08050201 CITY OF CUPERTINO
BUILDING C:'!ISZON PERMIT C01�[TRACTOR INFORMATION ;
BUl1.IpNp11DOREs$:ZINGWOOD AVE WYANDT DAVID A P08050201
E`1AS NAME:
LA PERMIT ISSUE DATE
N
WYANDT DAVID A 19827 COLBY CT 05/27/2008
ONE: SANITARY NO. CONTROL NO.
V
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
app LICENSED CONTRACTOR'S DECLARATION IOD Description
m 1 hereby affirm that li
1 ao:nsed under provisions of Chapter 9(commencing
E
with Section 7")of Division3Orate:Business audProressionsdeu
Cods. WATER LINE REPAIR& TERMITE/WTR DAMAG REPAIR& SOME
I.fall rortt and effear-
j g i License Class Lie.g FRMNG
Dam Contractor
ARCHITECT'S DECLARATION
¢ I am ersuns N
nd my Plans be used as public record,
Jas
gQ y Ucc acd Professional
5OWNER-BUILDER DECLARATION
F I hr Sce(See that 1 am exempt from the Con=10rS Licanu Law far the
following reason. uan 1W 1.5.Busivas and Professions Cade:Any city or county
Tai which requires a Famous so e..L alo-+.imPro e,demolish,or mpsir any mumuro
=< prior Wits issuance.also requiresm applicant for such Permit m file a signed ytaumem
z
turn W u licensed pursuant mtam
provisions of roc Contractor's Lives,Law(Chapter 9 Sq.FL Floor Area $ Valuation
F^$ (commencing withSecuonT000)or Division3oftadBusinessandProfessionsCode)or 3000
Nat he is rump,tWmfrom aha the burn for the alleged eumpow Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty ofNumber
Door mom Joan five hundred dollars(115W), 3 6 9 2 0 019'O� Occupancy P Y Type
1,u Owner of tad property or my employceswith wagesat their sole eompensadon,
will d0 the work,and the ants,u not intruded art rRctcd for eas e(Ser.1044•Burd.
and Prorudaos Code:The Can"cufa License Law dxw far apply to an awmr or - - _ Required Inspections
pmpery who Wildsorimproves thaeon,and who doessuchw°rkhimselforthrough his
"a employees.provided thassuch Improvements are not intended Ororfcrnt Intimae.B. '
however.Joe building or improvement is mid within can year of Completion.the numm-
builder will have dm burden of Proving Nos he did not build or improve for purpam Of
um.).
1.as Owner of the Property w mtclmively contracting with lie uud Con answ s W
wmtmci are pmjem(See.TWa,Business and Pmressiou Cade:)The Cunasctor's U.
ceoae Taw does not apply to an owner of property who Wilds Or improve ahemon.and ,
wad cormacu far suets projects with a eonuactor(s)licensed pursuant to tic Conuacrrel
License law. '
❑
I.me mPr un B At P C fm this ream.
nrr /sq��/. �{, Dam
WORKEWSLOMPENSA ON DECLARATION ^�
1 kmby aRm uuder penalty°(perjury m art tic falbwin6 decleroorts:
I ham and will far b in a tion 37 0 of Conacnt Claim.
(s,Watlre ance of m
worn,r Providedh ui far mi Sudan 3TW.(rite Tatar code,for tha performance of the
work for which this permit is LV.ed.
❑1 have and will malmum Wale(s Comperu,ti°n htsu ..as required by Section
31W Of dm taWr Code,for the performance of tad wart for which this permit if issurd.
My Worker's Computation Luursnee carrier and Policy number ace:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This aceum went nos k cumPkmtl if rad permit Is faam hurtthed mBus(SI00)
Or Ices)
1 cutify that in the performance of the work for which ad permit u issued,l shall not
employ any Person in anYmanwermu become rob' Wo Com n tion
laws of ealifomit Dau
Applicant
NOTICE TO APPLICANT.1, makm Nu Ceni or Eacmption,you should
become subject to the WorkaS Compensation provisions of the labor Code you muss
.JO fntthwith comply with such Provisions or this Permit Nall W decmnt revealed.'�y CONSTRUCTION LENDING AGENCY
[-, 1 Mmby alliin and them is a Construction lending agency for the Performance of
C> iW wast fm which this Permit is Cauca(Sec.3097•Civ.C.)
A lsndcYs Nun" .
7 z Undeh Address
U O 1 certify this I have mad this application read suis into tic show,infmsumma Is
Iy F COMM I agree to Comply with all city and county ordinances and sum laws misting to
.O v Wilding com action,rand hereby authorix mpreumKiM of this city to enter upon the
ahave-menues dgm Property
ts,wa for inspenses Puryaua
a (We)agree to ave.indemnify and keep hsrmleis the City of Caperuoa against
h inconeraimde Ofthecosuua ing Of thus expenses which may in any wyurneagainst sald City
V z APPLICANT°UN EyMANDS AND WILL COMPLY WI LL ON-POINT Issued by: Date
SOURCE REGUL S.
�TWe-roofs �l
Signature or Applicaiiantractor VDau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appllamnt form Wilding Occupant nom uhambe hmardou material
u defined by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety
Sectionyc" ON.2ss3z(,)1
❑Ya All roofs shall be inspected prior to any roofing.material being installed.
Will the appfieant Or future building Occupant ace equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emir moaNnus air conuminants u darned by one Bay Asea Air Quality Management all new materials for inspection.
District?
DYC3 No
1 have mal the hayardeas materials mquimntenu umber Chapter 6.95 of au Cslifm-
meHralthh SafctyCOdc.Sccons 25505,25533 wel Zi534.1 understood that If Jie Wilding
draw our currently have a unsnl that is is mss responsibility as wary the neco,o t of the
mq°imwwft,;mplrrOytWRe`/ Pb°;mia",n °I C.*morgy Y' n) Signature of Applicant Date
Ou.er or autintriced agLe(l/VIl&1 Th ])am All roof coverings to be Class'{"or better
pyo 5 0o2 o
CITY OF CUPERTINO
[1t' ADDITION/REMODEL
CUP'fk" iN0 PERMIT APPLICATION FORM
APN # ,0 0/ C) l] Date:
Building Address: C _27 1
Mailing Address (if differ t Wing dre s : C_
Owner's NamPhone# :
Contractor: Phone#: S p �
SA w�
Fax #:
Contractor License #:
Cupertino Business License#:
Contact: Phone#:
Fax #:
Building Permit Info:
fihBldg. ❑ Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑
Job Description:
Addition (adding sq footage):
What is being remodeled? Pz+e- `� e r.e P� ,•. 2 r l i 1� e ! �/2�ph
C�?i� age Y't ,- lrfsv � Y ��r�n:tig
Remodel Includes Re-Roof: Yes ❑ No R- If yes list number of squares
Remodel Includes Structural: Yes ❑ No ®'
Square Footage: '
Addition: d Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath Other
Type of Construction (Usage Class): Occupancy Type: Q
1 A, pJ 11, 111 V-A ❑ 11, 111
Valuation: O Please check this box if the project is a
64 second-story addition ❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points Achieved:
include in plan set & the sheet index.
***For Office Use Only***
Over-the-Counter ❑
R_ CITY OF CUPERTINO
u " ADDITION/REMODEL
CUPEkTiNO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
ADDITIONS 1R3SFDADD
PLLONGRNGR Long Range PL
Planning/Residential
1R31NSP Dwellings Inspections B
1 R3PLNCK Dwellings plan check B
1R3REPINSP Dwellings Repeat B
Inspection
1 R3REPPLNC Dwellings Repeat Plan B
Check
1R3HINSP Dwellings Hillside B
inspection
1 R3HPLNCK Dwellings Hillside plan B
check
IR3HREINSP Dwellings Hillside B
Repeat Inspection
IR3HREPLNC Dwellings Hillside B
Re eat Plan Check
1R3ALTINSP Dwellings Alternate B
Materials Inspection
1R3ALTPLNC- Dwellings Alternate B
Materials Plan Check
1PCESS Cesspool P
1PPRSEWG Ea. Private Sewage P
Disposal System
1PRSEWER Sewers P
1BPSPRINK Lawn Sprinkler/Backflow P
IBPWSVCS Main Water Service P
1BSEISMICRE SeismicResidential B
DECKS IR3SFDADD OR
1R3SFDREM
1DECKWOOD Deck(Wood)-Each B •
Each
IDECKRAIL Deck Railing-Each B
(Each)
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
GARAGES MSFDADD OR
1R3SFDREM
1GARDTW<=1K Wood Frame up to B
1,000 SF
1GARDTM<=1K Masonry up to 1,000 SF B
BCONSTAXR Construction Tax Res
(new detached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1PATIOWOOD Wood Frame up to 300 B
SF
1 PATIOMETAL Metal Frame up to 300 B
SF
1PATIOOTHER Other Frame up to 300 SF B
PATIO'S CLOSED 1R3SFDADD OR
1R3SFDREM
1PATIOENCLW Enclosed Wood up to 300 B
SF
1PATIOENCLM Enclosed Metal up to 300 B
SF
1 PATIOENCLO Other Enclosed Patio up B
to 300 SF
1COVPORCH Porch Covered-Each B
Each
1REROOFRES Residential Re-roof Each B
100 SF
REMODELS 1R3SFDREM
IREMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check
1 REMRESBAT Bath Remodel up to 300 B 64
SF
I REMREOTH Other Remodel up to 300 B
SF
REMODEL PLNCK
1 STPLNCK(1-3 for Standard Plan Check B NOT FOR OVER THE
remodel) COUNTER PLAN CKS.
3of3
CITY OF CUPERTINO
ADDITON/REMODEL
FEESCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
WINDOW/SLIDING 1R3SFDREM
GLASS DOOR
1 WINREP Replacement windows B
ea 8 windows)
1 WINNEWNSTR New Window (non- B
structural)
1 WINMEWSTR New Window (Structural B
Shear Wall/Masonry)
1 WINBAYSTR Bay Window (Structural) B
SKYLIGHTS 1R3SFDREM
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 B
sf or structural
1STAIRS Stairs-first flight/ea addt'l B •
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln E
Ck our]
1 MECPLNCK Stand Alone Mechanical M
Pln Ck (hour]
1 PLMPLNCK Stand Alone Plumbing P
Pln Ck (hourl )
1BSEISMICRE Seismic Residential B
1TRAVDOC Travel &Documentation B •
1BUSLIC Business License B
4of3
Green Building Plan Check
Index of Green Building Points/Categories
A. Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 7points
11. Permeable Paving, Note L-1
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2
5. Use Truss with heels, (detail) S-2
6. B. OSB Sheathing, detail S-2
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11. A 2500 Gal. Tank, (Note/Spec L-1 10 points
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point
3. Energy Star Refrigerator, (Note/Spec, A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 40 points
•
Plan Review Process Work Book Page-12-Revised 3/25/08
1 .
Green Points Rating System for Remodeling Projects
• Due to the diversity of remodeling project types,assigning a'total points'value to a project to be considered environmentally friendly is
not feasible. However,25 measures have been highlighted to signify that every effort should be made to incorporate them into your
projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measures can be used as a starting point for'greening'your project.
INPUT ReSOUTces Energy ACHeal-th
A.Site
1.Recycle Job Site Construction&Demolition Waste
65% 1 point;75%= 2 points;60%=4 points I up to 4 Resource pts 0
2.Salvage Reusable Building Materials 4 Resource pts y=yes 0
3.Remodel for Mixed Use,Adaptive Reuse,and
Historic Preservation 4 Resource pts y=yes 0
4.Protect Native Soil 2 Resource pts y=yes 0
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes 0
6.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
[a.Design Resource-Efficient Landscapes and Gardens J 4 Resource pts y=yes 0
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes 0
10,Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes 0
1 1 1
B.Foundation
1.Incorporate Recycled Flyash in Concrete
• 25%Recycled Flyash=2 points;Add 1 point for every 10%,
increase of flyash,up to 5 points up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yesl;; 0
1 I 1
C.Structural Frame
1.Substitute to Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0
3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y=yes 0
4.Use Web Floor Trusses 2 Resource pts y=yes 0
5.Design Energy Heels on Trusses 6'or more 2 Energy pts y=yes 0
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0
B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes 0
b.Wall 3 Ener is
9Y P Y=Yes 0
c.Roof 3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications _ 3 Resource pts y=yes 0
12.Use OSB
a.Subfloors 1 Resource pt y=yes 0
b.Sheathing 1 Resource pt y=yes p
--- —
D.Extenor Frnis
Energy A01Health
r Use Sustainable Decking Materials •
a.Recycled content 3.Resource pts y=yes 0
to.FSC Certified Wood 3 Resource pts y=yes 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAO/Health pt y=yes 0
3.Install House Wrap under Siding 1 IAQ Health pt y=yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
E.Plumbing
1.Install Water Heater Jacket_ 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
3.Retrofit all Faucets and Showerheads with Flow Reducers I
a.Faucets(1 point each,up l0 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAO/Health pt y=yes 0
6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAO/Health pts. 0
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r.oecmcar
1.Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points)--J Up to 4 Energy pts. 0 •
2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to
5 points) Up to 5 Energy pts. 0
3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts. 0
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
1 1 1
G.Appliances
1.Install Energy Star Dishwasher } 1 Energy of y=yes 0
2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
3.Install Energy Star Refrigerator 1 Energy of y=yes 0
4.Install Built-In Recycling Center 3 Resource pts y=yes 0
1 1 1
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y=yes 0
b.Ceilings 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
f3.Install Recycled-Content,Fiberglass Insulation with
No Added Formaldehyde _ 31AO/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pts y=yes 0
b.Ceilings 4 Resource pts y=yes 0 •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.cemngs 4 Resource pts y=yes 0
INPUT Resources Energy 1ADIKealth
I.Win ows
• 1.Install Energy-EMcierll Windows
a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
Vic.Low.Conductivity Frames _ _ i 2 Energy pts y=yes 0
2.Install Low Heal Transmission Glazing- 1 Energy pt y=yes 0
1 11
J.Heating Ventilation and Air Conditioning .
1.Use Duct Mastic on All Duct Joints_ 2 Ener y=y
— ---_—�— —_ 1 9Y Pts es 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y--yes 7
0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts y=yes 0
6.Install Sealed Combustion Units
a.Furnaces - 31AQ/Health pts y=yes 0
b.Water Heaters 31A0/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0
• 13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stoves/inserts 1 IAQ/Health pt y--yes 0
J. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 41AQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0
2,Install Solar Water Heating System 10 Energy pts y=yes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=16 points) Up to 16 Energy pts 0
16.Select Safe and Durable Roofing Materials —? 1 Resource of y=yes 0
7.Install Radiant Barrier J 3 Energy pts y=yes p
I 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes p
• 1 1 1
M. n oor Arr Qua rty and meshes
!1.Use Low/No-VOC Paint - -- - - i 1 IAOMealth pts y=yes 0
2. .
Use Low VOC,Water-Based Wood Flnishes 2 IAOMeaith pts y=yes _ 0
[Y-Use-low e VOC Adhesives _ _ 3 IAQMealth pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6,Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
t7.Seal all Exposed Particleboard or MDF 4 IAO/Health pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
1 1 1
N.Flooring
i. ii
1.Select FSC Certified Wood Flooring __ 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials _ -_ 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 1 1
Total Points A 1 1401 1301 57 •
Total Points Project Received: 1 01 01 0
G:datarprogsrgreenbuildingguidelines4emodelersrgmenpointsfmal2.12.04proteded.xls
•
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36920019 . 00
DATE ISSUED. . . . . . . : 05/27/2008
RECEIPT # . . . . . . . . . : BS000004895
REFERENCE ID # . . . : 08050201
SITE ADDRESS . . . . . : 943 BLAZINGWOOD 'AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WYANDT DAVID A
ADDRESS . . . . . . . . . . : 19827 COLBY CT
CITY/STATE/ZIP . . . : SARATOGA CA, 95070-3202
RECEIVED FROM . . . . : DAVID A WYANDT
CONTRACTOR . . . . . . . . `LIC .V *OWNER*
COMPANY . . . . . . . . . . : WYANDT DAVID A
ADDRESS . . . . . . . . . . : 19827 COLBY CT
CITY/STATE/ZIP . . . : SARATOGA CA, 95070-3202
• TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ------- ------ ----- - --- - ---
IBSEISMICR VALUATION 3 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1REMRESBAT SQ FEET 2 . 00 551 . 00 0 . 00 551 . 00 0 . 00
IREMRESKIT SQ FEET 1 . 00 551 . 00 0 . 00 551 . 00 0. 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 1143 .29 0 . 00 1143 . 29 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 1, 143 . 29 MC
---------------
TOTAL RECEIPT 1, 143 . 29