99100140 Q 14D
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY D
CITY OF CUPERTINO � BUILDING-ELRUPNICAL PERMITN
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL
BUILDING PROJECT'II)ENFIFICATION
BUILDING ADOP.JSS:
S ANITARY NO, APP. NS .DATE
µryl?EyNAR14 \ r, I'h1ONE:� CON"fit 'IY b'NAMI;. LICN
lJE I��I wlI NIC CONT Bi ll0
RCHITECUENGINEP.R: LIC NO: ADDRESS: ❑
CONTACT: - PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Inifixp BLDG ELECT PLUMI MECH
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRICPERMII' FIiB
I hereby affirm that I nal licensed under pmvixions of Chapter 9lammmncing JOB DESCRIPTION
D�zp with Sccoon9(NXlln(Dlvlsimn 3afthelmdrussund l'm@.mos Cadaandin,liccnscla PERMIT ISSUANCE RFSIDHNTIAI:
ulO
F-i—
in se full form and effect. ❑SPDWL ❑KITCHIiN REMODEL
It_u ,tenClass
Cumtractor APPLIANCES—RESIDEN'DAL ❑ADDITION El PLUMBING RF.-PIPE
06p, [IMULTI-UNIT ❑STRULTURAL
y ARCHITECTS DECIARA11ON PANELS
z p n z I understand my plans shall be,used as public records MODIFICATION
Oz UP T0200AMPS ❑INTERIOR ❑CHIMNEY REPAIR
I,'(Jp ad Licensed Professional 201-1000AMPS IMPROVEMENT E]SWIMMING POOLS
�d2 OWNER-BUILDER DECI.ARA'I'ION OVER 1000 AMPS Ll BATH REMODIil.11ilil'AIR ❑D8MGL1'HON
C C I hereby anion that 1 am exempt form the Contractor's License Law nim the
3 p H following rearmsiness and.(Section]031.5,BuPrufcoum,Code:Any city or aunty SIGNS HLEC'I RICAL El OTHER ^
y which acquires a permit to conswct alter,improve,demolish,or repair any structure ' 1
0 prior to its issuance,also requires We applicagl for such Permit o file a signed statement I SPECIAL CIRCUITIMISC.
f } that he is licensed pursuant n0 the provisions of the Contractors License Law(Chapter 9
IL pO (commencing with Section 7000)of Division 3 of the Business and Professions Corka or TEMP.ME 117R OR POLE.INST. COMMERCIAL:
that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/AUDITION DDE OLfHON
�on Section TO L5 by any applicant for a permit summit,Iheapplicaorto a civil penally of POWER IIRVICHS ❑TENANT ❑FOOD SERVICE
yy of mate than rive hundred out tats lBNNy. IMPROVEMENT'
G ❑ has ownurofthe prnpeny,or my empluyocs with wnguatheir Hole colnpenxwinn, SWIMMING IKu)L ELECTRICH will do the work,and lhesunewre is not intended or mimed fertile(Sec.91W,Business ❑OTHER
and Professions Coda The Crntmcmr's License Law does not apply to m owner of ODD LE'I S—SWITCHES—FIXTURES
a'3 pm,mr,who builds or improves thereon,and who dues such work himself or through
his own employees,provided that such improvements am not intended or offered for NEW R&SIUENTIAL ELECfR SQ
FIA
sada If,howeve.the building inimprovement d could within one year ofcompletion,the SQ.17 FLOOR AREA LSQ.I'r
ownerbuildrr will have the harden of proving that be did not build or improve f n pun
pori�s o
Her of the PnopenY,um exclusively cordoned,with licensed emnnlcwrs to TOTALtie:
cunmrun the project(See.7044,Business and Profession,Code)The Cmunamrk Li- 0 9
cense Law does has apply to an owner of pmpuny of...builds or improves thereon,and QTY. PLUMBMG PERMIT FEE.
who counsel,torsed,Projects with a comrnal od licensed purauanl to the Convenor's
license Law. PERMIT ISSUANCE
❑ lam estraNn i.Jr. .B&P C for this mason
ALTER—DRAIN d VENT—WATER(EA) VALUATION
Dam
wncr µm order p COMPENSATION DECLARATION BACK PLOW PROTEGE DEVICE ��� D
1 hereby affirm under penalty re perjury one of sid following declaratiWorkers Cul
❑ L.as...will edinih,Scania,3cate ofConsent
LahorCodemurc for Workerslrmpcm DRAINS—Iq,OOR,ROODARRA,COND. 5'I'OItIHS TYPECfINS'fliDCfION
,mink,r provided 1'or byt is faro 9901 of the Lrlxm Cully,for the perfnnnencc of tire
work far andthisilo Permit is insure. FIXT11111:S—Pf:R TRAP
El 1 have and will main Win Wnrkeh Come ofnic w rkfor which
h required by Section
My Wo the Labor Code.
nsatifor nthe
surance canceofthewlic for permit isi.csucJ. GAS—IiA.SYSTEM-1 INC.40C1"LIffS OCC.GROUT' A
Myfia,. ,Compensation Insurance carrierand IN.,number am
Cameo Policy No.: GAS—F.A.SYSTEM-OVER 4 fFA)
CERTIFICATE OP EXEMPTION FROM WORKERS' GREASPJINUUS'1'RL WASTE.INTEHCEI'TOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(Thisseedo,head not heconileted ifthe Nnnit is Laurie hundred dollars($IM) GREASE*1RAP
on Iasx.) PLANCHECK Il1E
I certify that in lis lwrfnrmvnec rftM1e work fun whiehlospermitlsisHued,l shall SHWER—SANITARY—STORM IIA.200 FI'.
not employ any Person in any manner so as to bacon subject to the Workers'Conipen- ENERGY FEE
oZ amino Laws of California.Dae WATER HEAfCR W/VEWffiLECR GRADING FEE
Z Q Applicant
VI NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYS'TEAlOREATING
a , become subject o the Workers Compensation provisions of the Labor Code,you must SOILS FEE
W4 forthwith comply with such provisions or this permit shall be deemed residual. WATER SERVICE
Q
Uz CONhem is. rale LENDINGAGENCYNEW RESIDIiN'fIA1,PLMB, SQ.IU PAID pule Receipt#
1 humby o0il'nl Ihnl Ihcrc is a ammmmirn Ivndiug ngcncy for the pennrnuumr of
Gr. the work for which Otis penal is issued(Set.3(97,Civ.CJ
I<nder's Name TOIAI.:
L) Lm der,Address 'TOTAL:
I certify that I have read this application and state that the above information is BUILDING FEE
taA correct l agree to comply with all city and county ordinances and store laws relatingto QTY. MECHANICAL PERMIT FEE
V Z building construction,and hereby authorize representatives of this city to enter upon the SEISMIC FEF:
above mentioned property for inspection purpaec PHRMI'I'ISSUANCE ELECTRIC FEE(We)a,.to save,indemnify and keep hvnna lethe City of Cupeninu against
► liahililies.judgmentx,cons
and ex,.w,wbluhnwy In any way accrue ugaimi.ond City. ACPHIt OR ADD TO MSCI I.
in cnnsoquence of the gmnfing of This permit. PLUMBING 171717
APPLICANT UNDERS ' NDS AN .COMPLY WITH ALL NON POINT ABR HANDLING UNIT(1010,0X)CFM)
SOURCE REGUI ATIO MECHANICAL,IgHi
010:7AIRHANDLING UNIT(OVER IBJXXICFMI CONSTRUCI'ION'1'A%
'i atureo p i[nn tactor Dale EXHAUST 11001)IWMUC) HOUSING SID GANON FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orfwum building occupant store or handle haturibusmaterial HEATING UNIT(TO IW,100 BI UI
;is defined by the Ckpcnino Municipal Code,Chapter 9,12,and the Health t I Safety
Code,Section 25532(0)! HEXI'INO UNIT(OVER 10",000 It I'U)
❑Yes E]No PAID
VENTILATION PAN(SINGLE RES ID) Dutc ftcec' #
Will the applicant or future building occupeal use equipment or devices which
BOILER—COME CHP OR 1011,000 8'1"U)
mit hazardous air conmmin inG as defined by the Ray Arca Air Quality Management
DisWct^ -
❑Yes FJ No BOILER—COMP(OVER 1110,000 BTU)
I have reuul the huzanlons mnlerials re uircmmils under Chapter 695 of the Cali- AIR CONDITIONER ISSUANCE.DATE
fnmiu Hua, &Solely Cnda_ tions 25 .. ,9 used 25594.1 undursmnJ Ihut it fM1u NEW RCSIIII:NTIAI.MECH. SQ.FT. q Q
huildingdces ncu ally It :'f Ca, tel' n rcyy++nosihilirymnolify the aaupnml / i Z C `
of l m rugmret is t ch n n t 0 vl "IS'f a carom nu of Occupancy. (((
w."mau o edagem ��V Data TOTAL: ISSUED BY. A
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
v
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Blk: Lot:36932038.00
INVOICE DATE..... . : 10/26/1999
REFERENCE ID # ... : 99100140
SITE ADDRESS . .. . . : 20102 RODRIGUES AV
SUBDIVISION ... ... .
CITY ............. : CUPERTINO
IMPACT AREA .......
OWNER ... . .. . . . ... MICHELIS CATHERINE M AND FIRMI
.
ADDRESS .... . .. . . . :
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014
CONTRACTOR ....... : MCGEE, PAT LIC # 18986
COMPANY .......... : WATER HEATERS ONLY
ADDRESS ..........: 500 AIRPORT BLV
CITY/STATE/ZIP ...: BURLINGAME, CA 94010
TELEPHONE ........: (415)349-3747
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
isID vDESCRIPTION VOICE ID .. -_-_DESCRIPTION
... ....... ............ ........ ..............
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING