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04080008 CI'T'Y OF CUPERTINO 7 K- ," %m M>`W �"` y "^�t'e" ' . 'r`z""' BUILDING DIVISION PERMIT i50NTkM,;t0IRINF�,®RMAT ON ,' BUILDING ADDRESS: PERMIT N0. FISCHER PLUMBING & CONST 04080008 OWNER'S NAME: PERMR MUO DATE E: SANITARY OL N0. ARCHITEC(ENGINEER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 uo0 LICENSED CONTRACTOR'S DECLARATION .r,,,,,,,,yyyy����ffr1���� Qrp� C I hereby,form than l am limnud under provisions I Chapter 9l my I Ging / L � e I g lff'a� _ UU6 withEccsion]fKYJ)of D' ion Sof NC Businusand Prufcssin end my limmoo, 4 n faB foroe a-d335?j� Sq ueeraeel a REPAIR BATHRM WAL N K—p Da¢ Cuatracm 5r! of G,..! ARCNUTECI'S DECLARATION OCT / L^004 �i I undersand my Plass shall W used u co public mt& to On6 3pti Licensed Professional g OWNER-BUILDER exempt DE Ce Conn DN BUILDIp �� a I 1 hereby reaso ,(tion Not 11. exempt(rum the Cnnuns Co License Law for the N p o following reason,permit t RDLS,Business and n,de nm Code:Any city or county K m which requires a permit re conswct altar,imprr such demolish,or repair any tamctmc w—'^ prior to its issuance,also requires she applicant for such permiuu Olc,signed statement that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq,Ft. Floor Area Valu tlGn � $ (commencing with Section 7")of Division or the Business and Professions Code)of that he a exempt therefrom and Ne basis for the ellcgcd exemption.Any violation of Section 1031.3 by any applicant for a permit subjects the applicant m s civil penalty of g I 3gtgier00 - - Occupancy Type nos mom than Eve hundred dollars(S500). , 0 I,u owner of the property,or my employees with wages As their=to compensation, will do Ne work-and Ne structure or not intended or offered for sale(See,ION,Business and Pretenders Code:The Conuacter's Li«ve Law does om Appy to an Owner Of Required Inspections property who builds Or impraes theropn,and who dmsauch work himself ordrrough his Own employees,provided that such imprisonments are not intended Or offered fmsale If, h .Ne building or improvement ie sold within One yeti of completion,Ne awf buuilderilder will hese the When of proving that Mdid not Wild or improve for purpose e of tile.). 0 1,As owner of Ne propeny,am eselusively contracting with licensed contractors to construct the project(Sec.70,14,Business and Professions Code:)The Contractor's Li. cense Law does not apply in an owner of property who Wilda or improves thereon,and who contracts Tor such projects with a comncmr(s)licensed pursuant in thc Contractor's License Law. 0 I am exempt under Sec. ,B A P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION - I hereby arm under penalty of perjury one of Ne following dedmilimns: Mn m and will maintain a CeruOnof Cement to ulf-Wum fer Worker'sCapron- on,As provided for by Sedan 3900 of to Labor Code.for the performance of the work for which this permit is issued. 0 1 have and will maintain Wml i Compensation Insunru,As required by Section 17Wof Ne Labor Code,far the performance of Ne work for which this fiction,,I,issued. My Wmke n pe don surancc eaa=cr and Policy numbrWf�M.lo9/6>3 . Cvnier. Policy NO.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (TBU uminn need mi to mmplemd irthe iamamn B fm one bundmC dnllara(1110) or less.) I certify that in the perforromee of the work for which this Permit is issued.I shall not employ any person in any manncrao as to become subject u the Workers'Compensation Laws or Califomia.Data Applicant NOTICE TO APPLICANT:If,arm,meting Of.Comrimm of Exemption,you should become subject m duc Worker's Compcwtian provisions of the Laher Code,you must .,O forthwith comply with such provisions or this permit shall be deemed momked. . z" CONSTRUCTION LENDING AGENCY [-t taw I hereby affirm Nat them is a construction lending agency the perfurmance of the work for which this permit is issued(Sec,d097,Civ.C.) Wh Q tondo's Name D z Lender's Address U 0 1 certify that I have read this application and sore that Ne about information is lL,F correct 1 agree to comply with all city and county ordinances and stem laws relating to O V building construction,and hereby authorim mprrsemati s or Nis city to enter upon the LQ Nwomcmitim:d pmpcdy(a,inspection Purposes. G (We)agree to save,indemnify and keep harmless the City of Cupertino against pp liabilities.judgments,casts Andexpcosas which may in any way accmc agaimi said City U Z in consequence or Ne granting Of this permit ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOIT Issued by: Date SOURCZU O /1 Re-roofs Signaarc Ap,1wamnCmmoumr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store erhandle hawdous material as defined by the Cupertino Man pal Code,Chapter 9.13,and Ne Health and Safety Code.Section 25532(a)? �j/ All roofs shall be inspected prior to any roofing material being installed. 0 Yes NO Will rhe applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove I ha>ard^m air conmminanM crsncd by the Bay Arca Air Quality Management all new materials for inspection. Rin? ❑Yes Nu I have madtheloneird mamrials re uirtmcnu under Chepmr 695 of the Califor- ` ria HcalN kSafety Cadc,Satias:N5. JanJ 255]6.1 unJcrsuM BatiftM Wilding dcea nm cunendy M1mc a reran, remonsihility m notify Bw occupant more -\ requimermuwhichm WmeI dameofaCeniacateofeuF J 1 Signature of Applicant Date G� owner or mum 'W ageri Dore All roof coverings to be Class "B"or better CI'T'Y OF CUPERTINO 7 K- ," %m M>`W �"` y "^�t'e" ' . 'r`z""' BUILDING DIVISION PERMIT i50NTkM,;t0IRINF�,®RMAT ON ,' BUILDING ADDRESS: PERMIT N0. FISCHER PLUMBING & CONST 04080008 OWNER'S NAME: PERMR MUO DATE E: SANITARY OL N0. ARCHITEC(ENGINEER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 uo0 LICENSED CONTRACTOR'S DECLARATION .r,,,,,,,,yyyy����ffr1���� Qrp� C I hereby,form than l am limnud under provisions I Chapter 9l my I Ging / L � e I g lff'a� _ UU6 withEccsion]fKYJ)of D' ion Sof NC Businusand Prufcssin end my limmoo, 4 n faB foroe a-d335?j� Sq ueeraeel a REPAIR BATHRM WAL N K—p Da¢ Cuatracm 5r! of G,..! ARCNUTECI'S DECLARATION OCT / L^004 �i I undersand my Plass shall W used u co public mt& to On6 3pti Licensed Professional g OWNER-BUILDER exempt DE Ce Conn DN BUILDIp �� a I 1 hereby reaso ,(tion Not 11. exempt(rum the Cnnuns Co License Law for the N p o following reason,permit t RDLS,Business and n,de nm Code:Any city or county K m which requires a permit re conswct altar,imprr such demolish,or repair any tamctmc w—'^ prior to its issuance,also requires she applicant for such permiuu Olc,signed statement that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq,Ft. Floor Area Valu tlGn � $ (commencing with Section 7")of Division or the Business and Professions Code)of that he a exempt therefrom and Ne basis for the ellcgcd exemption.Any violation of Section 1031.3 by any applicant for a permit subjects the applicant m s civil penalty of g I 3gtgier00 - - Occupancy Type nos mom than Eve hundred dollars(S500). , 0 I,u owner of the property,or my employees with wages As their=to compensation, will do Ne work-and Ne structure or not intended or offered for sale(See,ION,Business and Pretenders Code:The Conuacter's Li«ve Law does om Appy to an Owner Of Required Inspections property who builds Or impraes theropn,and who dmsauch work himself ordrrough his Own employees,provided that such imprisonments are not intended Or offered fmsale If, h .Ne building or improvement ie sold within One yeti of completion,Ne awf buuilderilder will hese the When of proving that Mdid not Wild or improve for purpose e of tile.). 0 1,As owner of Ne propeny,am eselusively contracting with licensed contractors to construct the project(Sec.70,14,Business and Professions Code:)The Contractor's Li. cense Law does not apply in an owner of property who Wilda or improves thereon,and who contracts Tor such projects with a comncmr(s)licensed pursuant in thc Contractor's License Law. 0 I am exempt under Sec. ,B A P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION - I hereby arm under penalty of perjury one of Ne following dedmilimns: Mn m and will maintain a CeruOnof Cement to ulf-Wum fer Worker'sCapron- on,As provided for by Sedan 3900 of to Labor Code.for the performance of the work for which this permit is issued. 0 1 have and will maintain Wml i Compensation Insunru,As required by Section 17Wof Ne Labor Code,far the performance of Ne work for which this fiction,,I,issued. My Wmke n pe don surancc eaa=cr and Policy numbrWf�M.lo9/6>3 . Cvnier. Policy NO.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (TBU uminn need mi to mmplemd irthe iamamn B fm one bundmC dnllara(1110) or less.) I certify that in the perforromee of the work for which this Permit is issued.I shall not employ any person in any manncrao as to become subject u the Workers'Compensation Laws or Califomia.Data Applicant NOTICE TO APPLICANT:If,arm,meting Of.Comrimm of Exemption,you should become subject m duc Worker's Compcwtian provisions of the Laher Code,you must .,O forthwith comply with such provisions or this permit shall be deemed momked. . z" CONSTRUCTION LENDING AGENCY [-t taw I hereby affirm Nat them is a construction lending agency the perfurmance of the work for which this permit is issued(Sec,d097,Civ.C.) Wh Q tondo's Name D z Lender's Address U 0 1 certify that I have read this application and sore that Ne about information is lL,F correct 1 agree to comply with all city and county ordinances and stem laws relating to O V building construction,and hereby authorim mprrsemati s or Nis city to enter upon the LQ Nwomcmitim:d pmpcdy(a,inspection Purposes. G (We)agree to save,indemnify and keep harmless the City of Cupertino against pp liabilities.judgments,casts Andexpcosas which may in any way accmc agaimi said City U Z in consequence or Ne granting Of this permit ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOIT Issued by: Date SOURCZU O /1 Re-roofs Signaarc Ap,1wamnCmmoumr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store erhandle hawdous material as defined by the Cupertino Man pal Code,Chapter 9.13,and Ne Health and Safety Code.Section 25532(a)? �j/ All roofs shall be inspected prior to any roofing material being installed. 0 Yes NO Will rhe applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove I ha>ard^m air conmminanM crsncd by the Bay Arca Air Quality Management all new materials for inspection. Rin? ❑Yes Nu I have madtheloneird mamrials re uirtmcnu under Chepmr 695 of the Califor- ` ria HcalN kSafety Cadc,Satias:N5. JanJ 255]6.1 unJcrsuM BatiftM Wilding dcea nm cunendy M1mc a reran, remonsihility m notify Bw occupant more -\ requimermuwhichm WmeI dameofaCeniacateofeuF J 1 Signature of Applicant Date G� owner or mum 'W ageri Dore All roof coverings to be Class "B"or better w„ CONTROL # 43 PERMIT *#''640 ,?,2oo 9 DATE PROJECa' '- ADDKEAS 20836 APPLIeA tl C VVTER AGENCY IN RETURN status (nit IN RETURN status Init IN RETURN � status Init BLDG OUTSIDE PING 74 P I RE SAN,DIST. --- .. ASSESSOR HEALTH APN#,V�...3 4?_.,,3 , RES. (LUNG) (EARA '} # COMM.SQ.FT.(NFW) .. . T•i. S{ a'T. �_. RES. REMODEL C{ANT/+ ~ ------ --VHONI _ `� FAX _ VAL.U,�T`It `, _ 1 _ RECEIPT # . . _ PLN. CH C;IC ENE'RG1' t CONSTRUCTION TAX (Y} (N) GRADING ` SCHOOL FEES ,. .-_. ------ ..._ (Y) (N) SOILS HOUSING MITIGATION FEES-—(y) (N) .�...�, BLDG PMS HEART OF TI-IE CI I"Y (Y) (N) 'jEISMIC NOTES: :__..r._.. .. ELECT w....� _ PLBG MEC t ('1TY OF CUPERT'iN0 NTAAYN BUILDING DIVISION p)CtpeRmrr NO. .. .._..�r..:== _. I i,tl nlwc.,(�faft�ss: F1 SCHER PLUMBING & CONST 04080008 n "..'�"�""•`—�'�—•--'- - — p6RMtT ISl5L'r L5AT8 I- � 3 ..^ irtwns•.R'SNAM$. '. . _ SANITARY NU ��• ��• 6UtL AIPYI peabttt INtrU r ir_NnFCrr>41tc3iNa6lt: ji BiiaEr ?I, mecI __. x LICtiNSRp h^0'TRAC°!C)R'S OF.s=L,AAA7i0T•I 3ilb DCSCI'1pt1Un I httcS+y r(fina then i sm Based under gonisioro o(Chlp-H(cnfl~n IhR z�1 u:!z Sector a?tX%t)d U eksn 3 ar dee►vaetu trdPruf C �ny t.cne-,la <,linruli:mceant3tl Rl~..l?AIR BATHRM/WALL (NO XT ION) 1 � ...$ri - �� AkCHIrPCCl;G&CLAkA'fI vAdaatapd try pluu&W he mend Y PA k roc'nrdt +' __..,..roe-..,......._.�.«.........�_....._..�.,... .n�cnuA PttneKibod if njil6h L>SCt.A mtrwe - I hemby ofil m Jta+E am exrnfpt frttd Ae C nntrretCo :Any city O(or she = c�c�loeint rcttsw+.(&erten TLLkt,f,pmtitwaa tMi Ftoftr4'wm++Cods:Any cite tx soustty �/ 1- wht.h iNWMS a.permil W CINW?W,efarr,unprtnt•denbRak+ ,or fepait try ANClttlt �_ ••tl•--� Y$1Ia t ,. nota.ksfaesence,lioumquin-Alba Vik�mtfww Pan, fiks Il� ,NCncdsutcmcai �, joorAre =i lset hc'm Fctaaed putsuutt to alto atnrisfaRa of the Cotisnvxa�t Lamar law.(Chapty 9 ' �r t tcrxmerxle>awithsection?(MiOmvlek")af"riusipmmwproftuiomcood)ut E- occupanc uiteaosmptthmflomandtheler d e efWatx eeemptktn hey rMleUae td � y ha:ion yr1S t by atry +ra e p eexsul WeAM 11,41 egtficry fa a cwll"fly of ro 0 Y-Type n,m mart Ibfp flue kadtad dam(Svai I,u nwt�t of the imnprrty,tr roY ereP>uI^c+wth w tSao ss hnk ettle eompcnf ari m, win do till watfi,endNefauctmnitnot intemWWoffee4r«W0(-o4P,W94,but$011ult Required lnapeciio s and Pro(r,dtxe%f ade.Tim Canto wet Lmm,Law dm aot 4nar to m antler of j ,yptttyrtrobutWedrSmpeolesddwlwie.sedaMtii�tetcehasxk•tiw+ettftxdwu�hbb I rnn"eapky'vae, twSuch impeovemmumn,'Wknecle3mcaortdier"max,it. Merw•:wm.a nS a<ttrrpoxweeef ti a ntd wOk OWY"rl nnrepkJm Ne a aet• l bs ilder wdt hrP dw fewdaA o!Pmvfrrt dw M did nal tow of htwommr Ia pa pe ae d I•er.wvnne o(4w prepMy,em exWul.et;toevertm(t wA1 fico trod eau lCMIS fe sstorurnn>bn prtjeu ISst;'Nlei,Queituae erd pldesiksar Cods l rm Coauemulot tJ• ce"I raw owl no( ..y w In owm of Pm"'rb MdrM a fr>trwaa� + etm. "k0 mura6sterwc6pna WAWith aCOMK14*)rice mdpnwmvade[attltwcfml LfamahUW. ._^ g tCldrwanws0e [3 1 Ye efteeletK under See. d... .- _ �_ .,bWr �vrBtIGdAS+Oh1P' t+sMV),4DECtARATIW7 t hereby cava under purpy of W*?ar a of Mr rafiowule>wc;ere +' [�;haw*Mt WBI Melntikl i(.'Srtifi4e:A of Clam to rmed•Irnm6(clot Wrrkell Curafm forumro •m pvided for t1y Seevor I1W Offt WKW Coda(K Ibe petrereapw Olt U.t wak rot vhfeb"pts 4t 4 t I fore u,-1 rik mafoWl.,Wm(lw'e Co"Wiva iwsusncc,es ttr q*tid fly tlorxen Cale t s►m Cade.for Jw eufarin:rore d{M watt W whktt dw penpk it itrtred °rrre(atttion cfnis ctrl rr�lky rim w� , a�r Csrslwwgl�r sC6AYii'It OR GOfthISAtION WSU (Yltisane3notAereryrlaetMiUilypfernrs4eraaaa �'I� - of WK) - Y f t rNh"t In the terlutMmaj of*a work ret•it"""to 4 WAS,(Shea gh(Jey ary}e.++ram Ill4AY maaK w r tW to Will *h}ecft rts la ddw G'oapr'•nee f —:...,.........-i4------- Appikcitt..........,.....--- NOTICA T{7 APpWtAN'[:tf,afiee mafitre dsie Caeutk"lfr of F:arxoptroa.Yu.std vAcmx u.4W loft WnAtots Coenpotwtien ftcwfeieif offt l tdar t aur.VO4 K� -Z mrshwb arettoy vim Oak"Wow m dux pa?'ait AW k#n*A mrokatl, Z CONMUC(ION 1_fNDINC A01NCY £., i ba reM blvm utas dwm it a ao wt omm I atSi.'4atfaey(cw da pwtftmlvemr s r T.+ the work for-'Mcy this Msk Wtriload flee 30",Civ,C 11 l4Cods{f♦'deme .....,.... - ...r-....-.+-•.�.�-.,r. ^•' Olt WINS"Adlum l teetlfy 4 n 1 Ness teed thio eppiktriW ewd wt thu wv i0mae fareartailsxl b ;v,ea t Wee to auetoly wWh all Riyy sad c xssty ofaeeWet amt a»e Mr Mkollnt p S by`oir;t aaunwtbe,pW Aarhy aorinsttrc tcororAntaura eI�illy m eeee taprle Ikt ekok+-meenskatd pony tlr oninv ftm prrpaea IV/ay nttLY td SMR teraottl;'y Medlecp ttarylrpr dw C:Ua of 4vpetytrmeisai hrbH1dt,,,,•jud gwWA,COW 4441 r IPamdr*kA MOM i!MV wry'Welfcole 4*W (, kteaueat�ncee(dmgtYnwyyattbtatwrc"i! Date ARi.ICAtrr UNr?EPIS'f Ntu,\Mri WIt,4 Ci)At+r'7.Y WI't'tt ALL Ni MS-PWNT I56Uet by: ....._..,, �...... ;,,,,,,._,._,....e. ....a....._.�........ ` SflURCii>K t,6�JE7 ljtejpj yNtmtx:nn. m+ -.�." tela. 1}peof Roof. KAZARMUS MA'I'RIALR QESCLM VAII t!r m ruwe buUdkt6=uPkmxwe er haWK htntdaw6 metria de rpp u ddmcd by It Cusw+lrea M Cods,G9tttpme 9 I),rat the tiwEde tied SltAfy c«b, o11�P3{akY All roofs shall bo inspr ted prior to any roofing material being inaitalied, '�° if a roof is instailfrrfl without first obtaining err,insptetion, I agree tO re OVe VVIR der rf A*Art or fmlwt bmt>t>ind otl:upem vol NVIS"llot w dcvuare wket moth hemildflltt lie C 7Ide 1111Sf #cfir Ar tlta her My AN 401liti ClOAW*at all now materials for inspection, :Mv.aaidtoywarbrmmetr:riela, mirarrkateoeJerGhei+V�A95ottbaGkfn• rtrtkakh 3.Stir yGsedc.;4111x..11 Z'�iS�J um19.13�.I vdcY.+wiid ddt if tae ktmlNrS y'- _ _ WAt"r30VMWrho%aeaweeAt reafta+tairatYnt►afysheax�hauole6 �1tC �ltirew+tnu aA cA to to rpt e,y c@ at,ctw(Yctk of . r+ � Signatknre of Applicant All roof covierings tt�beClfats"11'or better ChtW um�P..Y red a Etl- ...�...:, DW �..�...-...... I INSPECTION WORK LOO - ONIS PER PAGE DETAIL FORMAT FAGr-001 PRI14TED ,ON 06/07/08 PERMIT NUMBER- 04080008 10236 NORTHBROOK SQ CVPJRTINO PERMIT TYPE: SFDWL-REM SINGLE FAMILY '0WELLING RF'M02)EL USAGE CLASS: DWL-WREM DWELLING TYPE5 WOOD REM SPECIAL REPAIR BATHRM/WP I,LL (NO ALTERATION) PERMIT CONDITIONS: Alit) NOTESc PARCEL ID: 31639023 . 00 LOT; BLOCK: SUBDIVISION OWRER NAME ES7€V MILLER OWNER ADDRESS: CONTRACTOR I D s 23896 CONTRACTOR NAME': TERRY FISCHE CoNTRAC'TOR PHONE s (408027-2426 INSPECTION T:'PF': 505 FINAL ELECUPRICAL INSPECTION AREA: SCHED DA'I'S s 1,1/01/04 INSPECT TIME: CONTACT IMF4: INSPECTOR: LS S4UARCIA, LARRY INS` 'RUC'.IONS: SCOTT, 40B-939-8452 C0101S+1TS s R$SRILTE3t pASB FAIL, CANCEL RE-FErb FAIL CODE .... `NOTES`s PQI.OR 11481'ECTION RESULTS s 301 ROUGH PLUMBING 08/23/04 P TO h'11 ROUGH PLUMBING p5/03l'04 P To 302 TUB & OR SHOWER 08/25/04 P TO 306 SHEE ROCK 08/25/04 P TO 310 INTERIOR LATH 08/30/04 P TTOO 310 IN'r'nERIOR LATH 08/04/+04 : 404 ELECTRIC METER RULZA. 08/30/04 P TO $05 -FINAL PSr.,zerRICAL 10/01/U4 N L9 S07 FINAL PLUMBING 10/01/04 K LS 508 FIN" MECHANICAL 20/01/04 L8 516 FINAL BUILDINO 10/01/04 L8 IzIe 4Ar� t�G s►1 Te�lc. " Qr1� �IaCC'�' Olt t�P�'€'�►rt�' �tnS«�it�� 1n,lW �wts3d�.Y'� �iGgG-Q T 0 It I tutsns anc4 h un i �t Cseir an the lob at dtl tlotyus yrititicst , tiE+ G 47G1'" K •Hake am O"A yen *X tns+A � "?".c+�p i .vttt�+oa{ writtc+n pC e�4tfS� stAtos�Ct�''� w.. .:�, san �t�j Cts# �t Citpert►tw• "`- �� iieitn� of ,hie Ik plan nn4 )qt s%mving tl w pe,mit C is be NAIL NOi taV14lsSr ' v 4 t tsn (A any Ov, cow a eAil c�..lb 2 � ut ;UMIANO \k all. 0934. no4, S 3�.�1 l ��,lcktN Y"• � f '-."��`� �p� ��I=k�� '3�►ti4� s.. � IIIA i Zoo k" �Mt�i6tl ffir41o�.1.1R'�"iltt �tl'1'!r �"tfr �r1AldG ) /. ] 13 ^wrfi � "fD[tG " r IG +5o/ I VE �t Oiy Q„ CUKWIN 411i1tA1r 4MI CITY OF CUPFRTINO Item 1 of 1 PERMIT RECEIPT O?ERATOR : conniew COPY # 3 Sec Twp -. Rng: Sub: B1.k: Lot APN . . . . . . . s 31639023. 00 DATE ISSUED . . . . . . . : 08/02/2004 RECEIPT #. . . 25518 REFERENCE ID # 04080008 SITE ADDRESS . . . 20236 NORTHBROOK SQ SUBDIVISION . . . CITY CUPERTINU IMPACT AREA . . . . . . OWNER . , . . . . ESTER MILLER ADDRESS ., . . .'. . . . . s CITY/STATE/ZIPCUPERTINO CA, 95014-0504 RECEIVED FROM . . . . : FI SCHER. CONSTRUCT Z o:' 4 CONTRACTOR . . . . t TERRY F I SCHER LIG: # 23896 COMPANY . . . FISCHER PLUMBING & CONST ADDRESS . . . . . . . . :,: 2766 SCOTT BLVD Cx'iY/STA`rE/ZIP SANTA CLLARA, CA 55050 TELEPHONE . . . . . s (408) '1227-2426 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW B.AiL - - BPERMFEE VALUATION 15, 000 . 00 223.56 0 . 00 223 . 56 0 . 00 aPFIXTURE, UNITS 6 . 00 54 .00 0 .00 54 . 00 0 . 00 SPI..ANCHK. PERMIT' FEE 223 . 56 298 .34 0 . 00 298. 34 0 . 00 SPSEWER SEWER SYSTEM 1 . 00 21, 58 0 . 00 21. 58 0 . 00 BENERG Y PERMIT FEE 223 . 56 107. 31 0 . 00 107. 31 0 .00 BPVENT UNITS 1 .00 1.0 .79 0 .00 10. 79 0 . 00 PPERMTTFEE FIAT RATE 1 .00 38 .37 0 . 00 38. 37 0 .00 82WATER UNIT 1 .00 9.00 0 . 00 9. 00 0- 00 IBREMRECSPT NO.' OUTLETS 2 . 00 2 .40 0 . 00 2 . 40 0 . 00 BSETSMICRE VA14U.AT.IUIq 15, 000 . 00 1. 50 C . 00 1. 50 0 . 00 EPERMITFEE FLAT RAT 1 . 00 38. 37 0.00 38. 37 0. 00 TOTAL PERMIT r 80 5.2 2 0. 00 805 . 22 0 00 METHOD OF PAYMENT AMOUNT NUMBER - -- CHECK $05 .22 42119 TOTAL RECEIPT 805 .22 06/22/2009 11:42 FAX 409 777 3333 CITY CUPERTINO ;D001/003 WY OF cUPE TING GUP�i�,iN0 PERNUT .ApPLICATION FORM y.._....`-.�--- Date• APN -- ( dit�arcnt trom building Meiling A dreea): Building A Wntr'a Name: Lfconse#; �i .t � rr � o H>ttain�a Lwonae#: Contact: no: 1 '?- 2 YL Cupart> R jj>tsilding pftudt lcatplumb lVlach(� IIld rc� r•�s �l rrx tvM lob`Doscriptian'. 'u pQ x.s girt N�'►l n�� h'1,4 mmdC 6al tegintal $lSgYt: saqmtolAlm, �lm, owupgncy Elet Of project: ' VID (? �. please�1Oak reject is !0 of ott: 8 1AddW941 � . Fm get ► St8ndalxd OT "" Fee Orae 'd "Fee M _—'----__. Qtbq Alma"1� � WEC�tCAL B�`OI1.ER1 Boiler<- 100 X00 BtuC CAL A' flII H6 l">]000 to 500K Btu CAL BtYII.ER3 Boiler>500K to iR+I_Fiume B1Cal.�BItA Boder>1M to 1.7 NJF.CYACAL• BB© Boiler> 1.75m B 1V1 CH 11CAL SULT WING BCf?�NSTAX BCONSTA7t t �zout G B CNS TAXB ..Kut. �. far g B Bil t1�IN $CONSTA 1°I Hotel �d MOW _ir m DING .,., BCO?+15TA R Consw g A iobile EBIItxi 644 8111 C1�gI let 5 0V> 1 A _$L 1CAI. IL ---'�--� Fx►artz�►Add Multi1�BNBRGmc ING AS}I� BV Dri*7G B1N`ii'$S'1'�C�Amv �ttion ff I oE3 V 06122/2004 11;42, FAX 408 TTT 3333 CITY CUPERTINO Q002/003 CY'I"Y OF CUPERW CuPE !NO PERMIT` "PLICATION FORM Fee m Fee Descripdo. Fee Group HMI5CPLL mWellm"us Fee BtTII17►ING BI�iTTICIATC HTI Mt.Fee BUMDING BNUCONM New Comm Elactxic P.I.E GAL BN(JCONlMM Now Comm Mochauical MECHANICAL BNUCUMMP Now Comm Plumb PL, IN'Q BOVERTI) tion Ovenim0 BUIWENG BPEI) haritolm PLUMBING BYChSSPO�L Nispool PLU�NBIriIG SPE.RhMB El Pelt F B[3ILbxNG Bll" Pbl nit re PLUMBING 13pQAszRium S Fla . 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