00010170APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY (!90010/7 O
CITY OF CUPERTINO BUILDING - ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL
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CONTACT:
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Sell inn'111Uf) of Division 3 ufnce Business and Pmfcsaiona C'We, and my Ilcnnsc is
in full force and elf �] 21
License '1: - -� Lie I /
Dolej6 Comraemr
ARCHITIiCI'S I3ECLARATIf tV
1 understand my plans shall be used us public records
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Comfacons, Locr,a Law for Ow
following reason. (Section 7031.5, Business and Professions Cade: Any city or county
which requires a permit to rnnsuua, cher, improve, demolish, or repair any summit,
prior u) its issuance, also requires the applicant forsuch perient file a%ignetl,element
that he is licensed pursuant the provisions of the Completots License law (Chapter 9
fcommenei ng with Section 9180) of Division 3 of the Bust ncss nod Profceaioas Code) ar
that he is exempt therefrom and the basis far the alleged exemption. Any violation of
Section )nils by any applicant for a strict subjects the applicant to a civil penalty of
not more than Bit so hundred dollars (SS(10).
❑ I. is owner of the property. or my employees with wages as their sole compensation.
will it,, the work, and they adore snot tmcndcdoroffered for Vale (See 9044. Business
and Professions Code: The Contractor's License law does not apply n an owner of
property who builds or improves thereon, and who does such work himself or mnugh
his own employees, provided that such improvements are not intended or offered for
w1e. If, however, the building or improvement is sold within one year ofcompletion, the
owner -builder will have the burden of proving that he did not build or improve for pur-
pom of sale.).
❑ I, w owner of the propen , am exclusively rmnme,iog with I c omed contractors to
commoner the project ISce.'OHd. Business pad Professions Code:) The Contractor's Li -
se Use docs ant apply ro an nwaer of progeny who builds nr in,pf..c, meteors. and
wl u contracts for such pmijmn with it communist licensed pursuant o the Comment's
License law.
D Ian exempt under Sec. , li k P C for Ibis reason
Dam
WORKER S COMPENSATION DECLARATION
I hereby aRirm under penalty of Perjury one of the following dedamtlons:
❑ IIII and will maintain o CertificanofConsenuoself-insurelmWorkers Cement-
sation, as provided for by Section 3700 of the Labor Cade, for the performance of the
jnk for which this pemtir I Issued.
yp I have and will maintain Workers Compensation Insuranre, as required by Section
_ 700 of the L.No CMe)forthe peibmartacu of me work for which this penin is issued.
My W,rkc/s C,ju, lonImu mrd.4wilLnd Pollcvnumber me_ —1.—
❑ Consultant Fees Paid by Applicant (Initial)
)TY ELECTRIC PERMIT FEE
PERMIT ISSUANCE
APPLIANCES - RESIDENTIAL
PANELS
UPT02MAMPS
21)1-1010JAMPS
OVER IIXp AMPS
SIGNS ELECTRICAL.
�r SPECIAL CIRCUIT/MISC.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thin section need not he completed if the permit is for one hundred dallau SUB)
or less.)
1 certify that in the perfonnence ofine work for which this permit i.a issued, 1 shall
not employ any person in any rammer se as m become subject to the Workers' Coni
O z cation Laws of California. Date
z Applicant
N
NOTICE '1 O APPLICANT: If, after making this Certificate of Essingtinn, you should
a; Mame subject it, the Workc, 's Co,npealcom provisions of the Labor Code, gnu mus,
forthwith comply whh such provisions,, this .if shall be deemed resold
CONSTRUCTION LENDING AGENCY
V Q work
vv rl his
that there isoco (Set. 3n lending agency fur the pcdummnce of
U Under', ,r whicti oris ryrmit is issued (Sec. Jn9l, Civ. C.)
C..1 Lender's Name
�y LenJcfs Address
F p, I certify,hat 1 have read this application and s,am thin the shove iromantion u
h cornet. 1 agree In comply with all city and county ordinances and state laws relating to QTY
V building construction, and hereby amhurire repniaeneroves of this city to enter upon the
above-mentioned progeny for inspection purposes.
(We) agree m save, indemnify and keep hamdcss,he City of Cape lint) against
hahili,ies.judgmenis, costs and expenses which may in any way accord against mid City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE Rk;G t gT10N$.
�4-7Ov
Signature of Al hcenUContmaor ])ate
HAZARDOUS MATERIALS DISCLOSURE I
Will the applicant or f dare (wilding occupant store or handle hazmdnu. material
as defined by ,he Cupenion Municipal Code, Chapoir 9.12, and ,he Health end Safety
,mWodq Semi25532(al^.
,%
❑Yes ED No
Will the applicant or future building occupant use equipment or devices which
ii harardoas air eonwntinuns as defined by the Bay Area Air Quality Management
Uis,ricf.'
FT Y" C] No
I have read ,he ha ardous materials requirements under Chapter 6.95 of the Celi-
fomia Ilculth k Safety Cabo, Sections 25505, 25533 and 25531,1 understand that it be
Wild ing does ¢urnn0e my have a mount, that it is my respnnsibili,y,on if if nccupam
ofthc art' w Leh nat, pdnno ixsu'na,fv Cenifnn oyTykeup.�icy
C
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BUILDING PERMIT INFO
B— % ELECT PLUM$. MECH
JOB UESCRIP'I'ION
N 1
POWER DEVICES
FDWL
fS1
❑ KITCHEN REMODEL
❑ADDITION
13 PLUMBING RE -PIPE
❑ MULTI -UNIT
❑ STRUCTURAL
$ISQ. F1'.
MODIFICATION
❑ INTERIOR
❑ CHIMNEY REPAIR
IMPROVEMENT [ISWIMMING POOLS
El BATH REM
EIIREPAIR DO OLITON
❑OTHER
0 Jdow)
Q
c. 3.5 Tm's_,
TEMP. METER OR POLE INST.
COMMERCIAL
❑NEW BLDG/ADDITION El DEMOLITION
❑TENANT ❑ FOOD SERVICE
IMPROVEMENT
❑ OTHER
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETS - SWITCHES - FIXTURES
N17W RESIDENTIAL F.LECTR S
SQ FT. FLOOR AREA
$ISQ. F1'.
TOI'A .
PLUMBING PERMIT FEE
PERMIT ISSUANCE
ALTER - DRAIN is VIiNT- WATER (EA)
VALUATION
BACK FLOW PROTECT. DEVICE
DRAINS- FLOOR, ROOF. AREA, COND.
STORIES
OCC. GROUP
TYPE CONSTRUCTION
APN
FIXTURES - PER TRAP
GAS -EA.SYSTEM-I INC. J OUTLETS
GAS -EA. SYSTEM -OVER V (EA)
GREASMNDUSTRL WASTE INTERCEPTOR
BUILDING DIVISION FEES
GREASETRAP
PLANCHECK FEE
SEWER - SANITARY - STORM EA. 200 MT
ENERGY PEE
WATER HEATER WHEN `UI.ECTR
GRADING FEE
WATER SYSTEM/TREATING
SOILS FEE
WATER SERVICE
PAID
NEW RESIDENTIAL PLMIL SQ. FL
Date Rcecipt p
TOTAL
TOTAL:
BUILDING FEE -i l,1, J
'n"
MECHANICAL PERMIT FEE
SEISMICFEE
ELECTRIC FEB
II 111
PERMIT ISSUANCE.
ALTER OR ADD TO MECH.
PLUMBING FEE
AIR HANDLING UNIT LTO 10,000 CPM)
MECHANICAL FEES
AIR HANDLING UNIT (OVER 10.Wn CFM)
CONSTRUCTION TAX
EXHAUST HOOD (W/DUCT)
HOUSING MITIGATION FEE
HEATING UNIT (TO 101,0() PTU)
HEATING UNIT (OVER 100,000 BTU)
PAID
_
VENTILATION FAN (SINGLE RESID)
BOILER -COMP @HP OR 100.000 BTU)
Dare Receipt W
TOTAL:
(TOILER - COMP LOVER I010I1 BTUJ
AIR CONDITIONER
ISSUANCE DATE
NEW RESIDENTIAL MECH. SQ. FT
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
0 BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Elk: Lot:36206026.00
INVOICE DATE......: 01/28/2000
REFERENCE ID N ...: 00010170
SITE ADDRESS .....: 1171 STAFFORD DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: KITANO DAVID K AND CATHY J
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4968
CONTRACTOR .......:
LEW SNAVELEY LIC # 21610
COMPANY ..........:
DIAL ONE SERVICE CHAMPIONS
ADDRESS ..........:
430 REYNOLDS CIRCLE
CITY/STATE/ZIP ...:
SAN JOSE, CA 95112
TELEPHONE ........:
(408)452-1174
FEE DESCRIPTION
---------------
CHK
TOTAL FEE
PAID -TO -DATE
BPVENT
---
P
---------
8.33
------------
0.00
BREMAIRHAN
P
8.33
0.00
BREMHEAT
P
6.11
0.00
BREISC
P
25.53
0.00
B 'CEPT
P
1.11
0.00
E TFEE
P
35.52
0.00
M':._ ITFEE
P
35.52
0.00
PPERMITFEE
P
35.52
0.00
---------
155.97
------------
0.00
VOICE ID
101
103
105
202
204
301
303
305
307
309
311
501
503
505
507
509
514
CJ
DESCRIPTION
FOUNDATION
UFER
ANCHOR BOLTS
UNDERFLOOR PLUMBING
UNDERFLOOR FRAME
ROUGH PLUMBING
ROUGH MECHANICAL
FRAME
INSULATION
EXTERIOR LATH
SCRATCH COAT
FINAL ELECTRICAL ENERGY
FINAL MECHANICAL ENERGY
FINAL ELECTRICAL
FINAL PLUMBING
FINAL GRADE
FINAL PUBLIC WORKS
VOICE ID
102
104
106
203
205
302
304
306
308
310
313
502
504
506
508
510
BALANCE DUE
8.33
8.33
6.11
25.53
1.11
35.52
35.52
35.52
155.97
DESCRIPTION
PIERS
REBAR
SEWER & WATER
UNDERFLOOR MECHANICAL
UNDERFLOOR INSULATION
TUB & OR SHOWER
ROUGH ELECTRICAL
HOLDOWNS
SHEETROCK
INTERIOR LATH
ROOF NAIL
FINAL PLUMBING ENERGY
FINAL BUILDING ENERGY
GAS TEST
FINAL MECHANICAL
FINAL PLANNING