99120060APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY J_F�1114 I 0110D 00
CITY OF CUPERTINO BUILDING. ELECOUCAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL.
- BUILDING PROJECT IDEN'T'IFICATION
PERMIT NO.
BUILDING ADDRESS: -
10.8T 5ycAKoru 0fu.v�r
SANT ARY N(l.
APPLICATION SUBMITTAL DA'Z'E
_ Q
�NERhrL (�O 3 ^ .YHONki cr/
w M 1I C/ VII 6
CONTRAC'1'OR:S NK�1W .1 � LIC NO.
NA ,•
r.
NIC
❑
CONTROLN
RCHITECT/ENGINEER: LIC NO:
ADDRESS:
C,O/NJT^'_/ eeGNE:
- ') �'5s :19 0 6o1 -'-F
' 6so a� o `t6gt
❑ Consultant Fees Paid by Applicant (Initial)
6UILELECT PERMU�iNFO
HLDQ MECH
ID 1:1 ❑
LICENSED CONTRACTORS DECLARATIONQTY
I hereby animation 1 am licensed under prevrsams of Chapter 9 (commencing
with Section 700)()olTmamn 3of the Bmiuoesmid Professions Code.and any licensee
in full force and effect.
License Class#
'
Dec.—Li,Car#
EL'BQTRIC.PERMIT ".t` ,FEE
t '
JOB DESCRIPTION
RESIDENTIAL'
[I SCOWL ❑ KITCHEN REMODEL
❑ADDITION PLUMBING RE PIPE
El
F1 MULTIUNIT E STRUCTURAL
MODIFICATION
❑INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT F]SWIMMING POOLS
ElBATH REMODELMEPAIR E:1 DEMOLITION "
❑ OTHER
PERM IT ISSUANCE
APPLIANCES -RESIDENTIAL
ARCHITECT'S DECLARATION
I understand my plans shall be used as ptiblie nce it,
"
PANELS
UP TO 200 AMPS
Licensed Professional
OWNERDUILDER DECLARATION
I hereby affirm that I ton exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professloms Code: Any city or county
which requires a permit I. construct, alley, Improve, demolish, atrophic any sweture prior tit its issuance, also requires the applicant for such permit to file a signed chairmen,
that he is licensed pursuant to the providers of me Contractor's License Law (Chapter9
(commencing with Section 7000) of Di vision 3 or Business and Professions Code)or
that he is exempt therefrom and the basin forthe alleged exemption. Any violation of
Section 7031.5 by any.ppliwnt fore permitsubjeets the applicant tea civil penally of
not -than eve hundred antlers (s50).
[[)/1 er of the property, or my employees with wages ac,heir Bole compensation,
will do the work and the structure is not intended proffered for sale (Sec. 704q Business
and Professions Code: The Convector's License Law doe, not.a,,Iy ,o an owner of
property who builds or improves thereon, and who does such work himself or through
his own employee,, provided that such lmpreverm nts are not intended or offered for
ecle.If, howeventhe lamfiinger improvement is sold wthin one yawi eontplalicn, the
owner -builder will have the burdenof proving that he, did not build or improve forpur-
P��Ff1
ncrs to
ively mmc,irg wim licensed convm
®1, 1 owner of the property, a xdusw
onsrucuhe project (Sec 7044 Business and Professions Cu. i The Con[rauo : L
cense Law does not apply to an owner I'prnp IY wh 1,11 in impumus(border and
who canteens for et project whir mmad (,)lice. d Tamm Ne Contractors
License Law.
❑lam emmpt nJ r$ee. ,R&PCfn his assn
ner� Ua
WORKS 'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury, one of the following declarations.
❑ I have and will maintain aLeniftcnte of Consentto sell' -Insure for Wor*es's Camper-
sa,ion, as provided for by Section 37W of the Labor Cade, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, ar required by Section
37M of the Labor Code, Tor the performance of the work for whichdos permit is issued
My Workers Compensation Insurance carlcrand Policy number we:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section rood no, hecomple[ed ifthe permit is Roche hundred dollars($ 100)
or less)
I certify than in the performance of the work for which this permit is issued, Leball
not employ any person in any manner so as to become subject to the Workers' Cumber -ENERGY
,.lion Laws of California Data
Applicant 1
201-1000AMPS
OVER IlN111AMPS
SIGNS ELECTRICAL
SPECIAL CIRCUIT/MISC.
TEMP. M FI'ER OR POLE INS' I'.
COMMERCIAL:
❑ ?W BLDG/ADDITION ❑ DEMOLITION
❑FOODSERVICE
-11:LROYPRENT
❑ OTH —
POWER DEVICESENANT
SWIMMING POOL ELECTRIC
OUTLETS -SWITCHES -FIXTURES
NEW RESIDENTIAL ELECT R SQ Ff.
Q. Ff. FLOOR AREA
.
$/SQ, FT.
TOTAL:
- . ". - 11
QTY PLUMBING: PERMIT 'FEE'
f
PERMIT ISSUANCE
"
ALTER -DRAIN & VENT -WATER (EA)
VALUAHON
lJ
BACK FLOW PROTECT. DEVICE
DRAINS- FLOOR, ROOF, AREA, GOND,
STORIES
,
TYPE CONSTRUCTION
-
FIXTURES - PER TRAP
GAS - EA. SYS Him- I INC. 4 OUTLETS
[xC. GROUP
_
O A
GAS -EA. SYSTEM -OVER 4(EA)
GRGASDINDUSTRLWASTE INTERCEPTOR
BUILDING DIVISION FEES
GREASE TRAP
PLANCHECK FEE
SEWER -SANITARY -STORM EA. 200 FT.
FEE
WATER HEATER W/VENT/ELECTR
,
GRADING FEE
NOTICE TO APPLICANT If, after making this Cenificute of Exemp,inn, you should
become subject to the Workers Compe.... inn provisions of the Labor Code, you min,(
forthwith comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby aftinmhvttherale acansnudirn landing agency for the performance of
the work for which this permit is msued(Sec. 3097, Civ. C)
Landers Name
WATER SYSTEM/TREATING
-
SOILS FEE
,WATER SERVICE
"
PAID
Date Receipt
- -
NEW RESIDENTIAL PLMB. SQ. FT.
-
- TOTAL:
OTAL
—
Lindero Addmsn
,_
ILdINC PEE _
I cunity that I have read this application aind... te dinette a have information is
rest. lagreemcomply wash Jl city rmd county oN'nanua and, cote loco_, relating to
building construction, and hereby authorize representatives of this'tymenmr upon the
above mentioned property for inspection purposes.
6Ve) agree m save, Indemnify and keep harmless the City of Cupertino against
dahilides,judgmems, colt, and expense which may in any wayawru ri'mislsaid City
f egmnting of dills peri tit.
IT,DS \ND P,1 OMPLY WITH ALL NO '-POINT
APgC1
SOG r 1
QTY' wIBGHANICAL PERMIT' FPE
a
' SMICQEC 9�: 9
'
PERMIT ISSUANCE
Cfk IC NEE -
ALTER ORADD TO SUCH.
RING I°BE
AIR HANDLING UNIT (TO lo,dgl CFM)
BCHANICALFBtl^�"�
AIR HANDLING UMT(OVHR 10,000 CFM)
CONSTRUCTION TAX •,
Sig atumofA plicaudCUmracmr ate
HAZARDOUS MATERIALS DISCLOSURE
Willtheapplicantorfuturebuildingoccupant store or handle hazardous mmerid
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Sidety
Code. Section 25532(a),
E] Yes , E] No
-
7 Will the applicant or furore building occupant use equipment m devices which
until hazardous air am,a ntioun as defined by the Bay Area Air Quality Management
District?
❑Ycc 7 N
I d, hazNu nal ial. ed her recision Chapter 695 of the Cali-
build 9uf yC 9 Y n 25505 ii d25534.1understand that if the
buildia ,c n,l t 1, that y pe sibaltyl 7 aecupant
offs me� th prix f C�T t encs
(�
EXHAUST HOOD(W/DUCT}
HOUSINGMITIGATION FEB
-
HEATING UNIT(TO 11X0,000 BTU)
,
HEATING UNIT (OVER 10,000 BTU)
PAID'
Date IieaeiptW
VENTILATION PAN (SINGLERP.SID)
_
BOILER - COMP (3HP OR 100,000 BTU)
-
TOT L:
BOILER- COMP (OVER 100,010 BTU)
AIR CONDITIONER
ISSUANCE DATE
ISSUED BY:
NEW RESIDENTIAL MECIi. SQ.
or autM1omed agent I Dam
TOTAL:
OFFICE
nr, it annlieable Fee ID . Fee Description Fee Group
�BPERNIFEE
JBLOG PERMIT FEES
JSUIL,DING
BCONSTAX
CONSTRUCTION TAX
(BUILDING
BENERGY
ENERGY
BUILDING
BENERGYADD
ENERGY ADD MULTI
BUILDING
BOVERTIME
IINSPECTION OVERTIME
BUILDING
STEMPPERM
ITEMPORARY BLDG PERMIT
IBUILOING
BNIITIGAT
IHOUSING MITIGATION FEE
1BUILDING
BPLANCHK
WI
IPLAN CHECK FEE
BUILDING
SPLANCKADD
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
BSPECIAL
SPECIAL INSPECTION
BUILDING,
BSWIM
SWIMMING POOL
BUILDING
ZADOCHG
JAIDDRESS CHANGE
BUILDING
EPERMITFEE
JELEC PERMIT ISSUANCE
ELECTRICAL
BELEC1000
ELEC 600V <=1000A
ELECTRICAL
BELEC1001
ELEC 600V >1000A
ELECTRICAL
BELEC200
ELECT SVCS 600V <=200A
ELECTRICAL
BNEWMULTI
MULTIFAMILY RES
ELECTRICAL
BREMBUSWAY
REMODELBUSWAYS
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
MECHANICAL
BAPPLOTHER
OTHER APPLIANCES
MECHANICAL
BBOILERI
BOILER <= 100,000 BTU
MECHANICAL
BB0ILER2
BOILER >100KT0500KBTU
MECHANICAL
BBOILER3
BOILER >500K TO 1M BTU
MECHANICAL
BBOILER4
BOILER>1M TO 1.75M BTU
MECHANICAL
BBOILERS
BOILER> 1.75M BTU
MECHANICAL
BREMAPPLI
APPLIANCE INSTALL
MECHANICAL
BREMHEAT
HEAT R INSTALLATION
MECHANICAL
BREMVENFAN
IVENT FAN SINGLE DUCT
MECHANICAL
BMNEWMULTI
INEW MULTI -FAMILY RES
MECHANICAL
BMNEWSF&2F
I NEW SF&2F RES BLOGS
MECHANICAL
1 oF2
Rav4cd 6110/99
e
9REMACOVER
QAC UNIT>IGQGGCFi%I
IM EC;:AN I CAL
FGREMAIP•HAN
JA/C UNITS <= 10.000CFM
IMCCH.INIC�L
BRENIFURN
RELOCATION OF FURNACE
INIECHANICAL
BRENIFURNOV
RELO FURNACE > ICK BTU
INIECHANICAL
BREMINH000
INSTALLATION OF HOOD
JMECHANiCAL
BRENIRELOCA
IRELOCATION OF HOOD
IMECHANICAL
BREMREPALT
REPAIR/ALTER HEATING
MECHANICAL
BREMVENSYS
IVENTILATION SYSTEMS
IMECHANICAL
PPERMITFEE
PLUMBNG PERMIT ISSUE
PLUMBING
BNUMULTI
INEW MULIFAMILY RES
1PLUMBING
BNUSFD
INEW SINGLEFANIILY RES
IPLUMBING
SPBACKFLOW
IATMOSPHERIC VACUUM
IPLUM13INU
BPCESSPOOL
ICESSPOOL
PLUMBING
BPFIXTURE
IPBLG FIXTURE
PLUMBING
BPGAS
IGAS PIPING SYSTEM FEE
IPLUMBING
SPINTERCEP
JIND WASTE INTERCEPTOR
IPLUMBING
BPREPIPE
IREPIPE OF FIXTURES
IPLUMBING
SPSEWAGE
ISEWAGE DISPOSAL
IPLUMBING
BPSEWER
ISEWERS
IPLUMBING
BPSPRINK
ILAWN SPRINKLER/BACKFLO
IPLUMBING
BPSTORM
ISTORWRAIN WATER
IPLUMBING
BPTRAP
I KITCHEN TRAP
IPLUMBING
BPVENT
JALT OF DRAIN & VENT
PLUMBING
BPWATER
JINSTALUALTER WATERPIP
PLUMBING
BPWHEATER
WATER HEATER/VENT
PLUMBING
BPWSVCS
IMAIN WATER SERVICE
PLUMBING
ZDEVAGREE
I DEVELOPMENT AGREEMENT
PLANNING
ZDIRTM
JOIR TENT MAP
PLANNING
ZFULLHR
JFULLAPPLBASE+HR
PLANNING
ZFULLTM
FULL APPL TENT MAP
1PLANNING
ZFULLUP
JFULLAPPL USE PERMIT
IPLANNING
ZFULLZONE
IFULLAPPLZONING
IPLANNING
ZGPAMEND _
IGENERALPLAN AMEND
IPLANNING
ZLIMAMEND
ILIMITED AMEND
IPLANNING
ZLIMTM
ILIMITED TENT MAP
IPLANNING
ZLIMUP
ILIMITEDAPPLUSEPERMI
IPLANNING
ZMATEMPUP,
IMIN AMEND TEMP USEPERM
PLANNING
ZMINHILLEX
IMINOR APPL HILL EXC
PLANNING
ZMINSIGNEX
MISC SIGN EXCEPTION
PLANNING
ZMINTM
MINOR APP TENT MAP
PLANNING
ZMINUP
MINOR APPL USE PERMIT
PLANNING
ZMISCASA
MISC ARCH SITE
PLANNING
ZMISCEXT
MISC TM AND UP
PLANNING
ZMISCFENCE
MISC FENCE EXCEPTION
PLANNING
ZMISCGEN
MISCELLAPPLGENERAL
PLANNING
ZMISCPCINT
MISC PC INTERPRETATION
PLANNING
ZSIGN
SIGN PERM[
PLANNING
ZTEMPSIGN
TEMPORARY SIGN
PLANNING
ZVARIANCE
DIRECTOR VARIANCE
PLANNING
2 oft
-Re iscd 8/ 10/99
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
— BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rug: Sub: Blk: Lot:34257029.00
INVOICE DATE......: 12/09/1999
REFERENCE ID # ...: 99120060
SITE ADDRESS .....:
1OB39 SYCAMORE DRIVE
SUBDIVISION .......
___--_-.____
P
CITY .............:
CUPERTINO
IMPACT AREA .......
P
OWNER ............:
WARD
ADDRESS ..........:
CITY/STATE/ZIP ...:
CUPERTINO, CA 95014
CONTRACTOR .......: LIC k 'OWNER -
COMPANY ..........: WARD
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE
_______________
BREMMISC
___--_-.____
P
25.53
EPERMITFEE
P
35.52
61.05
V ID
DESCRIPTION
.
............................
UFER
]
POOL/BONDING
304
ROUGH
ELECTRICAL
503
FINAL
MECHANICAL ENERGY
510
FINAL
PLANNING
516
FINAL
BUILDING
PAID -TO -DATE BALANCE DUE
____________ -----------
0.00 25.53
0.00 35.52
0.00 61.05
VOICE ID DESCRIPTION
........ ...... 6 ..............
104 REHM
301 ROUGH PLUMBING
502 FINAL PLU14BING ENERGY
506 GAS TEST
511 FINAL POOL