The URL can be used to link to this page

06010178CITY OF CUPERTINO "f COy�tiQR TO1�TTON...00' e BUILDING DIVISIONPERMIT BUILDING ADDRESS: FISCHER PLUMBING & CONST PERMIT No. 06010178 197 ADRIANA AV ERs NAME- AMECAMPBELL CAMPBELLGREGORY D 2766 SCOTT BLVD- 01/31/2006 PHONE SANITARY NO. CONnId. NO. (408)727-2426 ARCHITECryENGINEER: BUILDING PERMIT INFO BIRO ELECT PLUMB MECH LICENSED CONTRACIDR'S DECLARATION Job Description P 1 be" afB,m 'ba,I w Ikaned under pmu vilkoof CTyncr 9 (commencing with Section TOW) d Division 3 tithe Buten. aral Prdcon. Code. end my Ikxnz u in rLeucnnmrnawam frees �((, - REMODEL KITCHEN (NO STRUCTURAL ALTERATION) INST ?� � L NEW GAS LINE FOR COOK TOP, NEW MECH FOR HOOD, ILm camrcmr ARCHITECTS DECUB n N RE-PLUMB KITCHEN SINK. INSTALL GFI OUTLER IN IdnQrvaml my pluu tial. be acdupWlk rtcmrQ lirncd Pl fluknal OWNER-BUILDER DECLARATION 1 bertby aRmn that I w comp. from tY Contractors Lime Law for the follming mann. (Section Tin IS, Bushes; and Pmruliaoa Code: Any city or minty which rtqulra • .it to cora r dee. nnpmw, drmollak or repel• any attvctmc prior In, it, isuun¢. elm rcquirta Ile LWi= for such permit to Ilk a dyed =,anent Lice. La. cbalrer 9 Sq. Ft. Floor Area Valuation that he is fiaacd pura.nt to the p.miwu of We conuum:f (co nmmeing with Section 7000) Of Davkion 3 of the Burins, and Pmfeaioru Cade) or $10000 dill be, la mmpt Iherefmm ail Ne bub for de W epd e•^^pdan Any vWlatbn of APN Number Occupancy Type Section 7031.5 by any applicant for 4 Pemit Object, the appli lm aCivil p ty of w more than fire hu.drtd loWn(5. t..' eAt EINO ❑ L u arou d th propmly or my cmpbyea whh mgn u lhek mak corepemW m, Required Inspecti ns K eet for aale(See TO. Buaircn win do be, rah. arta amaum de 1, not lnteh oreRvN and Pmf=.m code: The conmcmh� LLa. dna not." to a nwrav d Property who bWlda or imprma thereon,"wde doer auch work himself or th.ouyh h4 own employ=. provided lhu Rvh imp,,e.uenu art nest intoded orofterel forsala If. hoaewc, the building or lmpmvemem I. W wkhin one year of Pkdon. me own"- I' 1 ,� 1 2006 �6 budder will have the buden of Purring thal he did not bWW or Impam,e for Purpoe Of uta). ❑ I. u aw+.er of de Property. w eulmiwlY cmvmsinL with Ikerted contractus m q�w], t{ 1 ,r g IfY Jb �t „ .0 ,1 .p� yf oouuuct be Ivojem (sec TDN, Enun. and Pmfoe ion code:) Tie Conva .. U. �'J`�t J� f7[ SjVI� m= Law does and apply u in ower a popeny abo h.iba"bnpmmv ftneon. and, . t{I] ijl� ItJJ who emvacu for such project, with a omuacur(a) Iioe ed pumunt m the Ceuuactarl a2law. w awpt uodv Sec. . B i P C for tMa ru,on a D.- WORKER'S COMPENSATION DECLARATION WORKER'S I hereby arnrm,m ,p:.Wly of perjury one of tK fdMing detlwtlor¢ I hawand ventmdnldn•CWn^,"d Cuuealto ulfdune fa Wmtrrace t Wlom, n prmWcd fm by Section ]TOO d de Labor Code. for.he prro.muvrr-f of de wart fm which that permit u iaoed. ❑ 1 haw orb will minuin Worker's CompensaU n Inmrvue, as rtquued by Section 37Wofde Labor Code, for the P fommvec of the west for which that perrok 4 i,ateei My woe &C®.peOat 1"um= anlm and Polity o,mbm are: ' Curio Policy Na: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Thu eclim.ertl not nd compktcd If.he Permit b for me hundred deft. (LI W) m leu) I ctmrfy ihel in the PCorrn. of the wak for which thio lemon is ion—I I ahali ea unpiny.nl'perm rmugr oembjm rode Worktrf Compenu0nn lawn of CtlJ at NOTICE NOTICE TOmteraft m og CcniffaleaEawPdon. you M= bccone auD n We 'a Campunim proridoro of th lahm Code, foo moil p rmthrithcomply w'uh uch prvvidwortbu permit Nall be dre..W mrotrd. CQ`1Srt NL AGENCY knOlING I.. spay for de performer.¢d Tho, hIellkhithatthcrt4ac (Seelkmlending ' the vwt wNch Ihb pennl141vued (Sec. W. Cir. C.) geodes Nara Na Lcndcra AdBu, - r 1 eerily 6.11 Uw tad Nies apPEevino .nd rue that the above information u . eorty 1age= m comply with dl city and county OWimoeCS Md rue lave relating to buiwinL coruuuclion, arW hereby mlhorie rep.esentatiwa a thia City to enter up.m the abow.meodmed pup,tr for [.,Ocdoa,rp.a (We) agree m ave, indemnify anti keep harmlcu the City d Cupwinct ag im j Iiabilida, M,,tnem, coma and a homea which may N art, ny accrue api said City e Io emt quenm of the Lrudng of dds permth APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -31 � SOURCEREGULATIONS. ^ — Re-roofs Type Roof Sigutwe nor AppliceAZARD or D oc IL OUS MATERIALS DISCLOSURE RAZARD of , or amp" vee or buWk h a maerid Will then, MunicipalHealth ipl Co Ql.,ai by the Clgcnim Muniripl CoQ. OaTxer 9.IT. ad de HedW and Safety plum. Satins 25532(a)7 ❑ora �1h'o All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the a,pji or fuwrt bWWing o=upm I0.' O W,mcnl Or &,i= which emit bvaadaa air mnumiww u Qnnc by the Bay Am AU Q"Hy Ma.ugrnem all new materials for inspection. DutrimT �No ❑Ya Ih.w read the Ivuednu..ia4 rcquucmem t CLpter695 dth califer. nu Health&SafayCodc.S bur+ 255OW533 aa115531. I understand thalfthe build..g d¢a ml CMTCNY ham IIWrLL that my reapondNlkr to notify the occupant a the qs b m" m mere er.0 area nor Signature of Applicant Date All roof coverings to be Class "B" or better ow mm rpm Dae 0 Item 1 of 1 CITY OF CUPERTINO 7�I:i5iYl�:ia[M�NII Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32620022.00 DATE ISSUED.......: 01/31/2006 RECEIPT #.........: 33021 REFERENCE ID # ...: 06010178 SITE ADDRESS .....: 10197 ADRIANA AV SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: kiersaw COPY # : 2 OWNER ............: CAMPBELL GREGORY D ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1125 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT NUMBER 350.11 44330 350.11 RECEIVED FROM ....: FISCHER CONSTRUCTION CONTRACTOR .......: TERRY FISCHER LIC # 23896 COMPANY ..........: FISCHER PLUMBING & CONST ADDRESS ..........: 2766 SCOTT BLVD CITY/STATE/ZIP _..: SANTA CLARA, CA. 95050 . TELEPHONE . (408)727-2426 FEE IO UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW DAL BPERMFEE VALUATION 10,000.00 169.56 0.00 169.56 0.00 BPFIXTURE UNITS 1.00 9.00 0.00 9.00 0.00 BENERGY 'PERMIT FEE 169.56 81.39 0.00 81.39 0.00 BPGAS OULETS 1.00 5.40 0.00 5.40 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BREMVENFAN NO UNITS 1.00 45.39 0.00 45.39 0.00 BSEISMICRE VALUATION 10,000.00 1.00 0.00 1.00 0.00 TOTAL PERMIT __________ __________ 350.11 __________ 0.00 350.11 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT NUMBER 350.11 44330 350.11 ( ButU.0 CITY Or CUPERJINO CITY OF CUPERTINO PERMIT APPLICATION FORM CLOD 101l'g APN# 2A0_ Date: Building Address: Mailing Address (if different from building address): 1,o47 Qdr�yn a ;1? Owner's Name:)0 �i-ir�t �'A.>. Phone #: 6 y ( J �U �•� c Boiler <= 100,000 Btu Contractor: ;cs del- P�� ,' 6>,S1 License #: 33,5,E � Contact: Phone: t¢o& 7a7 -2V2 L Cupertino Business License#: 7ZA2 Fax: Building Pchnit Info: C no fu. �/ r Sns �! Iry q �rS� �t vr' G.a:q°, re-p/��.rd &4<To�,new insc/n,�cq/� Bldg❑ Elect ❑ °uf/��'� �l a�r� Mach ❑ Job Description: Residential E9' Commercial ❑ Sq.Ft. Floor Area:q.Ft.: MECHANICAL Cost of Proiect: Occupancy Groun:- /d BCONSTAX Type of Construction: Please check this boa if the project is a iftr✓N second -story addition: Project Size: Standard 13— Large ❑ Major ❑ BCONSTAXBQ Quant Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1,75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 1� VC; WF CUPEkTINO mz CITY OF CUPERTINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMTTIGATC Comm. Housin Mit. Fee BUILDING BNUCOM2v1E New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERNIF'EE Bldg Permit Fees BUILDING BPFIYTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee . PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANTCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Cbeck Re eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Re' ection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lightina Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREACENROOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb S e fic Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BU LDING BSPECIAL Special Inspection BULDING BSW1M Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPEPLAI Temporary Bldg Permit BUILDING BTEMPSVCS Trmp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electical sq foot ELECTRICAL EPERIIHTFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMTTFEE Mech Permit Issuance MECHANICAL PPERNHTFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Foe sq foot PLUMBING PLLONGRNGC Planning LR Commel Multi-Fam PLANNING PLLONGRNGR Planning Lon Range Residential PLANNING ZADDCHG Address Change BUILDING • 3of3