99120081 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY U
XCITYFICUPF.RTINO BUILDING-ELECTRICAL v6BaIr N(,
4 APPLICATION/PERMIT PLUMBING-MECUA.N'ICAL
BUILDING DIVISION BUILDING PROJECT IDIENTIN'ICAI'ION
BUILDING ADDRESS: SANITARY No APPLICATION SURMI'TIA�L DAI
D� 0 V LLQ /� �O/ l
WNI?RB NAME: PHONI!: C HA OK' LIC NO;
QOOC' NIC CONTROL
RCHITE'AS (' EER: LIC NO: ADDRESS x ❑
loaa0 bLv ho
CONTACT PHONE: BUILDING PERMIT INFO
�o 4o h _y32 ❑ Consultant Fces Paid by Applicant(Initial) RLDG FI ECT PLUMB MIiCH
❑ ❑ ❑
LICENSELYCONTRACTORvi DEC.ARATIONQTY ELECTRIC PERMIT FEE
1 hereby affirm that I am licensed under Provisions of chapter 9(commencing 1013 DESCRIPTION
ZuI Dam C 1^csx anti Pmruvsions Cmic,nod myliccmcis RESIDENTIAL:
Da'Z dSmI1nn91NN0o1'13M,ton Jal'the Nus
woo tet I'[HMI'T ISSUANCE
F atoll fora wJ eRcc1 ' 7 ❑51'DWL ❑KITCIIIiN RISAfO1lISl.
Q,UU hiccnsc Ias.s l.ic.N APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING BE PIPE
malar
ARCII II SD1C1ARATION ❑MUI:I'hUNI'I' ❑,MODIFIURM.
OZF H Z I..dersmn l my plans shall he used as public records PANELS CHIMNEY REPA
N� OP'IY)flN1AMPS ❑IN'PROVR [I CHIMNEY POOI-
F 4.F.W Licensed ProfieWunal 201.IX10AMPS IMPROVEMENT SWIMMING IYlO1S
OWNER-BUILDER DHCLARAIION OVER IUIX1AMl'S ❑BATH RC IODEIJRF.PAM [ DEMOLITION
C C Q I hereby vlRmr that 1 am exempt from the Comommr'.v License Law lin me
3 o..0 following rmson.(Section 90)1.5,Business and Professions C,Nc:Any city err county SIGNS ELECTRICAL
OTHER w
which m a t m amsuuct,.hue improve,demolish or repair any"mature I
.u-ON m iuusseuancee,also.. the applicant for such permit asi ed.statement
r0yl prior quires pp permt Sn SPECIAL CIRCUTUMISC.
f Y� Oat he is loomed Pnrsosnuotbeprovitions of the Contractors Limn,Law(Chupmr9 F I '
W 00 (commencing with Sectio 7")of Division 3 oflhe Business and Prolessions Code)or 'DEMI'.ME]17K on POLE INST.
L Ee q thus he is exempt,here&nm and the basis for the alleged exemption.Any violation of L1NEW BLDG/ADDITION ElDEMOLITION
XScaion 9031.5 by any applicant lin a permit subjects[lie applicant",u civil pcmilly if POWER DEVICES ❑*1'17NANT ❑FOOD SERVICE
ad al
n more than Dvc hundred dollar ESSEX)). IM'to'v tS'O`"'
=Q D Lax owne—I he property,army employee,with wages as their sale compensaiun, SWIMMING POOL ELECTRIC
p., will Jo the work,and the structure is Immndedor offered tor sale(See.7044,Inness ❑O'f11ER
3 ae and Professions Code:The Contractors License law Jas nal apply toan owner of OUTLETS-SWITCHGS-Il%TURES
property who hands or Lnprovex thermn,and who does such work turnwlf or..rough
his own employees.Provided that such improvements arc not intended or offered lin NEW RESIDENT[A],ELT:CI'R I .
salt.IL however,the building or improvement is sold within one year ofcompletionthc SQ.19'.FLOOR ANSA $ISQ.PI'.
owncr-huildcr will have the burden of proving Out be dad not build err improve for par.
".of Belch TO F
❑ 1,as owner at the property,roti exclusively contracting with licensed contractors In _
construct the projmt(Sou.9044.Business and Professions Cock:)1ht contractor's Li-
can.eLow Jets not apply to an"wner of property who builds or improves memon,and QTY. PLUMBING PERMIT •.E3
who commas for such projects with a contmanr(s)licensed pursuant)the Contractofs
Limme Law. PERMIT ISSUANCE
El I am exempt under Sec. ,B&P C fm this mason
AI;TER-DRAIN&V ENT-WAI ER GSA) VA LUAI'ION
Owner Dam
WOR K ERS COMPENSATION DECLARN'ION BACK FLOW PROTECT.DEVICE 6/0 0
I hereby affirm underpenalty.1 enw,ane ofine follnwing dcdmuduns:
I have and will mainuina CcrtiOcae ofCanxnuo calf-insum for Worker's Co.,.. DRAINS-FLOOR,HOOF.ARBA.CONE). ESI0RG1(_,1D' TYPII(ONSIRUCIR)
Minasprovided for by Smlann 39X)of the Labor Gale,for the mmmaamcc of thework for which this permit is issuedVIX1 URIiS-I'IiRfltAl'Ll I have and will maintain Workers Compcmation Insurance,as required by Section3V(X)afmcCohnCode,Lathe padonnawe of te work far which this pc.i(is Esau. GAS-EA.SYSTEM I I NC.40NTET5
My Workers Compensation Insurance carder and Policy number are: GAS-EA.SYSTEM-OVBR4(EAU
lGs /
Canine Policy No.:
CERTII'ICATI.OP Ti%IIMITION FROM WORKERS' GRIEASNINDUSTRL WASTE IN'I'ERCEPTO
COMPENSATION INSURANCE HUILUING DIVISION FEIi.
1'I'hixsn'tinn neat na.n:mmplctcd il'me permit is foliar hundmddo11ms(SI00) GREASE'I RAP
PI.ANCH6CK FEL;
ar less)
I certify thm in the performance of the workfar which this permit is ismed,ishall SEWER-SANITARY-STORM ISA.21014.
not employ a y pc: y muu is y it Ilse Workcri Comma- ENERGY PEE
Z satin.laws of W11, t la- r/, ,, 2, WATER HISATER WNF:NTIELEC IO GRADING FEE
NOHCIS TO APE, sur making this Certificate of Exemption,you sb"ul'l WA'f8H SYSTIiM/1'REA'I'ING SOILS FEE
F' become subject to the Workers Compcnvtion provisions of the Cuban Calc,you must '
�j
tori comply with vnuh provisions or thixpermil.hall be deemed revoked. WATER S17RVIC17 ^ I r
LLLL (] RESIDENTIAL PCMB, ` I
n'
CONSTRUCT ION LENDING AGENCY NEW RESIDENTIAL FI'. PAD
-.Dale •� Razima �I
UO 1 hereby amrtn that mere is a lummultion landing agency far the m0b......aof
[4 I Oc work for which lois permit is issued(Sec.3091.Civ.C.) V I A,
0 17-V Lender's Name TOTAL DEC
r W Lender's Address UHAXN(IIs6B
1..t y 1 cenily that 1 have read this application and sum that the ohne information is
L. lin ""co.I agree Io canlply with all city and nmmy anlinauccx and sem laws rchbng m QTY. MECHANICAL PERMIT FEE SHISMIC TE
U Z buildingcomwction.amt hereby amhommm,msenmtivmof this city,o en r uqm hat
nbovcnwmioned property far itiTe tion purimses. PERMIT ISSUANCE ELECIRIQHEC—"�
(We)amac to save,indemnify anti Amp broulw,the City of Culmina again', --
liabiliticsjudgamnts,costs and expenses which may in any way aceme against said City ALTERORADDTOMECH. PLUMBING PLEB
in conw,ti,nic of the gaming of this pennies
API'LICAN�UNDISRSTANDS AND WILL COMPLY WITH ALA.NON-POIN"T AIR HANDLING ON]'1'(TO 10,000 CFM) MECHANICAL 17,17SOU11G[jtjiGULA'I'10Y5
AIR HANDLING ON]'I'[OVBR 101000 CPM) CONSTRUCTION FAN
Signauvc nl ApplicanVCnm cert ` (lata EXHAUST HOOD(W/DUCT) HOUSING MITIGATION IEE
IIAZARDOUSN 'IIHtIALS DISCLOSURE
Will the applicant or future building ucati,nt store or handle h.rardoua malarial IEFAT1 NO ON]'I(TO INO000 It'I U)
o Adjoin by me Ca,ruro Munielpul Code,Chapmr 9.12,and the Health and Safety IHiArING UNIT(OVER IXC IXNL BTU)
Code,Scrum.25532(a)1
❑Yes ❑No VF,NTILATION FAN(SINGLE RESID) ('AID
Ilam Receipt it
� Will the applicant or future building occupant use equip....,or devices which BOILER-COMP(3fIP OR Und(K)B'TU)
t hvardous air contwninants as defined by the Imy Arca Air Quality Mamgcmenl TOTAL:
,loct9 MOILER-COMP(OVIiR 100.001BU)
No
AIRCONUITu1NER ISSUANC17 UNIT
forI have read me hmaNnus mamr255 5,2553 cats undo .1 wid rua nf,he Cali 9
build Hcahh&Safety ylat Sections 255(15,25531 and 2551).1 umlertmnd loaf if me NEW RESIDENTIAL MECFl. SQ EF.
building) � not curmnlly bu 'u mnunLlmt it is my revpnnsihility ununily me marpanl ll /
of me me is It or to" nfa Ctn/,are o ( cepa y.
z-f f
•cr or emhovcd Umc TOTAL: ISSUED BY:
tbxaOFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: yvonnek
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Sec: Twp: Rug: Sub: Blk: Lot:32649014 X00
INVOICE DATE...... : 12/13/1999
REFERENCE ID h ... : 99120081
SITE ADDRESS . . . . . : 10641 STOKES AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER ..... .. . . . . . : HARVEL ROBERT W JR AND MARY J
ADDRESS .. . . . . . . . .:
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1236
CONTRACTOR .. .. . . . : JOLLY, RONALD E LIC d 21402
COMPANY .... . . . . . . : R.E. JOLLY BUILDERS
ADDRESS . . ...... . . : 10220 STERLING BLV
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . ...... : 14081253-4325
NOTE: THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE '
--------------- _-- --------- ------------ ---_--__--_
BENERGY A 50.10 0.00 50.10
BPERMFEE P 167.00 0.00 167.00
BPLANCHK A 141.95 0.00 141.95
BSEISMICRE P 1.10 0.00 1.10
--------- ------------ -----------
• 360.15 0.00 360.15
VOICE IO DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ -...........................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF TN-PROGRESS
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