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00010014 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 0 U 0 10 D 1 y' CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. Br:DING DIVISION APBLICATION/PERMIT PLUMBING-MECHANICAL 5��1 BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DA] W L/,u PxG5 2 4-u 3 CAllesO� YO CTOR'S NAME: LIC NO: 62 15 N/C CONTROL# ARCHrfECT/ENGINEER: LIC NO: ADDRESS: ❑ fS�-2� 5.9.��To�� Av�.S✓. CONTACT: PHONE: BUILDING PERMIT INFO O o El Consultant Fees Paid by Applicant(Initial) DG ELECT PL MB MECH (7 ❑ ❑ LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE I hereby affirm that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION q a Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is RESIDENTIAL: W O PERMIT ISSUANCE F in full force and eff a W F D� ❑SFDWL ❑KITCHEN REMODEL hU License Cl s Lic.# APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE Q RUWi Date C) Contractor�� F]h ARCHITECT'S DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL p V)Z I understand my plans shall be used as public records MODIFICATION Z 4`" UP TO 200 AMPS q El INTERIOR ❑CHIMNEY REPAIR Licensed Professional 201-1000AMPS IMPROVEMENT .a - E]SWIMMING POOLS 0C 94.a OWNER-BUILDER DECLARATION OVER 1000 AMPS �TH REMODEUREPAIR ❑DEMOLITION 04 W Q I hereby affirm that[am exempt from the Contractor's License Law for the wO a U following reason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER y which requires a permit to construct,alter,improve,demolish,or repair any structure aprior to its issuance,also requires the applicant for such permit to file a signed statement SPECIAL CIRCUIT/MISC. W,?+ that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 W Q (commencing with Section 7000)of Division 3 of the Business and Professions Code)or TEMP.METER OR POLE INST. M R IA p,c that he is exempt therefrom and the basis for the alleged exemption.Any violation of ; EWBLDG/ADDITION ❑DEMOLITION W Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES TENANT [-IFOOD SERVICE 14)not more than five hundred dollars($500). I,as owner of the property, IMPROVEMENT ❑ p perty,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC 04rH.oq will do the work,and the structure is not intended or offered for sale(Sec.7044,Business ❑OTHER W 3 ayo and Professions Code:The Contractors License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ FT. sale.If,however,the building or improvement is sold within one year of completion,the SQ.FT.FLOOR AREA $/SQ.FT. owner-builder will have the burden of proving that he did not build or improve for pur- pose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to TOTAL: construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and QTY PLUMBING PERMIT FEE who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. PERMIT ISSUANCE ❑I am exempt under Sec. ,B&P C for this reason lwner Dale ALTER-DRAIN&VENT-WATER(EA) VALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE / 3 L� I hereby affirm under penalty of perjury one of the following declarations: (�/ ❑1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- DRAINS-FLOOR,ROOF,AREA,COND. STO S TYPE CONSTRUCTIO1 sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 3 FIXTURES-PER TRAP ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN My Worker' mom n tion In;yrance carrier and Policy �� J Carrier:-_Z G ,(/�L(�f�Policy No.: r GAS-EA.SYSTEM-OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' V , COMPENSATION INSURANCE GREASE/INDUSTRL WASTE INTERCEPTOR BUII.DING DIVISION FEES (This section need not be completed if the permit is for one hundred dollars($100) GREASE TRAP or less.) PLANCHECK FEE I certify that in the performance of the work for which this permit is issued,I shall SEWER-SANITARY-STORM EA.200 FT. not employ any person in any manner so as to become subject to the Workers'Compen- ENERGY FEE ZZ sation Laws of California.Date WATER HEATER WNENT/ELECTR 0 Applicant GRADING FEE 0_4fj NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEM/TREATING become subject to the Worker's Compensation provisions of the Labor Code,you must SOILS FEE WA forthwith comply with such provisions or this permit shall be deemed revoked. WATER SERVICE Q" CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID V Z I hereby affirm that there is a construction lending agency for the performance of Date Receipt# i--i the work for which this permit is issued(Sec.3097,Civ.C.) OU Lender's Name TOTAL: Lender's Address TOTAL: >_1 a I certify that I have read this application and state that the above information is BUILDING FEE o..4 t) correct.I agree to comply with all city and county ordinances and state laws relating to QTy, MECHANICAL PERMIT FEE V Z building construction,and hereby authorize representatives of this city to enter upon the SEISMIC FEE H above-mentioned property for inspection purposes. PERMIT ISSUANCE ELECTRIC FEE (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MECH. in consequence of the granting of this permit. PLUMBING FEE APPLICANT U ERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) SOURCE CATIONS. ME, HANI 4 2000 AIR HANDLING UNIT(OVER 10.000 CFM) CNSTRUCTION TAX Signature of Applicant/Contractor Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE k Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO 100.000 BTU) - •-........ as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? HEATING UNIT(OVER 100,000 BTU) ❑Yes ❑No VENTILATION FAN(SINGLE RESiD) PAID Dale Receipt# Will the applicant or future building occupant use equipment or devices which BOILER-COMP(3HP OR]00.000 BTU) emit hazardous air contaminants as defined by the Bay Area Air Quality Management TOTAL. District? ❑Yes ❑No BOILER-COMP(OVER 100.000 BTU) I have read the hazardous materials requirements under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE fomia Health&Safety Code.Sections 25505.25533 and 25534.I understand that if the NEW RESIDENTIAL MECH. SQ.FT. building doe&V currently have a tenant,that it is my responsibility to notify the occupant of the reggWents which must be met prior to issuance of a Certificate/of cy.J p ner or authorized agent Date TOTAL: ISSUED BY: n�G►rl= INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: karenb Sec: Twp: Rng: Sub: Blk: Lot:35611045.00 INVOICE DATE. ..... : 01/05/2000 REFERENCE ID # ••.: 00010014 SITE ADDRESS ..... : 925 NEW HAVEN CT SUBDIVISION ...... CITY .. ........... : CUPERTINO IMPACT AREA ...... OWNER ............: LIU MING S AND GRACE C ADDRESS ........ .. : CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4023 CONTRACTOR .......: POND, HERB LIC # 20767 COMPANY ..........: BATHROOMS BY REMODELING SPEC ADDRESS .......... : 1422 SARATOGA AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95129 TELEPHONE ........ : (408)328-6700 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BENERGY A 38.10 0.00 38.10 BPERMFEE P 127.00 0.00 127.00 BPFIXTURE P 24.99 0.00 24.99 BSEISMICRE P 0.70 0.00 0.70 PPERMITFEE P 35.52 0.00 35.52 --------- ------------ ----------- 226.31 0.00 226.31 " 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 309 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