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00010176 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY CITY OF CUPERTINtO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATIONFPERMIT PLUMBING-MECHANICAL BUILDING PROJECT IDKNTIt'ICATION � V BUIL131pNG ADURPSS: \ /n /7 SANITARY NO. APPLICATION SUBMITTAL DATE 4 M. 'f1,15,T ftiI Ql- GtJ P�i�7 i rl/a 0 q J1 OWNER'S NAMEE; /) PHONE: CONTRALTO/R/}/ryA�E: NO / .0 G7�5�� JV �S r K/�" E� /y-)�Trl NIC CON'fROLp \RCHITECT/ENGINEER: LIC NO ADDRESS.. _ / �� ❑ CON'I'AC'E PHONE: `-•\I��/•^/ BUILDING PERMIT INFO ❑ Consullanl Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MITCH ❑ ❑ C� ❑ LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMiP FEE I hereby affirm that l am licensed under provisions of Chapter 9(commencing ]OB DESCRIPTION QMZ with Section]OM)of Division 7ofthe Balinese and PoA sou,Code.and my license is RESIDENTIAL: W O n PERMIT ISSUANCE CWF- in full force and effect. [ISPDWL O KITCHEN REMODEL QUI- Limma,Class Lic.M APPLIANCES-RESIDENTIAL. ❑AUDI]ION [I PLUMBING RIi-1 IPE Nzu 41 Dor Comhelor 7Ia. ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRI)CTURAL IT-Z OO rat Z 1 understand my Plans shall he used as public rcmms' MODIFICATION OZ4o UPTO 20p AMPS ❑INTERIOR [I CHIMNEY REPAIR 0'41 Licensed l4ofesrional 201-1000AMPS IMPROVEMENT CSWIMMING POOLS OWNER-BIJLLDER DECLARATION OVER 1000AMPS O BATH REMODE1112EPAIR 0DEMOLITION Q I hereby anion that I am exempt from the Conlracmr s License Law for the k 3 a.U following reason beat an 7I31.5.Business and Pec,simrs Code:Any city,,,county SIGNS ELECTRICAL OTHER 41 LL N which requires a permit In construct,alter,improve,demolish,or repair any slmcturc prior to its issuance,also requires the applicant for such permit in Ile a signed statement SPECIAL CIRCUIT/MISC, n thutheislicensed pnuaanttobeIII It the Contractor's LicenseLaw(Chapter 9 W IY�O (rommcnci,svith Section IIOtDof Division Bofthe Busincsand Professions Cade)or TEMP.MIT ER OR POLE INST. COMMERCIAL: A.L c that he is exempt therefrom and the basis for the ALI exemption.Any violation of 0 NEW BLDG/AUDITION 0 DEMOLITION �m Section 00315 by any applicant for a permit subjects the applicant nt a civil penalty of POWER DEVICES CTIiNANT [I FOOD SERVICE SQnot more than live hundred dollurs 015001 (]I,nsownaoftheproPny,or Tyentployecswithwagcsusthcirs,,leaotnpunsatloa. SWIMMING POOL ELECT RIC % PROVEMEN'T Fq will do the work.and the structure is not intended or offeed forsale(Sm.]UL1,Business OTHER 16m and Promssinns Calc:The Contractor's License Law deux not apply of an owner of OUTLETS-SWI'ICHFS-FIXTURIS progeny who builds or improves themon,and who does such work himself or through his own madames.provided that such improvements'etc not intended or offered for NEW RMID12NTIAL ELECIB SQ FT •-�- -- cdc,IL however,the building or improvement is sold within one year ofcomplcoon.the SV Iri'.IR<)ORARBA S/Q.FT. wnerboilder will have the burden of proving that hr did no ihuild or improve for par- D pus 1 -I 1. TOTAL:EJ D I ethic p < lIY< I i g with d t aaom to tr i theInject(Sm.704B rxd Professor,C-c;,E.Q.G .iwmrs LI JAN 312000 mum I 1 n t pply I sfproperty h builds ' p th,con and QTY PLUMBING PERMIT FEE who conquers for such pirifers with ac,ntract r()licensedpursuant tthe C mraaors License Law, IPERMIT ISSUANCE 0 I am exempt ander See. .D&P C for this reason I/— ALTER-DRAIN&VENT-WATER IEA) -/ VALIMTION__ Owner DI WORKER'S COMPENSATION DECLARATION BACK FLAW PROTECT.DEVICE I hereby alfino under penalty of perjury one of the following dcclam4on: ]I have and will maintain a Certificate of Consent m self-insure for Workers Compen- DRAINS-FLOOR.ROOF,AREA,GONDSTORIES TV PF.CONSTRUCTIOD cation,as provided for by Section J]W of the Labor Code,for the pedomtance of the work for which]his permit is issued, FIX'I L RF_S-PER'TRAP 0 1 have and will maintain Workers Compensation Insurance,as required by Section J]f.Onf'the Laf.n Code,on,he porion Ire of IIIc work for which his Permit is issued. GAS-EA.SYSTEM-I INC.4 OML17S OCC.GROUP MIN My Worker's Cnmpcnsalinn Inwmnce comer and Policy number arc Cartier. Policy No: I GAS-CA.SYSTEM OVER Y(EA) O CERTIFICATE 017 EXEMPTION FROM WORKERS' Z GREASF/INUUSTHL WASTE INTF.RCF,YfOk COMPENSATION INSURANCE BUILDING DIVISION FEES (Thissection need not be contplemd it the Permit isfor,,nahundreddollau($LW) GREASE"TRAP or less.) I PLANCHECK FEE Imodythaiotbe arderrommoftleworkou,shlchthrtpermit lsixvaed,1,hall SEWER-SANITARY-STORM F.A.21017, nm ot employ any person inanymoncrso as to Mx,,nteodim , qhs Workers'Compen- ENERGY FEE zz, cation Wwsof Califomia.Data WATIiR HE 1:R W/VENT/M.RcTR Applicant t GRADING IEE .N.I NOTICE TO APPLICANT:If,after making this Cenifiette of Exemption,you should WATER SVSTIIM/I'REAHNG a> booms mhjem m the Workeh Compcmmion provisions of the Iabnr Cale,you mull SOIhS!EE Qforthwith cmoply with such provisioner thispermit shall be dcented,conked. WATER SERVICE 7Z CONSTe UCI isaco[ON ardon1 agonyENCY NEW RESIDENTIALPLMB. SQ,ITT PAID U Q ]forhereby which onhero isoco (Sec.onlcttCm.agency fnnhe pedomwncc n! Uma Receipt lY the work for which this permit is issued(Sec.1092 Civ.CJ Lenders Nater TOTAL: r W Lender s Addres 'TOTAL. I ecnity that 1 have,cad this application and date that the above information is BUILDING FEE entiret.1 a%rec u.comply with xll city and mnmy orAin:mces and w:ne laws relating u' QTY. MECHANICAL.PERMIT FEE U Z building construction.and hereby amhom<repremnimmsofthis city turner upon the SEISMIC FEE ,move-nentinned pn,perty for hopmoon Purposes. I (We)agree msove,indemnify and krcp harrnles the City of Cupertino vgQis, PERMIT ISSUANCE ,ELECTRIC ITE liabilitim,judgtnents.costs and expenses which may many way accere againsisaid City ALTER OR ADDTO MFCH. m cnnsequenm of the gmming of Ih.,permit PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT To 10IXO CFM) MECHANICALFEE SOURCE REGULATIONS. AIR HANDLING UNIT RIWRIIJ.fXNI CFM) CONSTRUCTION TAX Signature of ApplicanVCommemr Dam EXHAUSTHOOD(W/DUCI) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE. Will the upplietmlor core buildingoccupantwore ar handle hannNoms material HEATING UNIT TO 100.000 BTU) Is,defined III Cotentin Municipal Code,Chapter 9.12,and the Health and Safety Code.Section 25532ud? HEATING UNIT(OVER 100.00 BTU) O Yes No VENTILATION CAN]SINGLE RESID) PAID Date Rece# Wfllrd the air coula or musfial.a building by the B use Area Air Qu or devices which BOILER-COMP(JHP OR 101.000 BTU) no hazardous air congaminann nz defined by the tiny Area Air Quality Management TOTAL.: inricif C Yes No BOILER-COME(OVER 10tL1 BTU)O I have rwd the hmumoos maenahr is under Chapter fi 4501 the Coli- AIR CONDITIONER nxluiremcn p ISSUANCE DATE fomia Health&Safety Cala.Seniors 25505,is Try and 25534.I undeo,mnd Iha1 if Ibc NIiW RISIUF.NI'IAL MECH. SQ.FT. nf,he redImnotbhi,mortify hut,nen poor it ismymorh Certificate nuify the a'mpam ,,f qhu reyuiremente whish nun be tact poor w issuance of a Cenificaenf Occupancy. Owner or uulhnriad agent Dane TOTAL: ISSUED BY OFFICE 9REMACOVER QAC UN17>1000GCFf•i JMECnANICALI 1BREMAIRHAN JA/C UNITS <= 10.OGCCF�.M IMECF'IANICAL IBRENIFURN IRELOCATION OF FURNACE MECHANICAL . BREMFURNOV IRELO FURNACE > ICK BTU INIECHANICAL 1BREMINHOOD JINSTALLATION OF HOOD MECHANICAL JBRENIRELOCA IRELOCATION OF HOOD IMECHANICALl BREMREPALT REPAIR/ALTER HEATING MECHANICAL BREMVENSYS IVENTILATION SYSTEMS (MECHANICAL PPERMITFEE PLUMBNG PERMIT ISSUE PLUMBING 11 BNUMULTI NEW MULIFAMILY RES PLUMBING BNUSFD NEW SINGLEFAMILY RES PLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING SPCESSPOOL CESSPOOL PLUMBING BPFIXTURE PBLG FIXTURE PLUMBING BPGAS GAS PIPING SYSTEM FEE PLUMBING SPINTERCEP IND WASTE INTERCEPTOR PLUMBING BPREPIPE REPIPE OF FIXTURES PLUMBING SPSEWAGE SEWAGE DISPOSAL PLUMBING SPSEWER SEWERS PLUMBING BPSPRINK LAWN SPRINKLERIBACKFLO PLUMBING SPSTORM STORM/RAIN WATER PLUMBING BPTRAP KITCHEN TRAP PLUMBING BPVENT ALT OF DRAIN,&VENT PLUMBING BPWATER INSTALLJALTER WATERPIP PLUMBING BPWHEATER WATER HEATER/VENT PLUMBING BPWSVCS MAIN WATER SERVICE PLUMBING • ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING ZDIRTM OIR TENT MAP PLANNING ZFULLHR FULL APPL BASE+HR PLANNING ZFULLTM FULLAPPL TENT MAP PLANNING ZFULLUP FULL APPL USE PERMIT PLANNING ZFULLZONE FULL APPL ZONING PLANNING ZGPAMENO GENERAL PLAN AMEND PLANNING ZLIMAMENO LIMITED AMEND PLANNING ZLIMTM LIMITED TENT MAP PLANNING p LIMITED APPL USE PERMI PLANNING MIN AMEND TEMP USEPERM PLANNING MINOR APPL HILL EXC PLANNING MISC SIGN EXCEPTION PLANNING MINOR APP TENT MAP PLANNING MINOR APPL USE PERMIT PLANNING MISC ARCH SITE PLANNING ZMISCEXT MISC TM AND UP EXT PLANNING ZMISCFENCE MISC FENCE IXCEPTION PLANNING ZMISCGEN MISCELL APPL GENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING ZSIGN SIGN PERMI PLANNING ZTEMPSIGN TEMPORARY SIGN PLANNING ZVARIANCE DIRECTOR VARIANCE PLANNING • 2 aft AeritM SlIN99 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE • CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: nancyc w Sec: Twp: Rng: Sub: Blk: LOC:35615022.00 INVOICE DATE......: 01/31/2000 ` REFERENCE ID q ...: 00010176 SITE ADDRESS .....: 218981SHATTUCK DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: CIOTEK JANET I ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4763 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 DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BPWHEATER P 9.99 ONO 909 PPERMITFEE P 35.52 0.00 35.52 --------- ------------ ----------- 45.51 0.00 45.51 VOICE ID DESCRIPTION VOICE ID DESCRIPTION FINAL PLUMBING ENERGY 506 GAS TEST FINAL PLUMBING