00010100 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 00 I V 0
CITY OF CUPERTINO &BUILD(NOR. CTRICAL M MIT NO.
BUILDING DIVISION APPLICATION/PERMIT HANICAI.IIENTIFICATION
SANITARY NO. APPLICATION SUBMITTAL DATE
B ILDINC ADUHE55yjOOWNERS NA PHO CONTRA R'SLIC NO:
NIC CONTROLM
bixHITF.C1'/ENGINEER: LIC O: ADDRESS: /' O ❑
/^
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUM MECH
El 1:1 21 ED
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby affirm that I um licensed under provisions or Chapter 9(commencing lOB DESCRIPTION
D a'Z with Section Divlslon 3 ofthe Business and Professions sale.and my license is
PERMIT ISSUANCE
I- in full force and e L WL ❑KITCHEN REMODEL
EU
Incense Class Lich gppl.lANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
F Z W Dam Conduc r
H7h CHITGLTS DE RATION _ PANELS ❑MULTI-UNIT ❑STRUCTURAL
Z O m Z I understand my plans.hull Ee used as public records MODIFICATION
OZN-,- UP TO 200 AMPS ❑INTERIOR L1 CHIMNEY REPAIR
I„ah; Licensed Professional 201-1000AMPS IMPROVEMENT L]SWIMMING POOLS
GNY ..I OWNER-BUILDER DECLARATION OVER I(XOAMPS ❑BATH REM 01�•UREPAIR ❑DF.MOI.ITION
C IY w 6 I hereby aRmn that 1 am exempt from the Conmtetor's license Law for the
�d O 09
U following reason,(Section]03 L5,Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER I a
41 W LL h- which minims a permit la consuceuc6 alter,improve,demolish,or repair any structurestructure06 prior In its issuan ,also requires pp
qs the alicant mi
lit such pert to file asigneJxtem
mcm SPECIA I.CIRCUIT/MISC.
that he is licensed puts uanuo the pro ki.m.fthe Commcmr's License Law(Chapter 9
m 00 (commencing with Section 7")of Division 3ofthe Business and Professions Code)or TEMP.METER OR POLE INST COMMERCIAL:
a p. IY that he is exempt thcrtftom and me basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
i� lL
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty or POWER DEVICES ❑TENANT ❑FOOD SERVICE
y of mom than five hundred dollars(55(0).
^ Q ❑1,as owner of the property.or my employee..wird wags.as dheirsole compensation. SWIMMING POOL ELECTRIC IMPROVEMENT
[I OTHERwill do the work,and the structure is not intended or offered for sale(Sec.7033,Business
3 and Professions Cade:The Contmemr's License Law Jaa oat apply to an owner of OUTLETS-SWITCHES-FTXT _
property who builds or improves Neuron,and who does such work himself or through ,
his own employees,provided that such improvenseux arc not intended or offered far NEW RESIDENTIAL ELECFR Q FT.
sale.If,however,the buildingimprovement is sold within one of completion,the SQ.`.FLOOR AREA SQ.FT.
ownar ed of leaving
yenta p
builder will have the burden of proving Ihat he did not Wild or improve for par-
' Iasecof anted.
1.as owner of the property,am exclusively contracting with licensed contractors to .T L: JAN 2 12000
construct the pmjecl(Sec.7113x.Business and Professions Cade:)The Conductor's Li-
cense Low does not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT 'FEE
whe contracts for such projects with a co nntctogs)licensed pursuant to the Cont actor's
License Law. PERMIT ISSUANCEI.
gy
1 am exempt under Sec. .B&P C for this mason ---.�_
ALTER-DRAIN&VENT-WATER(EA) "�Vg1aATAAA['�
Owner Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PRQI'ELT.DEVICE
1 hereby affirm under penalty of perjury one of the followingW Worker's
Croatian-
V
❑Ihave and will maintain Cernficiam of Consent to Code,fort for
erformace of the
DRAINS-FLOOR,ROOF,AREA,GOND. RIES TYPE CONSTRUCTION
whoa,as provided for mi Section J9fX)of the Labor Code,for the performance of the
work for which this Permit is issued. FIXTURES-PGR TRAP
I have and will mainfam Worker's Compen.wtion Insurance,as required Ey Section 300of the Labor Code.for psrfomerxvaf the work for whicht 'spermitisissucc. GAS-EA.SYSTEM-I INC.30UTLE1'S OCCGROUp APN
M W Com on Int -ca r$nd Polis nu r
Carr(¢/�' Lq� �Elicy Na. GAS-BA.SYSTHM-OVENJ(EA7 `9 r yoz
CERTIFICATE OF G M ION FROM WORKERS' GREASFANDUSTRL WASTE INTERCEPTOR ` [a r
COMPENSATI NINSURANCE BUILDING DIVISION FEES
('Kris section need not be completed ifihe permit is(or one hundred dollars($1 on GREAS17TRAP
or less.) PLANCHECK FEE
Ieenify Nm ilmhe performance nfNe weak fee which this pe man is issued.l shall SEWER-SANITARY-STORM EA.200 FT.
not employ any person in any manner so as to become subject to the Workers'Courtier- ENERGY FEE
Z cation Laws of California.Data WATER HEATER WNENT/FLECfft
Z O_ Applicant GRADING FEE
El
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should WATER SYSTEMaREATING SOILS FEE
E^ become eobject to the Worker's Compensation provisions of the Labor Calc,you moat
Uj ti forthwith comply with such provisions or Nis permit shall be deemed revoked. WATER SERVICE
Q
S CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.PC PAID Date ReceiplM
L) thereby affirm that them is acnnstmction larai..gagency for theperformanceof
the work far which this permit is issued(Sec.3097.Civ.C.)
OTOTAL:
V Lender's Name
W Lender's Address TOTAL:
y 1 certify that 1 have read Ibis application and aside that the.have inform.....is BUILDING FEE
[— h correct.l agree to comply with all city and county ordlnuncesa..d stem laws relating to QTY, MECHANICAL PERMIT FEE
(„J Z Euddingcmrswction.and herebyenuaimm,rawalativex ofthis city to enter upon the SEISMIC FEE
above-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)apace to save,indemnify and kap harmless the City of Cupertino against ELECTRIC FEE
liabilities,judgments.costs and expenses which may in any way acaveagainsl said City ALTER OR ADDTO MECH, PLUMBING FEE
In consequence of she griming of tho permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT IT010,(X10 CFM) MECHANICAL FEE
SOURCE REGULATIONS,
AIR HANDLING ON['1'(OVER 10.000 CFM) CONSTRUCTION TAX
Signature of ApplicanoCommmor Data EXHAUST HOOD(WMUCT) HOUSING MITIGATION ME
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO 100,1100 BTU)
as defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety
Cafe,Section 25532m)? HEATING UNIT(OVER 100,000 B'IT)
❑Yes 7N PAID
VENTILATION FAN(SINGLE RESIO) Date Recaps X
Will the applicant or
in nts a building occupant use co Air Qu m devices which BOILER-COMP UUP OR 100,0X0 BTU)
mit hazardous air contaminants as Jcfined by the Bay Area Air Quality Management TOTAL:
District? ❑Ne BOILER-COMP(OVER 100,0011 BTU)
I have maar
d the hitdamaterials aterials requirement mode,Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
Roma Health&Safety Cook.Sections 25505.25533 and 255M.I understand that if the NEW RESIDENTIAL MF,CH. SQ.Pf.
building rrently hmeamnntit,that it is my mspunsibilitym notify the occupant
xt Prier m iwuancc of a'k-a-1—
ervi I<.m mf occupancy.
u ave .gem Data TOTAL: ISSUED BY:
i OFFICE
BRENIACOVER QAC UNIT>1 CCGGCF,`.I 1bt CmANICALi
JBREMAIRHAN IA/C UNITS <e 10.000Crib1 IMECHANICAL
JBREMFURN IRELOCATION OF FURNACE (MECHANICAL
BREMFURNOV JP,ELO FURNACE > 10K BTU MECHANICAL
BREMINHOOD 1INSTALLATION OF HOOD IMECHANICAL
BRENIRELOCA IRELOCATION OF HOOD JIVIECHAKICAL
BREMREPALT REPAIR/ALTER HEATING MECHANICAL
BREMVENSYS IVENTILATION SYSTEMS IMECHANICAL
PPERMITFEE PLUMBNG PERMIT ISSUE PLUMBING
BNUMULTI NEW MULIFAMILY RES PLUMBING
BNUSFD NEW SINGLEFAMILY RES PLUMBING
BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING
BPCESSPOOL CESSPOOL PLUMBING
13PFIXTURE PBLG FIXTURE PLUMBING
BPGAS GAS PIPING SYSTEM FEE PLUMBING
BPINTERCEP IND WASTE INTERCEPTOR PLUMBING
SPREPIPE REPIPE OF FIXTURES PLUMBING
SPSEWAGE SEWAGE DISPOSAL PLUMBING
SPSEWER SEWERS PLUMBING
BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING
SPSTORM STORWRAIN WATER PLUMBING
BPTRAP i; TCMEN TRAP PLUMBING
BPVENT ALT OF DRAIN &VENT PLUMBING
BPWATER INSTALL/ALTER WATERPIP PLUMBING
BPWHEATER WATER HEATER/VENT PLUMBING
• BPWSVCS MAIN WATER SERVICE PLUMBING
ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING
ZDIRTM DIR TENT MAP PLANNING
ZFULLHR FULL APPL BASE+HR PLANNING
ZFULLTM FULLAPPLTENTMAP PLANNING
ZFULLUP FULL APPL USE PERMIT PLANNING
ZFULLZONE FULLAPPLZONING PLANNING
ZGPAMENO GENERAL PLAN AMEND PLANNING
ZLIMAMENO LIMITED AMEND PLANNING
ZLIMTM LIMITED TENT MAP PLANNING
ZLIMUP LIMIT D APPL USE PERMI PLANNING
ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING
ZMINHILLEX MINOR APPL HILL EXC PLANNING
ZMINSIGNEX MISC SIGN EXCEPTION PLANNING
ZMINTM MINOR APP TENT MAP PLANNING
ZMINUP MINOR APPL USE PERMIT PLANNING
ISCASA MISC ARCH SITE
PLANNING
ZMISCEXT MISC TM AND UP PLANNING
ISCFENCE MISC FENCE EXCEPTION PLANNING
ZMISCG N MISCELLAPPLGEN PLANNING
ZMISCPCINT MISC PC INTERPRETATION PLANNING
ZSIGN SIGN PERMI PLANNING
ZTSMPSIGN TEMPORARY SIGN PLANNING
• ZVARLANCE IDIRECTORVARIANCE PLANNING
2cf2
itM N10199
le, Moo
/ yob
Qty, if Applicable Fee 10 Fee Oescription Fee Group -
IBPERMFEE IBLOG PERMIT F=—=S IBUILOING
ISCONSTAX JCONSTRUCTION TAX 1BUILOING
IBENERGY JENERGY IBUILDING
BENERGYAOD JENERGY ADO MULTI IBUILOING
ISOVERTIME INSPECTION OVERTIME ISUILOING
STEMPPERM TEMPORARY SLOG PERMIT IBUILOING
BMITIGAT IHOUSING MITIGATION FEE ISUILDING
SPLANCHK PLAN CHECK FEE BUILDING
BPLANCKADD PLAN CHECK ADD MULTI BUILDING
BPLANCKREP PLAN CHECK REPEAT FEE BUILDING
BREINSPECT REINSPECTION FEE BUILDING
BSCBLVD TCB SPECIFIC PLAN BUILDING
BSEISMICOM SEISMIC COMMERCIAL BUILDING
BSEISMICRE SEISMIC FEE RES BUILDING
BSPECIAL SPECIAL INSPECTION BUILDING
BSWIM SWIMMING POOL BUILDING
ZADOCHG ADDRESS CHANGE BUILDING
EPERMITFEE ELEC PERMIT ISSUANCE ELECTRICAL
BELEC1000 ELEC 600V �1000A ELECTRICAL
B LEC1001 ELEC 600V>1000A ELECTRICAL
BELEC200 ELECT SVCS 600V c=200A ELECTRICAL
BNEWMULTI MULTIFAMILY RES ELECTRICAL
BREMBUSWAY REMODELBUSWAYS ELECTRICAL
BRENIFIXT LIGHTING FIXTURES ELECTRICAL
BREMMISC MISC APPARATUS ELECTRICAL
BREMNRAPP REM NON-RES APPLIANCE ELECTRICAL
BREMPOL POLE/PLATFORM FIXTURE ELECTRICAL
BREMPOWER POWER DEVICE/APPARATUS ELECTRICAL
BREMRECEPT RCPTL, SWITCH &OUTLETS ELECTRICAL
BREMRESAPP REMODEL RES APPLIANCE ELECTRICAL
BREMSIGNAD RMOL SIGNS ADD BRANCH ELECTRICAL
BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL
BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL
SSF&2FAM SINGLE&2 FAMILY ELECTRICAL
STEMP TEMPORARY POWER ELECTRICAL
BTEMPSVCS TEMP DIST SVCS ELECTRICAL
MPERMITFEE MECH PERMIT ISSUANCE MECHANICAL
SAPPLOTHER OTHER APPLIANCES IMECHANICALl
SBOILERI BOILER<= 100,000 BTU MECHANICAL
BBOILER2 BOILER>100KT0500KBTU MECHANICAL
BBOILER3 BOILER>500K TO 1M BTU MECHANICAL
BBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL
BBOILIERS BOILER> 1.75M BTU MECHANICAL
BREMAPPLI APPLIANCE INSTALL MECHANICAL
BREMH HEATER INSTALLATION M CHANICAL
BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL
BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL
BMNEWSF&2F NEW SF&2F RES SLOGS MECHANICAL
loft
It .wa MOM
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: karenb
Ser. Twp: ROB: Sub: Blk: LOL:36918024.00
INVOICE DATE......: 01/21/2000
REFERENCE ID # ...: 00010100
SITE ADDRESS .....: 831 CANDLEWOOD DR
SUBDIVISION ... ....
CITY ..... .... .. ..: CUPERTINO
IMPACT AREA . . .. .. .
OWNER ............ :
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4651
CONTRACTOR ....... : GARZA, KEVIN N LIC # 14200
COMPANY ..........: SAN JOSE PLUMBING
ADDRESS . . ........: 2667 ALDERWOOD DR
CITY/STATE/ZIP .. .: SAN JOSE, CA 95132
TELEPHONE . . . . . . . . : (408)296-1820
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
---------------- --_ --------- ------------ -----------
BUSLIC P 90.00 0.00 90.00 r�
PPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
125.52 0.00 125.52 ^
E ID DESCRIPTION VOICE ID ... .. DESCRIPT IONv- .
O63C6 SEWER I WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB 6 OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•