00010162 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 000 ) 01 (.2-
C
OQ ) O/ Z
CITY Of CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL Q
BUILDING PROJECT IDENT'IF'ICATION S
1{UILIIING ADIlR1iSS jow—
SANITARY NO. APPLICA'I'[ON SUBMITTAL DATE
i & C�
OW:�EH;S NAME: KNE: ) RAC'O LIC - -. �m�
Jr i NIC CONT'ROLa
CH TttENGINEER: LIC N RE..: Q ❑
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Feces Paid by Applicant(Initial) BLDG ELECT PL�UM/q MUCH
❑ ❑ ICJ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby amrnt that I am Incensed tilde.........ions of chapter 9 hu mmenemg JOB DESCRIPTION
i4aZ mSeminn 7lggpdolvislon3nDhe Business and Pmfessl s edea mylicenens RESIDENTIAL:
�� Wtfull force and eRect. (n� PERMIT ISSUANCE.
C_f„ '" a / ❑SFD I N ❑PLUMBING
REMODEL
i ZW License Class Lic.p APPLIANCIiS-RESII]ENTIAh ❑ADDI'TION ❑PLUMBING RE-PIPE
yC [dao Cnld[ECL
A HITE... DECLARATION ❑MULThUNIT ❑STRUCTURAL
F•�h PANELS
y p oe Z ders�d my plan.shall b used ax public ..reds MODIFICATION
pZ�0-a UP'10211(lAMPS [I INTERIOR ❑CHIMNEY REPAIR
Q4(:; Licensed Pndeommal 201-1000AMP5 IMPROVEMENT E]SWIMMING POOLS
=W .,...II OWNER-BUILDER
atI at BUILDtiRDECLARATION OVER 1000AMP5 ❑BATT]REMODEUREPAIR (]DEMOLITION
C 6 I hereby.ScIl mer 1 ten exmmpl from die ContractorsCod License Law far the
3 6 F whowimg uirsoa.Permit
t ]onsum Business steed improve,
de iom Crede:Any city or c:nmrY SIGNS IiLECTRICAL ❑OTHER
tL y which requires n permit to naswcq alter,improve,demolish,ore a sig any structure 01
that hoslicensed pumsorequirts the applicant the such pcm[iuLiccom Law sentiment hape,9 SPECIAL CIRCUIT/MISC.
that it rcInolhe vs nwf theeBuines and ProelawlC of 9
�pr mt.u;n pm i.in per
ng
ygal (ear he is exempth SectionMustof basis for
oftheeged Business A.ionsCode7or TEMItMET ER OR POLE INST.
a a e IY Fite he is exempt themfmm enJ the iasis for the alleged exemption.Any violation of ❑NE GIADDITION [I[_1 FOOD SERVICE,
DEMOLITION
HSectio"7031 5 by any npplicnnt fnr a permit subjects the applicant m a civil penalty of POWER DEVICES 0 TENAN
I more limn five hundred dollars(85001,
MPROVEMENT
fyFC ❑ I,as owner of the property,or my employees with wages m their sole compensation. SWIMMING PMOL ELECT RIC
Wwill do the work.and thenrucam is not:mended or offered for sale(See.]OM,Business HER
m anti Pro(ssions Code:The Contractor's License law does not apply In an owner of OITTI,IE0'S-SWITCHES-PIX'H1RES
4' property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements am not intended or offered for NEW RESIDENTIAL ELF.CTR SQ ET.
valesIf.h[nvevee the building or improve"tuns is sold wiNimmnc year Ufa"mplctioalhe SQ.PT.FLOOR AREA E/SQ.FT.
er-builder will have the handl"of pini",Thal he did nut build m Improve fnr pu.-
ryu of sale.).
1,as owner of the propcny,am exclusively contracting with licensed counselors to TOTAL:
construct the project(Sec.7N4,Business and Professions Clale:)The Contractor's I.I-
censeLaw does not apply toanownerofpropenywho builds orimproves thereon,and QTY, PLUMBING PERMIT FEE
who convects for Such projects with a com memn(s)licensed pursuant o the Commcmrs
License Low, PERMIT ISSUANCE
l am esempt umdcr Sec. ,B&P C fon this reason
Date ALTER-DRAIN&VENT-WATER(EA) VALUATION
r
WORKER'S COMPENSATION DECLARATION HACK FLOW PROTECT'.DEVICE,
e I hereby affirm under penalty of perjury onenfthe following declamti....
❑I have and will maintain a Certificate of Cuawntto self-insum for Workers Coolish- DRAINS-FLOOR,ROOF AREA,GOND. S'1'ORIE•S TYPE CONSTRUCTION
ration,as provided for by Section 371X1 of the Labor Coda,for the perforntanm of the
r which this Pet is issued. FIX I ORES-PER TRAP
w 1 have and will cadmium Vemkar's Compensation]as...ce,as required by Section
37M of Ne labor Code,for the performance of the work for which this pemtit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP Alibi
My Work �utell n l unmee cnrrieno i y No.: yip
Policy
Carrier: A'C/YE16LSJ Policy Na: F`F/� GAS-EA.SYSTEM-OVER 4(EA) IIn/A_ �0-041
OERTIPICAT.OF EXEMPT[ON FROM WORKERS' ILLY J VYI
COMPENSATION INSURANCE GRHASFANDUSTRL WASTE INTERCEPTOR OR
BUILDING 1]IVISION FRES
fThiveealion ted not be completed if Nepem[il is bmmchundred dollars I$Ila)) GREASETRAP
nr less.) PIANCH[CK FEE
I citify that in the performance ofthe work for which this permit is issued,[shall SEWER-SANITARY-STORM P.A.2W FT.
not employ any person i"any mmuter so my m bean"e subject lo the W"rkars'Campo. ENERGY FEE
C Z smarm Laws of California.Date / WATER HEATER W/VUNT/ELCCB
Q Applicant GRADING FEE
� y NOTICETO APPLICANT:IL after milking Nis Certificate of lixemptinn,you shmgd WA'T'ER SYS'I'hMORL'AT'ING
abecome subjal to the Workers Compensation provisions of the Labor Code,you muss SOILS FEC
W forthwith comply with such provisions or this permit shall be deemed revoked. WATER SERVICE
i A
UO CONSTRUCTION LNG AGENCY NEW RESIDENTIAL PLMU. SQ FT. PAID Date Receipt is
1 herebyaffirmthi that there is a. Sim3construction lending agency for the Performance of
the work far which this pemtit is issued Iscc.3097,Cie CJ
(-'' Limiters Name TOTAL:
�U Lenders AddAJJress TOTAL:
F1 1 verify that 1 have read this application and state that the above information is BUILDING FEE
V) correct.I agree to comply with all city and county ordinances ordinate laws relating to QTY. MECHANICAL PERMIT 'FEE.
U ,Z builhaticnnstmction,and hereby authorim repmnematives of this city[center upon the SEISMIC I:EE
above-meminned property for inspection purposes. PERMIT ISSUANCE
(We)agree to save,indemnify and keep harmless Ne City of Cupemam against ELECTRIC FEE
linhilhiea judgmema cants and expenses which only In any way acerae against said City ALI'1iR OR ADD10 MECIL
in cnns"ae"ce of Ne ranting of this penmh. PLUMBING FEE
APPLICANT of
�tSTAND$AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT 0'010,000 CFM) MECHANICAL FEE
SOURCE REGUL ONS.
0/-1-06— AIR HANDLING UNIT(OVER 10.00( CFMI CONSTRUCTION TAX
Signatureof Appk .lmcmr Date EXHAUST'ROOD DVMUCq
A/ARDOUS MAITRIALS DISCLOSURE HOUSING MITIGA'T'ION PEE
Will the applicant or furore building occupant store or handle hazardous material HEATING UNIT G 0 100,000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Calc,Section 25532m)! HEATING UNIT(OVER 100.000 BTU)
0Y°s VENTILATION PAN RFS Io) PAID
Dare Receipt#
Willtheair loort or contaminantures a building by the
hpant eByse Am Air
MiCagement BOILER-COMPQHPOR 100,00OBTU)
Out iterations air contaminants ms Defined by the Bay Areu Air Quality Management TOTp1, a
District?
❑Yes BOILER-COME(OVER Ifat"BTU)
n
I have read the hazmdous materials requirements under Chapter 6,95 of the Cali- AIR CONDITIONER ISSUANCE DATE
formHe h&Safety Code,Seetinns 255[15,25533 and 255.U.I understand any the NEW RESIDENTIAL MECH. SQ.FL c /) -2 � O
building non cumn0y have a te"a"t,that It is my responsibility to notify the exemput
it die cmcros wile st home[prior m issuance of.Ceriliearenf Occury"cy.
B a I
Owner r em Dae TOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rug: Sub: Elk: Lot:36650041.00
INVOICE DATE. . ....: 01/28/2000
REFERENCE ID # ...: 00010162
SITE ADDRESS ..... : 11856 WOODHILL COURT
SUBDIVISION .......
CITY ..... ........: CUPERTINO
IMPACT AREA .......
OWNER ............ : VIRGINIA CHEN
ADDRESS ..........:
CITY/STATE/ZIP ... : CUPERTINO, CA 95014
CONTRACTOR .......: WARREN, HENRY LIC # 20719
COMPANY ..........: ABSOLUTELY WATER HEATERS
ADDRESS ... .......: 191 PADDON PL '
CITY/STATE/ZIP ...: MARINA, CA 93933
TELEPHONE ........: (831)384-5133
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPWHEATER P 9.99 0.00 9.99
PPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
45.51 0.00 45.51
DESCRIPTION 0"
VID ......D.. .--- --O-- -------- VOICE ID .......................
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUhIDING
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