99090191 (2) 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