99070035 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BA POINT PEN ONLY Y (�
CITY OF CUPC'RTINO NUILDING ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL _ SOOOI
[--BUILDING PROJECT IDENTIFICATION
BULLDINGADDRESS: SANITARY NO, APPLICATION SUBMITTAL DATE
QTDr LAI TTNO
OWNER'S AME: PHONE _ CONTRA�� MF. GIJ0
Per4V4qM `.Jl N/C CUM ROLM
lop NCHITECUEN( ER: LIC NO: ADDRESS: ( ❑
CONTACT: PHONE: BUILDING PERMI'P INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT' P�UII�B MECH
IJ ❑ l,� ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
ZZ 1 hereby affirm That I am licensed under pmvisions of Chapter 9(commencing JOB DESCRIPTION
�ot with Seelon70U)of Divisio 3 the Busineasvnd Professions Codemi my licenmis VLRMII'ISSUANCE RESIDENTIAL,
CWr Liens¢full ace and ef^e ❑SFDWE ❑KITCHEN REMODEL
QU[,y Li«nscSln. Lic.p FIFAPLIANCIS-RESIDENTIAL
Ciba Date. i Commdo ❑ADDITION El PLUMBING kIi-PIPIT
to cid ARCHITECI"S DECLARATION PANELS ❑MULTIUNIT ❑S I'RUCURAL
OZ
Z O h I undcrsmnd my plans shall be octet as public rtcoNs MODIFICATION
UPT0200AMPS—Q El INTERIOR El CHIMNEY REPAIR
I-;��{�i Licensed F'mfessinnei e01-1000AMPS IMPROVEMENT' E]SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER IIX)(IAMPS O BATH REM
OUIiDREPAIR ❑DENT LI'fION
C 6 1 hereby affirm Nat I am exempt from the Contractor's License Law for the .rG ..
fGx C W U following reason.(Section 701 1.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑nQT�HE & A�ST�"�p
which requires a permit m continued,alter,improve,demolish,or repair any structure
primto it issusece.drarcepires thcapplicantforsuchpermit to fileasigneJ statement SPECIAL CIRCUITMISC.
} that he is licensed pursuant ro the Provisions of the Cortisones License Low(Chapter 9
(commencing with Section7(XAO of Division 3 otthe Business and Professions Code)or 'I'EMP.METER OR POLE INST. COMMERCIAL:
d
^g eG that he is exempt thcrefmm and the basis for the alleged exemption.Any violation of 0 NEW BLDG/ADDITION [IDEMOLITION
N Section 901 LS by any,applicant for apemmmiticcts Ne applicant to a civil Penalty of POWER DEVICES ❑TENANT ❑FOODSERVICE
not mom than live hundred dollars($500).
E] Las owner of Ne property,or my employees with wages as their sale compensation. SWIMMING POOL ELECT RIC IMPROVEMENT
ctFC wllldo the work and the structure is not intended or offered formic(Sea.7044.Business ❑OTHER
W 3..- and Professions Gale:The Contranta''s License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES
property who builds or improve,thereon,and who does such work himself art through
his own employees,provided That inch improvements;are not intended or offered for NEW RESIDENTIAL ELEC R SQ u
sale.If.however,the building or improvement is sold within one yearofcompletioo,the SQ.FT.MOOR AREA $/SQ.FT
moerhuilda will have the hurden of pawing that he did not build(ir improve for Pur
pose of sale.).
❑1.m owner of the pmpeny,am exclusively convecting with licensed contractors to TOLAI
construct the project(Sea 10FO,Business and Professions Code:)The Contractor's U. Q
c m low does not apply torn owner of pro isoy who builds or improces thereon,and QTY, PLUMBING PERMIT FEE !
who rn for ch projects with n cuntracmr(,)Iiren.eJ pursuContractor'sno the Contractor's
Licenseam Law,Law. suPERMIT ISSUANCE
❑ 1 am exempt under Sec. ,B&1'C for this reason
Owner Date
ALTER-DRAIN&VENT-WATER(G) q /VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLAW PROTECT.DEVICE
I herebyemrm under Penalty of fat one of the milawing decimations: P lJ `Y
Ihnvc and will mainmino Cenifcmeof Conunuo sdFinsure for Woderx Compem DRAINS-FLOOR,RUDE.AREA.COND. STORIES TYPECONSTRUC,1pN
action,as Provided far by Section 3900 of the LUMe Code,far Nform
e performance of the
work her which this permit is issued. FIXTURtS-PER TRAP
❑I haw and will maintain Worker's Compensation Inm ustt,a,requited by Section
37M of thMy Wemk�e1�laCCb�uaotrr4 Code,for the performance of the work for which thispermil isissu GAS-EA.SYSTEM-I INC.4 OUTLETS OCCGROUP APN
Co�o �g l and Policy
s1�,1yrllp�1•rlle Policy No, O GAS-EA.SYSTEM-OVER4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASE/1NDUSTRL WASTE INTERCEPTOR
BUILDING DIVISION FEES
('His section aced not be completed ifthe permit is fmone hundmddollms($100)
or less.) GREASET'RAP PLANCHECK FEE
I certify that in the performance ofthe workforwhich this permit is issued,l shall SEWGN-SANITARY-S'1 ORM EA.200 IT.
not employ any person in any �I' to be5a bblecuoth�j Wowrk�ers� I�pc ENERGY PEE
Z'z smionlowsof Califomi U Jy{�Ywlpxtri aaE�_ WATER HPIER W/VENTIELECTR
Applicant 1 7�--9 GRADING FEE
y NOTICE TO APPLICANT.if. outranking this Camficma of Exemption,you should WATER SYSTEMITREATING
a; become subject to the Workers Compensation pmvisions of the labor Code,you most SOILS FEE
t[1
forthwith comply wiffi uch pmvisions or this permit shall be d«med revoked. WATER SERVICE
ps G
5z CONSTRUCTION LENDING AGENCY NEWRESIDENTIALPLMB. SQ. T PAID Data Rc<1iPtx
U O I hdcly affirm thin is a construction ma
ction]ending agency for the pernence of
U. F the work far which this permit is issued(Sec.31197,Cih,C.)
O ULender's Name - 'TOTAL:
Lenders Address TOTAL:
I cavity Nat 1 have read this application and state that Ne eMve information is BUILDING PEE
raA coact.l agree to comply with all city and county ordinances and slate laws relating ht QTY. MECHANICAL PERMIT FEE
U building construction,and hereby anatomic repremoduives of this city to enter upon the SEISMIC FEE
.hove-mentioned pmpeny for inspection purpmen. PERMIT ISSUANCE(We)agree to save,' comedy and keep harmless the City of Cupenino stained ELECTRIC FEE
liabilities,judgments,co. mdexpenses which muy in any way acervc against sail City ALTER OR ADD TO MECH.
in asequence of the Lingo apamtit. PLUMBING FEE
APPLICANT ON ST )S NO WIL OMP 'WITH ALL NON-POINT ATR HANDLING UNITOO I(h(Xm CFM)
SOURCE HO MECHANICALFEE
_ AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Sigrmt App cant/ ontra me EXHAUST Wwl)(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or furore building cetioustsmen,handle ficanoous material HEATING UNIT(TO 100.000 BTU)
os defined by the Cupertino Municipal Cale,Chapter 9.V2,and the Heahh and Safety
Code,Scala m 25512(a)R HEATING UNIT(OVER 100.000 BTU)
❑Yea yrr VENTILATION FAN(SINGLE RESIU) PAID
Am Will then licanl or Ibwre M1uildin t ase c mar device.,whidl Date Reacts M
pp bythen Area
BOILER-COMP CUP OR 100,00(1 B'N)
mit havallous air emwminams as defined by the Pay Area Air Quality Munogemem ,
Oil mer' TOTAL:
Cl yes �IVo BOILER-COMPIOVER IIX),(XIO BTU)
AIR CONDITIONER
I have read Ih u vol x materials requireme t,under Cleapter 6.95 make Cali. ISSUANCE DATE
fomite HuIN ffi Sv y Cod�S ,rs 255 5,73531 oust 5534.1 vndcrsland Nm if Ne NEW RESIDENTIAL MECH, SQ,IT. q 7
building Nosno 0 nunO Chau 's anigilt(y al notify Wetncupant 7
of the req' TTTtsw t and rag 'u Cerfif nc of Occupan .
—...�
Own Nmnze Dare TOTAL: ISSUEDBY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE .INVOICE
•
• CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: nsncyc
qlw
Sec: Twp: Rng: Sub: Elk: Loc:35928007.00
INVOICE DATE......: 07/23/1999
REFERENCE ID R ...: 99070035
SITE ADDRESS .....: 7491 TIPTOE LA
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OWNER ............: SANTANA CLARENCE B AND PATRICI
ADDRESS
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-5818
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 DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPWHEATER P 9.98 0.00 9.98
PPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
45.50 0.00 45.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
.. ........ ............................
FINAL PLUMBING ENERGY 506 GAS TEST
FINAL PLUMBING
•