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99120082 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 4 90 9 2-[TV OF CUPERTINO eoaDING-ELECTRICAL. , PEM No. 'BUILDING DIVISION APPLICATIONIPERMIT PLUMPING-MECHANICAL BUILDING PROJECT IDENTIFICATION PUILDINGADDR 5. SANITARYNU. APPLICATION SUBMITTAL DATE /© Z 21 -i3-sP VINES'S NAME: PRONE: LIC NO: ✓ �� / NI /"o WC CONI'ROLM ,RCHITECf/ENGINEER: LIC NO: pJU$jj, /✓ `5 e•��x ❑ CONTACT PHONE: 7V] BUILDING PERMIT INFO 2 5 ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB ME❑CH Oy O -7 o LTJ/ LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION WO,CEWz with Section/0(10)oro f Division 3ofthe Business and Professions Cade,and my license is RESIDENTIAL' FOO in full face and F t. ^ PERMIT ISSUANCE fed =�G $`rj ❑SFDWL [_1 KITCHEN REMODEL �U j License Class +//��Lick A2 APPLIANCES-RESIDENTIAL ❑ADDITION [I PLUMBING RE-PIPE N46 Ual¢(- ny Cenlmen�-�. HIE DECLARATION []MULTI-UNIT ❑STRUCTURAL z8z �� �my pi�ars 4llfx�k«2d as public records PANr:I.s MODIFICATION oz—� UPT02MAMPS CIN'FURIOR ❑CHIMNIEY REPAIR FyFW Lansed Pmfessianal 201-I000AMPS IMPROVEMENT E]SWIMMING POOLS OWNER-BUILDUR DECLARATION OVER IIKK)AMP$ C1 BATH REMODEVREPAIR ❑DEMOLITION y Q I hereby affirm that 1 am exempt from the Conlrneun's License law for the 3 L U following reason.(Seetion 7031.5,Business and Prefexsiuvs Code:Any city or county SIGNS ELECTRICAL ❑OTHER . W LL Hwhich requires a permit to construct,alter,improve,demolish,or repair any structurex101 Emmen it,issuancealsaacquires theapplicamforsuchpermittoHleasiueedslalvmcm SPECIALCIRCUCOM1SC. jthat be is licensed pursuant o the Previsions of the Contractor's License Law(Chapter 9 .,00 (commencing with Section 700H,f Dividiat 3 of the Business and Professions Cale)or TEMP.MITER OR POLE INST COMMERCIAL d L c y that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION ^y Seclun7031.5 by any applicant for a permitseliects the applicant to a civil penalty of POWER DEVICES 9-TEMpIT ❑FOOD SERVICE b- t more Nan five hundred dollars P6500), IMPROVEMENT , _Q [11.as owner of One property,or my employee..with wages as their sole comprecatinn, SWIMMING POOL ELECTRIC SFCO will do Ne work,tnd Nexuvame isnot intended oroReted Porsalels P ❑OTHER ftL 5 R and Pieicssions cede:The Contractors License Law dues nota caIL property who builds ar impnrves ahcrcon,and wM10 Aoes such work 1 , ugh his own employees,provided Nm such impmvetrtents are not,men re c sale.It,howevaq the building or,mpmvement is sold within one ycaro compleuun, m ��SQfFETE RAR 5/SQ.FT. crbudder will have the h nwhat of pmving that he did not build or imp1-gPin I poseofsale.).po I, f owner of the pmpertY•em exclusively contracting withlieenud FT Im R1 Por OTkL: construct the project(Sec.7010,Baritesand Pmfessinns Cale)The Coease Law does not apply to an owner of property who builds or improveson, Q PTUAN M1 E C 13'�1999 who contracts for such pmject-c with a contracmr(s)lianscd pummuriEhIiiiiiisocillilift Licenu law. I, Imin.moplerderSa. .11h' ve T A N VALUATI Date WORKER'S COMPENSATION DECLARATION PACK FLOW PROTECT.DEVICE 1 herebyyill mai under penalty to perjury,one of the following declensions:Counter' o i] ithaw and a,FmAdesi f..hinecret,,3700 of Convert Code Worker's Comp the DRAINS-FLDOR.0.00E AREA,CONU. STORIP 'I'YPI3 CONS]RUC'TION snout,as provided fpr by Section 3RXI of the Labor Code,for the perfmm�mcc of the work far which this pennon is orker FlXTURES-PCR STETRAP i] 1 have and will maintain Workers Compensation Insurance,as required by Section M,W the lahurCode,ain 'he performance oflhe work rabic This permn iss�u ad� GAS•-F:A,SYSTEM-OVEROa ASYSTEM- TLIffS OCQ GROUP ��Pt-}�O My Worker' o penseti In ncec 'c and Poli 2 L. Canicc am Policy N .: RtIFlC O OF COMPENSATION NS FROM WORKERS GREASUINDUSTRL WASTE INTERCEPTOR �— COMPfiNSATIONINSURANCE BUILDING DIVISION FEES (Thos section need not be completed ifthepermit is furore hundred dollars($100) GREASETRAP m less.) PhANCHIECK IEE Ianify flim in the p¢rfomnmaeof the work fimsmch this permit is issued,I shall SEWER-SANITARY-STORM EA.200 IT. not employ any pecan in any manner so as mec bomsubject m N e subjee Workers'Compen- ENERGY FLEE ZZ cation laws of California.Dale WATER HEATER W/VENf/ELECIR 0 Applicant I GRADING FEE y NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should WATER SYSTEMITREATING a ; homes,subject In the Worker's Compensation previsions of the Labor Calc.you must SOILS FEE HJfoMwith comply wi@such provisions or this permilshall bmre Ise deemed revoked WATER SERVICE Q .a7Z CONSTRUCTION LENDING AGENCY NI,W RESIDENTIAL FUME. SQ.FT. PAID Dote Rcaipt# LJ 2I hereby nRrm Net there is a construction lending agency for the performance of the work for which this permit is issued(Sec97.30Civ,C.) 0 h Lenders No 'TOTAL: 0. I<ndcr'x AdNees TOTAL: BUILDING FEE! Ft'' I certify that 1 have rad city and ceen and sat¢ordinances the above information is rn burrshlegreetucompedweed all udiend coamyoedfives of and stem lawsrelatedupon the QTy, MECHANICAh PERMIT FEE U z building comwclion,and hereby authorize reprewntnives of this city to enter upon Ne SEISMIC FEE answ,ur enlioncd pmperty for inspection purposes. PERMIT ISSUANCE (We)agree N save,indemnify and keep himaless the City of Cupertino against ELECTRIC FEE liabilities,judgments,costs and expenses which may in any way accrue against said City ALTERORADDTOMECH. in consequence of the granting of this permit. PLUMPING FEF, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,0110 CFM) S HEULATIONS. Aele MECHANICAL FEE AIR HANDLING UNIT IBM)CFM) CONSTRUCTION TAX pl cant/Comactor Date EXHAUST HOOU(WIDUCI') HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE applicant or future building occupant store or handle hawdivm material HEATING UNIT(TO 101.000 BTU) e Cupertino Municipal Code,Chapter 9.12,and the Health and Safety 5532(a)? HEATING UNIT(OVER 100,00 BTU) ❑Yes ❑No VENTILATION PAN(SINGLE RESID) PAID Date ReceiptN Will the applicantoaoffmure building occupantyAea use Air ent Quordeviceswhich BOILER-COMP(3HPOR 1011,08)BTU) emir hazardous air conferment s as defined by the Buy Arca Air Quality Management t TOl'AL: District? BOILER-COMP(OVER 100,000 BTU) ❑Yes ❑No I have mad the"m eme;materials requtrementc under Chapter 6.95 of the Cali- AIR CONDITIONER / ISSUANCE DATE Epm,a Health Se Safely Coe.SvedPm 25505,25533 and 25534.I understand that if the NEW RESIDENTIAL MECH. $Q.IT. Wildingdoes not currently have a tenant thm it' y Ronsibilirymnaify devempant FI mens whichmustbe Ipn cafu Certifiare of(keupac re I � i armor ,agent Date TOTAL: ISSUED BY: \ F� OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: chriatya Sec: Twp:' Rng: Sub: Elk: Lot:35720022.00 INVOICE DATE......: 12/13/1999 REFERENCE ID N 99120082 SITE ADDRESS .....: 10240 BUBB RD SUBDIVISION ...... . CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: HOVER ELIZABETH B AND WADE H E ADDRESS ..........: CITY/STATE/ZIP ...: LOS GATOS CA, CA 95032-6916 CONTRACTOR ....... : LIC N COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ... TELEPHONE ........: FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE _______________ ___ --------- ------------ ___---__--- BPGAS P 4.44 0.00 4.44 BUSLIC P 90.00 0.00 90.00 PPERMITFEE P 35.52 0.00 35.52 _________ ____________ ___________ 129.96 0.00 129.96 ''J6ID 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