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99090047APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY n (,jnint v-1 CITY OF CUPERTINO _-- - BUILDING - ELECTRICAL %fl BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL BUILDING PROJECT IDENTIFICATION. BUILDIWI ADDRESS: SANITARY NO. APPLICATION SUB TTAL DATE , w NHR'SN M:: PO E/:� 409 V , COF�-`�r�sI1`�01�'.SN LIC NO\—(rCZiI- ✓` -( �'rlIDEC lc,ol iNGINEE LIC NO:iN'I'ACI'; , 4411 PHONE: BUILDING PERMIT INFO Too ��� �O,g Qrg I I/� Y III O ❑ Consultant Fecs Paid by Applicant (Initial) BLDG ELECT PLUMB MECH ❑ ❑ ❑ LICENSED CONIRACTOR'S DECLARATION I hereby affirm that 1 am IinnkcJ under provisions of Chapter 9 (commencing QTY ELIiCTRIC PERMIT JOB DESCRIPTION with Section 7000) of Division 3 of Ne Business and Profesions Code, and my license i. Lionfarce and eIT 1iccnse `,- O Lic is � >-,5q 10 can me •-��- �'� PERMIT ISSUANCE WL DKITCHEN REMODEL DPLUMBING FE PIPE TI -UNIT ❑STRUCTURAL MODIFICATION ERIOR ' ElCHIMNEY REPAIR ROVEMENT LSWIMMING POOLS H BE DUE JREPAIR [I DEMOLITION APPLIANCES-RESIDENTIALITION A CHITECTSDECLARATION I undcF rand my plans /A�ty Jus pnhllc reuutLvPANELS ` ` �/1, 47RESIDENTIAL, UP TO NIO AMPS hicenseJferal anal OWNER-BUILDHR DECLARATION I hereby affirm Nat 1 am exempt from the Contractors License law for thefollowing 201-IWBAMPS py -R H)MAMPS SIGNS ELECTRICAL. reason.(Section]031.5, Business and Professions Cade: Any city Or county which requires a permit to construct, alter, improve, demolish, or repair any structure HE SPECIAL CIRCUIT/MISE. prior to its issuance, also requires the applicant forsuch permit to file a signed statement and he is licensedpars ant mthe,no kionsofthe Cnnteacmrs License law(ChapterY TEMP. METER OR POLE INSI. (commencing with Section 70101of Division 3ofthe Business and Professions Cadd) or that he is exempt therefrom and the basis far the alleged evomMion. Any oblation of D NEW B DDITION D DEMOLITION POWER DEVICES Section 7031.5 by any applicant for a permit. subjects the applicant to a civil Penalty of nut morethan Eve handrail dnllurs (650(h, Dl. an owner of the property, Or my employees with wages as their sole cmnpensmion, e, [Hit,, the work, and Paramedic in not intended or offered for sale (Sec. TOLE. Easiness ❑TENANT C3 FOOD SERVICE IMPROVEMENT []OTHER SWIMMING POLL ELECTRIC and P ficslom Code: the Contmchn's Lneand Law does not apply to on owner of OUTLETS -SWII'CH17S-FI X'fORES property who builds or improves Iherenn, and who does such work himself or through his Own employees, provided that such haprovenmms me not intended or offered far NEW RESIDENTIAL ELECTS SQ FT. I-� ^ D ly 'lu flfl 17 ([ L/ "SQ. FT. sale.If,howeveq the building or improvement is sold within oneyearafcompation,the owner willhmr meburdenof Proving that hedid not buildorimprovetorpor- ,mc ofsaley. D 1, as owner of the property, am exclusively contracting with licensed contractors m TOTAL: construct the project (Sec. lo44, Business and Professions Code:)Tbe Contractor's Li- - - comeLawdoes not apply to an owner of property, who builds or improses thereon, and who contracts for such projects with a cnmracodid licensed pursuant to the Connector's Q'rY.. '. PLUMBING PERMIT FEE SEP - 7 f / �i10(1 PERMIT ISSUANCE Licenkd Law. ❑ lam excnph ander sea ,B&P C ter thiarwknn .7.7x7 ALTER - DRAIN &VENT'- VAI HR(EA) Date y VALUATION WORKER'S COM PP.N DECLARATION RACK FLOW I'ROI'ECT. DEVICE -jury on 1 hereby affirm undo penalty Of perjury one of the following Co DRAINS - PLOOIt,RWF, AREA. COND. Workers to Curb. fort for Worker's CnmPem plaavc and will forbynation ofComead the Ube, sminn, m provided for by Section JIW of the Labor CWe, for the performance of the STORIES TYPE CONSTRUCTION FIXTURES - PER TRAP work for which this Permit is issued. D 1 have and will maintain Workers Compenmtion Insurance, as required by Sense. 3I(Mofthe labor Code, fon he pedtmnance nfase work for which this pemtit is issued My Workers Compema.am Insurance carrier and Policy number are: GAS- EA. SYSTEM. INC. 4 OUTLETS OCC. GROUP APN Caner: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' GAS - G. SYSTRM-OVER 4 HIA) I` COMPENSATION INSURANCE ('thin section need not be completed it the permit is farone hundred dollars IS l BO) nr Ica") GREASE/INDUSTRI. WASTE INTERCEPTOR i -p» k 5 BUIIAINO,DIVISIQNOFl+ASw s. -. GREASE TRAP PLANCHECK FEE SEWER -SANITARY -STORM EA. NO IF I certify that in the performance of the work forwhichthis permit is lsmul. Is hal l not employ any paromor an tanners a^Feeym�syye�Ne Wnrkerli Cntnpcn- ENERGY FEB WATER HEATER W/VENT/ELECTR cation Laws') alifir at 1 -I Applicata f �� �� _ GRADING FEE NOTICE. TO ICA . , after making this Corti -care of Exemption. you should become subject to the Workers Compensation prevision, of the Later Cie, you must WATER SYSTEM/TREAI'ING SOILS FEE forthwith comply witi,ach pmvid.morthis Permit shall la, deemed revoked. WATER SERVICE CONSTRUCTION LENDING AGENCY I M1ereby affirm 0auhuc iso ennslmelion lending agency for the perfnrmnnoe of NEW RESIDEMI'I Al. PLMB. SQ. FT. PAID Dale Receipt# the work for which this permit is issued (Sec. 3097, Ci, CJ Lender's Name TOTAL: I,cndcds Address TOTAL: I certify that I have read this application nnJ state that the above int nnalion in -BUILDING FEE Ircct.Ing-eehoromplywiN all cihyvndeounty nminances and stmt law. rdming to building construction, and hereby authorize representatives ofthis city to truer Orion the QTY. '' MEC) IANICAL' PERMIT )FEE SEISMIC FEE alwee-mentioned property for inspection purpmes. Died) agree to save, indemnify and keep harmless the City of Cupertino against PERMIT ISSUANCE ELECTRIC FEE Iiubilihies.judgments, insistent expenses which may in any way acc-ueagainstsaid City in asequence of the granting of this Permit. ALTER OR ADD TO MECH. PLUMBING FEE AIR HANDLING UNIT' (TO I0,(I(I) CFM) ' MECHANICAL FTE? APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS AIR HANDLING UNI "I'(OVER 10,000 CFM) CONSTRUCTION TAX Signauu ppiicanJComtndor Ilton HAZARDOUS MATERIALS DISCLOSURE EXHAUST HOOD OV/DUCT) HOUSING MITIGATION FEE HBATING UN I'I'(11) 100,00( BTU) Will l he applicant m furan hollding occupant share or handle hozunlous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532mL HEATING UNIT (OVER 100,000 BTU) C] YL, []No Will the soldiered or future building Occupant use equipment or devices which emit bvmco Jous vin ntate minas as defined- by the Bay Arta Air Quality Management District? D YO, []No PAID Date Receipt# T L: VENTILATION PAN (SINGLE RESIDE BOILER (3HP OR 100.000 BTU) BOILER- COM P(OVER 100," BTU) AIR CONDITIONER I lave mai the hudardous materials rduimmism, add, Chapter fi.95of the Coli" B P ISSUAN ATE NEW BESIDE N'I'IA1. MECH. SQ. Ff. haddo,dovs & Safmy Code, Sections Arai 25on, Led pornin4.1 m namiImnfe )het if tae lheecaipnm it isnryce the of hcuircnmcuneidlych muvcatonet prion III of the reyuimmenn which must he met prior w Ixsutncc nfe CeniBdam of Ocatpanuy. artunlithe .1 ISSUED BY: !Owner or authorized agent Date TOTAL: OFFICE 'x r INVOICE—INVOICE INVOICE INVOICCE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE I Sec: Twp: Rng: Sub: Blk: Lot:35708042.00 INVOICE DATE......: 09/07/1999 REFERENCE IO # ...: 99090047 SITE ADDRESS .....: 10380 RIVIERA RD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ......, OWNER ............: PENS ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014 CONTRACTOR .......: LIC # COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ..,..... : OPERATOR: katenb FEE DESCRIPTION CHK --------------- TOTAL FEE PAID -TO -DATE BALANCE DUE BELEC200 --- P --------- 22.20 ------------ 0.00 __--------_ 22.20 EPERMITFEE P 35.52 0.00 35.52 _________ 57.72 ____________ 0.00 ___________ 57.72 V�ID I VOICE ID PTIONO.VVVVOCI .TION .. .._VIII 304 ROUGH ........ION. ELECTRICAL ....... VOICE... .... 501 FINAL .. VDES........ ELECTRICAL ENERGY 505 FINAL ELECTRICAL is E • Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE JBLDG PERMIT FEES BUILDING BCCNSTAX CONSTRUCTION TAX BUILDING BENERGY ENERGY/ BUILDING BENERGYADD ENERGY ADD MULTI BUILDING BOVERTIME INSPECTION OVERTIME BUILDING STEMPPERM TEMPORARY BLDG PERMIT 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 EPERMITFEE JELEC PERMIT ISSUANCE ELECTRICAL BELEC1000 ELEC 600V <=1000A ELECTRICAL BELEC1001 ELEC600V>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 DEVICEIAPPARATUS 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 MPERMITFEE IMECH PERMIT ISSUANCE MECHANICAL BAPPLOTHER OTHER APPLIANCES MECHANICAL BBOILERI BOILER <= 100,000 BTU MECHANICAL BBOILER2 BOILER >100KTO500K BTU MECHANICAL BBOILER3 BOILER >500K TO 1M BTU MECHANICAL BBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL BBOILER5 BOILER > 1.75M BTU MECHANICAL BREMAPPLI JAPPLANCE 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 I of 2 Revised 8/10/99 BREMACOVER AC UNIT>10000CFM MECHANICAL BREMAIRHAN A/C UNITS <= 10,000CFM MECHANICAL BREMFURN RELOCATION OF FURNACE MECHANICAL BREMFURNOV RELO FURNACE > 10K BTU MECHANICAL BREMINHOOD INSTALLATION OF HOOD MECHANICAL BREMRELOCA RELOCATION OF HOOD MECHANICAL BREMREPALT REPAIR/ALTER HEATING MECHANICAL BREMVENSYS VENTILATION SYSTEMS MECHANICAL PPERMITFEE PLUMBNG 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 INSTALLIALTER WATERPIP ,' PLUMBING BPWHEATER WATER HEATER/VENT PLUMBING BPWSVCS MAIN WATER SERVICE PLUMBING ZDEVAGREE IDEVELOPMENT AGREEMENT PLANNING ZDIRTM IDIR TENT MAP 1PLANNING ZFULLHR IFULL APPL BASE+HR IPLANNING ZFULLTM I FULL APPL TENT MAP IPLANNING ZFULLUP IFULL APPL USE PERMIT IPLANNING ZFULLZONE IFULL APPL ZONING IPLANNING ZGPAMEND IGENERAL PLAN AMEND IPLANNING ZLIMAMEND ILIMITEDAMEND IPLANNING ZLIMTM ILIMITED TENT MAP IPLANNING ZLIMUP LIMITED APPL USE FERMI PLANNING ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING ZMINHILLEX MINOR APPL HILL EXC PLANNING ZMINSIGNEX MISC SIGN EXCEPTION PLANNING ZMINTM MINOR APP TENT MAP IPLANNING ZMINUP MINOR APPL USE PERMIT IPLANNING ZMISCASA MISC ARCH SITE 1PLANNING 4 ZMISCEXT MISC TM AND UP EXT IPLANNING ZMISCFENCE MISC FENCE EXCEPTION PLANNING ZMISCGEN MISCELLAPPLGENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING Z SIGN SIGN PERMI PLANNING ZSIGN GN TEMPORARY SIGN PLANNING ZVARIANCE DIRECTOR VARIANCE PLANNING 2 of 2 Revised 8110199 E • CITY OF CUPERTINO Item 1 of 1 BUILDING PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot:35700042.00 DATE ISSUED.......: 09/07/1999 RECEIPT N.........: 9998 REFERENCE ID N ...: 99090047 SITE ADDRESS .....: 10380 RIVIERA RD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: PENS ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014 RECEIVED FROM ....: DAVE CONTRACTOR .......: LIC N COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ........: FEE ID UNIT QUANTITY AMOUNT PD -TO -DT __________ _____________ BELEC200 METERS _ 1.00 ____ 22.20 -____---_ 0.0 ITFEE FLAT RATE 1.00 - 35.52 0.0 T PERMIT 57.72 0.0 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ CHECK 57.72 __________________ 3421 TOTAL RECEIPT •• vv'57 72 OPERATOR: karenb COPY N : 1 THIS REC NEW SAL 22.20 0.00 35.52 0.00 57.72 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ....................... 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL ti x; „C�i �fla Y ;ir11r ar FS azionry v, 26747Uers ROad Suite kl ;+N )OSE CA ., WS) 227-2700 ,4, �:,:,,')NPITIO REf'CJRT 2 D ♦i - y IRyn { (n; _ iii areas are not. ey Cap J 50ark Jzrristor F c Si_ ^Date C' urm pu 4 Vas M. �C r.�r.� N:A1 C.LRV1Cr:i'>: `. f OMI Ind •,•_,_�a i== -t7Ml �cr I -amt9ar r r tv?ry er' 4.h ct� PRICE - 4X I Crab 1,�Gtml 3 WCtIOh I , jSTOVE OR FIREPLACE INN EKI _ KvePipe Condition (wood_tot) i r � r4VEd Fluc ConnE•_I .?n e : If�titrrr ThimGle J Clearances --- 2 A' CON { x sIDCRATIONs r2' tinciuisher J Smoke Detectu,i is Furnace Flue Liner __....._ Escape Plan A giq the result of dor p at 6hel i1o,e- 7 co6*f aui c . tomrr r) t. incIV.&d as a e worthines 6r safety., = r, I, ,�r's��ke;,tto: �' _ rranty o• s .. ,ti, ct:r mr +- �; J �'aou h -._oar al}oGt'as yy ,F` 10300 Torre Avt mu„• —ATJOH iLOd. R EC, f da'ti. i South Milpitas Bolllryaw, ;) 945-3600 Fax (409) 957-7 (9 4 DATE:t, lGL ATV4.' GGev fa 7-1 COMPANY: Sk FAX NUMBER: FROM: 3i DEPT: —*— 41� 4 414 1, I iL-4 4 . dew +, , 2674 TUefs Road ' Su+te 41- . .. " 'SAN JOSE, EA $5121' � (A08) 227-2700'. CONTRA OR OG 0fi005 J.' , 477,�- curzome• COMMENTS , 77, G ^J+t c� ,r. �;-2 Phan q/• Time�jg)'14d I.�1 C/ RIO I l CO -ND:''. ! y !*IMNEY r i - f'ha to r4occth;= , r t, nti n s., sed sr9nd svhd h ares, tai my wcitdtwm; EY g iys ein- appear c rwe 5 acinrry in which area5.a4 not s3tisfaetbry. 7 Height 1 i himney Cap / Spark Ariastor Or a. Craw- 'ulama _,=1,, I . cn�n � } 1""l NEXT F tV1C};�1Cx PEC1.C1MfV1E1�1t7EiJ ' 4. Bricicravrl. , Mortar �a cc Flashing }n,_ y ...T. �.�-...•....— a=G7 ,n i '. �F'ue Tiles qty = °t;.ep! a a 34 .1 hn Showib be: n4peric' yearly frrr any stmt tT�rp J htat'ture Resistants »_oe � � IM:3 utetrtq'' t n eke C1-:1m6ar9. Damper 10.'Firehox / Gnraetr r� f ✓fJ'S w iid� tiI"Ar* 11. Ash Come.' y'C,•.D'+. [Ly� 1-1rr.-•. i r �_ _ �' 1„'.. Sparcr,.en l Doors nih DUMP •'{ �'_.;..:„,-..__.,- `,,�., ^,< .? .-G - , " , t13; Tool / Glmres ^` 14. Hearth Froiection.- r 15. Misr ; � � •.�Y VVOOC)STOVE OR FIREPLACE INSERT _ IT— r �`"re.5to✓e,(;ipe Condition (wobdstove)s. 17;NFPA Approved Flue Connwytion (ins,?er) 18: -Installation / Thirnb!d /'dearanccs, .OTHER SAFETY C.ONSIt:f:RATIt?NS .. _. 19r Fire Extinguisher Srna Detector;. {}—� V r T �p Gas Furnace Flue Liner;,-.----�`' Ire Escape Plan — - -. 3UL TOTAL ...Pl fj 9: -Thi$ is the result of'a visual inspettlan-d�ngk+&S th? time of rM1 "_. it IS'inCl e(1�, a5 a convenience tb bur ci,l.Sff?rr+er, 1 Gt S: Certs `t^'$7'Zfa*+*4 tisd: r0TAL+^ a ticYr i t flee oyorthin or;safety. Since cond'ittbhs.of use,'Are bey; -- —� =, ict7nTrpl, -*!!c f718k .i10 t+Varre(itjl' Of.t�'S"a'let+ or fun(tiiiv of a�Yj° . ?a+e : � ; .F`o�+ TTd )'OU hear ^ al74uC Ari < ? cewd none 4x6 bedrnplled w . Flyer Ci �1a- - f�jMt R.fi� t p ��._: .j., �3ri.a .i'. Ik �_ r �i n ,eek .. 1 w .✓SA k.. Y 7 r ✓ ki. I ?���� �sz,INSMISSIQN ''i • FbMc 91 South Milpitas Botticvw. M11pitas,'C4fQtnLt 9501.. •' - ' •' (408) 9454600 Fax (408) 957-7193 DATE: ATTN. . AG �,GYS'O il ,Eb COMPANY: ;v PAX NUMBMi' -r OM: DEPT: �', SUJ3IBC:'1':, � Gtl }31 �'. 7 •? � _ rn .. . , , c', rt � `� T �'CC f G' F. •f' { � ��/-t . �L /Y d_ �Lrlf�lt � '�7.L� 5�� r,.$ �'- <,,,1 /? 'C� _ lot's-� .�'.',S,'�".}"Ci iQ C% ;fi Ip �Yd'y"; k+;Jy it'" Y. •f J �S�GIJNr` i IIeeG1 �.c1 �f s?. r rXy`' "7%'E' t?Gzz rGf' fx . t v Cf rr. M er iJfe yi';� �. h � µ� I �Y .c.� "�'ae �. f�?.e_.�� Lti �tr'Gl�� J C ¢* *�'� �. .P_ .. r_ ` ♦♦ � ... �?i ..h "7'! L! ..�.Ini m !ati t @ + �F'. I i � a ^"•� , r