99100010 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY y! U CJ
CITY OF CUPERTINO BUILDING-F.LE(THUCAL PDRMIT NO.
BUILDING DIVISION APPLICATION/PERMIT 1'LUMBING�MF:CHANICAI. S0001
BUILDINGPIS IDENT'IF'ICATION
BUILDING AUDHIiSS SANITARY NO. APPLICATION SUBMITTAL ONE
O 'NCR'S NAME: PHONE: CONTRACTOR'S NAME. LIC NO: v
NIC CONTROL CHI rECT/ENGINEER: F NK LIryo
C O: ADDKF'_SS: ❑ K.S/ ��
�, eN c-olS7 3' loll ST
CONTACT: PHONE: BUILDING PERMIT INFO
/MA ;Ikj Aye- y�/�g- 7633 ❑ Cunfiul[anl Fccs Fail by Applicant(Initial) BLDG / f:1.I❑3CI' PLUMB n1OH
uCENSED CONTRACrok9 Dl!CLARATION QTY CLECTRIC PERMIT FEE tSrCl/ JOB DESCRIPTION
I herehy aRrt.Shut 1 am licensed under provisions of Chapter 9(commencing
Z with Semlon ma li
700(pof Division J of the Business and Professions Cede.accnscis RESIDENTIAL'
PERM IT ISSUANCE
F�� in toll ti,nc and cu• GSFDWI. GKI'ICIIIiN REMOUEI.
a V fFj License Class _LIC.p �.������ �t�p APPLIANCES-RIiS1UPNTIAI. ❑AUDIT SON 0 PLUMBING RE:
eFiavy Dom-19�C-114—Cumractor— —l—.paw—' ❑MUITI-UNIT GMOUC[CAT[6
•� ARCHITECTS DF.CLARAt'ION PANELS MODII'ICATION
z Fp yZ I it mJ my porn.shun be used ns hfic ors, it, UP TU 2IXIAMPS
O14 - GINTERIOR DCIII:MNEY RIiI'AIR
,itauscI proonnl 201-10MAMPS IMPR(IVLMEtNI' GSWIMMINGPOOLS
OWNER-BUILDER DECLARATION ❑BATH REMODEJAE:PAIR El DEMOLITION
C 6 1 hereby aide.Aha I our exempt front The Contractor's Licence law for the OVER IIMM)AAIPS
xax O a V following=son.(Section 7031.5,Business and Professions Code:Any city or mune til E � 1 [I OTHER
W 3 a i7 which m'mer,a permit m eansnua,ober,improve,de...li t,.or repair any arm
F+u'OQ
prior o its issuance.also raquires the applicant for such Permit to file a xigneal stater SP A 1 S
S n'n thnhc is licenced pumuamm me provisions of Ne Cnmmetors Licenu law(Chap COMMERCIAu
�CpO la,mmendng with Sectio 7lNID)ot Diskum Jofthe Business and Pmtassin.sena r
d 1 p C (�t he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW B1.DOL\DDITION ❑DEMOLITION
X^',�y Section 7031.5 by any applicant lit a proud m siats the applicant a,a civil penalty of I TENANT 0 FOOD SERVICE
nor mate than live hundred dollars 145146. IMPROVEMENT
=Q 0 Lan owner ofthe propenNer mycmplayees with wages as their sole compensation. N ) ELEC L El OTHER -
C=� pill Jo the wak.mul rhe,lmcturc is not mmcMcdonalemd fnrsalc(Scc.7144.11...ams
W3 and 11...i..lens Codr, the Connacma's Liecrw law does nut apply m an owner of OUTLETS-SWITCIBS-FIXTURES
property who builds or improves nation,and who Juts such work himself or th
his own employees,provided that such imprtn
vcern,arc nm inm.ded Lir obe Ph, SID .Ef S
sack.11,however,the building or lmpowerecu is sold within one year ofeompleti( SV�Fr.FLOOR AREA SISU.IT.
owner-builder will have the huNcn of proving that he indent build Lir Improve Aim
ue
ry,of aLwle.). TOTAL:
❑ Las owner of the propcny,an,exclusively contracting with licensed contractors to
construct the project(Sec.9144,Busi.ecv and I'mir"ions Cidca nta Contmewr's L4
ase Law docs not apply m an owner of property who b.ild.s or imprness shearer,and QTY. PLUMBING PERMIT FEE
who contracts far such pmjons with a comenetons)IicenuA pursuant m the Contramurs
Liern is Law. VERMI'IISSUAN li
Q Ian excntpt under Sec. ,RKPCmrlhisremora o
AI:1'Gk-TRAIN f-WA'I'T?k TEN VALUATION
Dat,
WORKER'SCOMPENSATIONDECLARATION BACK FLOW OA's HVI li
hereby aBitm under penany.f perjury one of'he fail, dccbtmminns'.
I have and will nmi.hti.aCcnificum of CmwmtoxclPinsvm for Workers ComNn- DRAINS-FLOOR,ROO ,C U. � SEARS 'I'YI'Ii CONS'1'HUCI'101
anion,as provided for by Sectio 3700 of the Labor Code,for Abe praf err ante of She
work for which this Permit is issued. FEATURES-PIiK TRAP
yI have and will maintain Worker's Compensation Insurance,as required by Section GAS A..SYSTEM-I INC. OUT
37DIo1Rhe Labor Cock.for the perfommnceofthe work far which Nis pemtir is issued, r .GROUP
My WorAcr' Compcnxotion Insurance carziorond l'nlicy nuT heT/_Yam: GASB-IiA.SYS'IEM-OVER4(EA)
C 1R111lCATE Op SYTIONINSURANCE INN FROM WOR RS' GRE 1SF%INDUSTRL WASTE INTEHCEPTOH
COMI'IiNAfION BUILDING DIVISION h'IIES
ITIissection need nottecomplebdif Nepermir is foronchundraidnllars(5100) GREASETRAP PLANCHECK FEE
Iccnily Natlulhe Perforn,ane o(thc work for which thin pcnrdt ix issunJ.I shall $IiWER-SANITARY-STORM PA.200 lT. ENERGS'ILIi
not formay any pcaum in any mwncr to
become amocO^i—hcdWorkcrs4g n
Q ,� mtinn Taws of CaGfn ia,Date WATER IIIiATI,R WNCNT/F:LECEN GRADING FELT
z O ApPllcan
N(JrlCli TO Al"}LLI?mtlVT�tfn d m g this Cer iricmc of Exemption,you should WATER SYSTEM/I RENTING SOILS FEE
become subjecrt;!9 r er's Compri, ton pall cions of the Labor Code, no must
ai F�-I forthwith comply withmch provisions nn his permit shall be domed invoked. WATER SERVICE
0
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLM9. SQ.FL PAID
z _ Uale ReaciplM
�Q work lot
Which#1 tha.11nixaed(See.i30 len ding agency fur Nc performance of
f"t
the work lar which tmh is issued(Sec.31199.Cis.C.) fOTAI:
OI,ndcr's Ni is — TOTAL
rU Lenders AJdrer T- BUILDING EEE
1 I mnify Lima I have mad flus application tad stat.that The abase iarotmatien is
IFi rex correct.l agree u,comply with all city and county ordinances andmam laws reining to QTV. MECHANICAL PERMIT FEE SEISMIC FEh
V z building m,nstmcdan.and hereby authorize representatives of This city to enter upon the
alsmnmcmiuned plopmy for inspedion 1-111-1 PERMIT ISSUANCE ELECTRIC FEE
(We)signan,save,indemnify and keep harmless the City of Cupertino against
IiahilitiesJudgmenrs.costs and expenses which may in any way aceme against mid City ALTER OR ADD TO MECH PLUMBING FEE
in orooSer.cc of the granting of this permir.
APPLICANT UNDER. N S ANI)WILL COMPLY WITH ALL.NON-POINT AIR HANDLING UNI'1'('f(I SOLENESS CFM) MECHANICAL FEE
SOURCE RIiGULAI'IONS.
AIR HANDLING LINE r(OVER 10,000 CFM)' CONSTRUCT ION TAX
Sig or Dae EXHAUST HOOD(W/DUCT) HOUSING MITIGATION PER
HA S N ATERIA S DISCLOSURE
WIIUate,icantorlumm building occupant stanor madle hvmdous mamriul HEATING UNIT ITO 100,OIp SITU)
as defined by the Copcaino Mun'mipal Code,Chapler 9.12,and the Health and Safety HEATING UNIT(OVER 11g)•gNl B'I'U)
Coda Section 25532(a)'1
�Ycs ❑No VENT H.KrION FAN(SINGLE RES I DI PAID
Date Rccciplk
Will the applicant Lir fuwm building occupant use ofair cal ar devices which BOILER-COM('UBP OR Iplitha0 B'IT1) r
fir hucvJous air containment's as dcfncd by The Bay Area Air Quality Management 'rO)'AL:
D'onict9 BOILER-COMP(OVER BERMS tlTO)
❑Yes CIN,,
AIR CONDITIONER ISSUANCE DATE
1 hove teal the Leaman.,materials requimmenn under Chapter 6,95 of the Cmi.
fume.HmIN A Safdty Cafe,Sections 25505,25533 and 25534.1 ondcmund Inn ii the NEW RESIDENT[AS,MECH. SQ.PL
building does nor currently have i tenant,(,her it is my responsibility to renty the accupent l
of them menu which m t be,met prior to icmance of a Cri ificam of OcculameY /
-5- TUT'AL: ISSUIiD BY:
Dwmter ora Dae
OFFICE
CITY OF CUPERTINO
1 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: christya
COPY k 1
Sec: Twp: Rng: Sub: Elk: LOC:31607043.00
DATE ISSUED....... : 10/11/1999
RECEIPT p......... : 10292
REFERENCE ID # ... : 99100018
SITE ADDRESS .....: 11000 N WOLFE RD BDG 42
SUBDIVISION ......:
CITY .... . ........: CUPERTINO
IMPACT AREA .......
OWNER ... .........: HEWLETT PACKARD CO
ADDRESS .. ........:
CITY/STATE/ZIP ...: PALO ALTO CA, CA 94303
r RECEIVED FROM .... : TIM
CONTRACTOR .... ...: LIC A
COMPANY ... . .. ....:
ADDRESS .... . . . . ..:
CITY/STATE/ZIP . . . . ,
TELEPHONE ........ :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 5,000.00 107.00 0.00 107.00 0.00
BP 'CHK PERMIT FEE 107.00 90.95 0.00 90.95 0.00
BICOM VALUATION 5,000.00 1.050.00 1.05 0.00
_ _
TOTAL PERMIT 199.00 0.00 199.00 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 199.00 074
------------
TOTAL RECEIPT 19900
1
,f