of svle.). S
❑ I,as ox net of me progeny,am exclusively contracting with licensed convectors to
construct the prn)ect Noe 904,1 Business and1 f .Code)Th Contractor's L kill', s
cense Law docs not apply to fp penywh builds improves Th d tQTY: y MBINC PPRMIT I, t1 t I + :��- s=
wbo romans for such projects with a contra Cods)licensed pursuant to the Commctors .I -10 r••a
Licanse Law. PERMITANCE g
❑ lam exemptunder Si .B&P C for this reason
AI.TEl(DROia,Vlr - TER(EA) VALUATION -meq
Owner Dute 1 9 . tlLJ
W'ONKEkSCOty(if Perjury
on DIiCLARAI IONlowing BACK FLOW I'k r. ICE
Ih 1hereby ill mai under Penalty(if perjuryoneoftheinsum in6declarations:
I have and will maintain Certificate of Cnnsem maell-inxnm for Worke(x Comport. IlkA1N5-FLOOR,ROO BA,COND. rOkIFS 'CYPC CONSTRUCT cation, r provided fur by Section J9IX1 n[me Labor ado,for ire pvdormenec of
work have uich ill initiation
ratiis issued. FIXTURES-PER TRA
❑ I have Lo willadoWorkers Compcnxmi stick
ck far which
cs required M1y Stud t
39W ofthe Lclpr G++le,rorthe perfnrmmnce of the work lar which mis permit i.issued. GAS-EA.SYS"fEM-I INC.40UT1.: . (KQ GROUP APN
My Workers Compo c.,am.Insurance carrier and Pulley number are: R
Can'mc Pul'cy NO.: GAS-PA.SY5TEM 0 E 4tIiA) ,J [�. 'i AL
CERTIFICA'l li OF EXEMPTION FROM WORKERS' k1 I'V(/
COMPENSATION INSURANCE GREASUINDUSTRL WAS RCEPPOR
(This section need not he cnnmleaalif thcpennit is far one M1nndrnldnllvrx 15100) _ BUI.DING ISIONIE-
or lect.) GREASH TRAP PLANCHE 0
I certify that in thepertbrmance ofthe work mrwhich this permit is issued,(shall SEWEk-SANITARY-STO A.200 FT
not mm
uld.,my person in any mannerno as to becoeauongmry bjest nT The W�rkers'CENE 0 O
Zz 'namn Laws of California.hate WATER HEATER WNENT/ELECT
Applicant ' / GRADING FEE
NOTICE TO APPLICANT:11,after making his Certificate of Exemption,you should WATER SYS'rEMGRHATING
a , Ma+me whjut to The Worker's Compensation,mvisinnx of the labor Cale,you mus SOILS PEE '
Lkl fonnwithe"mplywith.such provisinns or this permit shall he dermal revoked. WATER SERVICE
Q
CONSTRUCTION NGAGENCY NEW RESIDENTIALPLMB. SQ.FT. PAID
`7 Z (hereby oftion thnus
hereumre
uweliun ctinn llending vgency for performance of Done ReeeiptN
LL r- me work for which his permit is issued(Sec.3099,Civ.C.)
O U Lenders NameTOTAL:
Lender's Adele, L:
a. I certify that 1 have read this application and state Oat he aMove inbourratioun is BUILDING 22.00
H r .
v7) correct,I g t ply with all city and county d and state laws relatigt QTY.�, 1� MLCHA_NICAL'PERMIT FEE O
Ua building cousTout,iul booby unhnr'm Irr.enrn esofth scry men ter upon Thu T L. . i I rt . SEISMIC
oMvo-men, ne progeny for in,, i purposes.
ON ag em'. indc fy�td keep harml<s City of Cupertino ngaimt 1'EkMI'I'ISSUANCE ELECTRI rSo �
lianllitics lud• cots,cols um ct swh lchmuyi any uy accmongairt"said City ALTUt-OR.AUD+TO MECH.
I'LUMRIN 1u131i O
incense len cur the&rend this xrmit.
FI
APPLI A 'U P.R. S A D ILL C I Y WITH ALL NON-POINT AI A DLING UKIC TO 10. C uM) MF.CHANI AI.PEE
SOUR 'E ATIO .
AIR AN LING UNIT(OVER TO." CONSTRU ON TAX
nature Of Applirnnl/COnlreclOr Date BX PST( 0\fY/lM HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE ^
Willmo applicuntorf"mrc building occ.Pnm score mhandle hnzurdaus material HEA' G ON]'1'(TO 1(10.000 BTU) Z'V
as defined by the Cupeninn Municipal Code,Chapter 9,12,and the health and Safety
Cale,Section 25532(a)" (IEA'1 ' UNI'1'(OVER 100,00013TU) _
FI Yes No VEN .'ATi(IM'PAft-NdIsIi,ilESID) PAID
Date Receipt#
Will The applicant infurore mewed occupantuseequipmentordevices which BOILER-COMP OHP OR 100,000 BTU)
n hazvrdnus vu amaminums as do Oned by the Bay Aren Air Quality Mnnugemem
.stns?
❑Yes F1 NO BOILER-CONY(OVER 100,004)BTU)
I hase real the haardn"smmenals reyonano s an Choptef h95 of the Call. AIR C'ONDI'TIONER ISSUANCE DATE
Orion Health At Safety C e.Sections 25505,25533 and 25534.1 undcrawri that if the NEW RMID17N BAL MUCH. SO.Fr. �Q
.ttleu,J+ws ncurrem mnT,Tbm iti rymagf a Courfical,tuorr Ofymeancy,
afthe bidding ai wh' tpnI s TpouaCenificwe Of Occupancy. \ 111 U
m
O c homed age m - Date T L g ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: chrietya
Sec: Twp: Rng: Sub: Blk: Lot:35920042.00
INVOICE DATE......: 12/17/1999
REFERENCE ID # ... : 99090040
SITE ADDRESS .....: 5 RESULTS WAY
SUBDIVISION ...... .
CITY ... .......... : CUPERTINO
IMPACT AREA ...... .
OWNER ............: GROSVENOR INTERNATIONAL
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR ... . ...: RUSSELL, DAVID J LIC # 5655
COMPANY SOUTHBAY CONSTRUCTION
ADDRESS ....... . . . : 511 DIVISION STREET
CITY/STATE/ZIP . ..: CAMPBELL, CA 95008
TELEPHONE ........ : (408)379-0400
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
RENERGY A 1446.60 1446.60 0.00
BPERMFEE P 4822.00 4098.70 723.3D
BPLANCHK A 4098.70 0.00 4098.70
BSEISMICOM P 250.11 0.00 250.11
--------- ------------ -----------
10617.41 5545.30 5072.11
VWD DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUhIDING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH'ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 30B 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
�\ CITY OF CUPERTINO
i
I of 1 BUILDING PERMIT RECEIPT OPERATOR: yvonnek
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lo[:35920042.00
DATE ISSUED. . . . ... : 11/08/1999
RECEIPT q. . . . . . ... : 10961
REFERENCE ID # . . .: 99090040
SITE ADDRESS . . . . .: 5 RESULTS WAY
SUBDIVISION . . . . . . .
CITY ....... . . . CUPERTINO
IMPACT AREA . . . . . .
t
OWNER ....... . . . . . : GROSVENOR INTERNATIONAL
ADDRESS .
CITY/STATE/ZIP .. . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : TIM
CONTRACTOR . . . . . .. : RUSSELL, DAVID S LIC N 5655 `I
COMPANY ..... . . . . . : SOUTHBAY CONSTRUCTION
ADDRESS .... . . . . . . : 511 DIVISION STREET
CITY/STATE/ZIP . CAMPBELL, CA 95008
TELEPHONE ..... ... : (400)379-0400
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ _____________ __________ __________ __________ __________ __________
BELEC200 METERS 1.00 22.20 0.00 22.20 0.00
BENERGY PERMIT FEE 4,822.00 1446.60 1446.60 0.00 0.00
BP EE VALUATION 1191,000.00 4822.00 4098.70 723.30 0.00 -
E
'URD UNITS 29.00 241.57 0.00 241.57 0.00
VBk. .CHK PERMIT FEE 4,822.00 4098.70 0.00 4098.70 0.00
BAPPLOTHER NO OF APPLIAN 4.00 33.32 0.00 33.32 0.00
BPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00
PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
BREMHEAT NO OF HEATERS 2.00 12.22 0.00 12.22 0.00
BREMMISC FLAT RATE1.00 25.53 0.00 25.53 0.00
BREMRECEPT NO. OUTLETS 44.00 38.28 0.00 38.28 0.00
BSEISMICOM VALUATION 1190,700.00 250.11 0.00 250.11 0.00 -
EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
MPERMITFEE FLAT RATE . 1.00 35.52 0.00 35,52 , 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 11107.08 5545.30 5561.78 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ __________________
CHECK v65561.78 5426 RECEIPT 4
TOTAL RECEIPT 5161.78