99080024 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY Q U O
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT N
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS. SANITARY NO. APPLICATION SU ITTAL DATE
E FfNl Loo - 1 8 3
OWN R'S NAME: ZONE: CO "HACIOR' NA i LIC NO:
NIC CONTROL
IT ENGINEER: LI. 0' ADDRESS' V S ❑ ��
r=t
lq 611
CONTACT: PH E: . BUILDING PERMIT INFO
I' ��� ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT' PLUMB MECH
LICENSED
at I a CONTRACTOR-1 under DECLARATION QTY. ELEL-MIC PERMIT FEE
1 nn,ny affirm mm 1 am fiec.ned ander nrotinm.n.renapmr9(commencing JOB DESCRIPTION
�pZO with Section]W(gofDivisi..3 oRhe Business and Professions Cale,and mylicenaeis - RESIDENTIAL:
F- O in full force and effect. PERMIT ISSUANCL
W p. ❑SFDWI. [I KITCHEN REMODEL
�zW License Class Lica APPLIANCES-RESIDENTIAL. C1 ADDITION El PLUMBING RE-PIPE
yGLDate Contractor
dr, N :TS DECLARATION L1 MULTI-UNIT []STRUCTURAL
ZpNZ • I § II ;dos public records PANELS MODIFICATION
O Z'4 Up In 200 AMPS F1 INTERIOR [I CHIMNEY REPAIR
a t; Lic sed ss nal 201-lap AMPS IMPROVEMENT E]SWIMMING POOLS
..I OWNP ILDEN DF:CLANA'1'ION ' OVER IWIAMPS ❑BATH REMODEUREPAIR (]DEMOLITION
gq Y,U r mreby affirm that 1 exempt from the Corm erce's License Law far the
Cliy$5 O a U follow g reason.(Section 7031.5,Business and Transitions Code:Anycity or county SIGNS ELECTRICAL []OTHER
W 3 W 1-" which requires a permit to construct.alter,improve.demolish,(it repair uny swcture
F 4'0t3 prior to itsissuance,also requires the applicant for such permit o file a signed statement SPECIAL CIHCUIT/AfISC. -
>a thin he is li,emnl pmumno the powi,ion,ofaha Comnmmr'v Licari Lew lCanines9
X00 (commencing with Section7NXE of Division 3 of the Business and Professions Cuba)or TEMItMEIT'RORIY)LE INS' COMMERCIAL:
O. cy that he is exempt therefrom and the basis for the alleged exemmi.n.Any violation of ���,,,.❑INEW BLVTD'T.
DEMOLITION
NSection 7031.5 by any applicant for a permit subjects the applicant m a civil permits of POWER DEVICES �gTESANT /^[7j FOOD
t more than five hundred dollars(5500). ` -IMPROVr_\U❑ I,us owner of thepropeny,nr my empinyws with wages as theft sole coanpensminn, SWIMMING POOL ELECTRIC
will do the work,and theswcture is not irnerdedmroRercd for sale X..70b Rosiness ❑OTHER
W mad Pn it,to.,Code:The Comrnnor's Liamsc Low dues nor apply m an owner of Z OUTLETS-SWIT......IXTURES
pnap,oy who builds or improves there..,mrd who dos such work Innovator though f
le,mon ou,lo,sc,rnwided that such imrrnvnnents um not intended or offered far NEW RESIDENTIAL ME CTR SQ PI'.
sale.If,however the building orimprovement is sold withinone yerro(completion.the SQ. .FLOORAREA Q.
pmer-builder will have the burden of proving that he did not build or improve for pur- n
.a.f sale.). D
❑1,as owner of the property,am exclusively contracting with licensed cnntmcmrx to TOTAL: Yom_
anuvuct the prrjcct ISce.7044,Buainexe and Profession,Code:I The Comnators Li- 1
cancia Law does not apply to an owner of property who builds or improves thereon,and QTY, ' PL NG sERMIT a FEE
whocommas forsueh projects with u mmractor(s)Iice.sed puroua.t to the C.mmewrs t
License law. PERMIT ISSUAN
❑ I am exempt under See. ,11&P C for this reason
ALTER-DRAIN&VENT YA R(EA) VA UATION
er WORKER;S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE DT O
n Ihereby affirm under penalty of perjury one of the following declarations v
❑ Ihave and will maintain a Ccnifiamm mfCons.ut to self-insure for Worker's Camper- DRAINS-FLOOR,ROOF.AREA,GOND. S1 ORks TYPE CONSTRUCTION
mien,as provided for by Section 37M of the Labor Cule,for the performance class
work for which this permit is issued, IIXTURIS-PF.R'I'RAP -
❑ I bats,and will maintain Worker's Compensation Ins.mnce,as required by So,don
3700 ofthe labor Code.for the Performance ofthe work for which this permit is issued GAS-FA.SYSTEM-1 INC.40 .TS OCC.GROUP APN
sly Worker's Compensation Insurance carrier and Policy number are:
Cavies Policy No.: GAS-EA.SYSTEM-OVER 4 -A)
CERTIFICATE?OF EXEMPTION FROM WORKERS' ((O 1 I
COMPENSATION INSURANCE GREASFIINDUSTRL W .TE INfERCCProR
U Ids section recd not blinf I
econ, ed ihepermit is formic hundred dollars BIND BUILDING DIVISION FEES
n,less) GREASE TRAP PLANCHECK HE
I rectify that in the perfordarecofthe work auwhich this permit is issued,lshall SEWER-SA ANY-S'T'ORM EA.200 F1'.
not cradoy any N...n in uny nanner xo as.,heron¢subject t.the Workers'Corr,n- ENERGY FEE
OZ onion pawn ofCalifomi..Date WATER ATER WNENT/F.LECrR
Z O APPliamt GRADING FEF
or, NM ICE TO APPLICANT.If.am,making this Certificate of Exemption,you should Wq SYSTEM/TREATING
become sobject in aha Workers Compcnoo am prwidons of the Lubar Code,you must SOILS FEE
forthwith comply with such provisions.,this permit shape he deemed revoked ATER SERVICE
Q
7sz CONS I them UCTION LENDING AGENCY NEW HESIDGNTIALPLMB. SQ,FT. PAID
LIp I for whip thi that i issued(Sec.i0lending agency for the performance of Due ReceiptY
F' the work for which This permit is issued(See.309],Civ.C)
Trustees Name TOl'AL:
Lender's Address TOTAL:
0. 1 certify that 1 have real this application and sum that the above information is - BUILDING FEE
.�.a to coned.legate to comply with all city and cnumyordimanres and omit haws relating so 'QTY. MECHANICAL PERMIT a FEE`
U ,Z building construction,anti hereby authorise representatives ofthiscity master upon the SEISMIC HE
abotamemi.ned property for immedionp "ves. PERM1'r,ISSUANCE?
(We)agree a save,adder nity and keep bamless In,City of Cupertino against ELECTRIC FEE
babilines,judgments,costs and expenses which may in any way scrod,againasnid City ALTER OR ADD TO MECH.
in mcquen,e of the gr ting of thla permit. PLUMBING ITE
APPLI T )E DS AND WILL COMPLY WIT[ ALI NON-POINT AIR HANDI.ING UNIT(TO IQap CIM)
MECHANICAL FEE
SOIL .1 I'.1 A
AIR HANDLING UNIT(OVER Ig000 CFM) CONSTRUCT ION TAX
Si a. re dApp aunt recur SCJ Dam EXHAUST HOOD(WA)UCT)
H ARD( S MATERIALS DISCLOSURE HOUSING MITIGATION FEE
Will theapplir mortal thmildingoc,,tw ,neo,handle hmardmasmntedid I I I XIING UNIT(TO I00,000 BTU)
as defined by the Cupertino Municipal Cade.Chapter 9.12.soothe Hcnith it Safety
Calc,Section 25532(a)1 / HEATING UNI T(OVER I W.OW ETC) _
❑Vex
/\�JNo VENT] FAN(SINGLE RESID) PAID
Date. Rea pt
allWill the applicant or future building occupant use equipment or devices which
:mit hazardous air conumirams as defined by the Bay Arc.Air Quality Management BOILER-COMP OHP OR 1 W,ap BTUj
District?ahh,.,.M
TOTAL:
❑ BOILER-COMP(OVER 1X1.000 BTU)
1 hterial AIRCONDITIONERtequiremrnu under Chapter M1.95 ofthe CWi- ISSUANCE DATEInuit Ilws 25505,25533and 25534.1 andnrua d than if the NEW RESIDENTIAL.MECH. SObuildingn0rhathismyresponsibility of aces.,tert pri. th i......e mf y('eAtl -a ncy,
Uner nu o egem (XJ to TOTAL: ISSUED BY:
OFFICE
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb
COPY 4 2
Sec: Twp: Rug: Sub: Blk: Lot:31602107.00
i
DATE ISSUED...... . : 08/03/1999
RECEIPT k. ... ..... : 9720
REFERENCE ID # . ..: 99080024
• SITE ADDRESS . . . ..: 1 INFINITE LP
SUBDIVISION ... . . . .
• CITY . ..... ... . . . . : CUPERTINO
,+ • IMPACT AREA ... . . . .
f OWNER CUPERTINO GATEWAY PARTNERS
b ADDRESS . . .....
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014
RECEIVED FROM . .. .: TIM
CONTRACTOR .. . . . . .: RUSSELL, DAVID J LIC # 5655
COMPANY ...... ... . : SOUTHBAY CONSTRUCTION
ADDRESS .......... : 511 DIVISION STREET
CITY/STATE/ZIP ... : CAMPBELL, CA 95008
TELEPHONE .. ......: (408)379-0400
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 8,000.00 137.00 0.00 137.00 0.00
BPLANCHK PERMIT FEE 137,00 116.45 0.00 116.45 0.00
P TXT NO. FIXTURES 7.00 7.77 0.00 7.77 0.00
IY PERMIT FEE 137.00 41.10 0.00 41.10 0.00
B' ECEPT NO. OUTLETS 16.00 17.76 0.00 17.76 0.00
MPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
BREMREPALT NO UNITS 5.00 61.05 0.00 61.05 0.00
BSEISMICRE VALUATION 7,500.00 0.80 0.00 0.80 0.00
EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
__________ __________ __________ ----------
TOTAL PERMIT 452.97 0.00 452,97 0.00
MET)JOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ __________________
CHECK 452.97 6602
TOTAL RECEIPT vena=•452.97
1{{ CITY OF CUPERTINO
p Item 1 of 2 BUILDING PERMIT RECEIPT OPERATOR: karenb
i11p COPY b 2
I -
{ Sec: Twp: Rng: Sub: Blk: Lot:31602107.00
V
" DATE ISSUED... . ...: 08/03/1999
r
tl - RECEIPT fl..... . . . . : 9720
REFERENCE ID N . . . : 99080024
SITE ADDRESS ..... : 1 INFINITE LP
SUBDIVISION . ......
CITY ..... .. . . ....: CUPERTINO
IMPACT AREA . ......
OWNER ... . . . . . . ... : CUPERTINO GATEWAY PARTNERS
ADDRESS .. . . . . . ....
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014
RECEIVED FROM . ... : TIM
t CONTRACTOR ...... . : RUSSELL, DAVID J LIC # 5655
COMPANY SOUTHBAY CONSTRUCTION
i, ADDRESS .. ........ 511 DIVISION STREET
CITY/STATE/ZIP .. . : CAMPBELL, CA 95008
TELEPHONE . . ...... : (408)379-0400
4
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS AEC NEW HAL
__________ __________ __________ __________ __---_____
i
IID DESCRIPTION VOICE ID .-..- ..DESCRIPTION
.............. ........ ..............
101 FOUNDATION 102 PIERS
103 LIFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMDING 203 UNDERFLOOR MECHANICAL
y 201 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
{1 301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
30] INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
{ 311 SCRATCH COAT 313 ROOF NAIL,
r 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY
503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY
505 FINAL ELECTRICAL S06 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
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