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99090132 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO - BUILDING-ELECTRICAL. PERMIT NO, PI BUILDI77G DIVISION APPLICATION/PERMIT BUILDINNGG -MECHANICAL PPRODROJECT IDENTIFICATION SANITARY NO. APPLICATION SUBMITTAL DATE BUILDING ADDRESS: O E 'SNAM,: Y ONE: CONTRACTOR'S NAME: LIC NO'. (�— � N/C CONTROL# CHITECT/ENGINEER: LIC NO• ADIIRESS: ,i gO E ❑ F7�) PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH ❑ ❑ A ❑ tLICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE JOB DESCRIPTION by affirm that 1 am Emoted under provisions of Chapter 9(commencing O L' with79 ))of0ivision 3 ofthe Business and Professions Code.and my license is RESIDENTIAL: 610PERMIT ISSUANCEEF- nte tJ ❑SFDWL ❑KITCHEN REMODEL aV Lic'N PPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE QCononc ❑MULTI-UNIT ❑STRUCTURAL ARCHITECTS DECLARATION PANELS MODIFICATION Z p OvJ Z 1 understand my plain shall he used ses public reor cds OZ;4, UP TO 200 AMPS ❑INTERIOR ❑CHIMNEYREPAIR Licensed Professional 201-1000AMPS IMPROVEMENT ❑SWIMMING POOLS 4y ; OWNER-BUILDER DECLARATIONOVER Iq)DAMPS ❑BATH REMODEUREPAIR ❑DEMOLITION �a C 6 1 hereby affirm Lha I am exempt from the Contract.",License Law for the ❑ HER 5xQ�O S V following reason.(Section 7031.5.Business and Professions Cee:Any cityor county SIGNS ELECTRICAL W LL WO y which requires a permit to construct.alte,improve,demolish,or repair any immure prior to its issuance,also requires the applicant far such Permit o file a signed statement SPECIAL CIRCUIT/MISC. that he is licensed pursuant to the provisions of the Contractors license Law(Chapter 9 OMMFR TAU HOC (commencing with Section 7")of Division 3 of the Business and Professions Code)of TEMP.METER OR POLE I NST. Lame' that he is exempt Therefrom and fbe basis far the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION -,oe Section]031.5 by any applicant on.permit subjects the applicant m a civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE not mme than five hundred dollars($500). IMPROVEMENT O ❑ I,as owner of The property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC C ❑OTHER will do the work,and thesmmum,is nut intended mothered for sale(Sm.7D44,Business L and prafesions Code:The Contractors License Low does not apply to an owner of OUTLETS-SWITCHES-FIXTURES property who builds or improves thereon,and who does such work himself or thmugh his awn employees,provided thin such impmvemenu are not intended m offered for NEW RESIDENTIAL ELECT SQ FT. SQ.FT.FLOOR AREA LSQ.FT. sale.If,however,the building or improvement issold within one year ofcompletlon,Ne owner-builder will have the burden of proving that he did not build m improve for par pose ofmla.) JVL; ❑ 1,asr of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)'Ihe Comracmr's Li. cense Low does not apply to an owner of property who builds ar improves m,fean,and QTY, PLUMBING PERMIT, FEE who cofnmets for such projress with a contmdor(s)licensed Pursuant m the Contracmm's License Law. PERMIT ISSUANCE ❑ 1 am exempt under Sec. ,B&P C for this reason ALDER-DRAIN&VENT-WATER CA) VALUATION weer Dale WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE. 1 hereby affirm under penally of perjury one of the following declarations: I have and will maintain a Certificate ofComentto self-insure for Wedones Comport- DRAINS-FLOOR.ROOF AREA,COND. STORIES TYPECONSTRUCTIOI salion,as provided for by Section 3700 of foe Labor Code,for the a fornmore of The work for which this permit is issue. FIXTURES-PER TRAP ;1 base and will maintain Worker's Compensation Insurance,as required by Section 37100 of no Labor Code,for be permrmunceaf the work for ebiithh driis parmil is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC—GROUP — APbL �. My Work y'�yfpgp aypj�fyyanc cYme and lel,NofiJaT aaaa.a+�dIB18 GAS-EA.SYSTEM OVER 4(EA) S LC.1 Cartier:(( f+ gJg1 1 CERTIFICATEOOF EXEMPTION FROM WORKERS' GREASE/INDUSTRL WASTE INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION FEES (This seaionneed not be compered iflhupemtit is(mane hundred dollars(5100) GREASETRAP Or less.7 PLANCHF:CK FEE I certify that in the ped'amtaareo1 the work for which this permit is mord,I shall SEWER-SANITARY-STORM EA.3110 FT, nut employ any person in any manner so com bm,ernobject to the Workers Compen- ENERGY FEE zZ Applicn I e.'Dore t�' � WATER HEATER W/VENT/ELECTR GRADING FEE O vation Lo Wry-1�..1� / 6- NOTICE TO APPLICANT:If,after making dos Cendicam of i:xe tpbon,you should WATER SYSTUNIGREA'1'ING SOILS FEE become subject to the Worker's Cmnpcnsalian provisions of the Labor Code,yen must 6xi ti forthwith comply with such provisions or this Permit shall be deemed revoked. WATER SERVICE i7 Q CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PCMB. SQ.PT. PAID I hereby affirm that them is o construction lendingagency for the setiormance of Date Receipt# the work for which this Permit is iz..ad(See.3197,Co.C.) T L. Lender's Name TOTAL: WLeaders Addrtss BUILDING FEE y I certify Na I have read this application and state that the aNice information is y cmmct.l agree mcomply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE SEISMIC MIT V Z building construction,and hereby aatonrixe mpmonatives ofthis city to enter upon the above-mentioned property for inspection purposes. PERMIT ISSUANCE ELECTRIC PEE (We)agree to xjy0i,.indemnify and keep humiless The City of Cupmam against liabilities.judgment, nets anoes re" ankh may in any way seemed againsT said City pLTF.R OR ADDTO MECH. PLUMBING FEE inconsequence of e g is pc APPLICANT DF AND AND" .am PL WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.80,0 CFM) MECHANICAL FEE SOU UL NS. _ AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX metre of Applica m Dae EXHAUST HOOD(WMUC) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant or from,building Occupant stem or bundle haaardoaa normal HEATING UNIT 1T0100,MX1 BTU) as defined by The Cuperano Municipal Code.Chapter 9.12,and the Health and Safely HEATING UNIT(OVER 100.010 BTO) Calc,Sedation 25532(a)'I AAA... ❑Yes *No VENTILATION FAN(SINGLE RESID) PAID Dam RmeiP1# Will the applicant or future Wilding occupant use equipment or devices which BOILER-COME DOE OR HE.X10 BTU) it by rdous air contaminants as defined by the Bay Area Air Quality Management TOTAL: J,Izz) 1 OLsais) BOILER-COMP(OVER 100,000 BTU) ❑Ye, 06. those read eh materiaB remenisu r Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE fnmia Health& feT e.S 'tions 2 R 5 .553) 534.1 mndersmnd that it the NF:W RCSIDP.NTIAL MECII. SQ.ET. / / C J Q huilAing yhav etenan4 fib tis. sibilitymnmify Nc a<upant 7/ mf the fh to t el to a Caf ate 04 VyWale TOTAL : ISSUED BY: , ^� O ar rhodaed agent OFFICE CITY OF CUPERTINO . 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: yvonnek COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot:35620010.00 DATE ISSUED....... : 09/21/1999 RECEIPT #.........: 10121 REFERENCE ID # .. . : 99090132 SITE ADDRESS ..... : 11171 BUBB RD SUBDIVISION . . . ... . CITY CUPERTINO IMPACT AREA ...... . OWNER . . . . . . . . . . . . : KING HARRISS T AND ILONA J ADDRESS . .. . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4956 RECEIVED FROM .. . . : TIM CONTRACTOR ...... . : GILROY, JOHN LIC # 15128 COMPANY .......... : JUST WATER HEATERS INC ADDRESS .......... : 1764 NATIONAL AVE CITY/STATE/ZIP ... : HAYWARD, CA 94545 TELEPHONE ........ : (510)293-9901 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL _________ ---------- ___ BPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00 PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 PERMIT 45.51 0.00 45.51 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ __________________ CHECK 45.51 2996 TOTAL RECEIPT ... . 45.51 VOICE IO DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ............................ 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO . BUILDING PERMIT INVOICE OPERATOR: chrietya Sec: Twp: Rng: Sub: Elk: Lot:35620010.00 INVOICE DATE......: 09/21/1999 REFERENCE ID # ...: 99090132 SITE ADDRESS .....: 11171 BUBB RD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA .... .. . OWNER ............: KING HARRIES T AND ILONA S ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4956 CONTRACTOR .......: GILROY, JOHN LIC # 15128 COMPANY ..........: MST WATER HEATERS INC ADDRESS ... .......: 1764 NATIONAL AVE CITY/STATE/ZIP ...: HAYWARD, CA 94545 TELEPHONE ........ (510)293-9901 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 ID .. .f DESCRIPTION VOICE ID ..----. DESCRIPTION ... .............. ........ ............ 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING •