00020156 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 00a S
CITY OF CUPERTINO BUILDING-ELECTRICAL P'
BUILDING DIVISION APPLICATION[PERMIT PLUMPING.-MECHANICAL.
BUILDING PROJECT IIIEM'IFICATION
BUILDING ADDRESS; SANITARY NO. ION SUBMITTAL DATR
9 s
UwNs " AML, PHONE' C TRpCTO 'S,r' ME: I/f `- LIQ NQ� NIC CONTROi,p
•ARC ITEC'UENGISEER: LIC NO: DR SS: IF'Na�1`A\&
- ❑
V
CONTACT: PHONE: BUILDING PERMIT INFO
�� _ �� ❑ Consultant Fncs Paid by Applicant(initial) BLDG ELECT PLUMB MECH
56 ❑ ❑ ❑ �.
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby addend Nat 1 am licenxd under prevision%of Chapter 9(commencin6 JOB DESCRIPTION
Od'Z with Section 7000)of Division 3 of the Business and Pn fcrvinnm Cedc,andnry licsme is
WOO PERMIT ISSUANCE RESIDENTIAL:
F ty i full force and elfec
C F- ' Cl., 1 —�) 'Jrkg= ❑SFDWL ❑PLUMBIN RE-PiPL
F a;
License Comp
FiiQL Date Contractor APPLIANCES-RESIDENTIAL ❑ADDRION F)PLUMBING RE-PIPE.
ARCHITECI-S DECLARATION ❑MULTI-UNIT ❑STRUCTURAL
F O Z_ I understand my hall bpuu Pu ' records PANELS MODIFICATION
OZ O 1Iay .- �{� UP TO 200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR
QN~WLicensed Pmfessron.I 101-1000AMPS IMPROVEMENT EISWIMMINGPOOLS
f� OWNER-BUILDER DECLARATION
W
W Q 1 hcrebv effmn that I am exempt from the Contractor's License law for the OVER IBRO AMPS ❑HATH REMODEUREPAIR DEMOLITION
3 a.U following reason.(Section 71131.5,Business and Pmf eiom Crdm Any city or county SIGNS ELECTRICAL ❑OTHER
W y which requires a permit to construct.ahee improve,demolish,or repair any structum 9 L/.yn Q.P i
Q prior to its issuance,also requires the applicant for such permit in fleasigncJ.vtatemem SPECIAL CIRCUITMISC.
f�y-�
that he is liccnuJ pdoodat to he provisioosofthe Contractors License La.(Chapter 9
3: (commencing with Section MIKE)of Division 3 ofhe B.slnessand Prodloon%Code)or TEMP.METER OR POLE[NST COMMERCIAL:
ca a c C that he is exempt therefrom and Ne basis for the alleged exemption.Any violation of El NEW BLDG/ADDITION ❑DEMOLITION
k m W net ot mort hon fine hundredrcant for.dollars ISSUED).V suhjems rhe upplicunuu u vivid penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
W^h
SSD71,asowncr ollhe pmpeny,onny employee with wages cs Their...to emnpensation, SWIMMING POOL EI,ECi'RIC IMPROVEMENT
winds Ne work,and Ne,havaie,,not intended or offered forsale(Sce.]O14,Bminos ❑OTHER
tp 3 m and Prof%ions Code:The Contractors License Law docs nor apply to an owner of OUTLETS-SWITCHI!S-FIXTURES
C property who builds or improves mercer,and who hes such work himself or hmugh
his own employee.,provided then such improvements arc not intended or offered for NEW RESIDENTIAL ELECB SQ E,
sale.IL however.the building or improvement issold within one year ofcompletion,the — FT.FLOOR AREA E/SQ.FT.
owslder will have the burden of proving that he did not build or uniform for pur-
pom of sale.).
❑L as owner of the propeny,am exclusively contracting wins licensed contractors to TOTAL:
entrust the Project(Sec.]DYI,Business and Professions Cade)The Commodore's Li- t
se Low Aocs nor.pPly torn owner ofpmpeny tubo huilds or imprcrves Neram,and QTY, PLUMBING PERMIT FEE 1p
�1
who contracts for such projects with a conararear licensed pursuanuo Ne Contractor's
License Law. PERMIT ISSUANCE
C3 1 am exunpt under Sec. ,B&P C for his mmen
)tuner Date
ALTER-DRAIN&VI?NT-WATHR(EA) VALUATION
e
WORKER'S COMPENSATION DECLARATION RACK FLOW PROTECT,DEVICE I-7�
1 hereby affirm under Penalty of perjury one ofthe following talker's C s:
❑ Ihme and will for byneCcoi 37W of me Eaduoself,Tr amp Worker'sce of do- DRAINS-FLOOR.ROOF,AREA,GOND. STORIES TYPE CONSTRUCTION
moron.us provide)for by Section 3]00 of Ne tabor Code,,Tramp performance of Ne
k have
which his permit WraoeJ. FIXTURtiS-EBR TRAP /
Nof and will maintain he orfs Compensation Insurance. h this rcJ by Section
J] rRhe Lahr Code,fonts penormance of the work for wM1ich this permit is issued. GAS-LA.SYSTEM INCA OUTLEl;S OCC.GROUP pPN
My WorkerL: e carrier and Policynu ��
furyt q�b�(y�
Cmncc - 1 mr UL Policy No GAS GAS-I3A.SYSTEM-0OVER
CERTIFICATE OE EXEMPTION FROM WORKERS GRF.ASIIINDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCIi
00
(Thiswetiouneed not recompleted ifthepenniusfnro hutd dollars(SIW) BUILDING DTVI NFEFS
or Ie%%) GREASE,TRAP
certify Patin he performanceof to work for which his Permit isissued,LahaO ENERGY CEFEB
employ any pcaoniany manner so as to become subject to the Workerd Compen- SEWER-SAN ITA NY-STORM EA.2(X)IT. ENERGY FEE
Z ojuApplicant
ant California,nDate
O O A Iicrrnt WATER HEATER WNENT/I;I,ECTB
PP GRADING FEE
N(FDCI?TO APPLICANT If,after making Nis Certificate of L attire ut you should WATER SYSTEM/TRFATING
a > Iecnme subject m the Workers i.orms or his provisions of he Lehor Code,you must SOILS FEE
fnnhwith comply wiN%uch provisions or permit shall be deemed revoked. WATER SERVICE
0.
7Z CONSTRUCTION Ltion ING lending
NIiW RLSIDENTIAI.PLMH. SQ.IT. PAID
U O Iherchy uh thk Re here irouied e,YNending agency for petionnance of Date ReceiprM
� F' the work for which his pennir is issued lScc.3(19],Civ.C.)
U er
Lend 's Name,
O TO Ah:
a. I Leader',Address TOTAL
y :
Fr-s certify that 1 have read this application and sac that Ne ahrve information is BUILDING EEE
to correct.1 agree to comply with all city and county ominance%and state laws relating to QTY. MECHANICAL PERMIT FEE
(.7 Z building construction.and hereby authorizer representatives of this city In enter upon the SEISMIC FEE
uMrve-mentioned property for inspection purposes. PERMIT ISSUANCE.
(we)agree m save,indemnify and keep harmless the City of Cupcnino a,uml ELECTRIC FEF.
Il abilities.judgments.costs and expenwe which may in any way accrue against said City ALTER OR ADD TOMECH.
a.consequence of the granting of this permit. PLUMBING FEE
APPLE C NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO,o00 CFM)
SOURC: .GBIATIONS.- 2-17:::Do MECHANICAL PER
AIR HANDLING UNIT(OVER 1OIX10 CFM) CONSTRUCTION TAX
Signature,of AppllcanVCommcwr Date, EXHAUST HOOD(W/DUCp) HOUSING MITIGATION FEE
MATERIALS DISCLOSURE
Will he applicant or future building occupant stomor handle hmperdous material HEATING UNIT(TO 100,()00 HTB)
m defined by he Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(.)1 HEATING UNIT(OVER 100.000 BTU)
❑Yes ❑Na
VENTILATION FAN(SINGLE RFSID) PAID plate Receipt#
Will the applicant or future building occupant use equipment or devices which p
mit Incautious air contaminants as defined by he Bay Arca Air Quality Management BOILER-COMP(3HP OR 100.000 BTU)
Districfl TOTAL:
❑Yea No BOILER-COMP(OVER 100,000 BTU)
Ian,read the CarNo catim,255requirements under Chapter 6.95 of that
Cali- AIR BESIDES
CONDITIONER ISSUANCE DATE
borers Heath a,Safety Code,e a non% .Thai i 255JJ and 25534.I unJcrstuP that if rhe NEW RE5IULNDAL MECII. SQ.FT.
building do.,oppice rn .hich have tenant.Nvt it isms responsibinitn a tify the«cupant
of Ne rcq� ent%which must Le�ttissuonce ofaCrni�r�f�k�ney. � �
Owdiimi ni,c].,cut Z Date CAJ TOTAL: ISSUED BY� ,/�1 c%TJ
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Elk: Lot:36908006.00
INVOICE DATE......: 02/18/2000
REFERENCE ID # ...: 00020156
SITE ADDRESS .....: 10199 E ESTATES DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............ : MORELLO FRED C AND DILMA A
ADDRESS ..........:
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-3303
CONTRACTOR .......: GENTILE, BILL LIC # 21328
COMPANY ..........: CONDITIONED AIR
ADDRESS ..........: 164B GII24AN AVE
CITY/STATE/ZIP ...: CAMPBELL, CA 95008
TELEPHONE ........: (408)374-6311
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ ___ --------- ------------ --___--____
BREMEEAT P 6.11 0.00 6.11
MPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
41.63 0.00 41.63
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
UNDERFLOOR FRAME 301 ROUGH PLUMBING
03 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS
Cry. i1 Applicable Fee 117 Fee Oescription Fee Group
IBPERNIFEE (BLDG PERMIT FEES IBUILD6vG
IBCONSTAX (CONSTRUCTION TAX (BUILDING
• IBENERGY (ENERGY BUILDING
IBENERGYADD (ENERGY ADD MULTI IBUILDING
IBOVERTINIE JINSPECTION OVERTIME (BUILDING
BTEMPPERM TEMPORARY BLDG PERMIT IBUILDING
BMITIGAT HOUSING MITIGATION FEE IBUILDING
1iIBPLANCHK PLAN CHECK FEE IBUILOING
BPLANCKADO PLAN CHECK ADD MULTI BUILDING
BPLANCKREP PLAN CHECK REPEAT FEE BUILDING
BREINSPECT REINSPECTION FEE BUILDING
BSCBLVO SCS SPECIFIC PLAN BUILDING
BSEISMICOM SEISMIC COMMERCIAL BUILDING
BSEISMICRE SEISMIC FEE RES BUILDING
ESPECIAL SPECIAL INSPECTION BUILDING
BSWIM SWIMMING POOL BUILDING
jZA0DCHG ADDRESS CHANGE BUILDING
EPERMITFEE JELEC PERMIT ISSUANCE ELECTRICAL
BELEC1000 ELEC 600V<=1000A ELECTRICAL
BELEC1001 ELEC 600V>1000A ELECTRICAL
BELEC200 ELECT SVCS 600V<=200A ELECTRICAL
BNEWMULTI MULTIFAMILY RES ELECTRICAL
BREMBUSWAY REMODELBUSWAYS ELECTRICAL
BREMFIXT UGHTING FIXTURES ELECTRICAL
• BREMMISC MISC APPARATUS ELECTRICAL
BREMNRAPP REM NON-RES APPUANCE ELECTRICAL
BREMPOLE POLE(PLATFORM FIXTURE ELECTRICAL
BREMPOWER POWER DEVICEIAPPARATUS ELECTRICAL
BREMRECEPT RCPTL, SWITCH &OUTLETS ELECTRICAL
BREMRESAPP REMODEL RES APPUANCE ELECTRICAL
BREMSIGNAD RMOL SIGNS ADD BRANCH ELECTRICAL
BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL
BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL
BSF&2FAM SINGLE&2 FAMILY ELECTRICAL
STEMP TEMPORARY POWER ELECTRICAL
BTEMPSVCS TEMP DIST SVCS . ELECTRICAL
MPERMITFEE MECH PERMIT ISSUANCE MECHANICAL
BAPPLOTHER OTHER APPLIANCES IMECHANICALI
BBOILERI BOILER <= 100,000 BTU MECHANICAL
BBOILER2 BOILER>100KTO500K BTU MECHANICAL
BBOILER3 BOILER>500K TO 1M BTU MECHANICAL
BBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL
BBOILER5 BOILER> 1.75M BTU MECHANICAL
BREMAPPLI APPLLANCE INSTALL MECHANICAL
BREMHEAT HEATER INSTALLATION MECHANICAL
BREMVENFAN IVENT FAN SINGLE DUCT MECHANICAL
BMNEWMULTI• INEW MULTI-FAMILY RES MECHANICAL
• BMNEWSF&2F INEW SF&2F RES BLOGS IMECHANICALI
k aft
Pa izca VIOl99