08010122CITY OF CUPERTINO
TQ*AN GRMA,TIt?1�:`
BUILDING DIVISION PERMIT
T.kk I
.�
BUILDING ADDRESS:
PERMIT N0.
10720 ALDERBROOK LN
TBD - TO BE DETERMINED
08010122
OWNER'S NAME:
PERMrr ISSUE DATE
DOLLY SANDOVAL AND ED HOFFMAN
01/18/2008
ONE:
SANITARY NO. CONTROL NO.
ARCHI ECnENGiNEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
DECLARATION
LICENSED CONDtACnder
-
lob Description
I nertby allirm Wt I sec limned under provisions of Chapter Y (commencing
p
with Section 7") of Division 3afthe Business and Profcssiuna Code, and my license is
METER UPGRADE 200AMP. G.E.RICHARDSON PD FOR BSL
in full forte and effect.
License Close Lt., g
1/18/08
Date Contractor
ARCHITECTS DECLARATION
[understand my plane shall he used as public record,
Licensed Professional
OWNER - BUILDER DECLARATION
I heathy a1Erm Nat 1 am exempt from the Contractors License Law for the
following reason. (Section 7101.5, Business and Pmfetsiov Codc: Any city or county
Which requtrm a permit to ... su uct, user. improve, demolish, nr mPat, any umetum
prior to its issuance, also requites Me applicant for such permit to file a signed atatemem
that he is licensed pursuanu0 the provisions of the Conescum's License law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Section 7000) of Division 3 of the Business and Pmfenions Cade) or
$2500
that he Is exempt ihemfmm and the basis for the alleged exempsm. Any violation of
Section 7031.5 by airy applicant for permit subjects the applicant o a civil penalty of
Number
Occupancy Type
not mom than five hundred dollar 5300
3 6 9 2 0 0 4 7 ,
❑ 1, u owner of the pmpaty, w my employees with wtu u 0chsok compenudon,
wills. the wank, and the sw ium la natimmnded or offemd foraale (Sm.7044, Busiwa
and Profeukes Cade; The Cmusselora License Law does not apply to an Owner of
Required Inspections
property who builds or im proves themon. and who does such work himself ar through his
awnemployces, provided thmsuch improvements art not intended nro @rod foredo. If,
however, the building or improvement is to with . one year of Completion, the owner -
builder will have the burden of proving man he did roe Mid or improve for purpose of
sale.).
❑ 1, u Owner of the property, am exclusively contracting with licensed contractors to
conetwel the project (Sec. 7044. Business and Professions Code:) The Contractor's Li.
ceve law does not apply to an owner of property, who builds or improves Nemon, and
who contracts for such projects with aeanuaclar(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under See ,B B PC For this won
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affrm under penalty of perjury arc of the following declarations:
_
I have and will maintain a Ce tificom of Covent to salfdmum fer Worker's Compen-
ton, as provided for by Section 37M of the labor Code, for the perfmmmec of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, u required by Section
3700.( the Latour Code, for the pedormanceofthe work farwhich this permit is Wised.
'
My Workers Compensation Insurance canter and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
.
(nos atcdoe need nor bs completed if the Permit Is for arc hundred dollars (S I dB
or leer)
I certify that in the performance of the work for which this permit Is issued, I Nall not
employ any permnt in any manner to u to become Object to the Woftrs' Compevadon
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, eMr making this Certifrmle of Exemption, you should
become subject to the Workers Compenwdan provisions of the labor Code, you most
forthwith comply with such previsions w this permit shall be decree revoked.
CONSTRUCTION LENDING AGENCY
1 hereby &frmm sw there is a consVUClien lending agency for the Performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
lender's Name
'
Lenders Add.
1 cenHy that I have read this application and state that the above information is
COMM I epee to camplY wish all city and county ordinances and swe how relating to
building mnmuctian, sort hereby amhodre mpresentatives of this city to envy upon the
shove - mentioned Property for impaction purposes
(We) agree to lave. indemnify and keep Mumlela se, City of Cupertino against
ea may kany way accme agsivllaid City
in Consequence of Swend
inconsequence of the this pewhich
of this
UNDERSTANDS
D WILL APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Dale
SOURCE REGULATIONS.
Re -roofs
Signature a(ApplicanUCam Pak
HAZARDODO US MATERIALS DISCLOSURE
Type of Roof
Willy m handle vmaterial
..
as defame by ste
die CkantnoMumipal ode. Chapter Health
Cupertino Municipal Code, Chapter 9.11, and the Health and Safely
Cork, section 15532(x)?
32(a)?
❑Yoe ❑No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to
Will the applicant as forum building aceupent use equipment or Juices Mich
g P g remove
'1111s dOV air contaminants as defined by the Bay Area Air Quality Mmagc moon
all new materials for inspection.
uictT
❑Yes 0 N
I have mad the meardom materials requirements under Chapter 6.95 of the Califor-
nhHulth& SafelYCade. S= dmv 505,25533md25534.iw&de dthkifthc building
does not.mo ndy hew a unu m, thas it is my oupovibilby tenuity do mcupant of the
roquimments which mum be met Putnam issuance oil Cenifcateaf Occupanry.
Signature of Applicant Date
All roof coverings to be Class "B" or better
g
owner or amhorizee egcm �
Dam
to 5 ITEMS OF 5
•
11
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36920047.00
DATE ISSUED.......: 01/18/2008
RECEIPT #.........: BS000003740
REFERENCE ID # ...: 08010122
SITE ADDRESS .....: 10720 ALDERBROOK LN
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............: DOLLY SANDOVAL AND ED HOFFMAN
ADDRESS ..........: 10720 ALDER BROOK LN
CITY /STATE /ZIP ...: CUPERTINO, CA 95014 -4604
RECEIVED FROM ....: GEORGE E RICHARDSON
CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBD - TO BE DETERMINED
ADDRESS ..........:
CITY /STATE /ZIP .... ,
TELEPHONE ........:
FEE IO UNIT
---- -- - - -- ------- - - -
QUANTITY
AMOUNT PD -TO -DT
THIS REC
NEW BAL
---
1BSEISMICR VALUATION
-- -- - - - - --
2,500.00
-- - -- - - - -- - ---
0.50
-- - - --
0.00
-- -- - --- --
0.50
-- -- - - -
0.00
- --
1BUSLIC FLAT RATE
1.00
110,00
0.00
110.00
0.00
IELECINSP HOUR
1.00
- 122.38
0.00
122.38
0.00
1EPERMITFE FLAT RATE
1.00
40.79
0.00
40.79
0.00
ITRAVDOC FLAT,RATE
1.00
40.79
0.00
40.79
0.00
TOTAL PERMIT
- --- - - - - -- ----
314.46
- - - - --
0.00
---- - - - - -- ----
314.46
- - - - --
0.00
METHOD OF PAYMENT
------- ---- - ----- ----
AMOUNT
REFERENCE
NUMBER
CREDIT CARD
--- ---- - ---
314.46
---------------
MC
- - ---
---------------
TOTAL RECEIPT
314.46
ft
CI OF
• CUPERIINO
•
•
09010 1 ZZ
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
APN # 5 (Pq A v ,n U
�1 � O U
Date:
Building Address:
t
D% O f}��ler bcoal� L/V
Mailing Address (if different from building address):
Owner's Name:
Phone #: fQ 6 y Q o f
�(7 -(4
Contractor:
Phone: ypg Y2 i (/ F.1
64f
Fax: Y6t 31 Y /07 d 1
Contractor License #: . !b ;46
Cupertino Business License #:
Contact: G e C rj P, . 4,i . J fo,
Phone: L/o y y 2 6 (1 q t
Fax:
Residential LLJ— Commercial ❑
Job Description:
M {fi`� ''N (. r,C)f aG 4 A ,o Fa 4w, p,
Building Permit Info:
Bldg ❑ Electq 1?' Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1 FR, 11FR ❑ 11, 111, VAHR ❑ 11, 111, 1V V -N
Valu n Square Footage:
,S G U
Project Size: Standard d- Large ❑ Major ❑
40,
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1 GENCOM
1BTEMPPER
Temporary Building Permit (good for
B
30 days)
1BBOILERI
For the installation or relocation of ea
M
boiler /compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h 29.3kw
1BBOILER2
Installation /relocation of ea
. M
boiler /compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1BBOILER3
Installation/relocation of ea
M
boiler /compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1BBOILER4
Installation/relocation of ea
M
boiler /compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5
Installation /relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1ELECINSP
Other Electrical Inspections (per hour)
E
1MECHINSP
Other Mechanical Inspections (per
M
hour)
1PLMBINSP
Other Plumbing & Gas Inspections
P
(per hour
1MEETINGIHR
Application Meeting
B
Me CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING APPLICATION
• FEE SCHEDULE
Quantity /Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1 GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW
SFDWL/Duplex New
B
IACOUSRESAD
SFDWL /Duplex- Addition/Alteration
B
1ACOUSCOM
Multi - Family /Commercial
B
CHIMNEY'S
1CHIMNEY
Chimney
B
1CHMMNEYR
Chimney Repair
B
FENCES
1FENCE >6FT
Non - masonry, over 6 ft in height
B
1FENCEMAS >6
Masonry, over 6 ft in height
B
FIREPLACES
1FIREPLMAS
Fireplace Masonry
B
IFIREPLFAB
Fireplace Pre- Fabricated/Metal
B
1FLAGPOL >20
Flag pole (over 20 ft in height)
B
1MODUSTRU
Modular Structures
B
FOUNDATIONS
1FOUNDREP
Foundation Repair
B
1PILECAST
Pile Foundation Cast in place concrete
B
1PILEDRIV
Pile Foundation Driven (steel, pre-
stressed concrete)
B
3 of 5
aclor
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONR
11tETSTN
Standard (up to 50 ft)
B
1RETSP310
Special Design, 3 -10' high (up to 50 `)
B
1RETSPIO
Special Design, over 10' high (up to
50'
B
1RETCRB<
Gravity /Crib Wall, 0- 10'high (up to
50 ft
B
1RETCRB>
Gravity /Crib Wall over 10' high (up to
50 ft)
B
SIDING
1SIDESTBK
Siding, Stone & Brick Veneer
(interior /exterior)
B
1SIDEOTHER
Siding all.other
B
SKYLIGHTS
1 SKYL <10 SF
Skylight less than 10 sf
B
1 SKYL >IOSF
Skylight greater than 10 sf or
structural
B
1STAIRS
Stairs -first flight/ea addt'l
B
STORAGE RACKS
1 SRACKS < =8
Storage Racks 0 -8' high (up to 100 sf)
B
1SRACKS >8
Storage Racks over 8' high (up to 100
st
B
ISTUCOAP
Stucco Applications (up to 400 sf)
additional stucco a pplication
B
U
4of5
UP0CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
CUPEkTINO
• FEE SCHEDULE
r
L
Quantity /Sf
Fee ID
Fee Description
Fee
Group
Permit Type
IGENRES or
1GENCOM
1 WINREP
Replacement windows /sliding glass
door (ea 8 windows
B
1WINMEWSTR
New Window - structural shear
wall /mason (includes plan ck fee
B
IEPERMITFEE
Electrical Permit Fee
E
IMPERMITFEE
Mechanical Permit Fee
M
1PPERMITTEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1 PLMPLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
ISTPLNCK -(3 Hr Min
when not over counter )
Standard Plan Check (when no E /M/P)
hourly-stand alone
B
/
1BSEISMICR
Seismic Residential
B
1BSEISMICO
Seismic Commercial
B
/
1TRAVDOC
Travel & Documentation
B
i1BUSLIC
Business License
B
11
5of5
PTY F
41 UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777 -3228
Fax(408)777 -3333
Building Department
JOB ADDRESS:
zo %-brz)-o I— zin
PERMIT #
,F E)
OWNER'S NAME: S e^6L a./ w
PHONE #
GENERAL CONTRACTOR: m, -
AX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
• Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
-�
Owner / Contractor Signature
/ / P' O f,
Date
SUBCONTRACTOR B
BUSINESS NAME B
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
-�
Owner / Contractor Signature
/ / P' O f,
Date