99110046 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECTRICAL PT:RMI'1'NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING PROJECT IDENTIFICATION
_fiUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
ji2kakrE PR 9:D7tA)n (-A
OWNER'S NA Ii: PHONE: 'CONTRACTOR'S A � LIC NO'.
_ 72 NIC CONTROLI,
cfTH-ECT ;NGINEHR: LIC NO: ADDRESS: ❑
CONTACT. PHONE: BUILDING PERMIT INFO
S
El Consultant Foes Paid by Applicant(Initial) BLD ELEC PLUMB ME❑CH
LICENSED CONTRACT'OR'S DF:CLARA'fION QTY ELECTRIC PERMIT FEE
1 hereby affirm mat 1 am licensed under previsions of Chapter 9(commencing JOB DESCRIPTION
OaZ with Scotton7M))pf Division Jul Bmatessand Profession.Code,and any license is
in full farce and effect. PRESIDENTIAL_
IiRMIT ISSUANCE
aUI License Class Lie.III ❑SFDWL El KITCHEN REMODEL
FZW Date Contractor APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMDING RE-PIPE
F'aj pdj ARCHITECT'S DECLARATION PANELS [I MULTI-UNIT []STRUCTURAL
ZOy^ l understand my plans shall he used as public records MODIFICATION
-Z 9z UPT02IXIAMPS ❑INTERIOR El CHIMNEY REPAIR
r4�'j Licensed Professional 201-IBWAMPS IMPROVEMENT [3SWIMMING POOLS
C OWNER-BUILDER DECLARATION OVER I"AMPS ❑BATH REMODEUREPAIR (j DEMOLITION
�^�^C W Q I hereby notion that 1 am exempt from the Commnurs License Law fn,the
k a tl F fill lowing reason.(Scrimp 7031.5.Business and Professions Cole:Any city or county SIGNS ELECTRICAL []OTHER
twill LL which resrm
respire,a peit to ronstruct,alar.improve,demorep
demolish,or air any situation, _
S=O prior to its issuance,also requires the applicant for such pernh to file a signed statement SPECIAL CIRCUIT/MISC. nn nn
Hypr that he is licensed pursuant m the provislonsnr the Contractor's license Law(Chapterr)
6F«6�10
00 (commencing with Section 700do of Division 3 ofthe Business and Professions Code)m / TF.MP.MEI'ERORPOLEINSL COMMERCIAL:
a ca C that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
-,y Section 7031.5 by any applicant for it permit suhjean the applicant to a civil penalty of POWER DEVICES 0TENANT ❑FOOD SERVICE
FZ> not more than five hundred do[]ars(SNT, IMPROVEMENT
6 (:1 I,as ounce of the propeny,Or my employees with wages as their sole compensation. SWIMM ING POOL ELECTRIC
O til l do the work,and theancmre k rul eade!moncred florins,(Sol.7614,Bust ties, ❑OTHER
3� and Professions Code:The Contractor',License Law does not apply to as owner of OUTLETS-SWI TCHES-FIXTURIS
progeny who builds or improves thereon,and who does such work himself or through
his awn employees,provided that.such impmvemers are not intended or offered for NEW RESIDENTIAL FLECI'R SQ FT
sale.If.however.the building orimprovement is sold within one year ofcompletlor,the SQ.FT.FLOOR AREA SJSQ.Cr
tier-builder will have the hordes of proving that he did not build or improve for put
fillftialc.I.
Zs owner of the property,am exclusively contracting with licensed contractors. OTA
onstructthe project(Sec.70,14.Business and Professions Code:)The Contrsnor's Li-
came,Law does amends to an owner of property who builds or improves thereon,and QTY PLUMBING PERMIT
who contracts for such projecu with a contractor(s)licensed pursuant to the Contractor's
License far. PERMIT ISSUANCE
❑lam nptumbi-Sec. "&P C for this.,no
ALTER-DRAIN&VENT-WATER IEA) VALUATION
Own Da¢
RKE 'S MPENSATTON DECLARATION BACK FLOW PROTECT.DEVICE
I hereby ollirm unA enaltyof,min,one ofthe following ill ons:
I have and will maintain a Certificate of Cometh to ml&Insure for Workers Contain DRAINS-FLOOR,RODE AREA,COND. STORIES TYPE CONSTRUCTION
.ion,as provided for by Section 37(X1 of the Labor Cnde,fnr the performance of the
work fnr which this Perot Is issued. FIXTURES-PER"TRAP
❑I have and will maintain Worker's Compcnsmion Im.prea.as required by Section
3700ofthe Labor Code,fart he Terminal ofthe work for whi,l is pannus issued. GAS-EA.SYSTHM-I INC.4 OUTLETS (5CC.GROUP Z / APNO�
My Worker's Comp,mation Insurance carrier and Policy mummer are
Carrier: Policy No.: GAS-EA.SYSTEM OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASFANDUSTRL WAS 1'It INTERCEPTOR
BUILDING DIVISION
(This section need not he completed if the permit is for one hundred dollars(S 100) FEIiS
or less.) GRIiASE"TRAP PLANCHECK FEF;
I,arify mut in the Perfmmanceofthe work for which thi.a permit is issued, SEWER-SANITARY-STORM EA.200 FE
not employ any person in any manner so as.become subject to the Work,,,Comprn- ENERGY FEE
Z scion Laws of California.Dae WATER HEATER WNEN VELECTR
z
'ZO Applicant GRADING FEE
EOn NOTICE TO APPLICANT:If,after actions this Certificate of Exemption,you should WATER SYSTEM?BEATING
a7 become subject.the Worker's Compensation provisions of the Labor Code.you must SOILS FEE
W4Q forthwith comply with such previsions m mi,Permit,hull be deemed revoked. WATER SERVICE
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID
U Thereby ollirm that herc isaronswninn lending agency for the perfnrmauce oa Data Receiptp
the work fnr which this permit is issued(Sec.LF)7,Co,C.)
U Lail is Name TOTAL:
WLender's Address TOTAL:
1 cenify that 1 have read this application and state mat the above information Is BUILDING FEE
%1 correct.l agree to comply withal[city and county oninanas and state laws relating. QTY MECHANICAL PERMIT FEF,
V Z halding conswction.and hereby auhorize representatives ofthis citym enter upon the SEISMIC w h
shove-mentioned propeny far impcminm purlwsea PERMIT ISSUANCE LI1
(We) exam save,indemnify and keep harmles,the City of Cupertino against ELECTRI I 1
Iiebilities,judgmems,costs and expenses which maymanyway accme against said City AlfER OR ADD TO MECIL
in cnnsesucncenf One'pandn'ofthis Permit PLUMBI Ekill _ A 10 313 1
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM)
SO CEREGULATIONS. MECHAN L
AIR HANDLING UNIT(OVER 10.000CPM) CONSTRI.MON TAX
S mature plf nn memo Dam EXHAUST HOLD IW/DUCT) xL
I ZAItDOUSMATERIAISDISCI.OSURIi HOUSING TtJAT10NFIiE
Will the app ward or future building occupant store or handle hazardous materia[ HEATING UNIT TO 100.000 BTU)
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
fide,Smiion 25532(a)7 HEATING UNIT(OVER 100000 BTU)
C]Yea, ❑No PAID
VENTILATION FAN(SINGERRESID)
Date Reccipl N
Will the air contaminants
mantra building occupant use equipment 9t devices which BOILER-COMP(3HP OR 100.000 PTU)
' Ll
n hmallous air mnmminams m defined by the Bey Area Air Quality Management T !1-9s
mut?
DYes ❑Nn BOILER-COMP(OVER I(X1,M BTU)
t
I have rend the hamNous nexriakrep[mmencs under Chapter of the Cali. AIR CONDIT IONER
9 P ISSUANCE DATE
fmmiu 1{c:din&Safety Code,Sections 25505,25533 rend 25534.1 understand tha if the NEW RESIDENTIAI.MICH. SQ.PT. �7)
Fu' - gdoesnotcurrentlyhaveaa nhthatitism srymsibility to notify the eccupaht // U
h �uirenerns, , must cto' r.is mail C ificmeo cu cyto ( ~ I
Owhere, u nz em ` U e TOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
\� BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: ling: Sub: Blk: Lot:32603041.00
INVOICE DATE...... : 11/09/1999
REFERENCE ID it ...: 99110046
SITE ADDRESS .... . : 22056 WALLACE DR
SUBDIVISION ...... .
CITY .... . ........ : CUPERTINO
IMPACT AREA .. .....
OWNER ....... . . . . .: XUAN NGUYEN
ADDRESS ....... . . . :
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-0128
CONTRACTOR . . . ....: LEE, FRAN LIC # 20526
COMPANY .... . . ....: FRAN LEE CONSTRUCTION INC
ADDRESS .... . . . ...: 20917 FARGO DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE ... . . . . .: (408)996-2527
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BTEMP P 57.50 0.00 57.50
EPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
93.02 0.00 93.02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
. ......_ ......._ ...= ---
...e. ............................
� UFEA 304 ROUGH ELECTRICAL