99090072 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY !1" 00-72-
CITY
O Z
CI*NAME
TINO BUILDING-ELECTRICAL PHRM19 O.
BSION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENFIFICATIDN Now
BUISANITARY NO. APPLICATION SUBMITTAL DATE
r -ia �'WPtlE: — CO471 NI' ACfO 'S NAM t� LIC NO8 !7 N/C CONROLis
dl RER: LIC NO: qDD� y ❑
COWACF. PHONE: I 5 BUILDING PERMIT INFO
it�p� �1^M �r7/�y ❑ Consultant Fag Paid by Applicant(Initial) BLDG E P MECH
j�V / / _(JW1// El
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby affirm that 1 am licensed under previsions of Chapter 9(commencing JOB DESCRI ON
D00 with Sectice'100n)of Divisiun7uf the Business and Rofcssions Code.and my license is RESIDENTIAL:
�� in full force and effect PERMIT ISSUANCE
W� OSFDWL [I KITCHEN REMODEL
QUV I'm Ess Li,.X
nFiszM Date Contmctor APPLIANCES-RESIDENTIAL []ADDITION [I PLUMBING RE-PIPE
ARCHITECTS DECLARA ON PANELS ❑MULTIUNIT OSTRUCTURAL
Z Sy Z 1 understand my plans shall he used uv public mosi ds MODIFICATION
OZ_Q UP 902110 AMPS El INTERIOR GCHIMNEYREPAIR
�^ L hlct,mcd Prour,monul 201-IfN10AMPS FIMPROVEMENT E]SWIMMING POOLS
CY4 OWNHILBUILDHR DECLARATION
R I hereby anion that I um exempt from the Contractor's License Law for the OVER 100DAMPS ❑BATH REMODEL/REPAIR (]DEMOLITIONyy
p( phi FU, fallowing reason,(Semon 9031.5,Busincss and Professions Cade:Any city or county SIGNS ELECTRICAL OOTHER
LLWJ 0y which reyuio x a permit to cumunct,altam
r,improve,demolish,or repair any wucoom
Q� prior la ilv iexuance,also requiresthoupplieant fnrsuehpemnto ftleasigned,umannem SPECIAL CIRCUIT/MISC.
,f License he is licensed pursuant to the provisions of the Contractors LicenLaw(Chapter 9
tv o0 (commencing with Section 7IXXp of Division 3 of the Business and Professions Code)or TEM E m Emu OR POLE INS'P.
a e e[ that he is cacntpt thcrefmm and the basis Lor the alleged exemption.Any violation of 0 N W BLDG/ADDITION 0 DEMOLITION
at Section 7031.5 by any applicant for a permit subjects the applicant a civil penalty of POWER DEVICES
�m []TENANT ❑FOOD SERVICE
not mare owner
five hundred dollars($SW).
=0 0 Lasownerofthe propeny,mmyo,employees wiNwagesar alc(Sale compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
dF- will Pathe work,ands: structure is sotLicense ma dos sal ap(Saoply o an Business ❑OTHER
3 and Professions Cale:The Contractor'stheretoLicense Inco Pres not apply tom owner of OVD.CI'S-SWITCtIFS-FI%TURKS
progeny who builds or improves thereon,and who does such work deed or or though
his own employees,provided that Such improvements ure not intended or plleerc4 for NEW RESIDF.NTIAI.I3LECTR SQ FT.
sale If.however.the building orimprovammis sold within one year of completion,the SQ.FT.FLOOR AREA 3/SQ.FT,
owner-builder will have the burden of proving that he did not Wild or improve for put.
you of talc.).
0 I,as owner of the prapeny,am isc mively contracting with licensed contractors to TOTAL:
construct the project(Sec,NW,Business and Professions CtNe:)The Contractor's ciarew QTY, PLUMBING PLRM`r ' FEE
who contracts for such pmjects with a cornmcor(s)Iicerawal Formation the Contractor's
License Law, PERMIT ISSUANCE 1-9
0 limesturaunder Sec. ,B&PCforthisromma
r Date ALTER-GRAIN&VENT-WATER(EA) VALUATION
WORK17R'S COM PCNSA['[ON DECLARATION
BACK PLOW PROTECT.DEVICE
1hereby
andwuflinntain apenaltyof perjuryone ofthe fol lowing artier Co � a
Olhave an,idell muinV Soclenifrucofffic Lan to Code,for
for Worker's Compen- DRAINS-EtL(yOR,kOOP,AR A,GOND. STORIES 'TYPE CONSTRUCTION
sninn,un pmviJul far by Suninn 37110 of the Labor Code,for the performance of the
work for audl this permit is IoUnid. FIXTURES-PER TRAP
have and will nmintoin Worker's Compensation Insurance,as required by Section
3900ot the Labor Cn to,for llia.,lismance of the work for which this permit is issued. GAS-HA.SYSTEM-I INC.4 OU'TLE'TS
OCC GROUT' APN
a.
t I it Policy
Can[ermy srkc �l�I IrIE�Ii o. 2 IAtI'I'IONyI XOM WOR(KE�� GAS-G.SYS'1'IiM-OVEk4(EA) n�r/I UL;p
COMPENSATION INSURANCE GRIEASDINDUSTRL WASTE INTERCEPTOR �S V
BUILDING DIVISION R?PS
f9'hisstttinn nmAnot hecompined if the pcmtit is torous hundred dollars Slight GREASETRAP arlesSJ PLANCHECK FEE
Loy my that inthe Performance work for which this thepairmWisiss'C,lehall SEWER-SANITARY-STORM F.A.200 FT.
not employ any Person in any mm�ner w as m become subject to the Workers'Compen- ENERGY FEE
Z cation laws of California.Date WATER HEATER WNENT/ELECTR
0 DE .E
Z(j) NOTICE 9'0 APPLICANT:IL after making this Cenificam of Exemption,you should WATER SYSTIEM)TREATING
> become Subject to the Workers Compensation Provisions of the Labor Code,you must SOI
61 forthwith comply with such provistawor this permit Shall W deemed revoked. WATER SERVICE. Ll Ly
as
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. JTMAI
SQ
PA a Receipt X
C-2 l hereby affirm that them is a concoction[ending agency forthe performance of '
{t. F the work for which this permit is issued(Sec.3197,Civ.C.)
Q U Lender's Name L:
} tLl Lender's Address
I verify that 1 have read this application and state that the above information is WING FEE
F4 correct.l agree to comply with all city and county ordinances and state laws relmingto QTY, MECHANICAL PER
U Wilding construction,and hereby authorim representatives of this city to enter upon the SEISM
above.mentioned property,for inspection purposes.(We)agree o save,indemnily and keep harmlessthe City of Cupcnine,against PERMIT ISSUANCEELECTRIC FIEk,
elialities,judgmentx,costs and exposes which may in any way accrue against said City ALTER OR ADD TO MECH. PLUMBINGF r
in nneyuence of the granting of this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT CTO 111,000 CFM)
50)U .@E�I ATR Nr //D/� MECHANICAL :H
(/' AIR HANDLING UNIT(OVER 10,000CFM) CONSTMECHANICAL
N X
Si omre of ApplicanJCnmfuetor Due CXItAU31'turro(WmuCT) HOUSING MITI ATION THEHAZARDOUS MATERIALS DISCLOSURE
Will the upplicnm or future building occupant sore or handle hazardous material HEATING UNIT(TO IW,=)BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cade,Section 25532(0)7 HP.AI'ING UNIT(OVER 100,010 RTU)
O Ye, I$No VENILA'1'[ON PAN(SINGLE RPSID) PAID � S3�
Data Receild# ta-
Wrdousll the air cicatn m fuore Wadingsycby ilpthe Bay Area
Air Quality
of dMana whiihen r BOILER-COMP OHP OR 100,000 BTU)
emit hnorJuus air contaminants as defined by the Ray Ame Air Quality Menegemem T
Dindct? BOILER_COMP(OVER 100.00)BTU)
D Yes )11�11
I have read the havudons materials tequimmenu under Chapter 6.95 of the Cali. AIR CONDITIONER ISSUANCE DATE
fomia Health&Safety Gale-Sections 23505,25533 and 25534.1 understand that if the NEW kFS1UENT1Al.MECtI. SQ.
build nm corona havcutrnw1,that it is my respomibiliymmdfy the occupant
of the be 0(et pnimm issuance �pT 0/(e/�/f/p��upancy.
Own amhnrimai.gran s /"� Da� TOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: chrietya
Sec: Twp: Rng: Sub: Elk: Lot:31630031.00
INVOICE DATE......: 09/10/1999
REFERENCE ID k ...: 99090072
SITE ADDRESS ..... : 10435 N PORTAL AV
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ... ....
OWNER ............ : FRASER EDWARD C TRUSTEE & ET A
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO CA, 95014-2304
CONTRACTOR . . .....: TRILLO, KELLY LIC # 4269
COMPANY ..........: ATLAS HEATING
ADDRESS ....... ... : 155 SAN LAZARD AVE
CITY/STATE/ZIP ... : SUNNYVALE, CA 94086
TELEPHONE ........ : (408)739-0516
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ --- --------- ------------ ____-------
BPVENT P 8.33 0.00 8.33
BREMACOVER P 14.43 0.00 14.43
EPERMITFEE P 35.52 0.00 35.52
MPERMITFEE P 35.52 0.00 35.52
PITFEE P 35.52 0.00 35.52
129 32 0.00 129.32
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR -
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
1309 EXTERIOR LATH 310 INTERIOR LATH
311 SCRATCH COAT 313 ROOF NAIL
501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY
,503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
509 FINAL GRADE 510 FINAL PLANNING
514 FINAL PUBLIC WORKS
•