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
•