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00020001 01 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 060'1-00 CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. HUILINNGDIVI510N APPLICATIONIIaF.RMIT PLUMBINGMECHANICAL BUILDING PROJECT IDENTIFICATION BUILDING ADDRHS� SANITARY NO. APPLICATION SURMITIAL.DST OWNER" AN CO ACTOR' N H. LIC NO: NIC CONTROL# HITECI3NGINEER: LIC NO: All E. S r 19`I`OM yI� JW, __ v ❑ fA CONTACT: PHONE: �1#` w (�7� BUILDING PERMITINFO ' ❑ Consultant FcPS Paid by Applicant(Initial) RBI- ELECy PLUMY- MECH i LICF.NSEDCONTRATOR'S DECLARATION QTY ELECTRIC PERMIT FEE Cr/Jf IeJ/ I I chy eflirm that I am licensed, ndar provisions of Chapter a fcnmmeming JOB DESCRIPTION DaZ with Sretis�]Ixtu)afDivision3 nl the business and Pmfcsaions Je.a try license is RESIDEN'rIAI; ❑100 q- ® Sn PL'RMI'1'ISSUANCE ,�� U�, Ucevseo@`nd effect. ;&^ Lm/# ' ❑SED\VL ydx11LHEN REMODEL Q V APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE T-Z tel Uatc Conaaclor Fly AITCH ITF.CPS DECLAR My PANELS ❑MULTI-UNIT ❑STRUCfURAI. Z O a I understand my'plans Ahall be needas public records a��•• MODIFICATION �+ UPI"0203AMPS OZ- � El INTERIOR El CHIMNEY REPAIR F4hj.n1 License I'an cssinna ,, 201-10DOAMPS IMPROVEMENT E]SWIMMING POOLS 'Y,i,; OWNHR-BUIIAER DECLARATION OVER But AMPS El BATH REMOUHUREPAIR QUEMOLITION 6 1 hereby uRnn that 1 am exempt from the Cnrnracmts License Law forme I X 06 V foil r Ing moon.(Section 7031.5.Business and Professions Code:Any city m county SIGNS ELECTRICAL F1 OTHER 1 YI k, wh requites v permit ro construct,viler.improve,demolish,ear repair any slmcmrc �� p- r[n its ixeuunrg also mquirca the upplicvm(nr arch permit lea Ble arigned emtoment SPECIALCHRCUHUMISC. � yyGE 1fiu1 he is licensed ponveranotha provisinmsof the Conmoome,License L.,(Chapter 9 1111�"1yp0!(cnmmencing with Sectinn]IXNB oI Division3ntthe Business and Professions CoJe)nr TEMP.MFITR OR POLE INST. COMMERCIAL.: that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION LLXl liy Section 7031s byan,rmmicam fornpermit subjects the apPlicem tnvcivil penaltyof LOWER DEVICES [I TENANT ❑FOOD SERVICE f„ oat more than five hundred dollars($500). IMPROVEMENT C IO F1 1,as owner of the propeny,or my employees with wages as thensole compensating SWIMMING POOL ELECTRIC 2 p., will do the work,and theslmmurc is not intended oroRered for sale(See.]tiness 134,BusBOTHER W�'m and Professions Curb:The Cemmcmr's License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES G pmpeny who builds nr impmvcs Ihcreon,and who Jsxs such work himaclf nr through his own employees,provided thin such improvements am not intended or offered for NEW RESIDENTIAL Fic' S sale.If,however,the building or improvement is sold within one yemofcompletlon,the SQ.FT.IT.00R AREA ESQ.FT. mer-builder will have the burden of proving that he did not build or improve for pur- pme of sole). 1,us owner of the pmpray,a r c.,Relived,contracting with Iicen.mJ cnntrunars ,A consume,the pmjeat(See.9144,Dusiness and Professlore Codc:)The Cnnwclar'e I. low cense law dues had apply m an owner mf progeny who builds or improves thereon,an eEF. whocantrmas for such projects with a conuacns tera)licensed pursuantto the Contractors License Law. F.R AN ❑1 am exempt under Sec. T.B&P C for this reason )RAIN&VE W A VALUATION Ine, Hate WORKERS COMPENSATION DECLARATION DA OTE VI 401 I hereby affirm under Penaltyof perjury one of the following declarations 9Q l havevndw Imaimaina Ceaifiwteof Cmn iittoself-inxurefor Worker's CO Pcn- A -1• ,AREA.GOND. STO IIS TYPF.CONSTRUCTION cation,as Wed for by Section 37M of the Labor Cole,for the performance of rhe r which This permit is i...ad. P RES-PER TRAP wort have and will maintain Worker's Compensation Insurance,as manned by Section X)ofthal.abar Cude,fnrtliepertrrnanceofthewnrkforwhichlhlslturnitisissucd. GAS-13A.SYN'f13M-I INC.40VfLETS OCC.GROUP C_ UPN/ My War asst nlnsurut wrier endl'olicynun GAS-['A.SY.l'TEM-OVF,RA(I?AI C•� Camicc �Pnlicy Na,:�. — CER IFI All E MPTTON tNOM W R F: GREASNINUl1STRl.WASTE INTIPRCEPTOR COMP17NSATION INSURANCE BUILDING DIVISION FEES (This section need not boson plated if the permit is forone hundred dollars($Had GREASF.TRAP nr lose.) 1'IANCHECK I'I!I! I crafty that in the p,rfonnunceof lhawtukl'rwh' thispernitlsillued,isholl SEWER-SANITARY-STORM 2A.21x1 ITT. not employ any person in any manna an a Workers'Camps n- ENERGY FEE Z sation Laws of Califomia.Date WATER THEATER WNENTIELEC R O Applicant I os a GRADING FEE V) NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should WATER SYSIEM/TREATING I^ become subject m the Workers Compensation provisions of the Labor Code.you most SOUS FEF, Wforthwith comply with such provisions or this Parana shall he deemed rmokcd. WATER SERVICE -�- P. O CONSTRUCT[ON LENDING AGENCY NEWRESIDEN'1'IALPL1,113. SQ.Fr. \ r[ PID V O L hereby affirm that there is v consaumlon lending agency for the performance of 'r.l �rUate I -a 'he F the work for which this permit in issued(See3097,Co.CJ 0 Lender's No. r-/ F 'DYPAL: WLender's AJArcss TOl'AL: �L,.t, L1. 1 ecaify lhm 1 have real thin upplicatinn nnA slam Ihm the above information is I 200n BUILDING PE13 C) mrtect.l ugme nt comply with all cityandanmynrJinnncea and rate luwsrelatingto QTY MEC({ANICAI.PERMIT FEE L) Z building construction,and hereby vathodze represemetivcs of this city or enter upon the SRI SMIC FEE above-mentioned property for inspection purposes. PERMIT ISSUANCE 4 v ( ,indemnify and keep harmless the City nf0 Winn against 1EEECTkf Ilabil" e,judgment'.c asan enaea which may it my way accm guinsl saWCiry AI-TER OR ADU'fO MECfI. n asequence of the gr ' got is mw"velit. PLUMBING HE t 'PLICAN'I'UNDERS AND AND WIT .0 PLY WITf i. AIR 1{pNDIJNC UNI'I'(TO MAX)CFM) MECHANICAL 1'EI: OURC3REGULA'1'1 /{A AIR HANDLING UNIT(OVER 10.000 CPM) CONSTRUCTION'LAX -emlContmclor 'FlAte EXHAUST HOOD(W)DUCT) HOUSING MITIGATION FEE HAZARDOUS M ERIALS DISCLOSURE. Will the applicant or future building occupant%fare or handle haenalnusmatedul HEATING UNIT TO 100.03111'U) as defined by the Cuperlimo Mmricmu We.Chapter 9.12,and the I IUJIh ImA Svfuy Code,Section 21532(a)] BEATING UNIT(OVER I000H)B'fU) ❑Yes � No VENTILATION FAN(SINGLE RPSID) PAID D.m Receipt# Will the applicant or future building occupant use equipment or devices which can hwardous air comxminams a.'deft h the flu Arca Air Quality Management BOILER-COMP QHP OR 100,000 BTU) Y Y Y TOTAL: District? BOILER-COMP(OVER I00,IXXT BTU) ❑Yc% AIR CONDI'1"ION13R 1 have teal Ne haranlws ntntedals requirements under Chapter fi 95 of the Call. ISSUANCB D 'rE .in Health&Safety Code,Sections 25585.25533 and 25534.1 undcmand that if the NEW RESIDENTIAL MECH. SQ.FI'. building does not currently have a tenant.that it is my responsibility m notify the occupant 2 f1 0� of the requirements which must be mer prior to issuance of a Certificate of Oce.,em,. Owner tri telt rived agent Data TOTAL:I I ISSUED BY. OFFICE Ory. i1 Ap licable Fee 10 Fee Description Fee Group 11BPERMFEE IBLOG PERMIT FEES L8UILDING �SCONSTAX lCONSTRUCTION TAX 1BUILDING • JBENERGY JENERGY ISUILOING ENERGYADD JENERGY ADD MULTI ISUILDING 1BOVERTIME IINSPECTION OVERTIME ISUILDING BTEhIPPERM ITEMPORARY BLDG PERMIT IBUILDING BMITIGAT HOUSING MITIGATION FEE ISUILDING PLANCHK PLAN CHECK FEE BUILDING BPLANCKADD PLAN CHECK ADD MULTI • BUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSCBLVO SCB SPECIFIC PLAN BUILDING SSEISMICOM SEISMIC COMMERCIAL BUILDING BSEISMICRE SEISMIC FEE RES BUILDING ESPECIAL SPECIAL INS ECTION BUILDING 8SWIM SWIMMING POOL BUILDING ZADDCHG ADDRESS CHANGE BUILDING eftRMITFEE ELEC PERMIT ISSUANCE ELECTRICAL BELEC1000 ELEC 600V<=1000A ELECTRICAL ELEC1001 ELEC 600V>t000A ELECTRICAL B C200 ELECT SVCS 600V<=200A ELECTRICAL 8N ULTI MULTIFAMILY RES ELECTRICAL EMB SWAY REMODEL BUSWAYS ELECTRICAL BREMFIXT LIGHTING FIXTURES ELECTRICAL • BREMMISC MISC APPARATUS ELECTRICAL BREMNRAPP REM NON-RES APPLIANCE ELECTRICAL A BREMPOLE POL PLATFORM FIXTURE ELECTRICAL BREMPOWER POWER DEVICEIAPPARATUS ELECTRICAL BREMRECEPT RCPTL, SWITCH &OUTLETS ELECTRICAL BREMRESAPP REMODEL RES APPUANCE ELECTRICAL BREMSIGNAD RMOL SIGNS ADD BRANCH ELECTRICAL BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL THEATR THEATRICAL LGHTNG FIX ELECTRICAL BSF AM SINGLE&2 FAMILY ELECTRICAL BTEMP TEMPORARY POWER ELECTRICAL BTEMPSVCS TEMP DIST SVCS ELECTRICAL MPERMITFEE IMECH PERMIT ISSUANCE MECHANICAL BAPPLOTHER OTHER APPLIANCES MECHANICAL BBOILERt BOILER<= 100,000 BTU MECHANICAL BOILER2 BOILER>100KT0500K BTU MECHANICAL 88 IL 3 BOILER>500K TO 1M BTU MECHANICAL BBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL BROILERS TOILER> 1.75M BTU MECHANICAL BREMAPPLI 1APPLIANUt INSTALL MECHANICAL BREMHEAT HEATER INSTALLATION MECHANICAL BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL BMNEWMUL II NEW MULTI AMILY RES MECHANICAL . UtNEWSMIF NEW SF&2F RES SLOGS MECHANICAL 1 of2 9REMACOVER QAC UNIT >iGGOGCF&I INIECMANICAL JBREMAIRHAN JA/C UNITS <= 10.000Cribl IMECHANIC'AL BREMFURN IRELOCATION OF FURNACE MECHANICAL BREMFURNOV IRELO FURNACE > ICK STU IMECHANICAL • BREMINHOOD JINSTALLATION OF HOOD IMECHAI CAL BREAoIRELOCA IRELOCATION OF HO00 IMECHANiCAL BREMREPALT IREPAIRALTER HEATING IMECHANICAL BREMVENSYSVENTILATION SYSTEMS MECHANICAL PPERMITFEE JPLUMBNG PERMIT ISSUE IPLUMBING 11 BNUMULTI NEW MULIFAMILY RES PLUMBING BNUSFD NEW SINGLEFAMILY RES PLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING CESSPOOL CESSPOOL PLUMBING BPFIXTURE PBLG FIXTURE PLUMBING BPGAS GAS PIPING SYSTEM FEE PLUMBING BI INTERCE.P IND WASTE INTERCEPTOR PLUMBING III REPIPE REPIPE OF FIXTURES PLUMBING BP AGE 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 BPWA ER INSTALLIALTER WATERPIP PLUMBING BPWHEATER WATER HEATER/VENT PLUMBING BPWSVCS MAIN WATER SERVICE PLUMBING ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING • ZDIRTM PIR TENT MAP PLANNING ZFULL.HR IFULLAPPL BASE t HR PLANNING ZFULLTM IFULLAPPL TENT MAP PLANNING ZFULLUP IFULLAPPLUS PERMIT PLANNING ZFULLZONE FULL APPL ZONING PLANNING ZGPAMEND GENERAL PLAN AMEND PLANNING ZLIMAMEND LIMITED AMEN PLANNING ZLIMTM LIMITED TENT MAP PLANNING IMUP LIMITED APPL USE PERMI PLANNING ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING ZMINHILLEX MINOR APPL HILL EXC PLANNING ZMINSIGNEX MISC SIGN EXCEPTION PLANNING ZMINTM MINOR APP NT MAP PLANNING ZMINUP MINOR APPL USE PERMIT PLANNING ISCASA MISC ARCH SITE PLANNING ZMISCEXT MISC TM AND UP PLANNING ISCFENCE MISC FENCE EXCEPTION PLANNING ZMISCGEN MISCELL APPL GENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING ZSIGN SIGN PERMI PLANNING MPSIGN TEMPORARY SIGN PLANNING ZVARIANC DIRECTOR VARIANCEPLANNING 2 of 2 • INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE ~ CITY OF CUPERTINO t BUILDING PERMIT INVOICE OPERATOR: karenb Sec: TwP: Rng: Sub: Blk: Lot:35914019.00 INVOICE DATE......: 02/01/2000 REFERENCE ID # ...: 00020001 SITE ADDRESS .....: 10326 WESTACRES DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... ONNER ............: VENTURA GLENN J AND DOROTHY M ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2939 CONTRACTOR .......: LIC # ' COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ........: NOTE: THE FEES LISTED ARE ONLY THOSE DUE AT PERMIT APPLICATION FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BELEC1000 P 44.40 0.00 0.00 BENERGY A 89.10 0.00 89.10 BPERMFEE P 297.00 0.00 0.00 BPFIKTURE P 8.33 0.00 0.00 A 252.45 0.00 252.45 CEPT P 1.11 0.00 0.00 B AN P 41.63 0.00 0.00 BSEISMICRE P 2.40 0.00 0.00 BUSLIC P 90.00 0.00 0.00 EPERMITFEE P 35.52 0.00 0.00 MPERMITFEE P 35.52 0.00 0.00 PPERMITFEE P 35.52 0.00 0.00 --------- ------------ ----------- _ 932.98 0.00 341.55 •