99110096 (2) `I.1 ?ULC ANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY — — / 9_ Z
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT N
BUILDINGDrvISIDN APPLICATION/1"FPLUMBING-MIICHANICAL
'BUILDINGPROJECT IDENTIFICATION
BUILDINGADDRISS: SANITARY NO. APPLICATION SUBMITTAL DATE
8.2 d lG.;ti.
ONA
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AOL /21"I
NIC CONTROL M
iCHITEC(ENGINEER: ff LIC NO: A DRC ' ❑
CON'I'AC'P PHONE: BUILDING PERMIT INFO,
❑ Consultant Fees Paid by Applicant(initial) BLDG ELECT PLUMB MIEECCIHH
❑ ❑ ❑ G
LICENSED CON I censed under p DECLARATION
of CON ELECTRIC PERMIT ' FEE.
1 hereby antrm mm I am hpenxm under provisions of Chapter 9(commencing Q 1 JOB DESCRIPTION
W0Z with Section7")of Division 3 of the Business and Professions Code,and my license is RESIDENTIAL
O in PVT ISSUANCE
N ty full force and ellcaff .jam i 1 1 le
�uU hicenxc I {••� Cm,' 'i L ❑ADITIWI, ❑PLUMBIKITCHENREMODEL
hzw Dam�� � sw Com oral APPI.In ES-RIiS1UENTIAI. []ADDITION [I PLUMBING RE-PIPE
ARCHI I EC'I'S DECLARA'f10N ❑MULTI-UNIT ❑STRUCTURAL
a N
PANHIS
ZO—Z IundemanJ my plans shall he axedazpublic records MODIFICATION
oz-- UP'f0 2fp AMP.
W Licensed Professional [I INTERIOR El CHIMNEY REPAIR
201-H)GOAMPS IMPROVEMENT (]SWIMMING POOLS
O C Oat I not exempt
front
The ContractRATIONor's
OVER l"AMPS ❑BATH REMODELREPAIR (]DEMOLITION
O I hereby uflim,that 1 em exempt from the Comrumor's License hew for the
paj 3 LL F following reason.(Section 7011.5,Business and Pmfessions Code:Any city or county SIGNS ELECTRICAL. ❑OTHER
W+ O y which requires a permit to construct•alter,improve,demolish,or repair any arocture
qq prirnnirs issuance,also requires the applicant fncmch permitm Ele asigneJ smremem SPECIAL. C C
Yt„r1y that he is liansal pursuant to provisions nl'the Contractors W�ha 9
0. W dedhe is exemitn Seneica.modJnf Division?neallegdheBmlicee t C i E COMMERCIAL,
tl d G C Nm he is exempt themfmm and the basis for the alleged euro t Iasi f [I NEW BLDG/ADDITION ❑DEMOLITION
X.n u• Section 9(I3L5 by any applicant for a permit suhj«ts the septic p
W y ° ❑TENANT ❑FOOD SERVICE
F m more than Eve hundred y,or on,om)' IMPROVEMENT
aQ ❑ Lothe work,and
the structure is
m offerse'sxlhulreo ape P . .
will Jn the work,and thexwcturc is nm intended ornlfercdfor sale(S NJ,B ❑OTHER
3 m and I'rofexsions Cwk:The Cnmmctor's License law does not apply r ..T -
propcny who builds m improves thereon,and who does'ach work It tt g RIF
his own employees,provided that such improvements ate nor intende e d for NEW RESIDENTIAL ELECTS FT.
sale.IL hnwe'en the huildins nrimpmvcmem i'xnld wiNin one he Q.Ff.FLOOa AREA (1 $I .Fr..
ownersolder will have the burden of proving that he did not h uITT ILII
posese of of ole.). D
❑ 1, owner of the property,am exclusively professions with .t r to NOWAL:
constructmtheesnot (file.oan wnerof and
rtywhobuidsori he sntmeturxId - r NOV 1 7 1999
Cot—
come Law dtsforsch apply teas with
ofpropertywhubuildeorimpro the Contractor's 'rY. PLUMBING PERMIT FEE
who umrrecrs for such projects with a ronvamor(s)licensed pursuant the Contractor's
License law' PERMIT ISSUANCE
❑I am exempt under Sec. ,B&P C for this reason
LR-DRAIN&V HIST-WATER(EA)
Owner Du e TION--
WORKER'S COMPENSATION DECLARATION PACK ' OW PROTECT.DEVICE
1 hereby affirm under penalty of perjury one of the following declamtionic J(O
I have and will maintain a CeniticmcofGm'cnfmscl-insure for Worker's Compen- DRAINS OR,ROOF,AREA.GOND. STORIES IF,CONSTRUCTION
sada,m provided for by Section 3900 of the labor Code,for the performance of the
Crk for which this permit is issued. FIXTURES-PER AP
1 have and will maintain Workers Compensation Insurance,as required by Section
"10 of the labor Code.for the rermnnance of the work
for
pwhich
ibis permit is issued. GAS-F.A.SYSTEM-1 C.40U1LEfS OCC.GROUP
My Work 'eC pen.' n/ rtran a Pol it Palle NOBS oycy4we07 GAS-hA.SYST[ OVER '.A) /y
Canicr y
CERTI CATS OF EXEMPTION FROM WORKERS' `
COMPENSATION INSURANCE GRF:ASMNDUS'I'RLWASTEI CEPTOR
(This xaion need nor In completed if the permit is for nuc hundred dollars($100) BUILDING DIVISION PEES
or
ex") GREASE TRAP PhANCHECK PEE
I cenRy that In the perfoummaceof the work forwhich this Permit is issued,l shall SF.WEN-SANITASY-STORM EA.200 FT.
not employ any person in any manner so as m neci me subn
jeco the Workers'Compen- ENERGY FEE
O Z scion laws of California.Data WATER HEATER WNF.NT/LLF:CTR
0 Applicant GRADING PEE
. NOTICE TO APPLICANT:If,alter among this Certificate of E.c.,ption,you Amold WATER SYSTF,MR READING
becrnne xubjecr to the Worker's Compensation provisions of the Labor Core,you must SOILS FEE
UJ forthwith comply with such prowWom.,this permit sha116e mrevoked.ked. WATER SERVICE
0.
Q
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.PT PAID
U 0 Ihcrenyallirnt thattnere is a cousoumtion tenting aguncy far theperfunnonceof Date Receipt
1L the work for which this permit is issued(See 309],Civ.C.)
F0 Lender's Name TOTAL:
WLender's Address TOTAL:
1 certify shut I have real this upplmmion and stare that the above information is ., BUILDING FG:E
Val corect.I scree m comply wlthall plied countyordinanees and slate laws relntingm ,QTY 1 MECHANICALPERMIT FEE
U Z buildho,msmactiot,and otho
hefehyarire reprcsenmtives of this city to enter upon the SEISMIC FEE
aMve-mentioned pmpeny for impartian putpo'cs.
(We)ag.emsave,indemnify and keep harmless We City of cugainnagains PERMIT ISSUANCE ELECTRIC FEE
babithno,pidgmenrs,possend expensed which may in any way acnriontinst'oid City AL'I'Fit OR ADD'I 0 MECH.
consequencein of the gmmin,.1 di is permh, PLUMBING FEI3
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,(00CFM)
SOUR. '..TIOF,GitA•y NS. A IV/ 1'`� CONSTRUCTION
FEE
(�j(�/-�NSA. � �� L AIR HANDLING UNIT(OVER 10,000 CPM) CONSTRUCf10N TAX
Signamre of plicuntlGmuamor Date EXHAUST HOOD IW/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE.
Will the applicant or future building nonfarm store or handle hazardous material / HEAPING UNIT(TO I W."BTU)
as defined the Cupertino Municipal Cnee,Chapter 9.12,and the Health and Safety
Crclq Section 255321x)? HEATING UNIT(OVER 100,000 BTU)
❑Yes F-1 No VENTILATION FAN(SINGLE RCSID) PAID --
Date Receipt at
Will ms applicant in fnmm building occupant use equipment or devices which
:ir buzurJou'air nmmminam'as refined by the Nay Arca Air Quality Mansgement BOILER-COMP(711P OR 100.000BTU)
rsvicFl TOTAL:
❑Yes ❑No BOILER-COMP(OVER 100,000 BTU)
I:have it the haisakas mareria6 requiremun
ent' der Chapter 6.95of rhe Cali- AIRCONDHIONER l/l ISSUANCE DATE
forma Hcuhh&Subtly Code,Secti°m 25505,25533 unit understand that if the NEW RESIDENTIAL MECH. SQ.IT.
building docs not currently have it cram,that it is myresponxlhifity to notify the occupant If/ •' .�T
rf Qytprluiy�effi ti which be ten prionoiamnce ofa Cenificam of y. tI
1 f
Owner ar rhunmd agent D,ff TOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: chrlstya
Sec: Twp: Rng: Sub: Elk: Lot:35919042.00
INVOICE DATE. .. ...: 11/17/1999
REFERENCE ID # ...: 99110096
SITE ADDRESS .....: 820 KIM ST
SUBDIVISION .... ...
CITY ............. : CUPERTINO
IMPACT AREA ...... .
OWNER ............ : BELLEFEUILLE ROLAND E AND JEAN
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4323
CONTRACTOR ....... : LIC N
COMPANY ....... . ..:
ADDRESS .......... :
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ ----------_
BREMHEAT P 6.11 0.00 6.11
MPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
41.63 0.00 41.63
VOI .E ID ...®----DESCRIPT10---------. VOICE ID DESCRIPTION
.. ........ ............................
UNDERFLOOR HAMS 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS
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