99110113 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY q 101 3
CITY OF CUPERTINO BUILDING-ELECTRICAL
BUILDING DIVISION APPLICATIONITERMIT PLUMBING.MECHANICAL.
BUILDING PROJECT IDENTIFICATION
IiI11LU1NG ADUR[S$; P Lq Sot y SANITA ATIO DAT
9
woo 14, rK fir. Cit �r ono C
WNERSNA E:. PHONE: CONTRACTORSisup ' NAME: iC LIC NO:
Jff�l
10./. _/� + n� � //J�.� C/� NIC CONTROLq
lor<Clil'I I:(T/ENGINEEN: LIC M1O.` 5W gf lC6 los Ufne-44/5- Q'1 ❑
COMIACT.. PHONE: JGt/ BUILDING PERMIT INFO
.+1 q (j�(J—O�ig ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MUCH
l ( e, O -` J ❑ ❑ ❑ C�
LICENSED CONTRA ORS DECLARATION OTT ELECTRIC PERMIT FEE
I hereby affurn Nan 1 am licensed Cher prockions of Chapter 9(commencing JOB DESCRIPTION
with Section]OLB)of Division 3oflhe Be, cssand l'rofe.ssions Code.and my lice.ne i. RESIDENTIAL:
t 1l in PERMIT ISSUANC12
W,r fail and efreclGt� ❑SFDW'L ❑KITCHEN REMODEL.
QZU License Cly LJ_—Lie. APPLIANCES-RESIDENRAL []ADDITION (D PLUMBING RE-PIPIT
F W Dmc ��f/�A�/ Con Taunt
m6L �JC'I"S UCCLARAI'ION ❑MULTI-UNIT El STRUCTURAL
PANELS MODIFICATION
OZ�" IundemmnJ my nxhall he aced nuc Js
I'YIO d'y UP'I'021XtAM1'S El INTERIOR 11 CHIMNEY RIiI'Alk
F nE'uCl Liccnw%Profcsninna 2(11-I(XXIAMIti IMPROVEMENT SWIMMING POOLS
It
C C QI I hereby affect(Ohm I am exempt Com the Contractor's Lier me Law for the OVER 1000 AMPS ❑BATH REM OU'%REPAIR DEMOLITION
X O a{U following mason.(Section 7031.5.Business and Professions Code:Any city or county SIGNS ELF.CfR1CA1. ❑OTHER
01
3 W which requires a permit to construct,alter.improve.demolish,or repair any saucture Q
F'E•Cg poor to its issuance.also requires the applicant for such Permit o file a signedmtemenl SPECIAL CIRCUI I'IMISC.
P "y that he is licensed pursuono the pmnnons of the Cnmmqurs License Lvw(Chapter Y
f W2� (commenciagwib Sectionl(OO)of Division 7 ofthe Businessand Professions Cedgm 'TEMP.METER OR POLE INST
a a c C ]hut he is exempt therefrom and the basic for the alleged exemption.Any violation of ❑NEW BLDGIADDITION ❑D040LITION
Xm_LL Section 7031 S by any applicant for a permit subjects the applicant ma civil penalty of POWER DEVICES []TENANT ❑FOOD SERVICE
I. y hiumne than Eve hundred doll...($50f).I.j Y IMPROVEMENT
PitD Los he onk,the mapealmoo l cmployce+or oll—wine,asnhcirsnle vompamuwell SWIMMING POOL RhIiCTNIC
P.. willAu.hcwnrk,Cde The Chair not.Licentlo Lawddfmsul apply.l(W4,Huslnms ❑OTHI?R
3 and er whops holds
or The oyes thereon,
License Law s s�c not apply to;at rwner al' (]DTLETS-SW I'I'CI U?S-FIXTURES
his own
who buil%.ar Improves nhmnmm r who nts such work himself or through
his own.eve,,a,buidaProvided Ihm such mens l,entemw me not intended or dfercJ for NEW RESIDENTIAL Ehlisti, SQ FT
sale.r-trudvevw ll have de Grand mprovcmees that h within on wild or improve f( lir "p"X7♦) SO.FT.FL(l(Ik AREA ASO.FI'.
erMtilder will have the buNcn of proving that he did not build or improve f nt- 11
pve of sale.),
❑1,as r of the proper&am exclusively contracting with licensed contracmrs t TA
construct the project(Sec.7644,Business and Professions Code:)Thc Contactors 1 t,
crew Law does not apply to an owner ofpmpeny who builds or improves thercan.a O P•) NG R F
who contract..for such projects%fill a coni nnefa)licensed pursuant or the Comment
License Law. MIT Cii
10 1
I on exempt uvdcr,Su:. ,B&PCfrthis rcuson
star ALTER-DRAIN&VENT-WATER(EA) VALUATION
Date
WORKERS COM of PSAIION DECLARATION BACK FLOW PHOI'IiCf.DEVICE
I hereby affirm under Certify of of Con one of the following declarations::
o
] Ihuvr ad will maintainbyeen.Certificate of file Labmwlf for the
Worker's Camper- DRAINS-FLOOR,ROOFARE STORIES TYPE CONSTRUCT 101,
%tin , r provided for mi Sermon 3]IIU of Ne tailor Cude.for the performance of the
far which this permit iz issued. Fl%"IlIRES-I'IiR TRAP ar
I have and will maintain Workers Compensation Insurance,as required by Section
JA afthehhor Code.fortbeper6mnanecnftheworkforwhichthispenmicisimued, GAS-EA.SYSTEM IINC.40UTLEfS CGHOUP A�
My Wor Cnm�'tIl�,tionl s dPnlicy�
CaniaehAL L=I�1'lJee confer vn L �IJ�L.�L GAS-EA.SYSTIiM-OVER4 PA)
Policy Nsx: AV
CERTIFICATEOEEXEMPTION RAN WOR ERS' GREASEANDUSTRL WASTE INTERCEPTOR
COMPIiNS ,,d t i INSURANCE BUILDING DIVISION FEES
(this section nwJ not he cnntpletcA if the lx+mit is fnrnne hundred Jollua($1U11) GREASLr'THAI'
or less.) PLANCHECK Iriii3
I ecnify that In thu pertarniance oflhe work for which this permit is issued.l shall SEWER-SANITARY-STORM EA.200 Fr.
on employ any person in any manner wt us to Rcnme subject m the Workers'Compen ENERGY FEE
O Z cation Ltws of California.Date WATER HEATER WNEN'1'/ELECfR GRADING FEE
Z O AFpficanl
NOTICE 10 APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEM/IREATING
I"' ? become subject ,,Ne Worker's Comptmwlian provisions of the Wbor Cal.,you must SOILS FEE
fonhwitb comply with suchIner,monsor this permit shall he deemed revoked. WATER SERVICE
LU
a �
UO CONSRUCTION ionlNGAGENCY NEW RESIDENT[A],PWB. SO.FT. PAID
herchy affirm thus tM1cm lsumnswetinn lending agency for the performance ill D:nc RecciptN
fL F the work lint which this permit is issued ser.94197,Civ.C.) TOTAL:
U Lender's Note TOTAL'.
Lender's AdJrus
r I verily that I have read this application and state that the shove amen tatien Is BUILDING FEE
a
F Z bonding l agar m comply with y dry and county natives of and star laws relining a QTY. MECPIANICAI.PERMIT FEE
U ,Z building cnnaaaion.and hcrcby:mthnrim representatives of this cirymrnmrupm the SEISMIC FEE
aMwamealioned property for inspection purposes. PERMIT ISSUANCE
(We)agree m save,indemnify and keep harmless the City of Crania.against ELECTRIC PEE
liabilitics,judgmems.costs and expenses which may in any way revere against said City ALTER OR ADD T'O SUCH.
PLUMBING FCC
in conseyucna of the glancing of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH L N -POINT AIR HANDLING UNIT(TO W."CFM) MECHANICAL Flit:
SOURCE REGULATIONS.
/7) ,7, �9
AIR HANDLING UNI'I'(OVER I0,1X08 CFM) CONSTRUCTION TAX
Signature of Apphcat/Con.a.mr T Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MA'I URIALS DISCLOSUI E
Winmeappreaatm finure Mtilding nu:upanome or handle hh,.wd lx lmaterial HEATING UNI I'(10100.000 If'I U)
us defined by the Cupertino Municipal Calc,Coupon 9.12,and the Health and Sit-ety E7NU �'J
Gait.Section 25532(.)'1 HEATING UNIT(OVER 100,(18(1 BTU)
E]Yes C]No PAID
vGNTI1.A1'ION FAN(SINGLE RESID) Dam RecciptN
Will the applicant or future building occupant use equipment or devices which
neat havadous air contaminants al defnW by the Buy Area Air Quality Management BORER-COME DHP OR I00,00B BTU)
District? TOTAL' TNC
E]Vex ❑No BOILUN-COh1PRJV[N IW,fX10 BTU) f--
AIR CONDITION17R
Ih ad the h d materials y T J Chapter 695 of Coli /// ISSUANCE ATE
ohnia Health&Safety Cd Senior,2550525537 d25534I underlined hail it the NEW RESMENIIAL MECH SQ.ET.
build b l t chromdylu n !pt.�tYhin t ty .I 'h tyt n the"tin n
e'n'tal It tact y).0
I the occoni �a f fc
1 �► , U 1 TOTAL
a tMateed agent • Dae ISSUED BY.
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: chriatya
Sec: Twp: Rng: Sub: Blk: Lot:36204034.00
INVOICE DATE......: 11/19/1999
REFERENCE ID 4 ...: 99110113
SITE ADDRESS .. ...: 7998 WOODLARK WY
SUBDIVISION ...... .
CITY ............. : CUPERTINO
IMPACT AREA ...... .
OWNER . . ..........: BRADLEY CYNTHIA M
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4944
CONTRACTOR . ......: LIC W
COMPANY .... ......:
ADDRESS ... .......:
CITY/STATE/ZIP ....
TELEPHONE . . ......:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BREMAIRHAN P 8.33 0.00 8.33
BREMREPALT P 12.21 0.00 12.21
BUSLIC P 86.00 0.00 86.00
MPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
142.06 0.00 142.06
ID ON
it.. ........DESCRIPTION......... VOICE ID ................I..
..... ........ ...............
204 UNDERFLOOR FRAME 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS