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99090191 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY !-el k!/ 0 f q a CITY OF CUPERTINO BUILDING-ELECTRICAL PER TN(l. BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL BUILDING PROJECT IDENTIFICATION BUILDINGADDRESS: SANITARY NO, APPLICATION SUBMITTAL DATE O N•R'S NAMI PHONE \ CONTRACTOR'S NAME: LIC NO: U _ NIC CO ROLM RrIETECTIFNGINEER: LIE NO: ADDRESS/1G/) N O a•V L�/ Li !!�I O 114-546 CONTACT: PHONE: BUILDING PERMIT INFO t ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION El El R 1:1I hereby affirm Thal 1 am licensed under provisions of Chapter 9(commencing QTY ELECTRIC PERMIT FEE JOB DESCRIPTION with Section 901N0ofDivi,lm 3o0nc Bmmae,and Pndcssiom Cale,xnd.,license is X00 PERMIT ISSUANCE RESIDENTIAL - 1­1= in full forte and aUU Liranse C,�LL��ss � Lie. ❑SFDWL ❑KITCHEN REMODEL y¢G Uum A Clear APPLIANCES-RESIDEMIAL ❑ADDITION C1 PLUMBING RF.-PIPE F O w A tCHITE.CPS DECLARATION PANELS 0 MULTI-UNIT 0 STRUCTURAL Z O y Z 1 understand my plans shall be used as public records MODIFICATION UP TO 200 AMPS -1 INTERIOR El CHIMNEY REPAIR IA LiccnscA Prnfecvional 201_1000AMPS IMPROVEMENT SWIMMING POOLS OWNER-BUILDER DECLARATION OVER labor AMPS 0 BATH REMODEUREPAIR 0DEMOLITION 2 Q 1 hereby affirm that 1 am exem,from the Contmaor's aLicense., Law for the 3 4 F- following rano..(Section 91ou,w Huainan and Prrfderm,ls Calc:Any city nr county SIGNS ELECTRICAL []OTHER Uwhich rtym uc a cidw,to asmtrom,alter,improve dem.if 1 a repair tory struaurc C prior to its issuance,also requites the applicant for soon pcimit m files signed zmlemem �; SPECIAL CIRNIT/MISC. I n (hat lie incingwitpursmnl lu the ofDwirnxof the Cousins ndProflzw(ChaptersCodr) 9 W vt (commencing with Section 9dp)rf Division3 r[tbe Business and Profcxsions Code)or 1'I?MP.METER OR POLE INST. COMMERCIAL a X,y mal he is exempt therefrom and the basis for the alleged exemption.Any violation of 0 NEW BLDGIADDITION D DEMOLITION _m Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES 0TENANT DFOOD SERVICE not marc man five hundred dollars($500). �5Q Q I,as rwnerorthe prrpcnYor my employees with wages as their sols compunsntion, SWIMMING POOL ELECTRIC IMPROVEMENT Fy1Fo _H do the work.and the amaure is not intended mothered for sale(St .1641 Business ❑OTHER aim and Professions Code:The Contractor's License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES properly who builds or irr,i thereon,and who does such work himvelf or drought his own employees,provided that such improvements um snot intended or offered for NEW RESIDENTIAL F,LECTR SQ sale.If,however.the building or Improvement is sold wimiwmw year ofoomplenon,the ;.Q-FT PLOORIAREA $ISO FL owner-builder x'ill have the burden of proving that hn e did m build nr improve pve for par- /z \ xl rsof sale), D /JZ1 1,as owner at the progeny,am exclusively contracting with licensed contractors so T T ". consumerthe projccl(Sec.7044,Business and Pro essio r,Codu)'I he Contractor's LI fC cens,Law does not apply to an owner of properly%in build%or naprovcv thereon,and QTY. PLUMBING PERMIT E• SEp 2 91939 ,I „ who contracts dr such projects with a crotractims)licensed pursuant to(be Commmor's L s License Law. PERMIT ISSUANCE. ❑1 am seen,ander See. ,B&P C for this reason AL9ER-IIRAIN&VENT-WATEEA)R AJfre, WORKIR'S COM PRNSATIOK DECLARATION BACK PLOW PROTECT.DEVICE I beach,affirm under pewllyof perjury one of the following declaration:I have and will maintain a Certificate w Consent to self-insum for Worker's Crmpen- DRAINS-FLOOR,ROOF,AREA,CONE.re,as provided for by Section 3900 of the Labor Code,for the performance of the STORIES work for which this pennn ix issues. FIXTURES-PER TRAP 1 have and will maintain W�rker's Cmer,r safiun Insurance,as r tan d by Section lb of the Labor pCpppodd�ee,aW,Yfppoqrr thppeWWpeffo�rnaknce of rhe work sy ffporaRwhich vgthis permit is issued. GAS-ITA.SYSTEM-I INC.s OUTLETS OCC.GROUP APN Al..:A (JIU�cmrrPoICYNh It:5 RO�)IRTIQ GAS-EA.SYSTEM-0OVER CERTIFICATE OF EXEMPTION FROMWORKER$' . COMPENSATION INSURANCE I GRI!ASIDINDUSTRL WASTE INTERCEPTOR (Thix xselam need.Ibecompleted ifthe permit is for one hundred doll ar 111W) BUILDING DIVISION FEES nr less) I GkGSE TRAP PLANCHECK FEE Ieenify that the perforan,wtoance ofthe me,I. ,twenkfne which Into pen mlisisxC...sball SEWER-SANITARY-STORM EA.20d)FT. not employ any person in any manner sr vs to acetonesuhjml to the Workers'Gmtpen" ENERGY FEE z z morn Laws lila yI WATER HEATER WNENTIELEC'IR 0 Applicum +�i`n Z rr L / GRADING FGE became TO d to the ANTWw IL Compebe fter akmg this Cc;uricwnionsxte of E Labor io de,y .umostraild WATER SYSTEhVI'kEATING UJ > became subject w the Workers vests or this provisions of the Lahr Crede,you must SOILS FEE forthwith comply with such provisions nr this permit shall M Jectlrcd revoke). WATER SERVICE 0. Q Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL.PLMB. SQ,FT. PAID L) p I hereby ffiIinnthat ernaniissued(Se30 lending agency for performance of Dam Reccipip 4 the weds for which this permit is toned(Sea.311)].Civ.C.) Lender's Name `� L) Lender's Address TOTAL: VCONSTRU�IONTAX T4 I certify that I have read Ihis application and state that the abwe information is Erp atecct lagrte mu,enply wim all shy and county ardinancen and.ante law.rclrving t" QTY MECHANICAL PERMIT PEEZ building construction,and hereby aahoriz reprsentatives of Ihis city to enter upon the above chaut d pro rIy GPERMIT 115I1ANCE(We)agme R a ,indemnify trod keep hamilsss me Citof Cuurtinn auiuvl Elidcmc .ceng1.T[R Ok AG TO MLCH.mncaluen' the W EL'APPLICA N SCOMPLY WITH ALL NON-POINT AIR HANDLING UNIT(To I g00o CFM)SOUE ;GU. IOL FEEAIR HANDLING UNIT(OVER I QWO CFM) ON TAX e 1q,p 'caHAZ moor Dale EXHA UST HOOD(W/DUC1) HAZARDOUS iange rocs DISCLOSURE HOUSING MITIGATION FEE Will y'he Cimemerfulurebuildmgxec hanlr9,12.handlh eaNnuto Safe,, HEATING UNIT(TO IIXI.fIDp BTU) C defined by the Cupertino Municipal Cade,Chapter 9.12,and me Health and Svfety CWc.Section 15532(x)^. HEATING UNIT LOVER II10,000 IiTU) ❑Yes �Alxr VIiMI'ILA'TION FAN SINGLE RESID) PAID Nmithe x liccaenrum a building pan Area n Date RtteiPtk pp grccu lu.ace ter devices which gO1LER-COMP CHIP IBB,IXIO BTU toll heeuNous air ,conlaminuna m'JcfineU by the Bay Arca Air Quality Management ( ) Drstriel^ TOTAL ❑Ycc )(No BOILER-COMP(OVLR IW,WOBTU) I harem the hmaJnus serials rcyuirtments under Chapter h 95 0(me Cali- AIR CONDITIONER ISSUANCE DATE �builifirgd ia Heald Safq� Ic.Scct///111���255115, San unJ 25536.1 undeownJ tam if the NEW RESIDENTIAL M1fECH. $Q.FT n nottGm hmcalc9(nt. amrrtxponsinihtrmtmbrme«apart h t /i( marina ce Treat ore ,��, sed age L11-4 - 17-rte/-I--)att4e-F4-- TOTAL: ISSUED BY: OFFICE CITY OF I 1 of 1 BUILDING PERMITRMIT RRECECE IPT OPERATOR: christya COPY # 1 Ser. Twp: Rng: Sub: Blk: Lot:359111022.00 DATE ISSUED....... : 09/30/1999 RECEIPT #......... : 10199 REFERENCE ID # . .. : 99090191 SITE ADDRESS . ....: 20629 SHELLY DRIVE SUBDIVISION . ...... CITY ......... ....: CUPERTINO IMPACT AREA .. ..... OWNER ............ : YIN, CHUNI ADDRESS .......... : CITY/STATE/ZIP ... : CUPERTINO, CA 95014 1 RECEIVED FROM ....: TIM CONTRACTOR . ......: GILROY, JOHN LIC # 15128 COMPANY ...... . . ..: JUST WATER HEATERS INC ADDRESS ...... . . . .: 1764 NATIONAL AVE CITY/STATE/ZIP . . . : HAYWARD, CA 94545 TELEPHONE ..... ... : (510)293-9901 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BPL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00 ITFEE FLAT RATE 1.00 35.52 0.00 ------0.00 35.52 ------ PERMIT 45.51 0.00 45.51 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- __ -------___-------_ CHECK 45.51 3027 TOTAL RECEIPT . 45.51 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING