99080128 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL ER TTWit ittti,o
rs�a',nxING DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL
Y: BI111.UING PROJECT IDENTIFICATION
BUi1.DINGADDRFSS: SANITARY NO. . APPLICNUON SUBMI'I'I'AL DAM
O ;R'S NAME: PHONE: CON'I'I2AC OR's NAME: LIC NO:
re r Q , NAC CONTROL#
CHITS EN F. . LIC NO: ADDRESS: ❑
INTACT: PHONE.: BUILDING PERMIT INFO.
TJCyis�3o8- ys� ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT' PLUMB MECH
El ❑=- ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ( - ELECTRICPERMIT FEE'
1 hereby arthro mat lam ficerand ander providonx nfchapter 9(commencing JOB DESCRIPTION
OaZ with Scetion]g0)of Divixion3of the Business end Rnfcssions Code,end my license is RESIDENTIAL'
FOO PERMIT ISSUANCE in full force and d e
RIF, ❑SFDWL El KITCHEN REMODEL.
i-UU License Class Co'N APPLIANCIES-RESIDENTIAL
yQd Dae Contractor El ADDITION El PLUMBING L PIPE
ARCHITECTS DECLARATION [I MULTI-UNIT
E3 STRUCTURAL
z0onz Iuadentand my pleassholl he asedas public records PANELS MODIFICATION
O Z-+Q UP TO 2N)AMPS El INTERIOR ❑CHIMNEY REPAIR
F(:t; Licensed Professional 201-1000AMPS IMPROVEMENT E]SWIMMING POOLS
gY7, OWNER-BUILDFR DECLARATION OVER TfMMTAMPS El BATH RIiMODEVREPAIR El DEMOLITION
5 C G 1 hereby alio that 1 am exempt from the Contractor's License Law for the
a'Oy V following reason.(Section 7031.5,Business end professions Gale:Any city or county SIGNS ELECTRICAL ❑OTHER
W OIs•-I which requires u permit to cvnavnel,alter.Improve,dinadish,or repair any structureL'i+ ¢ primm its issuance.also requires the applicant!orsuch permit to flea signed statement SPECIALCIRCUIT/MISC
CpC G that he is licensed pursuant to the provisions of the Convector's License Low(Chapters 6"oNt
(commencing with Section7f(tpof Division 3ofine Bminessand Professions Cale)or TEMP METER OR POLE INST COMMERCIAL:
d Oe mu he is exernpu merefront:uW the basis Thr me alleged exemption.Any vhiminn of ❑NEW BLDG/ADDITION ❑DEMOLITION
"m Section]031.5 by any applicant for a permit subjects the applicant m v civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
F
not more man five hundred dollars(4500)' IMPROVEMENT Sp I,us owner nithe progeny,or my employees with wages as theinnle mmpcnsetion. SWIMMING POOL ELECTRIC
will do 11,work.and destructor,knot intended m offered for sale(Sec.7044.Business ❑OTHER
and Professions Cada:The Comracm,Lioeme Low dam not apply to ua alar,of OUTLETS-SWI'TCIIBS-FIXT ES
a' property who builds or imPmw,s thereon,and who dozx such work himself or thmugh
his own employees,provided that such improvements arc not intended or offered for NEW RESIDENTIAL BE. SO BE
sale.IL however,the building or improvement is sold within one year of completion,the 3/SQ.FT.
onona,lailder will have the burden of proving that he did not build or improve for par,
pose of sale.).
1,as owner of the progeny.B sinessvad contracting wino licensed rnntranoa to
cnnstmm the projcm(Sec.](H4,Business and Professions Code:)Thc Contmcmfs Li
ciatic Law docs not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING F. . CCCI O T Ll 11H
wbocon¢aea halal pnijeu(s with acnntmctoKx)licensed Pursumnmthe CnntruemLs UUUL O L JIIV
License,Law. PERMIT ISSUANCE
I am exempt under Sec. ,B&1'C loris memo
Owner, (Irate ALTER-GRAIN&VENT-WATER U A T
WORKER'S COMPENSATION DECLARATION BACK FLAW PROTECT DEVICE hereby affirm under penalty of perjury one of the following declarations:
I haveand will mainmina Certificate of Coment avef-insurefor Workds Compete DRAINS-FLOOR,ROOF,AREA,COND. STORIES TYPE.CONSTRUCTION
workas provided for by Station 3700 of trip labor Code,for e so-Koparem of the
I'or which this permit is issued. FIXTUR17S-PER TRAP
C]I have and will maintain Wader's Cma,,mutian Insurance,as required by Section
3700 of the LaharQelC.for the peif..we of the work for whichthis pemtit is issued. GAS-PA.SYSTEM-I INC.4 OUTLETS OCC.GROUP �s—APN-z
My Worker's Compensation hourancecannerand Policynnmberare:
Currier: Policy GAS-F:A.SYSTEM-OVER 4(F.A) J 7�CERI'IFICO EXEMPTION FROM WORKIEItS'
COMPENSATION INSURANCE. CREAST%INUUS'TRL WASTE TNTIERCEPTON -
(This section need not becoplmedif the permit is loran,hundred dollars ` BUILDINCDIVISION PEES
or less.? mCRLASTi TRAP PLANCHF.CK PEE
I cemly that intho perhmmencool ,work forwhich mispermit isisaued.I shill SEWER-SANITARY-STORM EA.200 FC
not employ any person in any manner so as to become subject to the Workers'Compen- ENERGY FEE.
OZ sumn laws of California.Date WATER BEATER WNENUELECIR
z Applicant GRADING FEE
V] NOTICE TO APPLICANT:If,after making this Cenitleate of Exemption,you should WATER SYSTEM/TREATING
a ; hecotna subject In the Worker's Compensation pookions attic Lubar Cade,you must SOILS FEE
W fmiltwith comply withmelt ponisions m this pvinful bull be deemed revoked. WATER SERVICE
Q
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL I'IMB. SQ.FT. PAID
UQ I herchynlh tin thattharoissued Sec.
leading7,Cs.agency for PeHammnce of Dule Rene,p
F
the war,for which this permit is issued ISec.309],Civ.CJ
V lenders Name TOTAL:
Leader's Address T(YfAI.:
1 penlfy that 1 have rad this application and shot that the aMwe information is BUILDING F13C
In mtrcn.l agree m comply with all city mW county ordinances and pate Iews relining m QT'Y. MECHANICAL PI?RMIT �FBE
U building consumerism,and hereby authorize representatives of this city to enter upon the SEISMIC FEE
r aNve-mentioned pmpeny for impeeian purposes. PERMIT ISSUANCE
(We)agree to save.Indemnify and keep hamdess the City of Cupertino against ELECTRIC FET:
Iiuhilities,judgments,costs and expenses which may many way ocemengainst said City ALTER OR ADD TO MECH. PLUMBINGP
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINI' AIR HANDLING LINE TITO 10,mO CPM)
SOURCE REGULATIONS. MECHANICAL FEE
AIR HANDLING ONE f(OVER ILIRO CFM) I CONSTRUCTION TAX
Signature of AMiirant/Comartor Date EXHAUST HOLD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hmmdous mamiul HEATING UNIT U 0100.000 BTU)
Is defined by the Cupenino Municipal Code,Chapter 9.12,and the Health and Snbl,
Cove.Section 25532(a)'I HEATING UNIT(OVER l l,000 If POE
C]Yes ❑No VENTILATION FAN(SINGLE RfSID) PAID .-
Date Receipt#
Will the eir contaminants
"Ifuture
us building oesnpuBuyat se Area
Air equipment a, Mianwhlah BOILER-COMP(311POR 101,1100 BTU)it haznNous air comamimmts as ddineA by the Buy Area Air Qualify Mvnugement TOTAL
amt? as
❑No BOILER-COME(OVER 100.00 BTU) +
I have rod the hazanlnna mnteriWs rc tr under Chn Icr fi.95 of me Culi- AIR CONDITIONER
y2553cn p ISSUANCE DATE
Iberia Health&Safety cCod,omically
Sermons 255115,25533 and 25534.1 understand that if the NEW RESIDF.NTIAI.MECH. SQ.FT. / 3-
0,
^ ^ yr
of thengdcesammwhich muse amtunpiero ismyreeofaCertifuromify thepancy. 7 /
of the mquiremenu which mum be and prior to issuance of a Certificate of Occupancy.
Owner or authorized agent Date 'TOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
r BUILDING PERMIT INVOICE OPERATOR: christya
Agmk
Sec: Twp: Rng: Sub: Blk: Lot:37526063.00
INVOICE DATE...... : 08/19/1999
REFERENCE ID 4 ...: 99080128
SITE ADDRESS ..... : 18671 STARRETT CT
SUBDIVISION ...... ,
CITY ............. : CUPERTINO
IMPACT AREA ......:
OWNER ............: PRICE, GREGORY & JOAN
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO,
CONTRACTOR . ...... : LIC k
COMPANY ... . . .. . . . :
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........: '
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BTEMP P 57.50 0.00 57.50
EPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
93.02 0.00 93.02
VOICE ID - DESCRIPTIO.._ =..... VOICE IO -- DESCRIPTION
ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
FINAL ELECTRICAL "
CITY OF CUPERTINO
lip of 1 BUILDING PERMIT RECEIPT OPERATOR: chzistya
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:37526063.00
DATE ISSUED....... : 08/18/1999
RECEIPT #.........: 9840
REFERENCE ID # ...: 99080128
SITE ADDRESS .....: 18671 STARRETT CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ........ . ... : PRICE, GREGORY & JOAN
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO,
RECEIVED FROM . ... : TIMO
CONTRACTOR .. . .... : LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW DAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-TEMP FLAT RATE 1.00 57.50 0.00 57.50 0.00
EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
__________ __________ __________ __________
MOPERMIT 93.02 0.00 93.02 0.00
D OF PAYMENT AMOUNT NUMBER
_________________ ____________ __________________
CHECK 93.02 115
TOTAL RECEIPT .. 93.02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ....._----..................
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL