99080095 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY C 'J
CI TY OF CUPERTINO BUII,DING-ELECTRICAL PER IT NO.
BUu.nING DIVISION APPLICATION/PERMIT PLUMB NG-MKCHANICAL
BUILDING PROJRCp I DENI'IFICATION affigiffiffn
Bl11LDING ADDR17SS: SANITARY NO. APPLICATION SUBMITTAI,DATE
I I B I ybJ 4e.3 jf E- COL;0- £svz s y
OWNER'S SAME: PHONE: CONTRACTOR'S NAME: LIC NO:
NIC CONTROLp
UCCl/EN' GI, LIC NO: I ADDRESS: T
Qoe for 144 44W000 6,1A I no Flo GN s'✓6La eA vox� ❑ SS�7
CONTACT. PHONE: BUILDING PERMIT INFO
WB F{.<) Cy 7S-f slr9 ❑ GOR5DIlanl Fees Paid by Applicant(Initial) BLDG ELECT3- PLUMB MEr Cy
LICE SFD CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE VJ
I h,,rhy mrimt that am licensed under psfink nos of Chapter 9(commencing JOB DESCRIPTION
WOZ with Secdon7Bapan)ivi.ion 3oflhe Bmaw,a and Pmdb.domCale.and any fiaemeis RESIDENTIAL'
�1O in PERMIT ISSUANCIi
4[- Nil ClassJedrecl. ❑SPDWL [I KITCHEN REMODEL
V U License Class Liu.p APPLIANCES-RESIDENTI L ❑ADDITION ❑PLUMBING RU-P[PE
F Z W Dam Cnnnvror
ARCHIT[CI"S DECLARATION ❑MULTI-UNIT []STRUCTURAL
F'unnZ lunderstandmyplamahall housed m Public mord PANELS MODIFICATION
Oz KQ UPTO 200 AMPS El INTERIOR El CHIMNEY REPAIR
p7yFW Licensed Professional 201-1000AMPS IMPROVF,MENT E]SWIMMING POOLS
x s1fJ OWNER-BUILDER DECLARATION OVER AMPS
❑BATH REMODEUREPAIR ❑DEMOLITION
C C 6 1 hereby alfimt that 1 am exempt from the Contractors Licems Law for the
OI(�U Iidlowing rwmn.(Smoot 7031.5.Business and Profession.Code:Airy city err county SIGNS I31.HCTRICAI, C1 OTHER
Wa y which .q a pe n constrict, II ,improve.d m ikh, pa y svucmre S C' — _
{On g' puoT tot . ce I: q .Ih applicant for suchPe it to Tlsignedstatement SPCCIAL CIRCUITMISC.
py� p fort he . It . a tM1 p srlll C t r'xl L' (Chapter9CIAL
�
W EIM0 (commencing wnhbcclan7(Nl))ofD :on3 Oh Business.s andl s
o 'I I: P.MI
Code) MTER OR PULE INST. -OMM�
Q.a e C Thar he is exempt Ihaefmm mrd the basis for IM1e a11egW exemption.Any violation of [I NEW BLDG/ADDITION ❑DEMOLITION
X-T Section 7031,5 by any applicant forapermit subjcasthe applicant oacivil pieskyof POWER DEVICES ❑TENAM ❑FOOD SERVICE
~} not more than five hundred dollars($500). IMPROVIiMENT
EEQ 0Lesownerafthe propeny,or myemployees with wagesm theirsnle compensation, SWIMMING POOL ELECTRIC
E- will do the work,and IM1e structure is not intended oroRered forwle(Sec.7D .Business []OTHERC
mnail Profeaxiens Cu 1,The Cn omenn'a License Law six,a not apply ,,not owner alOUTLETS-SWITCHES-FIXTURES
property who builds or iniprtaes thereon,and who does such work himself or through
his own employees.provided that such improvements are not intended or offered for NEW RISIDENTIAL ELECTR S
%meif,however,the building or improvement is sold within one year of completion,the SQ.FT.FLOOR AREA qsQ.IT.
own
er-builder will have the hu irn of proving that he did not build or improve for pur-
pose of salt.)_ TOTAL $�
I.as owner of the property,am exclusively contracting with licensed contractors err
mstmel the pmjecl(Sec.7044,Bavi m,,mal Prof cions Grde:)The Cmanmmrs Li-
use Law Jrcs not apply err an no,net of property who build or initiatives theaon and QTY, PLUM B LNG PERM IT
ho<o amsfor such pmjeos with a contractors)licensed pursuant o the Contractors
I'me Lu PHRMII'ISSUANCH
t tun r5cc. .13APCfor
vner Dale wrensnn
ALTER-DRAIN&VENT-WATER(PA) VALUATION
owner0
W KER'S CO HNSATION DECLARATION BACK II,UW PROI RCT.DEVICEe O
I hereby affirm under Penally til perjury one of the following decimations: G.J
I haveandwdl maintain aCenitieateof Conwntioself-insum for Worker's Compen- DRAINS-FLOOR.RODE AREA.COND, STORIES TYPECONSTRUCTION
.vmian,us provided for by Section 3700 of the Lobar Code,for the performance of the
work for which this per mit is issued. PEN
TUNES-PF,It'TRAP
1 have and wilt maintain Worker's Compensation Insurance,as required by Seetion
37M of the Labor Cotte,for the performance of IM1e work for which this permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLITS OCC.GROUP APN
My Worker's Co rinnoution Insurance carrier and Policy number are:
Cartier: Policy No.: GAS-EA.SYSTEM OVER 4(EA) U
CERTIFICATE OF E%GMPUON FROM WORKERS' /e r II s
COMPENSNIONINSURANCEGREASE/INDUSTRLWASTEIN -.RCr.nOR BUILDING DIVISION FHIS
(ThisxlinnneednolMcomploedifthepermiti.Jorone hundtWJullars Shop) GREASE'fRAP
or les+.l PLANCHECK FEE
Iccnifythant he llcr omaWcofthe work for which this permit is issued.[,hall SpWER-SANITARY-STORM EA.200 FT.
it.,mnploy any Person in any manner xn as at became subject to the Workers'Compo.. ENERGY PGB
Z wrier Lows of Ciih omia.Date WATER HEATsit WIVRJ TH EC R
z Q Applicant GRADING FF.E
NOTICE TO APPLICANT':It,after nmking this Cenificum of Idemplmn,you should WATfar SYSTEM/TREATING
becon¢.vubjem e,IM1e Worker's Cnmpemmloti provision of IM1e futon Cafe,you mum SOILS FEE
W forthwith comply with such pmokimis or this permit shall be doemed revoked. WATER SERVICE
g(y Q
=z CONSI'RUCI'ION LiiNDING AGENCY NEW It IiS1UF.M'IAI.PI-MB. SQ.NC PAID Date Receipt It
V O l hereby affirm that there is a comwmion lending agency for the performance of 41,
LL P IM1e work for which this pemdl is issued(Sec.3092 Civ.CJ
O TOTAL
U Lcno...Name 1'Ol'AL:
Lenders Addre.vs t ' s
r P. I cenify that 1 have mad this application and state that the above information is BUILDING Flip
t sect.I agree nunmply with all city and county ordituncex and.state laws Td.dngm QTY, MECHANICAL PERMIT FEF. SfiISMIC FEE
C„)Z building construction.and hereby awhnriee npm.enmtivcx of this city(center upon the
stere mentioned pe ximy for inspection puryous. PERMIT ISSUANCE ELECTRIC FEE
(We).gree a,move,indemnify and keep hornless the City of Cupertino against
liffiililins.juJgmm�u,cows and expanacc which inaY wary wuY a¢ruc against said Oly A1.T'IiRORADD'IOMECH. PLUM RING IfiE
in n,mquence of IM1e Panting tit this PenN1,
APP ANT NDER.TAND ABU WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM) MECHANICAL FEE
SOU O :RE+ )[AT] S.
l/I0 p AIR HANDLING UNIT IUVIiR 10.000 CFM) CONSTRUC'FIONTA.
Signatiof AP cmCConoactn Date EXHAUST HOOD(WMUCI) HOUSING MITIGAI'lO E
HAZAROO S MAI TRIALS DISCLOSURH
Will the applicant or future building occupant wore or handle latzarrious moment HEATING UNI'1'CTO 100,000 BTU)
a%defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Calc,Section 25532(a)7 HEATING UNIT(OVER 100,001 BTU)
C]Y4v VENTILATION FAN(SINGLE RP-SID) PAID Date Raripta
Will the applicant or fmme building acuponl use equipment or device,%which 0011.1?R-CAMP(3fiP OR 100,000BTU)
h...Nw.v air c ittionnams as defined by the tiny Arca Air Gamily Munugemntl TOTAL:
m^crt ������////// BOILER-COMP(OVER 100,000 BTU)
0Y. Nn
I have read the hmashor,materials requirements under Chapter 6,95 of the Cali- AIR CONDITIONER ISSUANCE DATF
(ami wIN A I'afny Cn e.$celi x 15505,25533 and 25534.1 ull&rsU d lhm if the NEW RF_SIOEMIIAL MECH. SQ.FT. �— m Q Q
build ig Jncs nu vrtcnfy :rvcnt Incl,lbar it is my respmvibility m notify ibmoecupanl ( f/
of the c�uirem IIwhicl the i-I 6oTloiv%uanecotvCenificateolk vpncy.
q1 V 1 T �ti'7Jn.C�GC��
Owner elobnir agent ale TOTAL: ISSUED BY' ��+�
OFFICE
CITY OF CUPERTINO
1 BUILDING PERMIT RECEIPT OPERATOR: christya
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:36211005.00
DATE ISSUED....... : 09/10/1999
RECEIPT #.........: 10049
REFERENCE ID # ...: 99080095
SITE ADDRESS . . . . . : 1181 YORKSHIRE CT
SUBDIVISION ...... .
CITY ............. : CUPERTINO
IMPACT AREA ...... .
OWNER ............:
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4967
RECEIVED FROM ....: TING
CONTRACTOR .......: LIC #
COMPANY ..... .. ... :
ADDRESS . . . . . . . . .. :
CITY/STATE/ZIP . ...
TELEPHONE ........ :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ _________ ____ _____ ----------
BMNEWSF&2F SQUARE FEET 2,713.00 189.91 0.00 189.91 0.00
BNUSFD SQUARE FEET 2,713.00 189.91 0.00 189.91 0.00
-'
BE GY PERMIT FEE BBB.00 266.40 266.40 0.00 0.00
EE VALUATION 125,000.00 888.00 0.00 888.00 0.00
B I' M SQUARE FEET 2,713.00 189.91 0.00 189.91 0.00
BPLANCHK PERMIT FEE 888.00 754.80 754.80 0.00 0.00
BSEISMICRE VALUATION 125,000.00 12.50 0.00 12.50 0.00
__________ __________ ______
.TOTAL PERMIT 2491.43 1021.20 1470.23 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 1470.23 111
va
TOTAL RECEIPT 1470.23
r