99080190 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY t
CITY OF CUPERTINO BUILDING,.ELFCI RICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
IIOII,DING 1'11(1.In:C1'.IDF,N'I'IFICATION I :I ,
BUILDINGADURESR: SANITARY NO, A PLICATI h .DATE
D 'S AMIi: 4 NE C. T ACID 'S NAh E: LIC NO:
NIC CUNTHOLM
ARCIIITIiCT/IiNGINFa R: LIC N(s: -...) ADISS: — ❑
CONTACT PHONE: O '; 'Hl11LDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLI/MB MECH
❑ ❑ ❑ e�
LICENSED CONTRACTORS DI CLARAI ION QTY r ' 'ELPC PRIG 1 ERMI9• ) ,FRE, ;
I hereby alts Oat[ licensed d provisions of Chapter 9( g I. r _ JOB DESCRIPTION
QaZ with Section 700Fof D'v'sit id'the Bus dl duio:Cdettd rayl¢ ..is TIAL:
FOO f 111 font and cffec PERMIT ISSUANC17
F-Z F, 'n _�L•-, _ ❑ADRI ❑KUMBINREMODIi:
-I Li<cn. IIs 1,it. AI'I'LIANCF_S-RESIDEN'IIAI. - OAUUITION C3 PLUMBING IiIi-PII'li
rFit6L Dam GllnlmClnf
q A ,liall'beir,a DIiCLAenesnoN PANELS ❑MULTI-UNIT L:1 STRUCTURAL
Z O4-a lunderaund my plana shall be uwAmpUM1llC recants MODIFICATION
OZ-+0 UI"fO 210 AMI'B-. ❑INTERIOR OCHIMNIiY REPAIR
,~.W Licensed Professional 2014000AMPS IMPROVEMEINT []SWIMMING TOOLS
1 hereby afGmt thW 1 am IexemNEfmm Inc ContlION raemd License Law fie the at OVER 1010 AMPS El BATH RF.MODF.I/(RP.PNR ❑D!MOLITION
ya
C:1 d U following retool,fSec,lnn"1111 S,Bmines„rad Pudessianx Cade'.Any city nr ouwtY SIGNS I!LW'fItICN. ❑OTHEk
� WO to whin 4 pe tt d t he p J lkiretention,:mtemre O//T/J J•KL�
mJ 'for I t I, I II IPIi 11 hp - It fl .gLem em SPECINAIRCUI'I'/MISC.
(yT� whet - Ip n n th 1 '.'.n flh G t l Ia".(Chapter 9
X00 (u n,u t6wthSw on 91001 fOv',i l (tl•Buv'mas JP I .' msCndc)or TI.MP.MFGIR OR PiINS'1'. COMMERCIAL:
d c W tom he i,esmnpl m and ts merefroIse bofar,he allege)exemption.Any violmlon of 0 NI!W BLDGlADO1TION 0 DIiMOLI'HON
x-y Srtdian 703 1.5 ,I
T, fm aperm,vobjaty the applicant to a civil pcnully of POWER DEVICES ❑TENANT OFOODSIiRVICE
not mem than live hundred m1mr,IS d)(d.
I.MPRG'EM1f I!N"i'
❑SIn 0LasowneA.the pmpcnenceI, .,ineiirdAlm,hwagusasthci(S,r.contpeushee , SWIMMING
POOLII.ECIRIC
21„0 wJl do the work,and the nrumure is not imendcd or nBercJ for sole(Sea 7194.Business. I1EH _
µaj L m and Prol'e,i.ns Code:The Comractor'x License Law docs not apply to as owner of OUTLETS-SWITC)IES-FIX'1'11RPS
p,,,,dy who hatless or improves thereon,and xha does such work nimsdl or dinn r
his own cntployeas,po del that such improvements aro nal imended or aB'emd for NEW RESIDENTIAL ELIiCTR SQ PEEL G
sola h
If, ovever,tbennildingarimpnocmenllssolJ witm
hin ons yeof rnntpled r,he / Q.FL FLOOR AREA VSQ.Ep
eobuilder will have the harden of proving that he did and build or improve for pur-
Pnc o(aala).
❑I,vs owner of the prc,d,,am exdusively enntere ing with licensed comm r rs to 'TOTAL:
instruct the project(Sec.91114,Busini and l'adcssimu Court The Cunt racier a U.
cense Law does not apply to an owner of property t'he builds or intparves thereon,and QTY. PLUMBINCPERMIT' PEE r'
who conduct,fursuch"mist,wllh a anderom(,)liica,el onsnanno Ihe Com a,lor's
License law. PIEMi'1'ISSUANCE
O l inn exempt undf
er Sec. .II&1'C or this meson
Owner Dutra ALTER-DRAIN&VENT-WATER(EA), VALUNI ION
WORKER'S COMPENSATION DECLARATION. BACK FIEOW-Pk6lIFR)RVICE I �- Nr s'
Ihereby RA 1 'Ityorperjury Followingfthe declarations:
L
J the d 111 maintain C of to ofti a tt Code,t,the
Workers erof1h DRAINSthld OR,ItO(11'.AREA CONI. :1 STORIES TYPECONS'I'RUC'I'ION
moi provided lot by S ( l]IXI of tireL 1 Code,f the p f nca lit the
wink a whe his itimhis ..ser' FI%TI1RE t�I ER'IRAI'� O C �I I',t
beau and will,uuinu,in WUrscrs Cnn,pcnsvtinn In.avvnci,as required by Section � l �,
1 of the LuMx Gyle,for lM1e lnrfonnance ofthe work lbrwhich this permit is in,uea GAS—1!A.1J-S"flu '�IN_4OUTLETS OCC.GROUT' .� §N7
My Workkk,sC�t...�.I tion`tis icr uad['nett 3 7
Gmicr. Lt_'L 1\TRi Tunu�twu con Policy Nat GAS-hA. ' S9'I!M-OVERJfEA)
CHID FICATE OF EXEMPTION FROM WORKERS' IiR5AS1!llD1.WAS EINLTl3
COMPENSATION INSURANCE "kBUILDING DIVISION FEES
Thi-rationnerd notheenmplcteditthe pemdt is fornerhandreddollare13100p GREASE TH P
or less.) PLANCI RICK TETE
I cenily that in the performeneeof Ric tors far bi,helk Par n,il is issued,[,hall SEWER-SANITARY-S'FORM EA.200 FT.
not employ any pvrwn in any manner sit as to become subject In Ibe Worker,'C.... v - ENINGYPEE
6 Z union laws of COEtbmiu.Date WATER HEATER W/VI!NUELECDi
Applicant GRADING.FEE
y NOTICE'TO APPLICANT:If,after making tots Carthunte of Esanption,you should WATER SYSTEM/IFBIATING
a ; hucome subject to Thi Woder'e Compensation"'or..inos of the Labor Code.you nest SOILS FEE
forthwith cnnlPly with such pnwi.vim,nnhi,p[mtil shall he deemed revoked. Will Ek SERVICE
Q
UZ
CONSTRUCTION
to-ore LENDING AGENCY NEW'RESIDENI'IAL I'LMB, SQ.17. PAID
I hereby voi,'In than lheteivacnminlctlon lcnJiug agency B,nLe pert rmm�re of DBI, Rweiptp
V - the work for which this emal is issued"Sec.3097.Co.C.)
0 E" [,ad,,s Name pall
V Lenders Addm,s Tr YI'AI.:
I mnlfy shut I have savl this n,ou neon and stale that the above Inhrmtu ner i, - BUILDING FEE
F h orate,I agreem comply with alleiy aad...my mr,ineen,,tnduate Inws relating e' QTY. MECHANICAI,PERMIT FEF .
UIZ I dia,raismetion,and hcteby ant ve apresenmtives ofthlacity to cnten,arthe .r - -' SEISMIC FEE
alcove-mennaned prnpeny for mvpectinn patient.. PERNU T ISSI/ANCE ^
(Wil agree ler lava,indmnnify and seep h:mnlcs,the City of Cupcnino against ELECTRIC ITHE
Iiabilities,jnJ,rutio:,em,and expenses which may in any way venue...lonsaid City n ALTER Olt ADD to MI!CH.
mnscgncnw of Ott, of this pilin. PLUMBING PEI!
APPLICANTUNDERS'PANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNI'I'('I'O 10,000 CFM)
Sr1U C'HI!GULAfIONS. MECHANICAL 17ai
AIR HANDLING UNI'I'(OVHR 10,000 CFM) CONSTRUCT ION'I'AX
'Ig EILEVeoNs,,licaralConamentor Data IfXHA UST HOOD(W/DUCI) IIOUSINp MI'T'IGA'T'ION FREEHAlARDO IS MATERIALS DISCLOSURE
"',]line vppl...I or future huildo,tccupunl since nr handle honodou„natena l I IFNI'I NO UNIT 00 1110,000 B IH
eI defined by the Cupertino Municipal Cui Chapter 9.12,and the Health and Safe',
Cuda Scene.25532(a)'! HEAPING UNIT(OVER INDIA)Is I U)
M Ye, No VF.N'I'ILAI'I ON PAN(SINGLE RI!SID) PAID —
Ilotc RcmipI
Will the applicant or fwure building Uca,pant use equipment nr devices which
u ho,vird is air anointment,uv defmM by the Buy Argil Air Qmhy,Mmmgcmcnl BOILER—COMP(Jf1P OR 110,00 BTI])
I'AD
..,Intel'! BOILER—CONI'(OVL'R ItO,IXMI HTR)
E3 Y,, ONU
AIR CONDITIONER
II � ddteh I : mala q t: Ile Cl 11 [)S of Ib,C I, ISSUANCE DATE
font Health&Safety Code,Sections 25505 M533 d 25534 I do a rad that if the NEW RESIDENTIAL MECH. SQ.IT.
bnllf ,d I 'errantly l a t nLtl I t . y' '1 ...An, 'I'y the neer"n
of thcreyui men¢whaL moa rte inn prior In issuance nfa Ccrtiticam nl(heupancy.
Owner orumImn,sd agarol Data TOTAL: ISSUED BY:
OFFICE /b3
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY 4 1
Sec: Twp: .Rng: Sub: Blk: Lo[:32637011.00
DATE ISSUED.......: 00/26/1999
RECEIPT q.........: 9905
REFERENCE ID M .. .: 99080190
SITE ADDRESS ..... : 10335 STONYDALE DR
SUBDIVISION .......
CITY ....... . . .. . . : CUPERTINO
IMPACT AREA .... . ..
OWNER ............ : HOSE RICHARD K TR AND JANET K
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1029
• RECEIVED FROM .. .. : TIM
CONTRACTOR ....... : ATKINSON, THOMAS LIC k 141
COMPANY .......... : VALLEY HEATING & COOLING
ADDRESS . .........: 1171 N 4 TH ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE ....... . : (408)294-6290
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMHEAT NO OF HEATERS 1.00 6.11 0.00 6.11 0.00
MPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
1•PERMIT : 41.63 0.0D 41.63 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 41.63 6246
. •.•-'
TOTAL RECEIPT 41.63
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ .:.....................:.... ........ ............................
301 ROUGH PLUMBING - 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 5D8 FINAL MECHANICAL
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: nancyc
Sec: Twp: Rng: Sub: Blk: LOC:32637011.00
INVOICE DATE...... : 08/26/1999
REFERENCE ID R .. . : 99080190
SITE ADDRESS .....: 10335 STONYDALE DR
SUBDIVISION . . . . . ..
CITY ............ . : CUPERTINO
IMPACT AREA ...... .
OWNER .. ..........: HOSE RICHARD K TR AND JANET K
ADDRESS . . .. ......:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1029
CONTRACTOR .. . . . . . : ATKINSON, THOMAS LIC A 141
COMPANY VALLEY HEATING 6 COOLING
ADDRESS ......... . : 1171 N 4 TH ST
CITY/STATE/ZIP ... : SAN JOSE, CA 95112
TELEPHONE ........ : (408)294-6290
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ ___ --------- ------------ __-_---_-__
BREMHEAT P 6.11 0.00 6.11
MPERMITFEE P 35.52 0.00 35.52
_________ ____________ -----______
41.63 O.DD 41.63
V ID DESCRIPTIONVOICE ID DESCRIPTION
......v' =.......- ........ ............................
1 a ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
s