99070080 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-P,LP,CTIDCAL 1 O,
RUILEHNG DIVISION APPLICATIONIPERMIT PLUMBING.-MECHANICAL O
BUILDING PROJECT IDEVTIRCAnON
BUILDING ADDRESS SANITARY NO. APPLICATION SUBMITTAL DATE
2075/0 1! -Ae �r
TOWN ME: PHONE: /-� CONTRACTqµ��S NAME ^ / 2 3 97 WC CONTROLN
�RC FIECDINGINEER: UCNO: UW! ADDRESESSP:`/�/7 C/�/fJ -lf— J ❑ /T Y
/1a�7 G ///8 ZSR 57� J�i✓�/�.c.yca (l/y
CONTACT: PHONE: BUILDING PERMIT INFO
^ CM6r�� ❑ Consultant Fees Paid by Applicant(Initial) BLDG EO PLUMB MEC
LICENSED CONTRACTORS DEC LA TION QTy FEECTRIC PERMIT FEE S
1 herby our that 1 ant Ibccnsed aver provbsims O per 9(e« us,, JOB DESCRIPTION
O�Z th Scaim](Mp)of lTvisim Jof the Business and Pmfessimns Ods,mJ litttu,is RESIDENTIAL
a0Z w PERMITISSUANCE
�Ly� nfull Teas and fr ❑SFDWL [I KITCHEN REMODEL
LQ.ZW IDucpse OusCmtrcta APPLIANCf•S-RFSIDFNTIpL ❑ADDITION ❑PLUMBING RE-PIPE
y Q n ;I q Q ARCHIIIiCTS 0[CIAR YANIiIS ❑MULTI-UNIT C]STRUC URAL
Z p�Z 1 un ra d mylplec.r shell b<o,ol a public r,", MODIFICATION
OZ—� UP'102WAMPS El INTERIOR ❑CHIMNEY REPAIR
ENI= LwcnsM Pofnnimvl 201-IBIIBAMPS IMPROVEMENT 0SWIMMING POOLS
OWNER-BUILDER DECIARAI'10
C SI OVIIR FWAMPS [I RATE REMODEIJREPAIR El DEMOLITION
Q 1 herchy.elan 1comp Gram the moemr's License law fa
aX O a U follw Eng retrain.(Section
]oJ1.LS.Bu.uttan maidmfr,fec,iaItuCode:AnY city«cue SIGNS ELECTRICAL �OTHfiR
W 3 u ya which requiter•Permit Or consom'.ager,nal mvs.demolish.or repair any swum«e
F'�OJ pnrm io iswam,,alw require the applicant let wchl rmn to file a signo armament SFECIALCIRCUI'1'/MISC.
�y Thu he,licen.Wptrvlantothe provisionsoftheContractor sL,ecnrclsw(Clnpa9
p(p0 (.vnnvrncingwith S,etim]o00)of Division3ofthe Busircv and Plefca,iou,Code)« TFAIR.METER OR POLE INST. COMMERCIAL
a a e c the be is e,cmp thorefmm arW the bais fat the meed exemption.Any.ioW ion of ❑NEW BLDG/ADDRION ❑DEMOLITION
^f- Section 7031.5 by any oppicant for a permit subjects the appbcam or a civil Penalty of VER DEVICES SANT El FOOD SERVICE
n I mart Nan Fi c hrvlrM ddlun V5W).
IMPROVEMENT
Q ❑ I&lase and amsmyamY cm me m withwvgJf a,,re(Sok mnrycnwian. SW' MING P(RII.ELECTR
W C and dnthex.xk,and the umctuto rsmt,FaceN I,i,v& far salolSec.]OSd.Bu.umof C:1 OTHER
L and or,win,
Code:nEhc o es meacro Cedric law duct nm amdy to m owrer V( OU]l.h -SWITCHF_ti- R
hii, a wMt M1uiMis rixvnpove,t such amperes.and da,wch wank himselfo thmugh
salown emplvyccs,ptovihJ r o such omaisnk!w aR rest intutdcd w oITaN forme NEW R[SI IAL ELECiIt
sale.It.ttwe,er.lhe humming«impmvcmcnt ix.wkl within arc yesof c«npktim,thc SO.FT.FLOOR AREA USO.Er.
wbtailda will have the hmdvn of proving that he dad our build or improve tit" e
Pose of sale.).
❑L a owtm np
of rho pcny,am exclusively contracting with beemscri rnnuanon to TIAL
coast.da Pn jm(Sec.7044,Baine,and Pn fesvi.Cade:)no Cmaracmr'v Li-
umw Law duan nor apply loan uwcernl fryeny wbr builds Or intpmvc.r ihcrerm,and QTY. pl'W44 FEE
who catrr'ts for wch Pmleal*wiN a emtmcRx(,)licen.N purwstt to de Cmtrutars
License Lew. PERMIT ISSUAN
I am exanfe umber See. ,B&1'C for this reason
Date
A GCER-DRAIN&VENTE
T-W ER A) VALUATION
our
WORKER COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE
I thereby w of(rm rocker penalty to pepury me of the following dularuionc
Ihave a owmel irradiation etion 37W of Ill Lamm Coalfoaef«Wadromwe of tb- DRAINS-FLWR.RWF.AREA,CO - SNRIEG TYPE CONSI'RUCf10N
smon.werkf r pith that
fPe by Ss i"u J]W of de I�bor Code.for de Pedmretta of the
watt fa which ll Permit is resume FlJ(]1JRFS-PER TRAP
I.rive La willaden I,the
Cm,oOhun .,tor him«pis lradby Saban
37IMlof de WM1or Code,fathelerpxmanttafthewodtirwhichthirpstorm,ix ixruW. CAS-IEA.SYSTEM-1 INC,dOU]I,ITS OCC,GROUP
My N' «r,mment un Invar 7 aryl Policyw e L
Cance Pal icy No.: GAS-EA.SYti 1LM-OVBRd(G)
CE TIFlCATE OF PXEMPIJON FROM WORK:
COMPENSATION INSURANCE GREASMIS DUS'rRL WASTE INTERCEPTOR BUILDING DIVISION FEES
Oris section m l tat be small ifthm,c Permit is From,hurdml cialWs(SIW) GRPASETRAP -
m
les')Oris
FEE
Pttnifytl(atinth< KomnancemfthewtAf(wwhieb thin mnit ini ucd.Lrh I SEWBR-SANITARY-STORMEA.20OFT.
not employ my pmon in rcr mM t ENERGY FEE
C) Z vwim taxa of Celifo • sec WATER
O HEATER W'NEM/BLECTR GRADING FEE
7 Appli<mt
r7 rA NOTICE TO i 1,e . mak ie C tc or Excmpim,yon,h sold W aN SYSTF I/ T N
burse subject to the niter's Cnmpenution Pcovisiwu d the I.ahmr Code.yw must SOILS FEE
fort campy with such srai,iom m this Pena hall bed oomil n,'DaL W',
7 z CONSTRUCIIONLENDING AGENCY NE Ian ChOC Com D
Phtt,byaffnn that thee,is a cunrwetion kon,mg agency f«the lcrfanturre of /M1��..a.a.a �/. Disc RcttiptN
U. — the wok fa which this permit is i,wd(See.709),Civ C.) or Owner able
O 1- 1-cnda's Name s( /a_.�a I TOTAL:
I,endeh AJdrf.0 I for CORetS� adcft
�"' C 1 cmifY tbu lluv<�ead this applicuim earl ease the Ue above imfmmuion i, ^ B DI FEE
F' h crrcct.I agree m comply with all city sed cmntY adinarca orad vote las rtluing m QTY. Oml98*t QK1vrWi5"S n FEE
V z beildingeorsmctim,and hereby nwhmrim tc,o cmunivcv orlos city mcnwtccupmthc SEISMICV
alm,,mentiomd prol for ins,,coim pvp a,,, wnpma Blue
(We)agree to save,imdemmdy and keep hermle,the City 4C.,..againu �a�� F.f.ECfRIC
IiaMlities.jwlgmrni,.co,t,mat expense which may in my way amue agamt vim City AL I VI W MM V UP
in cvnrcyuaret Of the Counting of thin pe mit. PLUMBING FEF,
APPLICANT UNDERSTANDSV ILL C07"',
OMP, WITH ALL NON-POI ALIT HANDLINGU OIN, - p MECHANICAL FF.
SOURCEREG P
CONSTRUCTION TA
Signature tdApplicmt/Cmtns Ion Dani, Ex LISTH( DW/DUC) `l HOUSINGMITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the m
amlict to future bribing acupant stemor handle haaslou,materiel HG W.
as&:fired by the Cupcnino Munieipd Gdu.CLaNer 9.12,and the Ilcalth earl saffty
Rat,Seamon 255J21a)t 11 (OVER IW,O(X]tlTU)
❑Yes ONO VENTILAHON FAN(SINGLE RFSIDI PAID - -
Dale Racy,N
Will the appllcmt or future huilding«cupam use colui,r cm or deviecs which BOILER-COMP(JHP OR I W,tlEo BTU) M-s�
out larr u,av contamical a+dcOncd by the Bay Arta Air Qwliry Mm.eramt TOTAL' W
DmnnP BOILER-COMP(OVER IM.000 BTU)
❑Va ❑NO
I re a read the markers maviab, AIR CONDITIONER ISSUANCE DATE
repuirttmm order CM1apv(x95 of the Cdi-
famia Health&Safety Carlo.Sections 35505,2553]amb 255W.1 tadavamb that if NEW RESIDENTIAL.MF,CEI. SO EE J
bubNine mite out Ctumntl lawns.than tyre,pmsiMlirymnu ifY thea
nl the muprior ae Vin CC ill Oavpo C G_Y
prier ra z agrnt a TOTAL ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT'INVOICE OPERATOR: chrietya
Sec: Twp: RnS: Sub: Blk: Lot:3261047.00
INVOICE DATE...... : 08/04/1999
REFERENCE ID # ... : 99070080
SITE ADDRESS ..... : 20740 VALLEY GREEN DR
SUBDIVISION ...... .
CITY ......... . . . . : CUPERTINO
IMPACT AREA ... . . . .
OWNER ........ . . .. : SOBRATO/APPLE
ADDRESS ... .. . . ...:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR . . . .. ..: LIC #
COMPANY ... . . .....:
ADDRESS . . . .......:
CITY/STATE/ZIP .... ,
TELEPHONE . .......:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ ___ _________ ------------ ___________
BTEMPPERM P 200.00 200.00 0.00
_________ ____________ ___________
200.00 200.00 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
FOUNDATION 102 PIERS
.1103 LIFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMEING 203 UNDERFLOOR MECHANICAL
204 UNDERFLDOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB 6 OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETRGCK
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 GIS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
509 FINAL GRADE 510 FINAL PLANNING
514 FINAL PUBLIC WORKS