00020022pp ICAUTTO FI I IN INFnRNATION WITHIN RED LINES - USE BALL POINT PEN ONLY J4—__0 /1 a00 a a
CITY OF CUPERTINO BUILDING - ELEiCfRICAL
IEUILDING DIVISION APPLICATIONMERMIT PLUMBING - MECHANICAL
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: 06
SAN] rARY NO.
APPLICAI'10 ATF
O IiH;S NAMIi: I'1IONE: C . NTRACI OR'S NAME: LIC NO:
O
N96
NIC
❑
CtJN'1'HOi.q
NEER: ITER; LIC NO:
ADDRESS: eh9'
CONTACS 3 PHONE:
ae-7 -x391-
❑ Consultant Fees Paid by Applicant (Initial)
BUILDING PERMIT INFO
BI -DO ELECT' PLUMB MECH
LICF;NSGD CDNTRACIQ 'S DeCLA1tA'1'10
I hereby eBimt that 1 am licensed under provisions of Chapter 9 (commencing
QTY ELECTRIC PERMIT FEE
JOB DESCRIPTION
PERMIT ISSUANCE
with Smtiun7")ofDivision 3afthe Business and Professions Code, and my license is
in full Rnceaad enact.
RESIDENTIAL:
DSFDWI. ❑KI'I'CIIENRF.MODEL
APPI.I CES—RESIDENT EAI.
Lhcn>e Clu
Uutu� ��
❑AUDITION El PLUMBING RI3-I'IPH
❑MODIF fURA
AfODIFlCATION
❑INTERIOR WHIMNGY REPAIR
IMPROVEMENT EjSWIMMING POOLS
TS DEmr�
ARCHITECT'S DI3CLARATION❑MULTbUN1T
I understand my Plans shall to madas Fuhlic records ad
UPTO2WA IPS
Licensed Pmfesslonul
2ol-PIU)AMP.
OWNER BUILDER DECLARATION
1 hereby alum that 1 am exempt from the Cmilmlo, s License Law for the
following rcamn. (Section'1031.5. Business and Professions Code: Any city os roam,
❑BATE I RI?MODEWRIiPA1R /ISI UIdMOIATIO.N
DOTHER L; D
R��
DVI?R IWIIAMI'
SIGNS ELECTHICA
which requires a permit re construct, alter, improve, demolish, repair any structure
gPl?CIAI. CIRCIII'flMl
fi
dpritur uabr s issuunc oi,mue 1. lie dicapplicant for such Penni" tokens, Low(ihmmenl
tuts nuotm the Cmnmmors License Low
C{-z`Q�i/(JDr__��
er
(commencing with Sects of Division 3 Ccmter9
I (commencing with Sedi.n][M)n)nf Divisi.n3nDhe Business and Professions Ctde)nt
TEMP. METER DR FOL'
COMMERCIAL'
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
❑ NEW BLDG/ADDITION ❑ DEMOLITION
Schon7031.5 hyany appli.mfor a pemtirsubjems Nenpplicanno a civil pemltyof
mmutore than live hondr.ddolaus($500),
C] 1, as owner of the property. or my employees with wages un Their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. TW Business
and Professions Code: The Contractors License Law does not apply to an owner of
property who mildsor improves thereon, and who does such work himself nr through
POWER DEVICES
❑TENANT ❑FOOD SERVICE
IMPROVI3MF;N'T
(''OTHER
n /A �1
SWIMMING P( hELECTRIC
O(ITLEIS WITCHES—FIXTURES
I /f—V U In
his own employers, provided that such impmvanienis ora not intended nr offered fnr
sale. If. however, Ilia building orimpuvemenl is told within,,,,, year ofcontplerom,the
owner_1buildeT will have the burden of proving that he did not build or improve for put.
NEW I . IDENTIAL ELEC' SQ Pf.
Q. Ie1'. FLOOR ARBA
FEB 42000
Q. PI'.
ps'e of sale.).
❑ 1, as owner of the property, a exclusively commur ing with licensed comments; to
T( AL.
mamet the p umO (Sec. 7144, ilusiness and Professions Coale:) The Co,,mmtors Li.
- -
came Law does not apply to an owner of property who builds or improves mencon. and
who contracts far such projers with a c urammoHs) licensed Fursuanuo the Contractors
QTY. PLUMBING PERMIT ZEE
'II
Dy
PERMIT ISSUANCE
_
License law.
❑ I um exentputnder Sec. , B & P C fnr this reason
Owner Dem
AL'1'1;12— DRAIN M VEM'—WR'I'ER (EA)
VALUATION
OO
WORKER'S COMPENSATION DECLARATION
BACK I OW PRULECr. DEVICE
I hereby affirm under penalty of perjury one of he following declnrmions:
❑ I have and will maintains Ccnificate of Conscnno sell -insure for Workers Comped.
satins, es pmvidcd for by Smdon 9]00.1'the Unfair Code, Iiir the park .... mom of Lha
DRAINS—F OR,ROOP,AREA.COND.
S'I)RIF,S IT CONSTRUCT ION
work for whichthis permit is issued.
PI%TURFS-1'P.k AP
1 have and will maintain Workers Compensation Imuream, as required by Section
J](XlnDhe Labor Code, far the perfomance n(he work fnr w�phcci//c'h Ibis pcmnit is issued.
GAS—EA. SYSTEM -I 'C.40 .; 5
OCC. GROUP
CurW�rk any+ens.ails-nf[ts�artie, amal l'nl cy NnY O46a—OA_AAni
y� GAS — EA. SYS "I 13M"OVER .A7
CERTIFICATE OP It EMIT1pN FROM WORKERS'O
COMPENSATION INSURANCE qCep , /Ell
(This smtinn need not M+mmFlwed if tha permit is fnr nnnhundaAA„llmrs(EI00)
or I.".)
GREASEIINDUS'1'RL WA " 31NT. CEPION
BUILDING DIVISION Iti BS
GREASE TRAP
PLANCHECK FEE
I certify that in the performanceofthe work for which this permit is issued, i shall
any perms in 1 pen”
not employany manners. as become sub'mnothe Worker' Com
SliWlik—SAN1TAk—S'1'OItM 13A. 2001x1'.
13NIiRGY FEE
WATER HEALER VNIENTELECIER
cation Laws of California. Dae
Applicant )
GRADING FEE
N(TI'ICE TO APPLICANT: IL vf[er making this Certifiane of Exemption, you should
Income summi m the Worker's Compensation provisions of the Labor Code, you must
WA'T'ER SYSTI3 11'NEATING
SOILS FEE
Forthwith comply with such provisions orchis permit shall M deemed revoked.
WATIiR SERVICE
CONSI'kUCTION LENDING AGENCY
Iherehynl'Iinn that here is u consomaion lending agenry for the peefmmorm of
N13W RESIDENTIAL PLM. SQ, PT.
PAID
utc Re,,pt#
the work for which his pendia, issued (Sea 309]. Ci, C.)
TCI'AI_
BUILDING FEE
Landers Name
Lender's Address
TOTAL:
I canny milt I have at this uEmic lam and state that the above information in
caitr<t. I agree to comply with Ill city and nan[y ordinances and sant Inws relating in
bailding consmsninn, and hemb, millu nze representatives of mis city to enmr upon the
QTy. MECBANICAL PERMIT FEE
SEISMIC FEE
PERMIT ISSUANCE
I[LECfRiC I;FC
ab.vc-memianed protan, for inxpemion puce,..
(We) agree to nave, indemnify and keep harmless the City of Cupertino against
Add FR OR ADIPO MECH,
PLUMBING FEE
habililics,judgntnns, wnlsind expenses whiehmay in any way ummc againstsaid City
in conscquenm of Ilia prvnting of his poonit.
AIR HANDLINGITOO 10.00d CFM)
MECHANICAL FEF.
APPLICANT UNDERSTANDS AND WILL COMPLY WEI'11 ALL NON -POINT
SOURCE REGULATIONS.
AIR HANDLING D T(OVER 111,00) CFM)
CONSTRUCI ION TAX
Signature of A,,1i,:mVC(m1.,ur Data
HAZARDOUS MAI'ERIAI S DISCLOSURE
13XIIAUSTI{Opp( I1CT9
HOUSING MI LIGATION PER
HEALING ON] '1'('101 NOW) BTU)
Will the applicant or future Wilding occupant store or handle hazardous material
as defined by the Cupertino Municipal Code Chaplet 9.12, and the Heullh and Safety
Cada, Section 25592(a)]
[I Y.
Q
Dam Hecapl #
PAIWill
HEATING, UNIT (OVHR )( IIiTU)
VENTILATION IA>^rN .B BESIDE
BOILER—C P 0HP OR 1(10010 RTU)
he applicant or future building occupant use equipment or devices which
mit hmardom air,omamimonts as defined by he Bay Area Air Quality Management
Diavic4a
C3 Yes Nn
�
TO 1'AL:
ROILE COMP (OVER 1(110X)0 BTU)
AIR CONDITIONER
I have mudtha turmoil .antnamrich, captitemems under Chapter 6.95 of he Cali-
IS. CE DATI>
N17W RESIDEN'1'I AL MECH. SQ. PT.
!natio Health at Safety Code, Sections 25505, 25539 and 25594. 1 undcwtand hot if he
buildinregqduoc�s not rmwmly have a natant, that It is try responxihil Icy to notify the occupant
ofthemm,.
/ /.eswhiph ma,[M:etpmatoximnreof a CmifcatcoJQcupancy.
s
ISSUED BY:
TOTAL
Ow auhcnz agent Dote
OFFICE
0
is
•
Otv. i1 400ftable Fee ID . Fee Description Fee Group
/ SPERNIFEE
16LOG PERMIT FEES
ISUILDIN77,
18CONSTAX
lCONSTRUCTION TAX
IBUILDwG
JBENERGY
JENERGY
IBUILOING
BENERGYADD
JENERGY ADD MULTI
ISUILOING
�BOVERTIME
INSPECTION OVERTIME
BUILDING
STENIPPERM
TEMPORARY BLDG PERMITBUILDING
BNIITIGAT
HOUSING MITIGATION FEE
IBUILDING
BPLANCHK
PLAN CHECK FEE
BUILDING
BPLANCKAOO
PLAN CHECK ADO MULTI
BUILDING
BPLANCKREP
PLAN CHECK REPEAT FEE
BUILDING
BREINSPECT
REINSPECTION FEE
BUILDING
BSCBLVO
SCB SPECIFIC PLAN
BUILDING
BSEISMICOM
SEISMIC COMMERCIAL
BUILDING
BSEISMICRE
SEISMIC FEE RES
BUILDING
SPECIAL INSPECTION
BUILDING
QESPECIAL
M
SWIMMING POOL
BUILDING
ZAODCHG
ADDRESS CHANGE
IBUILDING
EPERMITFEE
JELEC PERMIT ISSUANCE
ELECTRICAL
BELEC1000
ELEC 600V -m-1000A
ELECTRICAL
BELEC1001
ELEC 600V >1000A
ELECTRICAL
BELEC200
ELECT SVCS 600V <=200A
ELECTRICAL
BNEWMULTI
MULTIFAMILY RES
ELECTRICAL
BREMBUSWAY
REMOOELBUSWAYS
ELECTRICAL
BREMFIXT
LIGHTING FIXTURES
ELECTRICAL
BREMMISC
MISC APPARATUS
ELECTRICAL
BREMNRAPP
REM NON -RES APPLIANCE
ELECTRICAL
BREMPOLE
POLE/PLATFORM FIXTURE
ELECTRICAL
BREMPOWER
POWER DEVICE/APPARATUS
ELECTRICAL
BREMRECEPT
RCPTL, SWITCH &OUTLETS
ELECTRICAL
BREMRESAPP
REMODEL RES APPLIANCE
ELECTRICAL
BREMSIGNAD
RMOL 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
IMECHANICAL11
BAPPLOTHER
OTHER APPLIANCES
MECHANICAL
BBOILERI
BOILER <=100.000 BTU
MECHANICAL
BBOILER2
BOILER >100KTO500K BTU
MECHANICAL
BBOILER3
BOILER >500K TO 1M BTU
MECHANICAL
BBOILER4
BOILER>IM TO 1.75M BTU
MECHANICAL
BBOILERS
BOILER> 1.75M BTU
MECHANICAL
BREMAPPLI
APPLIANCE INSTALL
MECHANICAL
BREMHEAT
H TER INSTALLATION
M CHANICAL
BREMVENFAN
VENT FAN SINGLE DUCT
MECHANICAL
BMNEWMULTI
NEW MULTI -FAMILY RES
IMECKANICAL
BMNEWSF&2F
NEW SF&2F RES SLOGS
IMECHANICAL
i oft
P. imd vias
JSREMACOVE�
JACUNIT >IGCOGCr`d
Ii�I�L�nNI�,RL�
JBREMAIRHAN
JA/C UNITS <= 10.OGCCribl
IMECHANICAL I-
IBRENIFURN
RELOCATION OF FURNACE
IMECHANICAL
BREMFURNOV
IRELO FURNACE > ICK BTU
INIEC4ANICAL
BREMINHOOD
JINSTALLATION OF HOODMECHANICAL
BRENIRELOCA
RELOCATION OF HOOD
NIECHANICAL
BREMREPALT
REPAIR/ALTER HEATING
MECHANICAL
BREMVENSYS
VENTILATION SYSTEMS
IMECHANICAL
IPPERMITFEE
JPLUMBNG PERMIT ISSUE
PLUM8ING
BNUMULTI
NEW MULIFAMILY RES
1PLUMBING
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
REPIPE OF FIXTURES
PLUMBING
BPSEWAGE
SEWAGE DISPOSAL
PLUMBING
9SPREPIPE
BPSEWER
SEWERS
PLUMBING
BPSPRINK
LAWN SPRINKLERIBACKFLO
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
ZOEVAGREE
DEVELOPMENT AGREEMENT
PLANNING
ZDIRTM
DIR TENT MAP
PLANNING
ZFULLHR
FULLAPPLBASE+HR
PLANNING
ZFULLTM
IFULL APPL TENT MAP
PLANNING
ULLUP
IFULLAPPLUSEPERMIT
PLANNING
ZFUL.LZONE
FULL APPL ZONING
PLANNING
ZGPAMEND
GENERAL PLAN AMEND
PLANNING
ZLIMAMEND
LIMITED AMEND
PLANNING
ZLIMTM
LIMITED TENT MAP
PLANNING
IMUP
LIMITED APPL US PERMI
ZMATEMPUP
MIN AMEND TEMP USEPERM
G
ZMINHILLEX
MINOR APPL HILL EXC
GZMINSIGNEX
MI C SIGN EXCEPTION
GZMINTM
MINOR APP TENT MAP
FLANNG
NGZMINUP
MINOR APPL USE PERMIT
NGZMISCASA
MISC ARCH SI
NGSC
MISC TM AND UP
NGISCFENCE
MISC FENCE EXCEPTION
NGMISCELLAPPLGENERAL
NG
ZMISCPCINT
MISC PC INTERPRETATION
PLANNING
ZSIGN
SIGN PERMI
PLANNING
MPSIGN
TEMPORARY SIGN
PLANNING
ZVARIANC
DIRECTOR VARIANCE
PLANNING
2 aft
Revised 8110199
•
E
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: TWP: Rng: Sub: Elk: Lot:32541021.00
INVOICE DATE......: 02/04/2000
REFERENCE ID p ...: 00020022
SITE ADDRESS .....: 21286 RUMFORD DRIVE
SUBDIVISION .......
CITYCUPERTINO
..............
IMPACT AREA .......
OWNER ............: CONSIGLIA DELEONS
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR .......:
KELLEY, JAMES M LIC
$ 11823
COMPANY ..........:
J K MASONRY
ADDRESS ..........:
400 HODGES AVE
CITY/STATE/ZIP ...:
SAN JOSE, CA 95128
TELEPHONE ........:
(408)287-2398
FEE DESCRIPTION CHR TOTAL FEE PAID -TO -DATE
--------------- ---
BALANCE DUE
BPERMFEE
---------
p
---------
------------
77.00 0.00
-----------
77.00
------------
77.00 0.00
-----------
77.00
VOICE ID
DESCRIPTION
VOICE ID
DESCRIPTION
..
01•FOUNDATION
............................
........ ......................
312 CHIMNEY REBAR 6 STRAPS
4
FINAL PUBLIC WORKS