00010164 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 000 1 Ol 6 i/ )
CITY.OF CLPERTINO BUILDING-ELECTRICAL PERMIT NO
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECIIANICALC
BUILDING PROJECT IDMIF'1C'ATION J
BUILDING ADDR/I�."S:
SANITARY NO. APPJCATION SUBMITTAL DATE
/V /M V 1, - 2�200�
ER'S ME:tiqh/�r? polo -P ON,44-3955 (;0 RA R' N MF,: IC NO:
H N C CONTROL X
RCHITECTAENG R: I ERTNO. A S: / ` ❑
CONTACF, PHONE IN BUILDING PGRMIT INFO
❑ Consultant Jim Paid by Applimnt UnRBJ) BLDG ELECT PLUMB MECH
❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 newy.Trust dw 1 am litcnwed Index p,o•:iwirtw err eh.pler 9( JOB DESCRIPTION
Z with Seruon]OIF)nfDry soon.olthe BusiecucaMPmfcsd C .elMm « RESIDENTIAL:
O p IIT ISSUANCE
��� in Nil Cone and eR-t�- LISFDWL O KITCHEN REMODEL.
aUU Loans Cay. IicX7,91
AI'PhIANCES-RESIUEMIAL ❑ADD]'TION C1 PLUMBING NEI'II'E
yi Dwe Comma ,
F.Oy A C TEC'S DECLARATION PANELS ❑MULT[-UNIT ❑STRUCTURAL
ZOv�Z Imdamud my plans 4,ll be stud ss pablicr ml. MODIFICATION
OZ-� UPTO200ANIM ❑INTERIOR ❑CHIMNEY REPAIR
F-hf-W Lmma,d]Pmfe.asimvl 201-IMAMIS IMPROVEMENT OSWIMMING POOLS
<57"
C Q 1 hcsby offmt that OWNER em BDei^JMCR DECLARATION Tom Its, w's Liccnsc law for Ne OVER 1000 AMPS 0 BATH REMODEi1REPAIR 0 DEMOLITION
x�x O y U Bussing rsavm.(Section 7031.5.Busimwa mut I'mfcssinns Civk,Any cit.or county SIGNS ELECTRICAL ❑OTHER
W 3 W which oc,mo,,a pamdt to construct,aha.In,l^^vc.damolind,or relpir any strucmm
F v-Oq Dinr1.it,iuuance,al.rtquirs0e yrpl.nt Iv such Pemitto File awignerl tuccrenn SPECIALCIRCUTIDMISC.
FesA that he is licensed pu.id m Ne pro.iwium of lk Cmuxt«s Licent law(Chaplet 9
�C OO commencing with Section]0(ID)of Disixicc.1cL a BusinesW Pock,siao Ccul TEMP.METER OR PULE INST. COMMERCIAL:
el.W a e y WI M1e is elo mp Ihaefmm and the Evsk for Abe ellegyl eacmpim.Any viola'nm M N BLIX✓ADDIIION 0 DFMOLI'1'ION
aeh Saloon]OJISbyanyappli lfinepermitsubjmisthevMil ntmvcivilpenallyof POWER DEVICES ANT [I FOOD SERVICE.
noe more than file hundred!dallors($5000).
FZi 1 PROVEMENT
Sol []Laewvncroamd with atmpcnsuinn, SWIMMING POOL HL[CTRIG
SSG mod Pofiewuh,and NesmCur is mos LiecsLawduIfssle(,See.to LL Busim.0 Q�
m otd Profession,Code:The Contractors I.innwe law docs rad opPly m an owner nr OUTLETS-SWITCHES-FlXTURES
,M,si who Wild,m improves Ncnasn.aha who docs wuch work himslf«through
his own employees pmvidcd 51st such onprnvemems enc nm inrnlcd or offered for NEW RESIDENTIAL ELECTR SQ Er.
salt.If.M1mv .the Wilding car iminwcmem is sold within am ycsr.frnmpleithe SQ.IT FLOOR AREA $ISQ.FT.
mer-milder will hvve Ilr burden of mussing That be did not Wild w impose for p.r-
rymc of wale).
1,as.,of the.prepen Y�nm e,droscly contracting with lieetnad comma.,m TOTAL:
mwma the pmj¢I(Sera.70TL Pus Id ITefnrs n.Com,:)'Ibe Cmtmemr's Li-
tense Law does on.pplyman owc,,ofpmpen,wtto builds wimple,,.uermn.and QTY PI,UMBING PERMIT FEE
who roomacd fm ouch projects with a ewtnraaor[e)Ikemxd pwnuannn Ne Cormdi
liter¢tau. PERMIT ISSUANCE
I un exi mpl uMcr Ser. .B A P C for this Trim
ALTER-DRAIN R VENT-WATER(EA) VALUATION
Owrcr hoe M
W(1RKHR'SCOMPENSATION DECLARATION HACK IlOW I'ROIECT.DEVICE 5w Ob
herd Mous i under penally of perjury orc of dm folfwing d orser'lms: L/
t] Iheve anJwi ftsr binaCmili7M of CemenHe slf-;,.for mer Woher'sce.1 cn- DRAINS-ItOOR.ROOF,AREA.COND. STORIES TYP[CONSTRUCTION
.tiro, r pmvidal Tar by s¢tion 3]11!1 of the Ichor endo,for the PeHw.nwntt of Oe
Cas which this Permit is ocher, FIXTURES-PERTRAP
I]00Ivve Lill
i will ode.fon.'men's mull o wbn Insunnr,as rcgw,ro by Scotus
My of the Lob lCode,fu the marac cmr11,uRe won fw which this permituia.1. GAS-EA.SYCTEM-I INCA OUTLETS OCC.GROUP APN
Mr o Wrr Pc y{ 1 u ce tamer vol Policypop yn 00 L 7,S D
Cnnicc x/17[-r,� � Poky NrrlJs'�/K-LC/-[.� GAS-EA.SYS'ILM-OVER 4(LA) 9-Gv�IY
CERTIFICATE OF EXEMPI'I ON FROM WORKERS' U
COMPENSAIION INSURANCE GREASEANDOS]RI.WASTE INTERCEPTOR -
BUILDING DIVISION FEES
hi,seat need not h cometaH&pll pccmi,is fwene hundred dollars l$IW) GREASETRAP
or less.)(TPV,NCHECK FEE
I avufy Inst in Nepmfmonil dllte word:forwhich this permit is issued.I ddl SEWER-SANITARY-STORM EA.200 IT.
r employ any Terson in any Teruo w m to heceme.subject m Ne Wmkers'Camper- ENERGY FEE
OZ ..film Lews.f Celifomie.Dar / WATER HEATER WATNTTELECTR
y Applicant GRADING F Ei
G7 y NGI'I CI-1 TO AITLICAN'E It,eller making this Cenificam of Ihenp,fxo,ym should WATER SYSIEM91'REATING
a , 2vro ne subject m Ne Workers Ctxnptnvllen provisions of the Idtvm Coda,you must SOILS WE -
Cy fxNwiN comply wiN such pmvisim,rr phis Permit Nill he.keret svakm. WATER SERVICE
Q
Uz CONSTRUCTION Ltionle AGFI.'CY NFN'RESIDESTIALPIMB. SQ.FT PAID
U O Ihoo hich,hi that them iso ed!( .30lading agcmy for Nc perf«mooux of
Due Receip
ci work for which Nix permit is homed!ISa.309],Civ.CJ
H I<,dcr's Add TOTAL
C) :
O U I..WRa Add,,, 'I(P'A L'
�+ 1BUILDING FliR
[r I certify that 1 M1ave.vd Nlz affiliation and state that the oWve information is I
h m t,lag tocimplywiNellcityudcruntyr inarcesardxwme wrreMngm QTY. MECHANICAL PERMIT FEE
UZ building cowrvction.and httdry autlmrize oimsermuvno(this city memeruPon de SEISMIC FEE
oWvc-nlrntiooM pmpcny fw impcctim pmposcs. PERMIT ISSUANCE
(We)agme to.save.indemnify and tett,hanothm the City of Cuper ino against ELECTRIC FEE
Iiabililics.judgnlrnts,ttnt.std eapcnsa which,uy in any way aarue agaioul wood City ALTER OR ADD TO MECH.
inn,
mc4tentt the granting of this Permit PLUMBING IT.Ii
APPLICANT ZERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNI'r(TO Oox)CPM) MECHANICAL FEE
SOURCE �i IATIONS.
-/b•� AIR HANDLING UNIT(OVER 10,M)CFM) CONSTRUCTION TAX
Sfgromr of 'on.or Duc EXHAUST HOOD(WMUCD HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Willft applicamurfrwc Wilding r,cri,msmr or handle e,,.nk.n maeral HEATING ON]'I'(rO 100.000 BTU)
as defined by Ise Cupcnim Municipal Code,Chi 9.12,ars!the DeeIN and Safety
Code,Section 3532(a)9 HEATING UNIT(OVER IIXkIXID BTU)
El Y,1 No PAID
VENTILATION FAN(SINGLP,RESIII) Date ReceiplM
Will do applicant or ftuum WHi ing occupant use eq.pl t or devices which
mit has at,cumeminama m defined by Nc 8,A,.An Q.Iil,Isanugemrnl BOILER-COMP CUP OR 100.00(I BTU) TOUAL
DiurEvy BOILER-COMP(OVER 100,0!10 BTU)
E]Y,
I have mod tW hvarsons"Inlrals r aimncros oncli(T ,Acr 695 of the Cob AIR CONDIT'IONF,R ISSUANCE DAIE
forma Hdi t Safmy Cade.Scai.n,255115.255)3 and 255311 understood Own if Nc NEW RFSIDEN'I'IAL MUCH SQ EL,
Wilding vcumn0ytwveanemnt.Nat'nivmYmslumsihillrymmufyNeaayunl Z^��'�a.�
.rile nuwhich mnslW dict proru'uwarcc of•Ccnifcste OOccupurcy. �{'�
IT.umme em Dese TOTAL ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: chrietya
Sec: Twp: Rng: Slab: Elk: Lot:37509048.00
INVOICE DATE.. . . . . : 01/28/3000
REFERENCE ID 4 . . .: 00010164
SITE ADDRESS .....: 10466 TANTAU AVENUE
SUBDIVISION .......
CITY .. . ... .......: CUPERTINO
IMPACT AREA .......
OWNER . . . ......... :
ADDRESS . .. .......: BRAHMAJA, POLU
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR .......: WARREN, HENRY LIC N 20719
COMPANY . .........: ABSOLUTELY WATER HEATERS
ADDRESS . .........: 191 PADDON PL
CITY/STATE/ZIP ... : MARINA, CA 93933
TELEPHONE ........ : (831)384-5133
FEE DESCRIPTION CHIC TOTAL FEE PAID-TO-DATE BALANCE DUE
BPWHEATER P 9.99 0.00 9.99
PPERMITFEE P 35.52 0.00 35.52
_____ ___________
45.51 0.00 45.51
V ID -___--- DESCRIPTION----__--_ VOICE ID -DESCRIPTION
. _• ........ ....... ..............
SEWER 4 WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB 6 OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING