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99090049 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILD IND ELECTRICAL BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL '. s,+" { I BUILDING PROJECT IDENTIFICATION'+, BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE VO ER'S NAM1'�: I:KFPHONECOMT TRALTOR'S NAME: LIC NO !J _ 2 NIC CONTROL N CHITECI'/ENGIN' . LIC NO: -J ADDRESS:/ &(y ATIO " I(E, ❑ CONTACT PHONE I { , ,BUILDING PERMIT fbi ' I ❑ Consultant Pees Paid by Applicant(Initial) BLDG ELECT PLUMB MUCH ❑ ID 10 ❑ LICENSED CONI RAC I OR S UFCIARADON QTY, 1`ELECTRIC PERMIT FEE -' I M1ereby aanm m t I r d d p .. renaPmr9(ecmme g ' , r. .> . - s• ' P+ -'+I' JOB DESCRIPTION WOZ IhS hon]OW)ofD 3ofNe Busi dP fsslo is Coee and rayl cense is RESIDENTIAL: F n fail❑ora vnd PHRMIT ISSUANCE �UU Licensef„Ias'Lic.N - ❑SFDWI. E)KITCHEN REMODEL �zW Date Comrama[�,�.�� f APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE ARCHITECT'S DECLARATION [I MULTI-UNIT El STRUCTURAL Z O'I'z 1 understand my plans shall be used as public records PANELS MODIFICATION OZrUP'CO2W AMPS Q El INTERIOR ❑CHIMNEY REPAIR F4tW Licensed Profencional 201-1000AMPS IMPROVEMENT J OWNER-BUILDER DECLARATION ❑SWIMMING POOLS O y Q I hereby afinm that I am exempt from the Contractor's License Law for the OVER IOW AMPS ❑BATH REMODEPREPAIR ElDEMO ITION iry$. U affecting reason.(Section 7031.5.Business vad Pmfessiens Code:Any ciry.,county SIGNS ELECTRICAL D E jlWMAL� w us h which requires v permit to construct,alter,improve,demolish,or repair any structure Y/hEJr/ F 14 a prior to its issuance,also squires the applicant for such permit to file a signed statement SPECIAL CIRWIT/MISC. �,ob that he is licensed Political it)the previsions of the Contractor's License Law(Chapter 9 W O (commencing with Section](100)of Division Sof lno Business and Professions Code)or TEMP.MH'fE.R OR POLE INST. COMMERCIAL: 6 ry,o eG that he is exempt Iherefrom and Inc basis for the alleged exemption.Any violation of El NEW BLDG/ADDITION L1 DEMOLITION W 2 Section 7031.5 by any applicant for a permit subject/the applicant to a civil penalty of POWER DEVICES net more than five hundred dollars(5500). El TENANT El FOOD SERVICE E]1,as owner of the property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT p. will do the work,and the structure is not intended or offered For sale(See,7044,Business OTHER and Professions Code:The Conlrador's License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES property who builds nr improvea thereon,and who does such work himself or through his two employees,provided Ihnt such improvemema arc not intended in of dee for NEW RESIDENTIAL ELECTR SQ FT. sale.If.however,the building or improvement is cold within one year of complaioglhe $Q„ ('.NL00 EA $ISQ.PI'. e ' ill will have theburden [p that gh cid Ibuild or reprove for p se f ) TOTAL: ❑ f theproperty, c n lycontracting th licensed contractors.i- constructh project(S c 7044 Business dll f cotle)Theeommaon F- '+ J�IFIE SEP - 81999 awel ac t hplyl fpr perry e n Id improves Contrn ,na QTY .PLUMBING PF,RMFI' eche se Use for euchp jedswthaeonrtecmge)licensed purcuanne the Con¢netors License Law. PERMIT ISSUANCE ❑ tem exempt under Sec. ,B&PCFnnhis reason Owner ALTER-DRAIN&VENT-WATER(EA) Dme WORKER'S COMPENSATION DECLARATION BACK PLOW PROTECT.DEVICE I hereby affirm under penally of perjury one of the following declurntions - - Ihevo andwillfeebinetion cand3700 of the ant tobor self Cuba forthema Workela Comp the DRAINS-FLOOR,ROOF,AREA,GOND. STORIES TYPE CONS UCTION codon,as provided for by Section 3]00 of the Labor Code,far Nc performuna of the at for which this permit in issued. FIXi'URES-PCR TRAP �I J will maintain Worker's Compensation Insurance, required by Section 3700of the Labor Cede,for the Performance tihwork forwhich this pormiis issud. GAS-EA.SYSTEM-1 INC.4OUTLETS OCC.GROUP APN My Workj5��Coatpeysaljon.(kos iencef+Irrierand Policy number ym _ ,AA CarrierMyWe (�C (y=CLe i ad No.'.Qfl(JL�nM/MR GAS-EA.SYSTEM-OVER 4(UA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASEANDUS'IRL WASTE INTERCEPTOR 77UR,I)INGD F N$P. (This section need not be completed ifthe permit is for one hundred dollars($100) GREASETRAP °r last PLANCHECK FEE Ianify perin son in perany anmanceofthe work forwhich this permit ankersuetionteshall SEWER-SANITARY-STORM EA. PT. smionmLe yany 0e don in mmmeryy_t�bery�Isuhjed to the Workus'Cnmpon- ENERGY FEE z Appllcnn .Tia, avt; SCC �77TT_ A t Ti I WATER HEATER WNEN'I'/ELECTR �- - --- GRADING PEE ay NOTICE TO APPLICANT:If, it,,making this Cisions if of Fish.,io d you shouts WATER SYSTE,WI'REATING bmomescomptothe Worker's Compensation or thisermiitihal if he Lahorvoke,you mum SOILS FEE � forthwith comply with such provisions or this permit shall he deemed revoked WATER SERVICE CONSTRUCTION LENDING AGENCY NEW RESIDF.NTIAI.PLMB. SQ.PT PAID V kforwyohthis ethereisvan(See.30 lending agency for performance of Date Receipt# L4 H the work for which this permit is issued(Sec.309],Cie CJ O U Leader's Name TOTAL: ay Lender's Address TOTAL 6 : � t 1 certify That 1 have reed this application and state Ihnl the above information istt M - - ,- BUILDING FEB tis 0demand.I agree to comply with all city end county ordinances and crarel m laws ating h' QTY. ECHANICAL PER 7MIT f?Fl) (.) a building connrrction,and lmreby authorize representatives of this city to enter upon the 9EISMICFEE ahove-abandoned pmpeny for inspection purposes. PERMIT ISSUANCE (We)agree to save,indemnify and keep harmless the City of Cupertino ngvinm ELECTRIC FEE ludilities.judgments, is and expenses which may in any way aameagainst raid City ALTER OR ADD TO MECH. onseyaenceeft gr. ngofthispe@lit. PLUMBING FEE APPLICANT U Fj6j� S AND HILL M LY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO,OW CPM) SOU R I R 'INS' MEC14ANICAL FEE 4-1 9S AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX gmnea olrppmnnV sur Dam" EXHAUST fI00D(W/DUCT) HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEE Will the applicant on future building occupant store or handle hazardous mamrial HEATING UNIT GO 1pi B U) as defined twine Cupertino Municipal Cade,Chapter 9.12,and Inc Health and Safety Code,Section 25532(n)? HEATING UNIT(OVER 100,000 BTU) L]Yes No VENTILATION FAN(SINGLE RESID) PAID Will the"Brain or future drilling Dote Be t# pp g by BusemAir emmcicalaswhich BOILER-COMP(3HPOR IW,OW BTU) mitict' nus air conteminvmx vs defnW by the Bay Arun Air Quality Management Dixlrid? n ❑Ym BOILER-COMP(OVER I(IgWO RTU) Tw I have read the nrdous muredals requirements under Chapter 6,95 of the Culi- AIR CONDITIONER ISSUANCE DATE f nnie Health&Snfe 'ado s 2550 5533 v d 25536.1 understand thnl if the NEW RESIDP.N'I'IAL MECU SQ.PT. hulldingdoes id art eat ant that' .my npoa ishymnotify lhatecindnt offhand - ;whi nU etp Cenificemo Occa, Owns aur rze ag 'Date TOTAL: ISSUF,D BY: OFFICE INVOICE INVOICE,.INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE • CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: karenb Sec: Twp: Rng: Sub: Blk: Lot:36904037.00 INVOICE DATE......: 09/08/1999 , REFERENCE IO 0 ...: 99090049 SITE ADDRESS ..... : 19865 RODRIGUEZ SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ... . . .. . .. . .: IKE MISTRY ADDRESS . .... .....: CITY/STATE/ZIP .. . : CUPERTINO CA, CA 95014 CONTRACTOR .......: GILROY, JOHN LIC # 15128 COMPANY .......... : JUST WATER HEATERS INC ADDRESS . . ... . ....: 1764 NATIONAL AVE CITY/STATE/ZIP ...: HAYWARD, CA 94545 TELEPHONE ........: (510)293-9901 FEE DESCRIPTION .CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BPWHEATER P 9.99 0.00 9.99 PPERMITFEE P 35.52 0.00 35.52 --------- ------------ ----------- 45.51 0.00 45.51 VOICE IO DESCRIPTION ......is IO .. =----DES ... DESCRIPTION .. ...................... ........ .............. FINAL PLUMBING ENERGY 506 GAE TEST 507 FINAL PLUMBING •