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05090113z� c' 4r s LC) C 0'j, t H tG L3 i CITY OF CUPERTINO BUILDING DIVISION PERMIT C9Ni RACTORj FORMATI,(�" BUILDING ADDRESS: ANTIQUE TERMITE & PEST PERMIT"°.05090113. 10143 AMADOR OAK CT OWNER'S NAME: PERMITLSSUEDATE TRUSSO JANET D 1913 STONE AVE 09/16/2005 E; SANITARY NO. CONTROL NO. (408)995-6300 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTORS DECLARATION Job Description P I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section?ON10) or Divia tit 3 of the Business and Professions Code, and my license is in Omn tame and cr$L �i�J.S � TERMITE REPAIR (3 WALLS IN MS BATH, License Clazs < < Lie" Dau,—,C(•'—%at C RIM JOIST/SHEETROCK) � ARCHITECTSonvacmrDECLARATION I understand my plans shall he used as public records Liec bsed Pmressianal I OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors license Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county l which ¢quires a permit to ennsuuct, alter, improve, demolish, or repair any structure ! prior m its issuance. also requires the applicant for such Permit to Bleasigncd staemcm FL Floor Area Valuat 3000 that he is licensed pursuant to the Provisions of the Contractor's License Law (Chaplet 9 Sq. 1 (commencing with Section 7")or Division 3 of the Businessand Profusions Code) or . that he is exempt thcerrom and Ne basis for the alleged exemption. Any violation of APN Number Occupancy Type Section ]031.5 by any applicant for. permit subjects Ne applicant to a civil penalty of not mare Nan five hundred d.11ara ($500). 34232021.00 ❑ I. as owner of the pmprrty, or my employees with wages az their sole compensation, a Required Inspections will do the work cad the structum is not a mnded or offered forsale (Sm. 7W, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who dears such work himself or through his Own employees, provided that such imprcwments arc not intended at offered for sale. If. however, the building or improvement is sold within one year of completion. Ne owner. builder will have the burden of proving that M1c did not build or improve for pusPoseof r� ® [III bale). ��VCp1 Owner of the property, am exclusively contracting with licensed contractors 10 C] 1. as tract ltg,Y�� t{GIS contract the project (9ec.90.4, Business and Professions Cade:) The Contractor's Li. cense law docs not apply to as an, of pmpcny who Wild. or improves therom, and who concocts for such projects with a comm�m(s) licensed pursuant m the Contractors SEP 2� 2005 License Law. I am attempt under Sec. .B& P C for this reason Owner Dam ppp ® I L{pgge!/ e' ®'■4'�� N %Z01 WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations:' have and will madded. a Ccaific.e of Consent to ssl6insum for WarkeeaCompen- sauan, az video far by Section 370 of the lobar Code. far the performance of the walk hieh this permit is issued. 1 have and will maintain Workcrs Compensation Insumme, as required by Section 37W of the labor Code, for the performance or the work for which this Permit is issued. My Worker's Compensation Ins{ ana artier and Policy number ase: (WORKd/H Yr Carrier. S, > MPTION O CERTIFICATEF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thissection need not W completed !film formals fa one hundmd dollars(5101) or less.) I xxmfv that In the performance' of the work for which this Permit Is hoped. I shall not employ any Iversen in any manner an as to become subject a the Workers Compensation Laws or California. Dam Applicant . NOTICE TO APPLICANT: Ir. afar making this Cenificam of ExcmPtian, you should become subject to the, Worker's Compewtion provisions of the labor Code, you must forthwith comply with Such previsions of this Permit shall M decoad revoked. ' CONSTRUCTION LENDING Y 1 hereby affirm then Nero is construction leading agency lot de peRermance of dingar ' Ne week for which this permit B issued (San 30)1, Civ, C.7 s Lender's Name ' fe U > nder's Address I «nify that I have read this application and sue that the above infosmatiun is ^ aoeccL 1 agree to comply with all city and county ordinances and sum laws missing in Wilding construction, and hereby autmule representatives cribs city to enter upon the L) shovcmemimed family far i.'Clhn Pmpmes (We) agree to save, indemnify and keep harmless the City or Cupertino against eLj babilities,judgereau, costs and expenses which may in any way scenic against said City > in consequence of the leading Orthis permit. ^ APPLICANT UNDERSTANDS AND WIL OMPLY WITH ALL NON -POINT Issued b Date y SOURCE REGULATIONS. Re-roofs Type of Roof SignatureSignarc of APPliwDor Dae m HAZARDOUS MATE RIALS DISCLOSURE HAZARDOUS Willy applicant of building occupant sae a handle m,fntuni as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety t Health and Code. Section 25532(.)? All roofs shall be inspected prior to an roofing material bei. P P Y g g installed. ❑Yea If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or futurebuildingavwpant use equipment or devices whim l ha,amous air comamiaants az gcfiacd by Nc Bay Arca Air Quality Management all new materials for inspection. N/ uelNCM1n'rardrws maurials rcyuirements under Chapmr 6.95 of the Califon f<ryCode, Secdoru 15505, 25533 and 25534.1undersand thatifthe Willingtly have a enanl Nat it ix my rcxponsihilitY m notify IW acupant of Nc L hich must be mmponn issuanc n Ccmheareor acapsney. Signature of Applicant Date —G�oimd All roof coverings to be Class "B" or better age. Dae ,an CITY OF CUPERTINO (WY OF CUPERTINO 40 PERMIT APPLICATION FORM 1,3 N# 3� Z 32— Date: X11: 'Z)5 Building Address: Mailing Address (if different from building address): /014/3 AM,4D0e_o6v_ -f Owner's Name: Phone #- :;I' <--+ Tr sso z 73- l L Contractor: h.741 e__ -72tZA-71l< License #: Gfi'S 8Z - Contact: p Phone: -9175`63061 Cupertino Business License#: //7'1 Fax: 9�s D / -1 BBOILER3. Building Permit Info: 7-6�,QCpAiC �1- %a s,(e�[Ga%G �2 TE?� 4r��rJc CimJo�s� zcK9S Bldg Bld Elect ❑ Plumb Mech ❑ Job Description: 3 W q ! /t't S iL S OCr� ei �, /Z2�as�t Residential It e C/,n oel .Tb ommercial ❑ Sq.Ft. Floor Area: q.Ft.: MECHANICAL BCONSTAX Cost of Project: dG Occupancy Group: Type of Construction: Please check this box if the project is a BUILDING second -story addition: ro'ect Size: Standard Laze ❑ Major ❑ BUILDING 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 BBOILERS Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ 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 BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING �AL3r23c�' 1 of 3 Iz S Ja ?% ArY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Ouantitv DFee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen TrapPLUMBING IE BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pi e PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel BuswaysJECRITRICAL BREMFIXT Lighting FixturesTRICAL BREMFURN Relocation of FurnaceANICAL BREMFURNOV Relo Furnace > I OK btuANICAL BREMHEAT Heater InstallationANICAL BREMINHOOD Installation of HoodANICAL BREMMISC Misc ApparatusTRICAL BREMNRAPP Rem Non -Res A lianceTRICALBREMPOLE Pole/Platform FixtureTRICALBREMPOWER Power Device/A aratusTRICALBREMRECEPT Rc tl, Switch & OutletsTRICALBREMRELOCA Relocation of HoodANICALBREMREPALT R air/Alter HeatingANICALBREMRESAPP Remodel Res A lianceTRICAL 2 of 3 S70 CITY OF CUPEkTINO 0 CITY OF CUPERTIA PERMIT APPLICATION FORM 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 Insection 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 Mechanicals . 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 Cbange BUILDING rJ 3of3 CITY OF CUPERTINO I� 1 of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34232021.00 DATE ISSUED.......: 09/16/2005 RECEIPT #.........: 31230 REFERENCE ID # ... 05090113 SITE ADDRESS .....: 10143 AMADOR OAK CT SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: conniew COPY # : 3 OWNER ............: TRUSSO JANET D ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5605 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT is AMOUNT NUMBER ------------ ------------------ 123.55 7820 123.55 NEW BAL 0.00 0.00 0.00 0.00 RECEIVED FROM ....: ANTIQUE TERMITE CONTRACTOR .......: RANDY MARTIN LIC # 24455 COMPANY ..........: ANTIQUE TERMITE & PEST ADDRESS ..........: 1913 STONE AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95125 TELEPHONE ........: (408)995-6300 &E ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC BENERGY ---------------------- PERMIT FEE 83.10 ------------- 39.89 0.00 ---------- 39.89 BPERMFEE VALUATION 3,000.00 83.16 0.00 83.16 BSEISMICRE VALUATION 3,000.00 0.50 0.00 0.50 TOTAL PERMIT : ---------- ---------- 123.55 0.00 ---------- 123.55 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT is AMOUNT NUMBER ------------ ------------------ 123.55 7820 123.55 NEW BAL 0.00 0.00 0.00 0.00 • CM OF T CUPEI�TINO • Assessor's Parcel Number: J 1-( 2- 7? Z G -2r 1 Name of owner. aA n e7L %/�uSS O Project address., AS if, Contact person. 60 ( t Phone. 6:5 5— 7 Fax. 99S— (251/7 Net square footage of lot. /Z A— Square footage: First floor: Second floor: Garage: TOTAL: Existing Aoq- 14 /a - Are there at least two 10 foot by 20 foot clear spaces inside the garage? Is privacy protection planting required for the project? Y N On what floor(s) is work being done? Z— n Brief description 99f work. %l C7'1 G deE 1� D.2 S Lr�d t X 2 3 L✓ A/ rr 1 �rS�i� T Proposed Y N /9//n J �'/ berg/AX f',,9--1 Code editions: 2001 CBC (Y - N)2001 CFC (Y - N)2b01 CMC (Y- N) 2001 CPC (Y - N)2001 NEC (Y - N) Effective 11/1/02 Plan Review Process Work Book Page -8-Revised 4/28/04 CITY OF CUPERTINO QfoMwith ✓ J Q Fcarted U w gL N z '—' '� +` "• ** °"`- `' "! ``' BUILDING DIVISION PERMIT N-"'' CONTRACTOR INFORMATION 0...,. 5$.•3. Y'�\.xAe S. :W v' BUILDING ADDRESS: ANTIQUE TERMITE & PEST PERMITN0.05090113 10143 AMADOR OAK CT OWNER'S NAME: PERMIT ISSUE DATE TRUSSO JANET D 1913 STONE AVE 09/16/2005 SANITARY NO. CONTROL NO. (408)995-6300 ARCHITECDENGINEER: BUILDING PERMIT INFO SLOG ELECT PLUMB MECH 0 (� LICENSED CONTRACTOR'S DECLARATION Job Description I W eby affirm that I am licensed under provisions or Chapter 9 (commencing p with Section7W))Of Division Scribe Ba,mea,md Professions Code,and my license is imm�mmea-dc�� (�Pjs u"nae class ` Lie." n n TERMITE REPAIR (3�WALL�S ,IN MSPBATH, RIM JOIST/SHEETROCK')I[ ARCHITECTS DECLARATION 1 undcrstanJ my plans shall W used as public records 2005 Licensed Professional OWNER -BUILDER DECLARATION I hereby .(Sero Nat I am exempt from the Contractor's : License Law for the I.S, Business and Code: Any city m county Tei mason. (Section 703 my Illpppppp p bb non II 11 ry Tr) I� n or ova.Prelcm6ons which constauct, a@n improve. demolish. , or epaig any which eyuircs "'J Ij p ,) n eemst i statement prior to its issuance. also mqo the the applicant for such permit to Glc signed cm Sq. Ft. Floor Area `� ""' � esu �`�'� Valuat B00 s Chaps That he islittnudpursuanno lhcpmvisinnanfthc Connector's License law(Chapter9 (commencing with Section 7") of Division S or the Business and Professions Cone) or that he u exempt Therefrom and the basis far the alleged exemption. Any violation of ApN Number Occupancy Type p y YP Section 7031.5 by airy applicant for a permit the applicant to a civil penalty of not mora Iran fin hundred dollars ($5(D). 34 2 32021.00 ❑ 1. as owner of the properly, or my employees with wages as their sole compensation, Required Inspections will do the.., end the structure is not intended or offend for sale (Sec. 7014. Business and Pmressions Cade: The Contractors Littt,Y Law does an, apply m an owner of property who builds orimponws thereon. and whodoea such work himself or through his own employees, provided Our such improvements ase not intended .,offered for vie. If. however. the building or improvement is sold within one year of completion, the owner. builder will have the burden of proving that k did not Wild Or improve for purpose of vle.7. ❑ 1, as Owner of the property, am exclusively convecting with licensed contractors to convect the pmjem (Sec. ]814, Business and Professions Codeq The Comeacmr's Li. cove Law does not apply to an Owner of property who Wilds or improves thereon. and . who contracts for such projects with a contractors) licensed pursuant in the COnVactOrs IAtenee La .. Q l am exempt under Sec. , B & P C for this moon Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby on. under penally of pe Jury nuc of the following dmaratiminc `t I ban and will maintain a Certificate of Covens to sel6inaum for Workefs Compere .tion, as vided for by Section 37M of the Labor Code. for Ne performance, of the work which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, ns required by Section 37W of the labor Code. for the performance of the work for which this permit is issued , My Work�ce,,'C"1mp_aru/.�do�n�lln�s��yy//yfaantt comic, end Poli y number ae: Canner. e6dpSfl Policy No.: n00d/e/4r- CERTIFICATE bbbF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (11tis section need not W eomplcmd HOW permil Is forma hundred dollars (5100) or kis.) I certify that in Oc performance of the work for which Nis permit 0 issued, I shall not employ any pmson in any manner v as It become subject to the Workers' Comp romon _ Lawsof Calilomia. Dam ' Applicant NOTICE TO APPLICANT: If. after making this Cenifcam, of Exemption, you should became Subject to the Worker's Compensation provisions Of the Labor Codc, you mus comply with such Presidium or Nis permit shalt W deemed revoked. CONSTRUCTION LENDING AGENCY 1 Wreby affirm Nat them 4. conslIDelion lending agency Ise the perfurmantt of the work fm which this permit is issued (Sec. 3(19'/. Civ. C.) - Lenders Name Lenders Add. I cenify that I have read this application and sate that the above information is I agree m comply with all city and county oadinanm and sune laws elating to Wilding construction, and hereby authonm representatives of this city to enter upon the shave -mentioned prolapse for inspection purpntea. (We) agom to saw, indemnify and keep harmless Ne City of Cupertino against liabilities. judgments. casts and expenses which may in any way save against said City 6�Date in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WIL OMPLY WITH ALL NON -POINT `_ C Issued by: SOURCE REGULATIONS. ��— %� G'a-5 Re -roofs Type of Roof Sigvwrc of ApplicanUContsactor Disc HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant store or handle harudous material as defined by IW Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Cale. Section 25532(.)?/ O's W 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 remove Will the applicant or future building Occupant use equipment or devices which d Ise ardnps air contaminant as fined by the Bay Area Air Quality Management all new materials for inspection. Disuict? ❑secs Ihave man rdoaxmaterials Chapter l ircmcnha5 the the / ria Health& ftyCas.Smu,25505.2533534.1 mant Wilding . dmntcurtnilyhawawnan4NatitumyespmihiiitywnotifyN=upntofNc requiementwhich must Wmetpbrmis.a raceniriemeoracupaney Signature of Applicant Date 2 g— /6 a� All roof coverings to be Class "B" or better Owner Or authorise agent Dam