00040013 CITY OF CUPERTINO • + 111117 NO.
BUILDING DIVISION PERMIT; CONTRACTOR INFORMATION-
BUILDING ADDRESS. -
r!V7l /P T•.�GJy'a+p• '/I!�s /�V 1/13 SANITARY NO �I A�PW P Lgy`rI�C A�TI/
I(ON SSUB�M ITT/A•L DATE
LI,- . -5 7
OW SNAMC. '
` .$` =_teJL- Wd^n L'lt.P9{�j✓v C7 NIC •CONTROLO
f<CNITIiCT GINF,ER 'OAS ' l9 t 0 - I HOLDING I'BRMI'r INFO
HZUi
III Z o H i LICENSED CONTRACTOR'S DECLARATION
I o z-� 1 nerebr,lean,gnat Lm hansed Bona Povismnna nr @agef 9 mommarmcine ' `. ' Job Description ,
F=I-J •with Smbon)000)ofDi 3of theBUnnuA amq Ro&anon Code.aril myliunse l[ ,a
6o4infillforea,end<Re ( �.r/�49 C'5
SS rrGG YvLar Cl9w_ _ Vim. ,g n
;a Date Co.(,�— =Z 'Z—COnwcrw iD" 1j/d P��• P
k• C eJ , ARC he use DECLARAII N
I y- I undemerW mY Plans a HI W used w CLA ATKFN JIQ!•,gJl pL�b_(yl=~•,`psi/
f• C Licanied Pro(ewional. '
OWNER-BUILDER DECLARATION ,
C Z Q 1 bereb,aRrm Nn 1 con wempt from Ne ContruroY.Lear.Lew for the
2=0 following meson(Sclum 7031.5.Business and Prok iia..Cade:A,,,,,.cnunsy
$ which rcquues a Permit n construct,afar.improve,demoheb,or span my stmnwe S Ft. Floor Area Valuation
priory O'rauanca,also regmms thaappl,cam fwsuch Person to file.sigradantement q: %' n
Nat be is liaasedpormmta,that prorwmsoftbe COmm�ols Limn.Law(CMgar9 • i ;. r, +. 0UO. r d
(eoi encingwithSm n7W0)ofDivi&ion3afineBasitawatrd fessmw_... . A(P]N,Numbe'r Occupancy Iype
dial he is exempt thveffom and she ban for the alleged exemption.Any violmoss Of I, 7 1
Secuon 7031.5 by any applicant far a permit subjects she appliant to a Bmvd penalty Of
not mesa than five hundred dollars(SS00).
1,.owner of the propertyor any cmployeas with wages u dsrsola campanwtion, Required Inspections -
w0ldothewnrk,aril theamciurc is non rmcMedmoRcrtd far ae(Sec]OOC,Buma. ,
Add Professions Code:The Contractor's License Law does not apply to m,.,of -
Property who builds of m ya,i thence,and who does such wort himself m through 1
his own employees,pmnded that such impruvemenu ere nw mnanded Or Sand for '
We.If,howevm the Wilding Or improvement is mid within one year of mmplelion.the "
owner-Wilder will have the burden of Provme that W did nos Wild or improve far par-
pose a sale)
❑1,As u t the el the See 701,.m sines,Add ftidescung who beanies!conmoosa i.
construct the profit(See )041,eusinesa aril Professions Codeb The s!CM C 10
tense law does WE apply to an owner of property who builds m improves tWreon,cod
who contracts for such pojmu with aconuactorlsl iicenfed puwuani to the CBnmctWe
License Law, '
Iomeacrodurs Son. .B&PC forthis nano -
Owner • ' Date +
WORKER'S COMPENSATION DECLARATION -
I M1Cnby"E=dw penally Of perjury one Of do full
owing decimations L
1 Mv<aid will for by ...37Z ofCrnsenuo self-m.nfarWork.e.Compen-
oion.es providW far by Secuon 3]00 of the Labor Code.for the performance Of the
rk for which Nis pemdt is issued -•51
❑I have end will mamlain Worker's Cmipenawion Insensate,es required by Section
3]0001 Wr Code,far the pent.mama of the work far which this pennn isi.ued.
MY Wo npcW A 0.{en ec crantl P011cyn ,
' CERTIFlCATE OP EXEMPTION FROM WORT IS'
COMPENSATION INSURANCE -
-1This sent.need not W completed ifthe pemit is forme hundred dollars($lo) ,
w Ices 1 • ' ' ,
' Iremf Ihatwthe Rormanc Ac.11A ..whichthli
Y Pe pemmtnissued,6hdl ,
net employ any person in my manner m w to Wmme subject io the Worker'Compen_-,
.sauce Lews of Cebfdmie Data t S
Applies`
NOTICE Ib AP.ilia We T:IL Nu missing. C si.A of An LaWr Cast, should
become sub)ep ro the Worh per Companseuis promsmns of the nn df Cade,yes
-
forthwith comply with such provision m this perms shell W decmcd rtvdred ,
ti
CONSTRUCTION LENDING AGENCY
p I hereby eRtmthwtMmis.ued(S continuum 30lerdmg agency far the performance of
the week for which thrs permit s msswd(Son:709],Crv.CJ • r '
t.., 4ndele Na-- -
,v 0( larder's Ad1ro^ '
fs7 a I trolly ihu I nave read Ws application and sea that the above Warroauo t is
Ocorner.I agree to comPly w11h all city and county ordinances wit Ante laws rtlmng to '•, `
budding copse dm,aril hacby amhBnre represenanves of this city to enter upon the
above-mamioned mopeny far inspection purposes
kr E. (We) U.to.;A.indemnity and kecp harmless she City of Cupertino against a. 1
Q f, Labmlites,judgsncnn,costs and expenses which may in my way axisa against mid City -
>s W m consmucmmce of the growing of thdpemmB -
[�
'•U96 APPLICAN r UNDe�ARWUS LMATMALS WI'I If ALL NON POINT
UO -SOURCE RFCULAt
� �{,s W
5�
Smgwnre s�g� pan. ideCLOSURC
Wijby :Cu';mor fu iun Wilding oecupmi rove orMldle haraNOUS mamial Re-rOOfS -
widrfined by the Cupenmo Munici Code,Chapter 9 12,cod the Health and Safety
'Crick,Section 25532,)) Type of Roof
"0 Yes
Will the epPhcsatwr future Wddmg occupant use equipmem or devices which All roofs shall be inspected prior to any roofing material being
nit hawedions air conumimnu w deficit by the Bay Ana Asr Qwlmry Marugament installed. If a roof is installed without first obtaining an inspection
°itritoYea I agree to remove all new materials for inspection. Applicant
' ',Mvertedth n..;:non eaa; rtmmaunder hap 615 olds,�i- understands and will comply.with all non point source•regulations: '
IOmia"Audh&Sucly Code,Sections 2W-,Z533 and 25534.1 understand that if the
Wilding dons 0.Onstridy stem at 1111 my reapomibibly n nosily the cocvpmt
of a min be nuance aft Cendicale of Occupancy
y CJ�i Signature of Applicant Date
Owner ni1luffinAbd.gem pan
' All roof-coverings to be Class"B"or better
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
: '• BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Elk: Lot:35719019.00
INVOICE DATE...... : 04/05/2000
REFERENCE ID N ...: 00040013
SITE ADDRESS .....: 21733 ALCAZAR AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ..... ..
OWNER ............ : DAVID WONG
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO, CA 95014
CONTRACTOR ....... : CARDIA, FRANK L LIC W 612
COMPANY ..........: CUPERTINO PLUMBING
ADDRESS ...... . ...: 10297 S DE ANZA BLV
CITY/STATE/ZIP ... : CUPERTINO, CA 95014
TELEPHONE ........ : (408)283-0618
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- ___ --------- ------------ -----------
BPREPIPE P 8.33 0.00 8.33
BPWHEATER P 9.99 0.00 9.99
PPERMITFEE P 35.52 0.00 35.52
53.84 0.00 53.84
V M IO DESCRIPTION.... ......... VOICE ID DESCRIPTION
... ........ ........ ........7...................
t UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING
9RE,'6'ACU� IAC UNIT >IGCOGCFAd INIE-rANICAL !'
I SA—CMAIHHAN IA/C UNITS <= 10,00CCPM )MECHANICAL
IBRENIFURN ]RELOCATION OF FURNACE IMECHANICAL
1 I IBRENII URNOV P.ELO FURNACE > 1 C STU IMECHANICAL I
IBRE:MINHOOD (INSTALLATION OF HOOD IMECHANICAL I
I BRENIRELOCA RELOCATION OF HOOD MECHANICAL
IBREMREPALT IVENTILATION REPAIR/ALTER HEATING MECHANICAL
BBREMVENSYS SYSTEMS INIECHANICAL!
�� rY�t}iln{ tt INLUMbNU PERMIT ISSUE IPLUMBING If1
)III BNU UL 4EW MULIFAtalLY RES IPLUMBING J
9NUSFD NEW SINGLEFAMILY RES IPLUMBING
I IO$ACKFLOW • ATMOSPHERIC VACUUM IPLUMBING I
I ' BPCESSPOOL CESSPOOL IPLUMBING
I
IBPFIXTURE PBLG FIXTURE PLUMBING I
I 1BPGAS GAS PIPING SYSTEM FEE IPLUMBING I
g IPINTERCEP IND WASTE INTERCEPTOR PLUMBING
SPREPIPE REPIPE OF FIXTURES PLUMBING
IBPSEWAGE ISEWAGE DISPOSAL PLUMBING I
ISPSEWER SEWERS IRUMBING I7
I IBPSPRINK (LAWN SPRINKLER/BACKFLO PLUMBING I
ISPSTORM ISTORM/RAIN WATER PLUMBING
IBPTRAP IKITCHEN TRAP IPLUMBING I
i IBPVENT IAL•T OF DRAIN &VENT PLUMBING I
IBPWATER IINSTALUALTER WATERPIP PLUMBING
/ BPWHEATER WATER.HEATERNENT PLUMBING I
I BPWSVCS IDEVELOPMENT MAINWATERSERVICE IPLUMBING ZDEVAGREE AGREEMENT IPLANNING
ZOIRTM IOIR TENT MAP (PLANNING
I ZFULLHR FULLAPPL BASE+HR PLANNING
ZFULLTM FULL APPL TENT MAP PLANNING
J'NULLUP IFU LLAPPL USE PERMIT ,PLANNING
IZFULLZONE FULLAPPLZONING PLANNING
FZGPAMENO GENERAL PLAN AMEND PLANNING
ZLIMAMEN0 LIMITED AMEND PLANNING I
MTM LIMITED TENT MAP LANNING I
ZUMUP LIMITED APPL USE PERM) JPL"NING I
ZMATEMPUP IMIN AMEND TEMP USEPERM PLANNING
ZMINHILLEX MINOR APPL HILL EXC PLANNING I
IZMINSIGNEX MISC SIGN EXCEPTION PLANNING I
I IZMINTM MINOR APP TENT MAP IPLANNING
ZMINUP MINOR APPL USE PERMIT PLANNING I
ZMISCASA MISC ARCH SITE (PLANNING
ZMISCEXT MISC TM AND UP EXT PLANNING I
ZMISCFENCE MISC FENCE EXCEPTION IPLANNING I
ZMISCGEN MISCELLAPPLGENERAL PLANNING
ZMISCPCINT MISC PC INTERPRETATION r-=ING I
ZSIGN SIGN PERM[ IPLANNING I
ZTEMPSIGN ITEMPORARY SIGN PLANNING I
ZVARIANCE )DIRECTOR VARIANCE PLANNING I
• 2 aft
Ory. it Applicable Fee 10 Fee Description 'Fee Group
I� Itlr c❑ jc-UG PERMIT F=—=—S (BUILDING
1 jBGtONSTAX 16ONSTRUCTION LAX 1BUILDING ,
ISENERGY JENERGY 1BUILDING I
IBENERGYADO ENERGY ADD MULTI ISUILDING I (�
BOVERTIME JINSPECT. ION OVERTINIE IBUILDING
ISTEMPPERM (TEMPORARY BLDG PERMIT BUILDING
BMITIGAT HOUSING MITIGATION FEE ISUILDIING
BPLANCHK PLAN CHECK FEE (BUILDING
SPLANCKAOD PLAN CHECK ADD MULTI BUILDING
H0L,4NCICREP PLAN CHECK REPEAT FEE BUILDING
BREINSPECT I REINSPECTION FEE BUILDING
8SC8LVD SCS SPECIFIC PLAN (BUILDING
18SPEBSEISMICOM SEISMIC COMMERCIAL BUILDING
CIAL BSEISMICRE (SEISMIC FEE RES IBUILDING
SPECIAL INSPECTION 'BUILDING
BSWIM, SWIMMING POOL IBUILDING
ZAODCHG (ADDRESS CHANGE (BUILDING
JEPEHMI7FEE JELEC PERMIT ISSUANCE JELECTRICAL I�
'6ELEbf 0 fELEC 600V <=t00U ELE&IkICAL
IBELEC1001 ELEC 600V>1000A (ELECTRICAL
BELEC200 ELECT SVGS 600V<=200A ELECTRICAL
SNEYMULTI IMULTIFAMILY RES ELECTRICAL
1BREMBUSWAY REMODEL BUSWAYS JELECTRICAL
8REMFIXT (LIGHTING FIXTURES ELECTRICAL
IBREMMISC MISC APPARATUS ELECTRICAL
REMNRAPP REM NON-RES APPLIANCE ELECTRICAL O
ISREMPOLE POLE/PLATFORM FIXTURE ELECTRICAL
IBREMPOWER POWER.DEVICE/APPARATUS ELECTRICAL
SREMRECEPT . RCPTL, SWITCH &OUTLETS ELECTRICAL
IREMODEL'BREMRESAPP RES APPLIANCE JELECTRICAL
IBREMSIGNAD RMOL SIGNS ADD BRANCH ELECTRICAL
SREMSIGNS I REMODEL SIGNS, MARQUEE ELECTRICAL
SREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL
SF&2FAM SINGLE&2 FAMILY 11LECTRICAL
STEMP TEMPORARY POWER JELECTRICAL I
STEMPSVCS ITEMP DIST SVCS ELECTRICAL
II IMPERMITFEE IMECH PERMIT ISSUANCE IMECHANICAL11
fiAP�L� ER OTT DER XPP IANCES Ifv ECAAf ICAL 1111111
13BOILERI BOILER a 100,000 BTU MECHANICAL
SBOILER2 BOILER>100KTO500K BTU MECHANICAL
SSOILER3 BOILER >500K TO 1M STU MECHANICAL
SBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL
BROILERS BOILER> 1.75M BTU MECHANICAL
BREMAPPLI APPLIANCE INSTALL MECHANICAL
BREMHEAT HEATER INSTALLATION MECHANICAL
BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL
BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL
IBMNEWSF&2F NEW SF&2F RES SLOGS (MECHANICAL O
1 oft
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