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99080185 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY _I 4 O pO 1 $ CITY OF CUPERTINO BUILDING-ELECTRICAL BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL. BUILDING PRO1RCr IDENTIFICATION BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE _ 5`bol l CR q vo l 4 - �r-�y ,q N R'S AME: \x to� PHONE A TORACTOR'S NAME: LIC NO I I,IYVI nv�zf NIC CONTROL# .CIII'1'E /ENGINEER: LIC NO: DDRESS: �Ix ❑ CON'T'ACT: PHONE: BUILDING PERMIT INFO 1 ❑ Consultant Fees Paid by Applicant(Initial) BLDG hli PLUMB MELD LICENSED CONTRACTORS DECLARATION U QTY ELECTRIC PERMIT FEE ❑ ❑ I hereby affirm hal I am licensed under provisions of Chapter 9(commencing JO DESCRIPTION Two, with Section 700a of Division 7 of the Business and Professions Code,and my license is RESIDENTIAL: F W O 'n full ores nn t PERMIT ISSUANCE aUU License Lic.p ❑SFI]WL El KITCHEN REMODEL. F�R Dam Conl*i APPLIANCES-NESIDENTIAI- ❑ADDITION El PLUMBING RE-PIPE. [re[-,r D y CHIVE S DECLARATION ❑MULTI-UNIT ❑STRUCTURAL. y p y 4 uodcou nJ my plans shall he used us Mie rccoNn PANELS Pu MODIFICATION OZ�O UP T0200AM1'S ❑INTERIOR El CHIMNEY REPAIR Licenseol l'rotessional 20I-IUgIgMPS IMPROVEMIiNT SWIMMING POOLS �X OWNER-BUILDER DECLARATION OVER IWAMPS BATHR T fMOLITION X 1 hertM1y affirm that I am exempt from the Cantracou's License Law far the (•-� X U following reactor.(Section 707 L5,Business and Professions Code:Any city or county SIGNS ELECTRICAL OTHER LL y which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requirvs the applicant]or such Permit file a signedslamourn h SPECIAL CIRCUIT/MISC. W;!10 hal he islicensed!pursuant robs of Divinm of he ConlrenLicense loons Code)or WE: (commencing ixemit thereforeandth Division)ofthe egeBusiness mpt Professionsslation or TGMP.METER ORPo vI OM�MFRLIA� 116 a that he is exempt therefrom and the basis for the alleged exemption.Any violation of Demon Section 7031.5h ❑TEWBLDG/ADDITION ❑DEMOLITION ad on by subjects he applicant to penally of POWER DEVICES ❑TENANT [_1 FOOD SF.RVICF. p� nal nmrc than live hundrcJ dollars($5(g). 6 I,m owner of he IMPROVEMEN'L ❑ ❑ the unco,r is on with emdfosale sole cempensa.on, SWIMMING POOL EI-li IC will do he work,and e:The Cont is nal s Licenl m Law do far solo(Sec.]M4.❑uxiness El OTHER C m vnA I'rnl'csxions Code:The Contractor's license bow hrs not apply to aa owner of OUTLETS-SWITCHES-FIXTURES 6 properly who builds or improves hereon,and who dives such work himself or through his own employees,provided that such intprommena ac not intended or ofered far NEW RESIDEN'T'IAL El ECTR SQ ET. _ f ale.). sale.IL hnww'cn the building or improvement ivodd within one year of completion,the .Fl. AR S?My FT. ownend bu er will have he burden o'proving hal he did not build or improve for pur, 1 pweo 0 h i ow r of ct SeeTumporly,am exclusively rommaing wlh licen:)Th ed contractors IIce TOTAL-: enamel the project(Sec.o an owner oss and Professions Cade:i The Cnmremers Li- �3 5 1999 inose Law dtxs notapplyplytoan with ofpctco,who licensed prevent improves hneon,and QTY. PLUMBING PERMIT who contracts for such projecte wish u nmtrvchrts)licensed punuanuo the Cnmmcuds Li Law' PERMIT'ISSUANCE Y ❑lam ace exempt under Sec. ,B&PCfonhis reason ALTER-DRAIN&VENT-WATER DA) P/ mer Date UA' ON II WORKER'S COM PF.NSATION DFCLARATION ^ �c BACK FLOW PROTECT.DEVICE. x I hand will maintain ai under penalty of PerofCon enc of the following or de rksr's Counter. V ❑ Ihave and will main tainsmin 37 le of Ce LathooCnt are,for the Worker'sce or th- DRAINS-FLOOR,R(x)Ii AREA,CORD. STORIES TYPE CONSTR UCI'ION wham,as provided for mi Ss issued. 7]ql of the IrMm Cade,for he perfnnnance mf he TURES-PER TRAP have and Insurance,as"Woul by Section — �ofhewhich Labol Ctde,fodomain rtthe perfrmam'eof thewrk for which Thisperuit is issued. GAS--EA.SYSTEM-lNC.AOUTLETS Cumcr�$��'�p�� yry �'7 OCC GROUT' APN r„}LT1W��f-�TIVW1�tII�ayNo. ft�Sf is 1 GAS-G.SYS'T'EM-OVER 4(EA) ��50GI�I'1 CERTIFICATE 01;EXEMPTION FROM WORKERS' I COMPHNSA'r1ON INSURANCE GREASE(INDUS'I RL WASfB INTERCEPTOR kU1LUING DIVISION FEES (ThismeJon needrot fisc...Pricd if peon..is far one hundred dol h¢c(s I For GREASE TRAP nr las.) PLANCHECK TEE Iny anylhaial in aperformance rcirsosi)ork become a which subjechist the nut is Workers'Catalan. SEWER-SANITAkY-S'I'ONM HA, PT. notmi Law.any person in any manner so as m haeme subject m the Workers'Cnmlmm ENERGY PEE Z whom ant nl Colifomia.Dec O WATER HEATER W/VIiMI'/ELECTR GRADING FEE z� Applicant rn NOOCE*TO APPLICANT:IL after making this Ccri firma of Exemption,you should WATER SYSTEM?REATING a ; become subject m the Workers Compenmtinn provisions of the Labor Cde,you must SOILS FEE onhwilh ramply wih such provisions uritis items:,shall be deemed revoked. WATER SERVICE Q U=0 COM 'IONLENDING AGENCY NEW RESIDENTIAL PLMB. SQ.IR. PAID I hereby affirm uhem m thaherc isisanmswnion lending agency for perfnmance of Dae Receipt FCthe work for which this permit is issued(Sec.7119],Co,C.) ULender's Nae TOTAL' Lnaler's Address TOTAL: 0. 1 certify that 1 have read This application uta slam that rbc above information is BUILDING HE h correct.1 agree to comply with all city and county on inances and slate laws relating to QTY. MECHANICAL PERMIT FEE,Z building construction,and hereby audition representatives ofhis city to enter open the SEISMIC FEE aMwm-mentioned property for inspect an purposes. PERMIT ISSUANCE ELECTRIC FEE (We).9.to save,indemnify and keep hamdess the City of Cupcnim again Iiabilities,judgmenes.costs and expenms which may in any way assure againstxaid City ALTER OR ADD TO MECH. in consequence of he granting of this pernil. PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO Io.000 CFM) SOURCE RF.G �NS� MECHANICAL HE 8(iys AIR HANDLING UNIT(OVER IU,UIIU CFM) CONSTRUCTION TAX Stgnatim Apphc.r, acmr Dale EXHAUST HOOT)IW/DUCT) HOUSING MITIGATION THE H \RDOIIS 1ATIiNIALS DISCLOSURE WII rappitim or Idingocnmunl,r car handle laeardorx nominal HEATING UNIT ffO IfNI,(NNI B'flp ns Jerred by the Criterion Municipal Code,Chapu:r 9.12,and the I Icahn and Safely Code.Section 25581(x)7 HEATING UNIT(OVER 100.000 BTU) ❑YCs VENTILATION FAN(SINGLE RLSID) PAID Dae Receipt TO Will he applicant or future building by the Bt use equipment Qu or Marta which BOILER-COMP CTHP OR 100,000 BTU) mit hvsNous air romaminanu ax JcfineJ by he Buy Alta Air Quality Management TOTAL: DizldnY Yes Nn BOILER-COMP(OVER I0s),”BTU) I have read the hanWous materials acuirements under Cha ler 695 of the Cali- AIR CONDITIONER 9 I ISSUANCE.DATE Earn HeHealth&Safety Code.Smlinns 25.50-5,25533 and 255]4.1 mndemanJ hal if the NEW RESIDBN'1'IAI.MECIf. SQ.FI'. In buildin,it, s not cu tly have a mnnt alit is m,mx,msihility m nmify hcocculuml eo ofthe rcquirenm uc art he nnnissuunce of n CeriOcmf( warm. Owner or um n e ag Dec TOTAL: ISSUED Y. CITY OF CUPERTINO I• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: christya COPY # 1 Sec: Twp: Rng: Sub: Elk: Lot:37535017.00 DATE ISSUED.......: 08/25/1999 RECEIPT #.........: 9894 REFERENCE ID # ... : 99080185 SITE ADDRESS ..... : 5855 BOLLINGER RD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... - OWNER ............ : WORKMAN, HELENE ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-3536 RECEIVED FROM ....: TIMO ' CONTRACTOR ....... : OWEN, GREGORY LIC # 20610 COMPANY .......... : AIR DESIGN INC ADDRESS ..........: 4970 ALLISON PRY CITY/STATE/ZIP ...: VACAVILLE, CA 95688 TELEPHONE ........ : (707)452-0123 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS RED NEW SAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- . BREMACOVER NO UNITS 1.00 14.43 0.00 14.43 0.00 BREMHEAT NO OF HEATERS 1.00 6.11 0.00 6.11 0.00 TFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 E. TFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 91.58 0.00 91.58 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 91.58 6129 TOTAL RECEIPT 91.58 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 00::00.. 000:0..000000..00:.:.......: ..:000.0 0000000000000.00:0....000... 204 UNDERFLOOR FRAME 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING ' =1 508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS ;^ • I • AIR DESIGN INC 99080185 5855 BOLLINGER RD 4970 ALLISON PKY 08/25/1999 VACAVILLE, CA 95688 WORKMAN, HELENE 20610 - REPLACE HVAC EQUIP. , FURNACE/AC UNIT 0 $1 37535017.00 • • INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: chrietya Sec: Twp: RnS: Sub: Elk: Lot:37535017.00 INVOICE DATE...... : OB/25/1999 REFERENCE ID # ...: 990BOIB5 SITE ADDRESS ..... : 5855 BOLLINGER RD SUBDIVISION ...... . CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............ : WORKMAN, HELENE ADDRESS .......... : • CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-3536 CONTRACTOR .......: OWEN, GREGORY LIC # 20610 COMPANY ..........: AIR DESIGN INC ADDRESS ..........: 4970 ALLISON PKY CITY/STATE/ZIP ...: VACAVILLE, CA 95688 TELEPHONE ........ : (707)452-0123 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- -__ ----- --- ------------ -------_-__ BREMACOVER P 14.43 0.00 14.43 BREMHEAT P 6.11 0.00 6.11 EPERMITFEE P 35.52 0.00 35.52 MPERMITFEE P 35.52 0.00 35.52 _________ ____________ ___________ • 91.58 0.00 91.58 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ 204 UNDERFLOOR FRAME 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 50B FINAL MECHANICAL 514 FINAL PUBLIC WORKS �1 •