The URL can be used to link to this page

00010152 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY o Q 0 10 1 s, CITY OF CUPFRTINO BUILDS -ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERNIT PI,UMBING.MECHANICAL. BUILDING PROJECTIDENI'IFLCATION BUILDING A DRESS: r. SANITARY NO. APPLICATION SUBMITTAL DATE QZ65 a2n� l e G1, 1 2.., 2,C,.Qp ,OWVRSNAMp: ' �_D /-., C HALTER$N ME: LIC NO CL�KJ 'Jl 1/�_/1 NIC CONTROL p ARCHITECTENIGENHEW LIC NO: ADpR r'S:'T I I ❑ 'oNTncr; PHONE, VL 'IVI r/llla/ , - BUILDING PfiRMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH ❑ ❑ ❑ LICENSED CONTRACT'OR'S DECLARATION QTY. ELECTRIC PERMIT FEE 1 hereby affirm that 1 am licensed under provisions of Chapter 9 Ic nmencing - JOB DESCRIPTION "Z with Section 7OE0)of Division 3ofthe Business and Professions Cale,and, license is �00 ' MIT ISSUANCIi RESIDENTIAL: In full fnrcc nnJ eHat �UU License Class c36g Lica ❑ADITI ❑PLUMBINREMODFE H<2 Date Comrndor APPLIANCES-RE.SIDEhT1A1- ❑ADDITION ❑PLUMBING RE-PIPE F.pm ARCHITECTS DF.CLARA'TION PANELS ❑MULTI-UNIT ❑STRUCTURAL z O m 7,. I undc,smnd my plum,Loll he used os puhlic swords MODIFICATION OZ=a UP TO 200E AMPS ❑INTERIOR El CHIMNEY REPAIR F4Fttl Licensed Profesvumst 2oI-I(IfIn AMPS IMPROVEMENT SWIMMING POOLS < 2, OWNER-HUILDEH DECLARATION OVER IfXN1AMP5 g C I hmchy abino that 1 um wempt from the Cunmema. Jcvmc Low for the ❑BATH RCMODEIIREPAIR DEMOLITION �g506 U following reason.(Section 7031.5.Business and Pmfessions Cane:Any city or county SIGNS 131.ECTRICAL ❑OTHER �++W ds E- which requires a permit to construct,alter,improve,demolish,or repair any stmcturc do priorto its Issuance,ulsorequirev the applicant forsuch lumpitto rile u signedstatementSPECIAL CIRCUIT/MISC. y that he is licensed pursuant to the provisions id Oe Councemrs License Law(Chapter 9 Id C OO (eommered.,with Sidman70f(b of Division 3 of the Business and Professions Crate)... TEMP.MITER OR POLE INST, COMMERCIAL: 1 c y that he is exempt therefrom and the basis for the alleged exemption.Any situation of ❑NEW BLDG/ADDITION ❑DEMOLITION ^ Sr,lmd7(1.31.5 by any appliwm I..u permit nobject,the applieanno u civil penaltynf POWER DEVICES ^m ❑TENANT E3 FOOD SERVICE t marc ohne Five hundred dollars y amp. IMPROVEMENT �_� ❑ do sow der of the pm pent',onnycmntended wrof wages raidtheir(Sec. 044,Bsiness SWIMMING POOL ELECTRI HE Bothe work,and the he Ccallisndintended moffered fm aide(Sec.it do Business,I ❑OTHER W� ardent',no ns COAs:TheC themed. LicensedLow dodocsnutapplysrotowner of OUTLP.TS-SWITCHES-F TURES property who hail%,or vided that thereon,and who dims such uvrk himself offered gh his awn employees.provided Ihm such improvemen„are not intended or offered for NEW RFSIDENTIAI.ELfSe SQ sale.If.however.the building or Improvement is sold within odeyear of armpletion,the SQ.FT.FLOOR AREA ESQ.FT. wner-hmlder will have the burden of proving that he did not hail)or improve for pnr- pou of sale.). I,asr of the property,am exclusively contracting with licensed conduction to OT nmsauct the projem(Sec 7044,Business and Profasiom Cale.,The Cadmctork. - - nwLawdoesnotapplytoondwnetofpropenywhobuildsorimprovesthereon,and QTY- PLUM BINGTERMIT who contracts for such projects with a enmm eons)licensed pursuant to the Contractor's License Law. PERMIT ISSUANCE ❑ I am exempt under Sec. ,11&P C for this reason Outer Date ALTER-DRAIN&VENT-WATER(EA) VALUATION WORKER'S COMPENSATION DECLARATION BACK FLAW PROTECT.DEVICE �� /,ry.� Iherchy ul3irm under pcnnhy of perjury one of the following dee luntli os. 7 00 IhevcanJ will maimaina Cenificalenf Cnasenuosclf-insure for Worker's Comped- DRAINS-FLOOR.ROOF,AREA,COND' STORIES TYPE CONSTRUCTION as provided for by Section 37M of the Labor Code,for the performance of the CJr which this pandit is issued. FIXTURES-PER TRAP I heave and will nmintain Wmker'a Compensation Insurance,as required by Section .700of,he Labor Cale,for the performance ofthe work for whichthis permit .iis.iss.suuredd.. GAS-EA.SYSTEM-]INC.4 OUTLETS OCC.GROUI' APN MY Wark S�� pep�Jpait yfecame policy Naand Y Kj2j2EA..Y( 6 GAS-EA.SYSTEM-OVER 4I t:A) Cartier ` rC (lC.7J -OZ-0,3� CER'I'IFICATH OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASE IINDUSTRI.WASTE INTERCEPEIOR (This section need not he completed tithe permit i,forone hundred dollars($101) BUILDING DIVISION IT3FS or less) GREASE TRAP PLANCHECK FEE I cenifythat in the perforrencenfthe work farwhich,hmpendit is issued,l shall SEWER-SANITARY-STORM EA.200 FT nomb t employ any Person in any manner so us to become subject FEE C) z ,inion Laws of Cxlifomia.Data / Wq'1'ER HEATER WNENT/ELECTR z Applicam GRADING FEE .N., NOT'ICE'1 O APPLICANT.If,after making this Cenificam of Exemption,you should WATER SYSTEM/TREATING a , become subject to the Worker's Compensation previsions ofthe labor Code,you must SOILS FEE forthwith comply with such provisions or this permit shall be damned revoked. WATER SERVICE Q 7z CONSTRUCTION LENDING AGENCY NEW RLSIDEN'I'IAh FILMS. SQ,FT. PAID L) 0 I therebywhich pernifri is.mi(Sec.30 len ding agency far Ne perbrmtancc of Dem Rweipta W F the were bur which this penult is;,seed(See.3097,Civ.C) O VLender's Name 'TOTgI.: W fenders Address TOTAL: I certify ohm 1 have real this npplicmion anJ stem that,he above information is BUILDING PEE vV) QTY, MECI IANICAL PERMIT F17P V Z building construction,and hereby mode ins representatives ofthis city to enter amen the _ SEISMIC PER. alxwe-medioned property for inspection purposes. PERMIT ISSUANCE(Wal agree to save,indemnify and keep harmless the City of Cupertino against ELECTRIC FEE Iiobililica,judgmeme,rostsand expenses which maylndny wo,reeme opt.instood City ALTER OR ADD TO MECH. in asequence of the grading of this penes. PLUMBING FEE APPLICANX UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO W."CFM) SOURCE:f Gl ATLONS. MECHANICAL FEE '/N sic AIR HANDLING UNIT(OVER IO,Wn CFM) CONSTNUCTIONTAX Signauve oft r t/ unnoun DLLatn sic AIR IiXHAUST HOOD DODUC) HOUSING MITIGATION FF,F. Z,ARDOIIS MA'I'ENIALS DISCLOSI1Rli N'illthe app;cant or dome building occupant store or handle hazallou,material HEATING UNIT LTO I Oddly)HT U) m defined by the Cupertino Municipal Cede,Chapter 9.12,and the Health and Safety Code,Section 25532(u)p HEATING UNIT LOVER 100.000 BTU) E:1 Ye, Po PAID - P YEN TILAI'ION FAN(SINGLERESID) Dam Receipt R Will the applicant orbounda building by the[l use equipment lor ily Management which infer, uus air contaminants u.%etinnl by the Huy Area Air Quality Management BOILER-COMP(3HP OR IfX),O0)BTU) TOTAL.: tancl i BOILER-COMP(OVER 10.0001 BTU) C]Yes �.'o Ilato,madlhchv.urdmt,editrials requirements under Chnpterfi91 of the Cull- AIR CONDITIONER ISSUANCE DATE forma Health& afety Code.Sections 25505.25533 and 25534, undemand,hm if me building Jrmsn it naen ybave utant,thm it is myresponsibility to notify the occupant NEW RESIDENTIAL MF.CIi. SQ.P. oftheeopt s hich must be met prior to issuance ofe Certificate of Occupancy. Owner or amho' m Date TOTAL: ISSUEDBY: OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: chriatya 40 Sec: Twp: Rng: Sub: Elk: Lot:35602038.00 INVOICE DATE......: 01/28/2000 REFERENCE ID # ...: 00010152 SITE ADDRESS .....: 22365 RANCHO DEEP CLI DR SUBDIVISION ....... CITY ... ..........: CUPERTINO IMPACT AREA ....... OWNER ...... .. . . . . : WOZNIAK, MARGRET ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-3927 CONTRACTOR .......: GILROY, JOHN LIC # 15128 COMPANY ..........: NST WATER HEATERS INC ADDRESS ..........: 1764 NATIONAL AVE CITY/STATE/ZIP ...: HAYWARD, CA 94545 TELEPHONE .. .. .... : (510293-9901 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BPWHEATER P 9.99 0.00 9.99 PPERMITFEE P 35.52 0.00 35.52 45 51 0.00 45.51 VOICE ID DESCRIPTION VOICE ID DESCRIPTION . .. ............................ ........ ............................ SEWER & WATER 202 UNDERFLOOR PLUMBING ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING