02030025 TY
CI
BUILDING DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
Ahk11238 BUBB RD MCCLURE JAMES E II AND TOVA 02030025
[/ 1NER'S NAME: APPLICATION SUB DATE
J )MCCLURE JAMES E II AND MANTO A 03/07/2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC nENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
U C-1 L..:I U
w i LICENSED CONTRACTOR'S DECLARATION Job Desc
],Z= Iherebyvnirmthn l am licensed under provisions of Chapter 9(commencing s, Y���
\j_Cw- with Section 7W0)ofDivision3oftheBusiness and ProfessionsCode.and mylicense 13ATHRM REMODEL. M
j is in full force and effect.
'a�� Di,rn Glata C000racm' OCT 2' 3 2003
1
?;Stu
ARCHITECT'S DECLARATION
S 1 underamnd my plans shall he used es public records
Y pe
1 O o Licensed Professional �'�'s.�
Oar I a.BUILDER DECLARATION ry
1 hereby,(Bert the 1emm from the Cession Coca:
License Low for she
C?a fallowing reason.(Section 7031.5. t.alter.
and Professions Code:Any city or emery $50000
8 S. which requires a permit re cores W alcor.impove,demolish, fie a sig any structure
nam (nmiiklic with io{tbegievisonoftheoBactor cokesseaw(Chater9 ._...Valva
or to its instance.also requires applicant or xuc perms
shpt hoeing wit enediol lgthe ptbDivisi n the the Business
Licenselnwons Cong) Valuation
(commencing uand 0nomi Any
code) `,..f.'r3'6��'(96.033ii.�"
or mat he its 31.5 br tanyefmm'and the basis for she subjects
sire aunjtibo Any l genion
of Section]031.3 by my applicant for v permit mbjccn the applirnnt m e rnibpcmhy , �
-
ofnotmomthan fivehundred dolbn($iW). 10PN P&VDATION ''""'-`'"' Occupancy Type
°1,as owner of the property,or my employees with wages as their sole compensation.
'-will ab the work.and he "drum is not intended or'eHcred'for mI,(Sed.--7(a10.- - - - -
'Banners and Professions Code The Conuanm's License,Low does not apply to an10 3 - UFER Required Inspeetions•L ''I("','`
owner of property Who builds or improves thereon,and who does such work himself
or through his awn employees,provided that such Improvements are not intended or __ _ _ 1 Q_4._-._.RIa''BAR"._"__._._-_"_..___.._
�hRead fo sale.If.howevar.the building or improvement is gold wiNin one year of -
ciampleikin,the owner budder will have the bardn of proving that he did not Wild 105 - ANCHOR BOLTS
impmve for PmPou err tale.). 106 - SEWER & WATER
1 s owner f theproperty, exdmi d c mmnln --"-- --'- -- �--" — -- -�- -
Q y contracting Cigk:)xhe vacs am 202 - UNDERFLOOR PLUMBING
License the does
no(Sec ]044 Business d Profession.Code 7 The Conuxm , l'-i
-
LicenseLawawdoesnotr-such nowncrtha,conywho buddsartmpmvathe a 203 - UNDERFLOOR MECHANICAL
n.
.. .i ,und.who.commns,fLaw..h pmjeaa wnh a.conwaor(s).licensed.punuent-m the. ...._..__-.._.._. .._.__... _.. ...___.._.....____.......__. ._.., .. _......
- 2 0'4' - UNDERFLOOR:-FRAME:
Col em a amps undo yeti.:...,..•c„- ti, . .,.
-+ ;B;&PCfar @isrtason 205 - UNDERFLOOR” INSUliATION
.., . .. 301 - ROUGH PLUMBING
wnee' .Date
I;, ', •, WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
"IhercbYaffirm and ePat I�ltyoIperjaryona,othe following declarations:- 303 — ROUGH MECHANICAL
° I have end will momitin a'6offitme'of Consent to alf-inma,for worker', 3 04 - ROUGH ELECTRICAL
Compensation,-as provided for by Section 37W of the Labor Code, for the '"'�.3 1
'performance or the work for which this pe`mn is jssued. 305 - FRAME
°I have and will maintain Workers Compoositjoriinsumnce.ei required bj Semon 306 - HOLDOWNS
37W of the Labor Code:for the performance of the work'for'which this 1.permit is
iss ed My Worker'sC cope"uF lnsmance Lamer and Pol cy number ore ,v, 307 INSULATION
308..r � ;EETROCK. ;:..
t;CEKnFlCATION OF EXEMPTION FROM,WORKERS9' -(_J 1'3 O'9` : 'EX.�$HTERIOR`LATH`
_ -T COMPENSATION INSURANCE a
"I'', (rnnsedno�neeanotx'dd;npletm fthe Pernir. hundred 310,:'—, xXTERT
(sIW),arlepr.) I, 311 - SCRATCH COAT
-aif I centfy'thm in the perf rtnanhe ohhe wo k f( which,th garcon tseued 1. -.313-t'ROOF NAI I`-:.,`
,hall not em 1 y any perm i nymgpner to me n io thrwo Work..
4 '
Cramping o wt tfomta.D�_� _�� 501 - FINAL ELECTRICAL ENERGY
��cEagympigp 502-----FINAL PLUMBING- ENERGY- -- - -
ApoBcPl[ \L
L ANl`If,after makln;this Cert Tcem'of Exemption you rho ld
z " aWorkersCompensmt' pr rrinonneDabgreodeyamaat, 503 - FINAL MECHANICAL ENERGY
O forthwith comply wish ouch provisions or this parroll shallbc deemed a eked. - 504 ---.-FINAL- BU-I-LDING-ENERGY-_-,\_.
..
"CONSTRUC ION LENDING AGENCY
Therbyid mtthat b -' aco ztmctonlentlngergncyfo m 1 11pert,mance 505 - FINAL ELECTRICAL :, ,
'of the nrkmrhigh tnnpermltin ee(su3o9] Civ.c1 ,- _..._ .. _50.6_...7_ GAS_TEST_. _ _
p.z T<mkr,naa, k ITT- - 507 - FINAL PLUMBING i
V-0 Iccun'rythatIhavemadthis application and state thattheabove information i. 508 - FINAL MECHANICAL
.Wib (agree tp cgmply�withtill cisy and I...ty,ordinances and std¢laws aiming 509 - FINAL GRADE
0:,f,J to building mnnrticilon;aril hereby'anhurize mpreganbid es of this city to enter upon
W theabommentmnecl pcmyfar inspection purpo s 510 - FINAL PLANNING
Qa I We)agree to's v indemn fy and keep htrmlesi the C ty of Cupcn no age nsi
h liab I t«judgments.costs and expenses which may m any way opera gain,said 514 - F INA PC WORKS
6,1 �, Ciry n co sequence of thegrating of this Permit f
APPLICANT UN}n�t;STANDS ANP WILL COMPLY WITH ALL NON bl Ta i
S L REGUr*ONS t z4 .(z[a.,[,.. Issued by: Date
'gn Ppiner anU i nil s D Re-roofs
HAZARDOUS MATERIALS DISCLOSUR
••' Win the appliant furvrc bidding occupant trort or hatMle haarduu mNenal -Type.of Roof_ __. _ - -- -- -
as de0nad by the Cupepmo Municipal Cod Chapter 9.12.and the Health and Safety ,it
-
.. ode ❑Yon 25532fa1e dJ �, T'
__All roofs.sball be.lnspected prior_to_any-roofing.material_being,installed _ .
•,i Will tbeapplicant orfuture Wilding occupant use equipment ardeviceswhich If a roof is installed Without first obtaining an inspecti61i;1tagree't6remove
ern hazaidous'atr cont m nano as deft ed by the Bay Area Air Quality Management'
District?
- all new materials for inspection. Applicant understands and will comply with
lit °YeS - 'O„
IT ; '. all non-point sourcE'regulations; ,I t ,;,,
3' I have read the hezerdo s mptenatt agwrtmenn.'underCTlapecfi.95 of that
Callfomie Health 'S cry Code,Sections 25505,25533 and 25534:1 understand that
'adc ant dt th q.ircm ass which run be et dot I" a of a Ca to notify the
P tic 9 P "fdaf of
Signature of Applicant _Date_
B Y.responsibility
e a th nxeJ a ant I I t s All roof coverings to be Class `B" or better
--OFFICE-
U E _ _. . . ... ._._ .._... .. .. . ..-_ .._..
CITYILDII GG nmsio�D CONTRACTOR INFORMATI
PERMIT
BUILDING ADDRESS: PERMIT N0.
11238 BUBB RD MCCLURE JAMES E II AND TOVA 02030025
OWNER'S NAME:
APPLICATION SUB DATE
MCCLURE JAMES E II AND MANTO A 03/07/2002
ONE: SANITARY NO. CONTROL NO.
iqq
Ln D O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
88 BLDG ELECT PLUMB MECH
�Z u CJ L. 7 IJ
°j LICENSED CONTRACTOR'S DECLARATION
i = I hereby omrm than I am licensed under provisions of Chapter9(commencing Job Description
»t with Section 70DO)of Division 3 of the Business and Professions Code.and my licensm BATHRM REMODEL.
Y is in full forte and epee(.
M6 Linea ClassLic.N
j ; Date
ARCHITECT DECLARATION
doS
I understand my plans shall be used as public records
1 i p O Licensed Professional /
OWNER-BUILDER DECLARATION
I hereby offnm that 1 am em
expt from the Contncmr's Linn.law fm the O
h? following re n.(Section 7031.3.Business and Professions Cade:Any city m county ` 5 O 0 0(]
EL5 F G which requires a pantoconstruct,(to coctar,alimprove.demolish,or npir arty structure v
53$_ priortoiuiuume,elso alms,the applicant forsuch Permit o file a signed statement
that he is licensed pursuant to tfis V' suns of the Contractor's License Law(Chapter 9r a : Valuation
(commencing wish Section 7 )of Division 3 of the Business and Prpfeuions Cade }: '
or in.,he is eiempl tbenamon end the basis far the alleged exemplibo.Any violation
d Section 7031.5 bymny applicant torn pwit subjects the epplicent m e evil gentry A ,
a frmmorodanfverturni Enllam(s600). 10: PN DATION Occupancy Type
01.as owner of the property,ser my employees with wages us their sale compensation,
—wise do he work,andira ode:Th, not intended License
eredLoa, foes ma(Sec.7tlias 102 PirsRs
10 3 — UFER Required Inspections`
..ia of and Professions Code:Th,Comnctah License Law docs nm apply m an
owner of property Whoem builds or improves at such,.rod who does such wink need l
o credo h his own employes,provcded that such impedwmems art not intended m 104 - REBAR.
morph or tile:If.w hmvevec the building m indim of pent is veld-within otic yev of
`eomplerion,the awncr-builder will have the burden o(proving that era builds 105 - ANCHOR BOLTS '
cmprovefor"rupouofsals.)' _ 106 SEWER & WATER
loss__s owner._the. exclusively - -mown!
_ Cdl,nucttheofjest(Seny.omBusinissandmnnisiong ns lia:)no onoodu s 202 - UNDERFLOOR PLUMBING -
-_
construct the projat(Sec.7000,Business and professions Coda)The Conlramors � ,
License Law don no apply to an owned of pedptny who Eviler or improver therton, 203 - UNDERFLOOR MECHANICAL
and who coarodu or.su .contnctorpl licented.pursuans.to tha. ........ ..... ... ._ ...._ -_..._.__...
204 UNDERFLOOR FRAME' '-
_ and who comncu(orsuch p.jecu with s
❑lameiemplunder$ct. :BRP,C(mthisrtnon 205 - UNDERFLOORINSULATION
Owns Do[.' 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
` 1 hereby eRrm under penalty or perjuryone of the follmving d imtions:
302 - TUB & OR SHOWER
I neve and will maintain a Conic.te of Consent to sell-into.fm workers 3 0 3 - ROUGH MECHANICAL
f _
Campensatimn,-n provided for by Section 3700 of the tabor Code, for the 304 - ROUGH ELECTRICAL
'performance of the work for which this permit is issued.
305 - FRAME
0r'have and will maintain Worker's Compedsatio.[I.. .as real by Section 306 - HOEDOWNS
37W of the e;for tabor Codthe peiftimunce of the work'fm which this pewit is
hate d.my wmker'i Campedsetion Lunde,carrier aM Policy number a.: 307 INSULATION
_ .. ..-
.-,;loss. . -
-._ 308.::`-,: SIEETROCK
Policy Na::
S� ti;CERTIFICATION OF EXEMPTION FROM.WsgRKER.S'" ' ' 309' —"EXTERIOR"LATH•
.. ,'.-_. COMPENSATION•1NSUWCE.,,..... , _ _
:1..,, ..., __.....___.
_loss.-.310;,'-' `xNTER'IOR
(Tills region hied net he comPle.d if the pewit it for one hundred dollen
glop)ane .) 311 - SCRATCH COAT
tf
fee nif mat In the par fomVaace at wok for which tins pemu W Issued,( • . .. -313 '-_"ROOF NAIL—— ' � .• ••'.
y
shall of emptoy oily penin m a y e1 ad me I to Ira Worken
compere�:y1o3PypBa��g urn in D p °'�� 501 - FINAL ELECTRICAL ENERGY
ApplicaRr.' \�T.`• � --- 502' -"FINALPLUMBING ENERGY -" - '-"• - -' - -
.After making this
N077CE L CONSTRUCTION LENDINOcficane of&GPNCY' mpcien.you should
C becartdsubj ewdkseaCampenseunnPedvislwaofthe lab"Cods,'you must, 503 - FINAL MECHANICAL ENERGY
forthwith Comply witn such provisions err tor.permit... euxeeemed..akee. 504 FINAL- BUILDING
�.— loss. .. _. ..
1.
;4: "'1 hcnby affirm Ihat there ii a Convection lehdiag agency for the pnlgntante -
505 FINAL ELECTRICAL
Wk'fo which his permitii iuued_(See.]097,Civ. _ - '
6rT1'1' -Lendeli Name:...r:a:.............._. _ .loss�. ._....._'___ _s.. _. .-... ... -... . loss .. . ._. .
50.6. ... GAS TEST
�pz 507 - FINAL PLUMBING-..
U-:O ,t t certify that I have road this application and sten that the above infonvtian is 508 - FINAL MECHANICAL
bermu I agree t9 c mPly with all city and county oNinmcn and sore laws.feting 509 - FINAL GRADE
:�. to building construction:acid hasent
.by authorize representatives of this city to enter upon
rW the above-mentioned pmprry for inspection purpo.r. .. 510 — FINAL PLANNING
_6a' IWe)egmets,ave,andepenwasy ad keep which
mmearsmay
the w.y.sof cod,ainoegeiaid 514 — FI P C WORKS
V1 Ctyliabilities,, judgments,costs end expenrce which may in any wry�ccne against said
VC�i City i I conequence of the prating A of this peat ' " - r
APPLICANT UN]�STANDS ANp W]LL COMPLY WRH ALL N QN S 7" 7/
REGU5gONS.r 5 Issued by: Dale
'g rc f, plic�aln-JCant mar De , Re-roofs
' HAZARDOUS MATERIALS DISCLQSUR
Wi .ur.
n the ippfnht or futile buil7Ni occupant stole or handle hadws materia .Type of Roof.
ndefnedby Ne Cupepum Mancipa Code Chap. 912..d he Healthacd Safety
°Yu r r t All roofs sball_bs.inspectetl prior to any.roofing.material being installed. _
izari usairca,manaresudefinnjbytupant heBiyA mAlr udItyMmijmi`h If a roof is installed'without first obtaining an inspection,I'agree`to remove
mil harardous eat conuminanu g defined by Ne Bey Aree Air @Wiry Management
Isn mT all new materials for inspection. Applicant understands and-will comply with
q
°1" all n'on-point source regulanons,` .
1 have read the hmrdous ma.das requirements undeo'chepter6.93 of the
Cald'owa Health&Safely Cade,Sectio.25305,25533 end 25530.1 undenund the(
_ oCcu rot ot,5he reqins an WNch ma 6a f that it is my responsibility m notify Ne -' - "' -' '- --- - -
If the building dace net cumene have a unan
p. ,met pdono issurnme of a C 'fear of
.i
Signature,of Applicant, Date
norath.r@eq.genl, - W� ca , All roof coverings to be Class "B"or better'
--OFFICE--
7 1 _
."4;"5 _
0 0
CITY OF CUPERTINO
I�m 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng : Sub: Blk: Lot :
APN . . . . . . . . : 36206033 . 00
DATE ISSUED. . . . . . . : 03/07/2002
RECEIPT # . . . . . . . . . : 17574
REFERENCE ID # . . . : 02030025
SITE ADDRESS . . . . . : 11238 BUBB RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MCCLURE JAMES E II AND MANTOVA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4979
RECEIVED FROM . . . . : JAMES MC CLURE
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : MCCLURE JAMES E II AND MANTOVA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4979
• TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - -------- ----------- -- ---------- ---------- ---------- - - -------- ------- - --
BPERMFEE VALUATION 50 , 000 . 00 500 . 00 0 . 00 500 . 00 0 . 00
BPFIXTURE UNITS 6 . 00 49 . 98 0 . 00 49 . 98 0 . 00
BPLANCHK PERMIT FEE 500 . 00 425 . 00 0 . 00 425 . 00 0 . 00
BREMFIXT NO. FIXTURES 6 . 00 6 . 66 0 . 00 6 . 66 0 . 00
BENERGY PERMIT FEE 500 . 00 150 . 00 0 . 00 150 . 00 0 . 00
BREMRECEPT NO. OUTLETS 16 . 00 17 . 76 0 . 00 17 . 76 0 . 00
PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
BREMVENFAN NO UNITS 1 . 00 41 . 63 0 . 00 41 . 63 0 . 00
BRJEMVENSYS NO UNITS 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00
B.,EISMICRE VALUATION 50, 000 . 00 5 . 00 0 . 00 5 . 00 0 . 00
EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
I ---------- ---------- ---------- ----------
TOTAL PERMIT 1310 . 92 0 . 00 1310 . 92 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--- --- - -- --- -- --- ------------ ------------ ------
CHECK 1310 . 92 6021
------------
TOTAL RECEIPT 1310 . 92
0
CrY OF CUPERTINO
f .
r cuPEr�Tirvo PERMIT APPLICATION FORM
�.. APN# o Date:
3 .6 - 62
Building Address
112 38 6 w b o Cif 2�i G f}- . 9SOl.�{
Owner's Name: Phone#:
M 16 y408- 7s7-1N63
Contractor: License#:
S � f
Contact: Phone#:
Applicant/Co ctor.
M �GLr�re
uildi
Bldg Elec lumb Mech
Job scription:
esidential: Rem 9,44 Commercial:
Sq.Ft. Floor Area:. . $/Sq.Ft.:
".A.rehitect/Engi�heer: Valuation: a/ Occupancy G oup:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
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/ uasi BUILDING
BCONSTA)MQ 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 E6ergy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
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