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05030213 CITY OF CUPERTINO BUILDING DIVISION PEOIT ,CONTRA@TnR INFORI�TION Ya§SES a 3 BUILDING Es ApORS: PERMIT NO. WNER'S GREENHOUSES ETC 05030213 ONAME: PERMIT LSSUE DATE IONS: - IDT4 AN7.4 SANITARYC OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +�aop LICENSED CONTRACTOR'S DECLARATION � � 0 0 CI hcmb affirm Nal 1 am licensed under provisions of Chamcr v(commencing Job Description nii i,,,,I Divi,ion Sof the Business and Professions Code.and my liccrmc is 0qg yro iacanscclas . Li.Is /`�ti(o 4'-f REPLACE WINDOW (1) n^� lE Con r"mr 9-V 1 undcrst /m p ons shARCfyf yc uud asT Ic�Tc10N 314 h LoX t mfcssiod 1 - , J OWNER.e , Orfro the Contractor's j n p 1 hereby (Section 31.5.Business from the Cnntranos Cast:Any c Law f.,the i o O fallowing mason.(Section 703 1.5.Business and improve, de inm h. Any tiny nr county '+5Bv, which,eyuimvapermitthtcnn¢trthe alcor,improsuch demolish,ore a signed soucros y prior it)its issuonce,also ur to the lhovisio sof for Contra permit Lice se signed statement OZ< thalhe isliccnud pursuanuo Nc previsions of nhc C.noacmr's Liccnsc law(Chepmr9 Sq.Ft. Floor Area tl� a[on cH. (commencing with Section]000)of Division 3 of me Business and Profesou Cnde)or as = dun he u exempt Bertfmm and Ih basis for the alleged cump0on.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more Nan five hundred dollars(S501). 3 79VAu1rIb?r0 0 Occupancy Type ❑1,as owner of the property,or my employees with wag"as their rule compensation, will do the work,and the structure is not branded or offered for sok(Sec.]pfd,Business and Professions Cods:The Contractors Litems Law docs not apply to an owner of Required Inspections Property who builds or improves thereon,and who does such work himself or through his own employees,D,.video Iran such impmmmenm arc not intended.,offered for sale.IC ' however,the Wilding or improvement is sold within one year ofmmphomr,the owner. - Euilder will have the burden of proving that he did not Wild or improve for purpose of sale.). 0 L as owner of the property,am"elusively concocting with became e.nconors to consumer one project(Sec.70114.Business and Professions Cade:)The Comoselor's Li. µ ;hoe law does not apply to an owner of property who Wilds or improves themorm and. ho contracts for such projects with a concocmf(s)licensed Pursuant o the Commmors License Law. ❑ I am exempt rouser Sec B h P C for this mason Game, Dam WORKER'S COMPENSATION DECLARATION 40 1 hereby affirm under penalty of perjury one of thc following declarations! ❑1 ham and will maintain a Cenifi"m.fConum to self-insure for WorkerSCompcn- sari.n,as provided for by Senion 37W of the labor Code,for the peAormance of the work for which this permit is issued. C I have and will maintain Worlmes Compensation Insurance,as required by Section 3700 of the Labor Code.for the performance of the work for which this permit is sound. My Worker's Compensation Insurance carrier and Policy number art: Cartier. Policy No.: _ CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE or lcsx)(this section need not be completed if the permit is for one hundred dollars(S 101)) 1 etfilry,Nm in ttirc perRvrr I nee of un work for which Nis t iryissued.I shall nut cm toy any pbrs.Il'n ytnanact, .into s �(cuo 1pttacrrQW.rKcrs'Comjmnsation L s of Cali(orma.'DaWtq1Q5' fml[G9Y..„ /X . N CET .APPLI NT:If,after ming ffiix CcniOcam of Exemption,you should become subject to the Worker's CorEpermlion p3ovisions of ire Labor Code.you must .J Z forthwith comply with Asch provisim¢lfrBfiipermil shall W docmcd mvokcd. z2 ANSFRUMON LENDING AGENCY r.�• 04 I hem by than thei there is sued( o,.309 ending agency f.nW performance of R'. i the work for which Nis permin u issued(Sec.709],Civ.11.) IS] Under',Nam. Undcr's Address az U O 1 ecnee that 1 have moa Chia application and sum that the shove information rmminn is CL t" eliding 1agree to"MPIYand With all city and coumyordinances and oak lawsr upon e >.W building mentioned.,and forcbyamhori prposeumanivrs of this city menkrupon Nc ahovemenuogment, crycosts faniexpenses purposes. �„y (We)agree to save,indemnify and keep harmless the City of Cupenino against t;OZ liabilities, fthemalsand expenses which may in anyway accmc against said City ..)z ho.ccoA rible NT of DERST N of this pc WILL 'PPlaICp NT UNDERSTANDS AND WILL COMP WITH ALL NON-POINT Issued by: SOURCE' EGU6ATIONS, y" Date '1A �� rgnam,e.r Re-roofs vpt¢antA41R?}OoUS / Dae NAZ/rRD0115 MATERIALS DISCLOSURE Type of Roof Will the applicant or flit ru c building occupant r 9,1 or handle Health and y as defined by the Cupertino Municipal Code,Chapter 9.13,and Ne Health an8 Safety Code.Section�5532(a)] R5 N. ❑Yes All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building Occupant on equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove min ha'/suous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District) . Yes �No Ihavc mad Nc havallous materials reyuiremcnm under Chaper 6.95ofthc Califgqr nice Hcolth.k SafmyCWc,Sccu.ns25505,35533and25534.1undcraandthmifthc Wildill does not cmrandy WMT.mnanL Nan it rs my rexpmrsibilby,1p notify the a[upant of me cmc heh mustWincl donuissu cc of a'Ec f camof Occupancy. Ignatbrc of Applicant/ w gg� �rl Date oLncc.or5mhdflmd agent / i• p„p G All roof coverings to be Class"B”or better \ f , J I C5 ig Es .J � •� •G ^ 9 ��. N.� t�. N i 9 O cvQ 1 � y � h O • �C C u G CITY OF CUPERTINO m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng : Sub: Blk: Lot : APN . . . . . . . . : 37533016 . 00 DATE ISSUED. . . . . . . : 03/23/2005 RECEIPT # . . . . . . . . . : 29041 REFERENCE ID # . . . : 05030213 SITE ADDRESS . . . . . : 18840 BARNHART AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : JEFF GREGG ADDRESS . . . . . . . . . . : 18840 BARNHART CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : GREENHOUSES, ETC CONTRACTOR . . . . . . . : VICTOR HEBERT LIC # 8115 COMPANY . . . . . . . . . . : GREENHOUSES ETC ADDRESS . . . . . . . . . . : 1532 S DE ANZA BLV CITY/STATE/ZIP . . . : SAN JOSE, CA 95129 ® TELEPHONE . . . . . . . . : (408) 446-1224 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL --- ---- --------- - ------- - -- --- -- BPERMFEE VALUATION 3 , 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00 BPLANCHK PERMIT FEE 83 . 16 110 . 98 0 . 00 110 . 98 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 BSEISMICRE VALUATION 3 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 TOTAL PERMIT 274 . 13 0 . 00 274 . 13 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -- - - - - - - - - - - - - - - - ----------- - --- -- - - CHECK 274 . 13 1374 TOTAL RECEIPT 274 . 13 40 SIR CITY OF CUPERTINO CITYOF PERMIT APPLICATION FORM CUPERTINO APN 93 75 3 U l Date: z3- o Building Address: /8L{0 Mailing Address (if different from building address): %,Aj b RT Owner's Name: 6?4e UJ>W' Phone#: �F ��GC Fes• yv�� Z6'-IgZq Contractor: • License #: �.�� 1� • �IRCN y4b6 � �-i Contact:! C /`/vs��� Phone: U4.6—122 y Cupertino Business License#: !� Fax: 252- - QIZ6 Building Permit Info: Bldg 04 Elect (� Plumb ❑ Mech ❑ Job Descripti`� / SAL � OG1l7DOResidential Commercial ❑ Sq.Ft. Floor Area: S/Sq.Ft.: Cost of Project: an Occupancy Group: 3.r�� - Type of Construction: Please check this box if the project is a /2� fNlN�OW second-storyaddition: ❑ Project Size: Standard D. Laze ❑ 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 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 I BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1of327f�� PF-ATIoD 1 � ) X3833 FiW\ a1mv 9 CITY OF CUPERTIl4 CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee 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 Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie 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 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 IMP, ATY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO 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 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 Change BUILDING • 3 of 3 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMITNO. GREENHOUSES ETC 05030213 IRMO R.ARIN4ART- AVE — OWNER'S NAME: PERNHIT ISSUE DATE 2 �:)� AN2A PT-327 IE: SANITARYN(Y.' --CdOROLNO. (4ns) 44r-1994 ARCHITECT/111,61NEER: BUILDING PERMIT INFO BILDG Eff F�r MECH nee, LICENSED CONTRACTOR S DECLARATION 1 lacrathytrinan that Is.licensed teols,paivisimacifCh.poeli?(anommumidi; Job Dc!�Cripiivonl �O�don7�)orDivision3offtB����ofcssiumC�,mdmyiic�is wbq � R 1�r11.1gC and�aff� 44�0 =o, C, an REPLACE WINDOW (1) zit2_ a —I.Lic.# 4�n t.ir c now' I _�i?S 40 1� ARCIII DE 7.A q, lien ..swid se �&M F� W.-,fSV C C; Lwcd"`d"�'Rd`m"m I OWN C I lenc.,.11, .1 1=6V!iIiIN�.C�h�`C`201a License Law for Be 0 following mason.(See n 7(BI.5.Business and Profeasioni Code:Any city or county which quit.. aN.Idlo emistrail,aluct,Improve.demolim.or repair any structure re a prior u,its issuance.alsomiunea the Applicant for such Permit to file a signed am me I _x that he is licensed p.not.at to he provisions of the Contractor's U..Law(Chapter 9 Sq. Ft. Floor Area W'in (commencing with Section 7")of Division 3 of one Business and Prisfiessuars Cade)or that hic or exempt therefrom and de,bounis far ft aflcgrul ascription.Any violari on of Section 7031.5 by an,applicant for A Permit Subjects the applicant to a civil penalty of not mom than five hundred doll.($500). 3-Aff-IftridIV0 0 Occupancy Type El 1.as owner afore property,army emplarmas with wagesm theirsolecounKrisation, will do ft wok and thm it"Come is not intended or offered for side sec.704,1.Business and Prolesidimes Cal The Ciontractor's License Law does not apply be an owder of Required Inspections topiary who builcas or improver,thencon,and who doessuch work himseefforthrough his own amploymes.provided 0.1 such ouproverrearis are notimenticil or offered for sale.If. however,the building or improvement is mid within am year ofcomplerion,the owner. Wills,will have bir burden of proving bar be did a.,Wild or improve far p.m..of sala.). [3 1.as owner of be property.am cialusively contracting with licensed commemrso, constract he project(Sce.70dul.Basin.and Preffessions CWc:)The Cinumetels U. ceme Law it=not apply to an Owner of property who Wilds or imponves thencon.and who contracts for such Projects With A emirlICLOT(A)licensed pursuant to the Contractol's Gkinse Law. 0 1 am.,.p,at See B&P C far thi, Owner Date WORKER'S COMPENSATION­DK�RATION I hereby M.an&, ca.ft,idf perjury a.of do following declarations' or'Nave and will maintain a Ccifificare afConsam to self-imum for Wor1ccesCompen. ,mir,as .ided!far by Section 37W or the Latin,Caudle.for one pieff...of dr. work far which this Permit is issued. 1 haw and will mountain Worker's Comperoation livaturzacc,as mt,ired by Section 37W of be Labor Codr.for thic Brformance of he woA for which Ili&Permit is issued. My Worker's Compensation Inarmance carrier and Policy number am: Comic,. Policy No.: CERTIFICATE OF IE(EMPTION MOM WORKERS' COMPENSATION INSURANCE Tibet section need not x completed lithe permit is formic hundred dollars(SIM) it,lass.) I ce try Bur I. c'Of th.work r w or is tied.I shall not rei�� an We obe ern ],any,. n cat'll 0 c I to es,ciani'miatma ny a of Crairom a. g a a'C rom a a * heart P,14Av'L * CET A PUT NT.If.after is Cedificate or Exemption,you should C. in bacome so Joel to the ork I motion p5m,1, sions of the Labor Code,you must 'y OwunV z forthwidt comply with car in _11117rranit.h.11 lic seemed orralmd. z C N UL '10, C NSMUCTION LENDING AGENCY da theress.re as Ilic.byeffiranda 1:4 the anal,far which this permit a stated(See.30D,Ci,C.) Lenders Name Lenders Address M z J 0 1 certify doa I have ad ons application and more ti.ft move irdiumodim,is It, correct.I agree,to comply with art city and county ordinances and slide laws retailing to U Wilding consimuclion.and hereby asolsonre mpredentatims;of this city to enter upon ft W atome-mentioned pmNny for inspection purpmess. 04 (We)agree E.serve.indemnify and me,harmless Or.City of Cd,�nhm against ,, liabilities,judgmenta.costs and expenses which may in any way see=against mid try U Z in consequence of thelraming of this Permit. N'T ND FISTANDS AND WILL COMPW WTTTl ALL NON-POINT Issued by: Date SOURC I&ATION2� _Z2a 15 Re-roofs S—ignaturc orApplicam"C"; Dam HAZ _!�n�YsMA�TIERIALS DISCLOSURE Type of Roof Will as cher, Coleman Municipal Code.Chapter 9.12.and the Health and Safety Coda, Dy. 55320)? )�No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future,building=open,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove WI.Ol air anumommis as defined by the Bay Area Air Quality Management all new materials for inspection. 0 yes 4110 lh r 9501:1 "i 11 "u'r", �i��l"Sg�,yC��.�6..25Y)5,�533.d25534 londcratand ead. 2i�d .11, doesmOctmend he .oM tours yocarams"'Iny1noury Tornio Or a,C�'Com cc_ Parry _ ..._� _I be met no,ur smi --Signat�re of Appllican�/ Date ro- roof coverings to be Class"B"or better flh�,�d agent