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05070043 CITY OF CUPERTINO -- BUILDING DIVISION PERMIT aCONTRACTOR;INFORMATION:gl 1BUILDING ADDRESS DELTA ELECTRIC PERMIT NIb5070043 10780 ALDERRRnnW TA OWNER'S NAME: PERMIT ISSUE DATE HALLORAN TIMOTHY P 724 COLLEEN DR _ _ 07/07/2005 E. SANITARY NO CONTROL NO (408) 224-0176 ARCHITECT/ENGINEER. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 u`oo LICENSED CONTRACTOR'S DECLARATION _w❑ I hereby grim that l am licensed under provuians of Chapter 9(commencing Job Description iW won Sention 7").rDm5mn 3ofthc Business and Perfessiu ndc andmyliccnuI '_may mmurn eanderrecL/t , n (� REPLACE EXISTING ELECTRIC FIXTURES S�z Littnse lit _U11/ Lk.Y �_y c Dons — GSDECr L AND RECEPTACLES BATH/KITCHEN/LIV RM ARCHITECTS DECLA ATION n u 1 o u hall h used as public¢eruct il a Lien S OWNER-BUILDERDECLARATION +� 2 1 herchy aIT,.that I am exempt frum the Conlracmr's License Law for the 00 following mason (Section 703 1.5,Business and Professions Code'Any city or county K$ which requires a permit to consuuCi,alter,improve,demolish,or apart any structure Lzi poor tons issuanec,also requires the applicant for such permit in file a signed sutemcn S< that he is licensed pursuant m one provisions of the Contractor's Licenx Law(Chapter 9 Sq.Ft. Floor Area Valuation yF� (commemnng with section 7")of Division 3 of the B usiness and Proressions Code)or i that he u exempt therefrom and the basis for the alleged exemption.My violation Of $2200 Section 7031.5 by any applicant for a permnsublecu cm applicant In a etvi penalty of APN Number Occupancy Type not mote than five hundred dollars(3500). P Y YP I,uownerofthepmpmy,mmyemploycuwiNw goaslhevmlecompensadon, will do the work,and NCSwnumurwtintendcd oroRcnA forsele(Sec.]064,BU51aL.3 307L V VYL V V and Profcsalons Code:The Conencmrl License Law does not apply to an owner of Required Inspections property who builds or improve thereon,and who does such work himself or through his own employees,provided that such improvements art not ntended oraRered forme.IL however,the building or Improvement is sold within one yav of compleuon,the owner. builder will have the burden of proving Nat he did not Wild or improve for purpose of FIN ALEN eft—, ALE® ❑1,as owner of the pmpcnF am exclusively contracting with licensed contractors to construct the pmlecl apply to in c Business ner of and property who Ni Cade:)The Contractor's nd mve law dais not apply m ar owns of propenY who builds or ImPmvu thereon.and who contracts for such prolecu with a canuanar(s7 licensed pursuant to the Convenors f y Ifv License Law. I I LIB ?moos. O l am oempt under Sec. ,B k P C for thureuon11 !llfU!) Owner Dam ��� W If ORKER'S COMPENSATION DECLARATION I hereby affirm under penally of pagury one of the following dolaraumca L]I 0 ban and will maintain a CCNfiealc Of Cooent t0 self-insure for Worker's ComPen- svmo,a provided for by Section 37W of the labor Cade.for the perform inem of the work for which Nu Permit is usucd. I have and will maintain Worker's Compensation Insurance.u required by Section 37W ofthe Labor Code.for the performance of the work for which this permit is issued. My WorkersCm ono nmle/amerand Puh,yynmm�tN,.mm; 4'� may[ Cartier. -�1� i 1]Policy NdLl�6l _010f CERTIFICATE OF EXEMPTION FROM ORKERS• COMPENSATION INSURANCE (Thu seeuan need not he completed tribe perm,is for.him and dollars(SI W) or less I 1 ccmfv shot in thc performance of the work for which this Permit u issued,1 shall too employ an)person in any manner An u to become subject o the Workeri Coripensadom Laws of Celdorma Dv- Applicant NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should become subject in the Worker's Compensation provisions of the Lahr,Code,you mu, .,z forthwith comply with such pmvnima or thss permit shall bo deemed revoked. z CONSTRUCTION LENDING AGENCY )hereby affirm that there is a construction lending agcnry for the performance of a the work for which this p.it is issued(Sec 3097,Cw.C.) .D z Lander'.Addrta< V C) I cenify that I have road this application and sate that the above Information or La. P Comm I agree in comply with all City and county ordinances and cox lava mlamg to V building ,judg ents,and hand cxpnouns which in any of this me reenter upon the Y.�� r a ahow-mentioned pmpeny for inspection purposes (We)agree m save•oriented,and keep harmless the City or Cupcnirm again l Hy in consequence thec9suandOfPenxswhmh maymanyway same against mid City U'z m APPLICANT of the RSTA gof dmDWIk ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P9;W Issued b Date ( SOURCE REGUL� Re-roofs SignalbreErAp�/pR��ianUC 1'Date HAZARDOUS MATERIALS DISCLOSURE f Type of Roof Will the applicant or future building occupant stem or handle hamdous material as defined by the Cupenmo Municipal Code.Chapter 9.12,and the Health and Safety Code,Sec ..25532(a)'r All roofs shall be inspected prior to any roofing material being installed. Yo u Will the apple r future Wilding occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove Su horardon,air conlamroanu u defined by the Bay Area Air Quality Managcmcm all new materials for inspection. Di.line" ❑Yes ❑N. 1 have real the hanrdous malcrialsmyuiremcnu under Chapter 695 of the Cation. nu Health&Safely Code,Socu ins M%5.25533 and 25534.1undersand dasifthe bmldmg does not cone d have a Icnana Nat ius my rnsponsibduy m notify the occupant of the myuircmcn nma,t eapliortrla,uamecmraCcrI,1 gofp�pn,6/SignatureofApplicant Date owncroraumorla ddje�—�} // /•/ Win All roof coverings to be Class"B" or better Community Development ` 10300 Torre Avenue Cupertino CA 95014 N Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: K PERMIT# _ "7 Os` 3 O R'S NAME: PHONE #try GENERAL CONTRACTOR FAX# C/Ql; I am not using any subcontractors�L Signature Date Please check applicable subcontractors and complete the following information I 66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical ( Excavation Fencing Flooring: Carpeting Linoleum/ Wood •I I Glass / Glazing Heating Insulation I, Landscaping Lathin g Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering I, Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile I I Owner/Contractor Signature Date CITY OF CUPERTINO rt 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 36920042.00 DATE ISSUED. . . . . . . : 07/07/2005 RECEIPT #. . . . . . . . . : 30263 REFERENCE ID # . . . : 05070043 SITE ADDRESS . . . . . : 10780 ALDERBROOK LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HALLORAN TIMOTHY P ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4604 RECEIVED FROM . . . . : DELTA ELECTRIC CONTRACTOR . . . . . . . : SANDY FRANKS LIC # 24971 COMPANY . . . . . . . . . . : DELTA ELECTRIC ADDRESS . . . . . . . . . . : 724 COLLEEN DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : (408)224-0176 OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL BENERGY PERMIT FEE 1.00 34.86 0.00 34 .86 0.00 BPERMFEE VALUATION 2,200.00 83.16 0.00 83 .16 0. 00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BREMRECEPT NO. OUTLETS 18.00 21.60 0.00 21.60 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 177.99 0.00 177.99 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ------------ ------------------ CHECK 177.99 3031 TOTAL RECEIPT 177.99 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL afflm- ' CITY OF CUPERTINO CUPCITY PERMIT APPLICATION FORM �j 70D y_3 �APN# � � �/ Date: , 1,� �> X70 '� r ��� K7� Building Address: Mailing Address (Ifdifftrent from building address): L-62mk / Any Owner's Name: hone �_O/ n/ TY7 C acto : Dense #: Cent Phone:-0-to /-01 Oil Cupertino Business License#: n n r Fax: �-f Building ermit Info: ��J/� ��✓+��a�,, ./_� Bldg ❑ rtEl1eTct� Plumb El bJ k) . e Job Description: Residential ,�5 Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story, addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ I Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax -Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL / I BENERGY Energy BUILDING f BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 avtba CITY OF CUPERTINO CITY Of PERMIT APPLICATION FORM CUPEkTINO Quantity I Fee ID Fee Description Fee Group j BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL 13NUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP I New Comm Plumb I PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum I PLUMBING BPCESSPOOL Cesspool I PLUMBING I / BPERMFEE I Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture I PLUMBING _I BPGAS Gas Piping System Fee I PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP I Plan Check Repeat Fee BUILDING f BPREPIPE I Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING f I BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING I BPVENT Alt of Drain &Vent PLUMBING BPWATER I InstaWAlter Water Pipe PLUMBING BPWHEATER Water Heater[Vent PLUMBING BPWSVCS I Main Water Service PLUMBING f BREINSPECT I Reinspection Fee BUILDING I BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL j BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways I ELECTRICAL BREMFIXT I Lighting Fixtures I ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL j BREMFURNOV I Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL j BREMINHOOD I Installation of Hood MECHANICAL BREMMISC I Misc Apparatus ELECTRICAL j BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER I Power Device/Apparatus ELECTRICAL / I BREMRECEPT I Rcpt], Switch & Outlets ELECTRICAL BREMRELOCA I Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating I MECHANICAL BREMRESAPP I Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO °N OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic,Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL / EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq.foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3