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00010073 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 0 CITY OF CUPERTINO- BUILDING-ELECTRICAL PERMITNO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. BUILDING PROJECT IDENT'IF'ICATION BL'TLDINGArWRESS: SANITARY NO. PPLICATION SUBMITTAL DATE OWNER'S NAME: HONE: CONTRACJDR'S NAME: LIC C 0 V D f /Ik 3 NIC CONTROL 40CHITELT/ENGINEER: LIC NO: ADDRESS: ❑ CON TAC'F. PHONE: BUILDING PERMIT INFO ❑ Commoltant Fees Paid by Applicant(Initial) BLDG ELECT LUMB- MECCH LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby affirm that I am Ecemed under provisions m of chapter 9(vamencing JOB DESCRIPTION OW�OZ with Secd.n7010)cf Division3 of the Businessand l4ofessions Code,andmy license is RESIDENTIAL: O� in full force and effecter PERMIT'ISSUANCI? QUV Lic<nu Cy�stt F7 Lica ❑SFDWL [I KITCHEN REMODEL mzw Datc FO-L iCGfl Contrw�r MaLN GO �1'�F APPLIANCES-RESIDENTIAL. ❑ADDITION ❑PLUMBING RE-PIPE ARCHITECT'S DECLARATION ❑MULTI-UNIT ❑STRUCTURAL Zp Z Iunderans rsnd rryplashall beusedaspublicrecords PANELS MODIFICATION ONFO UPT0200AMPS ❑INTERIOR El CHIMNEY REPAIR (• ped Licensed Pncionnnl 201-1000AMPS X 9 (MPR VF.MENT W OWNER-BUILDER DECLARATION E]SWIMMING POOLS '4 OVER 10(OAMPS REMODELIREPAIR ❑DEMOLITION C W Q I hereby affirm that 1 am exempt from the Contractor's License Law for the 3 a U following reason.(Section 7031.5,Business and Profusions Cale:Any city or county SIGNS ELECTRICAL FR which requires a permit m Connmeo almq improve,demnlish,.r repair any structure I",a•O Prior o its issurraci]so requires thic.,[icient for such Ferritin fileaoignedmatemenl SPECIAL CIRCOIT/MISC. '!�!s�(�y that he is licensed pursuant to the provisions of the Contmem',License Low(Chapter W+00 fcnmmencing with Sectio.]O(1f17 of Divisinn3nfthc BueinessaM Pmfcssions Code)or TE P.MITER OR POLE INST. COMMERCIAL, ayx e C rhm he is exempt thcrefmm ane me bvis fm the alle6ed exemption.Any vinlotion o! ❑NEW BLDGIADDITION ❑DEMOLITION W�ti Section 70J LS M1y any upplicanl for a permit subjects the applicam tit a civil penu0y of PO S ria more than five hundred dollars IS501b, []TENANT [I FOOD SERVICE SpI,os owner of the Fmpeny.nny empinyces with wages as their sole compensation, S IMPROVEMENT will do the work,and the structure is not intendedoroffemd formic(Sec.7144,Business g%ER {ail G m and Pofessions Code:The Contractor's Licence law does not apply to an owner n( OffIL -SW' HES-FIXTU .SIV �A•�` 63 property who builds or improves thereon,and whit does.such work himself or through ES Nftw his own employees,providal that such improvements are not intended.r o(tered for NEW IDE .E A fT sale,If,howeverthe building or fmprovenernat is sold within one year of completion,the SQ.Ff.FLOOR AREA LSQ.FT. ownerhuilder will have the burden of pawing Nat he did not hudd or improve for par- pose ofaale.). L] ro 1,as owner of doe property, on exclusively contracting with licensed connn actnto IOTA.: construct the project(Sec.ID14,Business and Profession,Cale:)The Continuities Li- Cease L.w docs not apply ntannwne,of propeny who builds.,improvesrbeaon,:md QTY. 1 r who contracts for such projects with a Contractors)licensed pursnanno the Cumm, Liceme Law. PERMIT ISSUANCE. tLi +' ❑ I am eumptum mder Sec. ,B&PC for this aven It DD ALDER-DRAIN&VENT-WATER(PA) VALUATION weer Date ^^^��� WORKER'S COMPENSATION DECLARATION HACK(TAW PROTGCT.DEVICE ( l� 'fes Ihereby upon under Final ty of perjury one of the fol lowing declarations: J Y I have and will maintain a Cenifcate ofConsenuo self-insure for Wnrkcrs Compact. DRAINS-FLOOR,ROOF.AREA,CONED. sation,as provided for by Section 3710 of the Lnr MCode,for the pem rforance of the ST IPS TYPE CONSi'RUCTION work far which this permit is issued. FIXTURES-PER TRAP ❑ 1 have and will mainmin Workers Compensation Insurance,as requiad by Section 3700m`the Labor Cade,for the fonnancem the work for which this noir is issued. GAS-EA.SYSTEM.I INC.4 OUTLETS Per pe OCC.GROUP ` �f A7 My Wnrkcrs Compensation insurance carne Poli Policy number am: GAS_PA.SYSTEM OVER 4(EA) CI(Q ( 7 Cartier. Policy FROM CERTIFICATE OF 2— COMPENSATION PROM WORKERS' GREASIVINDUSTRL WASTE INTERCEPTOR Z COMPHNSATI(1N INSURANCE BUILDING DIVISION IL'ES This section need not becompined if the pencil is(crone hundred dollies(SIDE or less) GREASE TRAP PLANCHBCK I•'EH I Certify,that in the podmmumcc.fthe work forwhich this permit is isxuent,[shall SEWER-SANITARY-STORM EA.200 FT. not employ any person in any manner xo as to become wobject to the Worker%Compen- ENERGY FEE Z smion Lawsof Calamora.Dare WATER HEATER WNENT/ELITCHi O Applicam GRADING FEE cA NGFICE TO APPLICANT:Border making this Certificate of Exemption,you should WATER SYSTEMIFREAT ING become subject ,,the Workers Compensation provi'm.,.1'am Labor Calc,you must SOILS HE f47 forthwith comply with such provisions or this pe,mit shallMdeemed revoked. WATERSERVICE 7 z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL.PCMB. SQ.FT. PAID L)O I herebywhich thi that isamnnmc.30 lending agency for the performance of Date Fthe work for which this permit is iseued(Sec.31X1],Co.C.) r pU L.endeAAddo -1 t1\ I I TOTAL W Lender's Addass TOTAL: 1 Certify that 1 have cad thin application and state that the above information is BUILDING FEE kA corms.l agree to comply with all city and county ordinances and irate laws relating to QTY. MECHANICAL PERMIT FEE 1V (] 2 LJ Z building construction,and hereby authorize representatives of this city to enter upon the ,ISM sYY zuuu 11 above-mentioned property for inspection pmpwnes. (We)agree m save,indemnify and keep harmless Ne City of Cupertino against PERM['I'ISSUANCE LECTRIC FEE liabilities,j uduriums,costs and expenses which may in any way occmnagaimt said City ALTER OR ADD TO MECH. in consequence.1 the granting of this permit. PLUMBING FEE APPLICANT It STANDS AN L CO WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) d1LCHANIGAL-PEB SOUR ' 11 O AIR HANDLING UNIT(OVER 10,100CPM) CONSTRUCTION TAX rgraure of ApplsanUCnmmcusr Dale EXHAUST HOOD MMUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the oppliant.,more building cecCromt.mc or handle hmaN.ns material HEATING UNIT TO HXkBW BTU) os defined by the Cupertino Memclpol Cafe,Chapter 9.12,and the Health and Safmy Cade,Section 25532(a)'! HEATING UNIT(OV P.R 100,000 BTI) ­1 Yet �&N. VENTILATION PAN(SINGLE RPS]D) PAID Will the applici rll no,famm building cove...to use equipment or devices which Date Receipt tl 'mit hazmdous air comaminonts as deuced by the Bay Area Air Quality Management BOILER-COMP QHP OR 100,000 BTU) District^ IDEAL: E3Yu BOILER-COMP(OVER 110,0(IBBTU) PfIJu Ilreve read the hazardous matedal.s requirements under Chapter 6.95 of the Cali. AIR CONDITIONER ISSUANCE DATE I'omia Health&Safety Code.S bm 25505, d 25534.1 Cadenhead and Brhe NEW RESIDENTIAL MECH. SQ.FT. / r.- buildingdoesn eale a Room spermibilitytonolifylheoccupam of rho run el prior info C-4 ren Occupancy. authorized agent Dare TOTAL: ISSUED BY: OFFICE Qty. if Applicable Fee 10 Fee Description Fee Group �BPERMFEE BLDG PERMIT FEES LBUILINING ISCONSTAX ICONSTRUCTION TAX BUILDING • ISENERGY JENERGY IBUILDING BENERGYADD I ENERGY ADD MULTI IBUILOING BOVERTIME JINSPECTION OVERTIME IBUILDING BTEMPPERM ITEMPORARY BLDG PERMIT IBUILDING BMITIGAT HOUSING MITIGATION FEE IBUILDING SPLANCHK PLAN CHECK FEE IBUILDING BPLANCKADD PLAN CHECK ADD MULTI IBUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSCBLVO SCS SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING BSEISMICRE SEISMIC FEE RES BUILDING BSPECIAL SPECIAL INSPECTION BUILDING 8SWIM SWIMMING POOL BUILDING ZADDCHG ADDRESS 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 TR_ EMFIXT LIGHTING FIXTURES ELECTRICAL • BREMMISC MISC APPARATUS ELECTRICAL BREMNRAPP REM NON-RES APPLIANCE ELECTRICAL ri�EMPOLE POLE/PLATFORM FIXTURE ELECTRICAL BREMPOWER POWER DEVICE/APPARATUS ELECTRICAL BREMRECEPT RCPTL, SWITCH &OUTLETS ELECTRICAL BREMRESAPP REMODEL RES APPLIANCE ELECTRICAL BREMSIGNAD RMDL SIGNS ADD BRANCH ELECTRICAL BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL BSF&2FAM SINGLE&2 FAMILY ELECTRICAL STEMP TEMPORARY POWER ELECTRICAL BTEMPSVCS ITEMP DIST SVCS ELECTRICAL MPERMITFEE IMECH PERMIT ISSUANCE MECHANICAL BAPPLOTHER OTHER APPLIANCES MECHANICAL BBOILERI BOILER <= 100,000 BTU MECHANICAL BBOILER2 BOILER>100KTO500K BTU MECHANICAL BBOILER3 BOILER>500KTO IM BTU MECHANICAL BBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL BBOILFRS BOILER> 1.75M BTU MECHANICAL BREMAPPLI APPLIANC INSTALL MECHANICAL BREMHEAT HEATER INSTALLATION MECHANICAL BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL • BMNEWSF&2F NEW SF&2F RES BLDGS MECHANICAL F of 2 Reviscd 8110199 BREiNIACOVER QAC UNIT >ICC00CFM Iib1ECHANICAL.1 IBREMAIRHAN JA/C UNITS <= 10.OGCCFb1 MECHANICAL ` BREiNIFURN IRELOCATION Or FURNACE JIVIECHANICAL BREMFURNOV IRELO FURNACE > ICK BTU IiMECHANICAL I • BREMINHOOD JINSTeLLATION OF HOOD MECHANICAL BRENIRELOCA IRELOCATION OF HOOD MECHANICAL BREMREPALT REPAIR/ALTER HEATING MECHANICAL BREMVENSYS IVENTILATION SYSTEMS tiIECHANICAL PPERMITFEE PLUMBNG PERMIT ISSUE PLUMBING BNUMULTI NEW MULIFAMILY RES PLUMBING BNUSFO NEW SINGLEFAMILY RES PLUMBING SPBACKFLOW ATMOSPHERIC VACUUM PLUMBING BPCESSPOOL CESSPOOL PLUMBING BPFIXTURE PBLG FIXTURE PLUMBING —v —BPGAS GAS PIPING SYSTEM FEE PLUMBING BPINTERCEP IND WASTE INTERCEPTOR PLUMBING SPREPIPE REPIPE OF FIXTURES PLUMBING BPSEWAGE SEWAGE DISPOSAL PLUMBING SPSEWER SEWERS PLUMBING BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING BPSTORM STORM/RAIN WATER PLUMBING BPTRAP KITCHEN TRAP PLUMBING BPVENT ALT OF DRAIN &VENT PLUMBING BPWATER INSTALLIALTER WATERPIP NPLANNII,"ING BPWHEATER WATER HEATERNENT BPWSVCS MAIN WATER SERVICE ' ZDEVAGREE DEVELOPMENT AGREEMENT ZOIRTM DIR TENT MAP ZFULLHR FULLAPPLBASE+HR ZFULLTM FULL APPL TENT MAP ZFULLUP FULL APPL USE PERMIT PLANNING ZFULLZONE FULL APPL ZONING PLANNING ZGPAMEND GENERAL PLAN AMEND PLANNING ZLIMAMEND LIMITED AMEND PLANNING ZLIMTM LIMITED TENT MAP PLANNING ZLIMUP LIMITED APPL USE PERM[ PLANNING ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING ZMINHILLEX MINOR 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 ZMISCEX MISC TM AND UP EXT PLANNING ZMISCFENCE MISC FENCE EXCEPTION PLANNING ZMISCGEN MISCELL ADPL GENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING ZSIGN SIGN PERM[ PLANNING ZTEMPSIGN TEMPORARY SIGN PLANNING ZVARIANCE DIRECTOR.VARIANCE PLANNING 2 of 2 • Revised 8710/99 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE ' • CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: karenb Sec: Twp: RnS: Sub: Blk: Lot:36617029.00 INVOICE DATE...... : 01/12/2000 REFERENCE ID # . ..: 00010073 SITE ADDRESS . ....: 7573 WATERFORD DR SUBDIVISION ..... . . CITY ........... . .: CUPERTINO IMPACT AREA ...... . OWNER . . .......... : PRAVIN MADHANI ADDRESS .......... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-5233 CONTRACTOR ........ LIC # COMPANY . ... . . ....: ADDRESS . . ... . ....: CITY/STATE/ZIP .. .. TELEPHONE . . . . ....: FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- __- --------- ------------ _---------- BPFIXTURE P 8.33 0.00 8.33 BREM IISC P 25.53 0.00 25.53 BREMRECEPT P 26.89 0.00 26.89 BUSLIC P 90.00 0.00 90.00 EPERMITFEE P 35.52 0.00 35.52 PPERMITFEE P 35.52 0,00 35.52 - • 221.79 0.00 221.79 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ............................ 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL 506 GAS TEST 507 FINAL PLUMBING 508 FINAL MECHANICAL 509 FINAL GRADE 510 FINAL PLANNING 514 FINAL PUBLIC WORKS •