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99090051 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL PEN ONLY a q V" I I l/_l f CITY OF CUPERTINO BDILBING-ELECTRICAL rPERMIT N�� a/�, /I,� R �, BUILDING DIVISION APPLICATION/PERMIT PING PROGCTIDENNIFIC "'--3+�WWVJ"1""J��^��.'yh�� r1y � BUILDING PROJECT ID4:N'pIFICA'f10N BUILDING ADWRESS: SANT"I'ARY NO. APPLICATION SUBMITTAL DATE AL4 RIP L ' OW R'S NAME: PHONE: COM"RACfOR'S NAME: LIC NO: O 3a NIC CONTROLN HI11 T'CI'/ENGINEF.R: LIC NO: ADDRESS: 4 (r- Q �'L V ❑ CONTACT; PHONE: - BUILDING PERMIT IN170 ❑ Consultant Pecs Paid by Applicant(Initial) BLDG ELIiCI PLUMB MECH ❑ ❑ g ❑ LICENSED CON'I'RACIOR'S DECLARATION QTy ELECTRICPERMFr, FEE I hereby affirm that I am licensed under provisions of Chapter 9(commencing _ JOE DESCRIPTION Q IYZ with Se Iloal7000)ofDivision 30 the]susinessand l'rol'mslore Code,undmy license is RESIDENTIAL: WOO PERMIT'IS, F-W� in full force untie QI ❑SPDWL ❑KITCHEN REMODEL. �UU Licen Clad Lie.0 APPLIANCIES-RILSIDENTIAL []ADDITION ❑PLUMBING RE-PIPE hQd Dae Conv ARCHITECT'S DECLARATION ❑MULTI-UNIT ❑STRUCTURAL. ZcNZ I understand my plans shall be toed as public records PANES MODIFICATION OZ�nQ UPTO2UTAMPS ❑INTERIOR [I CHIMNEY REPAIR [v+[QJJ IA Licmnsed Prol'eWoral - 201-1000AMPS IMPROVEMENT C]SWIMMING POOLS �� J OWNER-BUILDER DECLARATION OVER IOW AMPS ❑IEATIi REMODIEIJkEI'AI ❑UE 1(L'I IO Q I hereby appear thol 1 an exempt from the Comselor's License Law for the XO6U following ressna(Section]031.5,Business and Professions CMe:Any city or County SIGNS ELECTRICAL C1o- EEB It 0m7i=-/ , 3 LLa which mi tims a permit Ins consvuer,tiller,improve,demolish,m repair any structure „�,.LL.O..1 pportoits isnunna.alw requires the applicant far such pcnniuo fileasignN amement SPECIALCIRCUI"UMISC. —� that he is licensed pursuant mhe provisions ofthe Contmcmes license Law(Chapter 9 WaCCO (commencing with SecJon](N)0)nl'Ulvisinn3ofthollusinessand Profc.i.iniu Cwlo)or 'I'IiMPMEGIR()It POLP.INST. COMMERCIAL: LL y o T 'hot he is exempt therefrom and the basis for the alleged exeniptien.Any violatimn of ❑NEW BLUGIADDITION ❑DEMOLITION YX7 N Section 7031.5 by any applicant for a pemtit subjects the applicant o a civil penalty of POWER DEVICES ❑TIENANT L1 FOOD SERVICE not more than five hundred dollars(85110). N Z Y IMPROVEMENT < ❑1,as owner of the property.ear my employees with wages es Neir sole cnmp[mabon, SWIMMING MCI.ELECTRIC �pZ.O will do the work,and thearactue is not intended m.1fiered for sale(Sec.l(Uq Business ❑GfHI:R 3 and Professions Code:The Contractor's License law does not apply to on owner of OUTLETS-SWI'I CITES-FIXTURIES property who builds or improve,thercm,and who does such work hinoch ear through his own employees,provided dentsuch improvemems no,mol monde]or offered for NEW RESIDENTIAL.ELECI'R 5Q sale.If,however,the building or impervemern is sold within one yew of completion.be FT FLOOR AkEA 1. FT owner builderwill have the burden of Evolving that he did not build or improve for pur- pn.emfsele.l. TOTAL: SEP 8199 ❑I,as owner of the property,a sclusively commeting with licensed contractors to constrict the project(Sec.7044.Business and Professions Cud)The Contracmr'a Li- --cense Low does not apply to an owner of property who btt'tlds or improves Iiccon,and QTY. PLUMBING PERMIT HUE who ccormul,fm such projects wair.mntmclor(s)licensed pursuant m Inc Contractors p c lam Oscan under Sec. .B&P C for this reason PERMIT ISSUANCE Y ❑ ALTER-DRAIN at VENT-WATER(EA) VALUATION owner Dae WORKERS COMPENSATION DECLARATION BACK FLOW PRUI'ECI.DEVICE 1 hereby infirm under pen�lty of PeCtiry one of the following deelanaions: * -57&.(o5- ❑l have and will maintain u Cenilicate of Consenfto self-Insure for Wnrkcr'N Compen- DRAINS-FLOOR.ROOF,ARIA.GOND. STORIES '1'YI'H CONS"IRGCT]ON satlon,us provided for by Section PW of the Labor Code,for the peronnunce of the work for which thio,permit is issued. FIXTURES-PER TRAP 1 have and will maintain Worker's Compensation Insurance.as required by Section of the Labor Code.for performance of the work for which this permit is issued. GAS-EA.SYSTEM-I INCAOUTI.EIS OCC.GROUP APN My Workyw c e^aAlA utnn�0anie rial Polcy Notirk /1Q GAS-EA.SYSTEM-OVER 4(EA) L- CERTTIIFIIC{AT'IE OFEXEMPTION FROM WORKERS' 9�� v COMPENSATION INSURANCE, GREASFANDUNIIRL WASTE INTERCEPTOR BUILDING DIVISION FIRES (This section need not be completed if me pemtit is for one hundred dollars(S 100) GREASETRAP or less] PLANCHECK FEF. Icertify that in the perfomanceofthe wort for whi,h,hi,arran is issued.)shall SEWER-SANITARY-STORM EA,200 RI'. not employ anPer ,ma Peon in any manner sea as to become subject to the Workers'Compen- ENERGY FEE z cation Laws olifm f Camle.Da""te�� WATER HE.ATIEIt W/VENT/ELECI'It 'Z� Applicant�, 4 _r:1 g GRADING FEE h NOTICE'f0 APPLICANT:If,ifler making this Ceniflcwo of Exemption,you should WATER Sys'nEMO'RHATING become subject m the Workers Compensation provisions of the Labor GNe,you must SOILS FEE W fonhwithcamply wird such pmvi,inion,this permit shall be deemed revoke]. WATER SERVICE 7z CONSTRUCTION LENDINOAOENCY NIEW RESIDENI'[AL PLMN. SQ.IT. PAID Dare Receipts U O Iherebyfshish thi Lnw them is a.ed(Sec.30 leading c agency for the performance ear 'he work 1'nr which this permit is lxsudl(Sea.J09],Civ.CJ 0 f-t Lender's Name - TOTAL U Lenders Address TOTAL: } W — BUILDINGFEE 1 certify that I have mad this application and state Ill.,me.borenormaton information is F I0, career.I agree to comply with all city and county ordinances and state laws relating to QTY, MECHANICAL PERMIT FEE U building construction.and hereby authorize repictraalives aflhis city melioration the SEISMIC FEE above-mention.]Pmpony far inslwction purposes. PERMIT ISSUANCE (We)agree to save,fish, dfy and keep hurmlcss the City of Cupertino against BLIR:I'k IC FEE llabilions,judgment. 'its and expenses which may in any wayacaueagai......fCity ALTERORADD9'OMECH. PLUMBING FEE a. nseyuence o e of t o permit. APPLICANT DE DS AND W L COMP TH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 GPM) MECHANICAL FEE SOU .Ul. ' N _ _ AIR HANDLING UNI'I'(OVER I0ASCEM) CONSTRUCTION TAX awns of App anntlCnntmcmr Ilaa EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material BEATING UNIT G'0 I O000 BTU) as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(x)'! HEATING UNIT'(OVER Bill."BTU) E]yes jXNo PAID VENTILATION PAN(SINGLE RESID) Date kceaiptN Will the applicant or I'tomc building occupant use equipment or devices which BOILEk-COMP(3HP OR I(NI,IYJII BTU) emit hazardous air contaminants as defined by the Hay Area Air Quality Managemea TOTAL: Disldet Yes )(NoBOILER-COMP(OVER 100,000 BTU) ❑ AIR CONDI"I'IONER Iholh&S t i Nets material requirtmenn under Chapter 6.95 of the Cult- ;ISS&ANCF, TC fomin Health&S' ty C� s 2' 05,25533 and 255]4.I undermanJ that if Nc NIEW RESIUF:NTIAI.MECtL SQ,FT. huildin6 uurt, hu�elon, tennl,�ati -sponsibilitytonotilytheoccupanl mf)n tl e. cat h1 nil 0 cof.Cenifi tOn I 10ccuPao O maser emMt]edaBem Uam TOTAL: ISSUED BY: OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO \� BUILDING PERMIT INVOICE OPERATOR: yv nnek 1 Sec: Twp: Rng: Sub: Elk: Lot:36230038.00 INVOICE DATE......: 09/08/1999 REFERENCE ID # ...: 99090051 SITE ADDRESS .....: 1224 RUPPELL PL SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ... .. ....... : NAKAMURA JERRY AND CATHERINE N ADDRESS ..........: CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-5049 - CONTRACTOR .......: GILROY, JOHN LIC # 15128 COMPANY ........... NST WATER HEATERS INC ADDRESS ..........: 1764 NATIONAL AVE CITY/STATE/ZIP ... : HAYWARD, CA 94545 TELEPHONE ........: (510)293-9901 NOTE: THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING 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 'W'D DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ............................ 106 SEWER 6 WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB 6 OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING it {