08010085 PERTINO
7775,577 F'�'l
IG'DIVISZON IN AT
CITY OF CU
BUILDIN PERMIT ��"'COMTIUCTTP Q09UMA,
A
AN
SUI LITtfiffRESS: PERMIT
BUBB RD WARD CONSTRUCTTON 80iOO85
OWNER'S NAME: PERMIT ISSUE DATE
WASSON ROGER E AND LILLIAN H 5526 MAPLECREST CT 01/15/2008
NE. SANITARY NO. CONTROL NO,
ARCHIMECTIENCINEER: BUILDING PERMIT INFO
RMDL LAUNDRY RM,RPLC UTLTY BLDG ELECT PLUMB MECH
cmv 1.1�1
Z' LICENSED CONTRACTORS DECLARATION
I bunny it Wt I sm ficcessed under provisions of Chapter 9(commancla, -- -----4Gb-DGscription
wiNS=don7OM)ofDiviMan3ofNeBusinmod of 'omC and ylit
=t uin full face and effacl.,Z /so,
Z LIC
.,
Dal. Co.
tl6 [==ARCHITECTSDECI-AiAn
y plans shall be taredas Public menX
Licensed poulbandmott
OWNER-BUILDSR DECLARATION
I hereby arrimr hot I A.mount from the Conarouron's License Law for Ne
D O following reason.(snedon 7031.5,Document and prolamines Code:Any city or county
Z
.,slc! which ampone,a permit to consurem,aluer,improve.deartflarda,or repair any structure
4;m prior to its coureacco.also resaires mis applicant for such permit an rile a signed statement
thus he is licaroced portuallL W the provisions of the Conarammes Lictume,Law pChipmr,9 Sq.Ft. Floor Area Valuation
st (commenting with Scction 7")of Division 3 or the Business and Profmons Code)or
Nat l ba Is contain thmorrom and me,basis for the alleged exemption,Any violation of
Section 7031.5 by my applicant far a permit sntbjmcu the applicant an a civil penalty of -APN Number Occupancy Type
an,come,Was five hundred dollars fl
0 Lu.of the F.P.M.or my cooployeac,with wagon,as their sole compensation,
will dot arm work,and the mroseum is Out intended or ff=d far We(See.7044,Basmat
and Prallcanderes Codec The Cormanomer',Lomas Law does an,apply un an armut,of Required Inspections
Property who Wilds atrimprooness aboacion.and who deusuehwrk Wrialrormouth his
man cropkynce,provided that such improvements son no,inboard warranties fmo U.
Ne Wilding arrimproveracent is said within man lose,ofacroploona.the awvar-
builder wig leve the buresear of proonni,that Is did not build or Improve far purpose of
sale.).
[3 1,as airier of the property.me sexclusively commuting with focused caurvionam an
constrom the project(Sm.700x.Business and Prafeadons;Cordo:)The Com cubes U.
muse Law,does mo apply to an crovernar ofmaparty wed Wilde.,improves thention,and
who comestm For such projects with amonscloms)licensed P..[to man Centimes
'"We"Law.
El lanneximpt'verearSec, —.B&PC(.th4..
Owne Dau
WORKER'SCOMPENSATIONGEC�RATION
1 Imanclay afflon under penalty of perjury We offt following declarations:
Whavems aiiii maintain cmustaimac.con.t to self-Inas reawmicar.compon,
,as provided far by Secdon 3700 of the Labor Cade.for We performance of can
work for which mrs,permit is aimed.
r-I I leve and will..!.We Wtarktati C..pd.O Inman .as acquired by Section
3700 of me Labor Cooke.rhar We part..anco of the work far which this permit as Issued.
ma
My Wmams C Peassiductirtsurpacecarricranuiplicy -5 V
Carrier: Policy No.:
;FaC- 27.
—
cExt i?PCATE OF MEM PT70N FROM WORKERS'
COMPENSATION INSURANCE
(nois socamr,wount wattincompimad franc,Korea Is i.e.hundred deflater(SIM)
or but
I QWiCV Net in do isileamstram Of me work far which this forms IS Issued.I mail not
employ any person in any Water an an W become subject as the Workers'Compensation
Laws of California.Dam
Applicant
Notice TO APPLICANT:If.efur unions,this Cerilficau,of Exemption,you should
,ccomm subim at me Workers Compensation provisions or toc Latin,Cam.year mail
Z forthwith comply what Shich provisions W Nu permit Shall W deem est evoked.
z 0 . .
CONSTRUCTION LENDING AGENCY
yI hammy anim tom taccon ir a comarromima lending agency far the performance at
> the work:to,which this Permit is named(Sec.3097,Civ.Q
Leader Normo
:3 z Lander's Add.
J 0 1 certify that I have mad this application and sum Wa the seven information Is
LT. P correct lagam an comply with all city and county anAreancesand sum laws existing W
0 U building construction,and kmby mmonm representatives of this city to enter aria the
LA abone-ninumned Property for marcolon purposes.
(We)agree to save,indemnify and laccept bromanimus ft City of Cupertino against
liabilities.Judgments,comm
y tmormattgainstuddChy
in Consequence of the stranim of =1 me,in an
APPLICANT UNDER TI�L N07POI Issuedby: Date
SOURCEREGOLATIO
7 Re-roofs
SignamanofAnplicom On tor' Thea
DnUS MATERIALS DISCLOSURE Type of Roof
Will du applicant or future building rotational store or larrefix,havandom,namorial
a dadatud by the Cupertino Municipal Code.Chapmr 9.12.and dis Hulth and Safety
Cook.Section 25532(a)?
[_]Y. AN. All roofs shall be inspected prior to any roofing material being installed.
%'Iapplicant
_ foiling=Opant use equipment w devicas which If a roof is installed without first obtaining an inspection,,I agree to remove
1,contaminants as deflond by dic Bay Am.Air Quality Management all new materials for inspection.
"'u",
Ne a
0 ya. No
ilon", allbolumenj ated�Igq re" U da"Char,0695 fdr.C.1ifor.
an ou a
.is Health C 25M5 3-d�25 Aterommasadili;ifurt,Wilding
,dms'� an idil the
&Sit y ill
does n currently Wt' in an 7//,abhor or to that y in.
Tricau,
Signature of Applicant Date
rolum lvpari.r�� cifc�ca ad
4/14
;X11V1Pdj �T/ 4'
Owner or authorizedAll roof coverings to be Class"B"or better
alva�` CITY OF CUPERTINO
C, OF
• CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
0Z
APN# Date: /" /t; `,yi'am
/ r
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone#:
Pow
Contractor: p �/ Phone: `lQtq, 003
wg L //�f� C/vV /vd Fax: Q X933
Contractor License#:
Cupertino Business License
• Contact: oV �� gZ� g 3�� Phone:
Fax:
Residential Commercial ❑
Job Description:
7ZV Y ��.5 e®efli,(/
Building Permit Info:
Bldg Elect Plumb Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, HFR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N E 3
Valuati r�; Q. Qv Square Footage:
d t?
Project Size: Standard ❑ Large ❑ Major ❑
•
(alo
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BTEMPPER Temporary Building Permit (good for B
30 days)
1BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1BBOILER2 Installation /relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3 Install ation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
IBBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
lELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B
a(ME CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPEfiiTINO
• FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
JACOUSFDW SFDWL/DuplexNew B
1ACOUSRESAD SFDWL/Duplex-Addition/Alteration B
1ACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
1CHIMNEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 It in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
IFLAGPOL>20 Flag pole(over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRN Pile Foundation Driven (steel, pre- B
stressed concrete)
3 of 5
CITY OF CUPERTINO
CU cion NO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group IGENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY)
1RETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high (up to 50 `) B
IRETSP10 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1SIDEST/BK Siding, Stone & Brick Veneer B
interior/exterior)
1SIDEOTHER Siding all other B
SKYLIGHTS
ISKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'1 B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 sfl B
additional stucco application
4of5
sonCITY OF CUPERTINO
CUPEfZr GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
j lELCPLNCK Stand Alone Electric Pln Ck (hourly) E
/ 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
I 1BSEISMICR Seismic Residential B
1BSEISMIC0 Seismic Commercial B
/ 1TRAVD0C Travel &Documentation B
1BUSLIC Business License B
•
5 of 5
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36211061. 00
DATE ISSUED. . . . . . . : 01/15/2008
RECEIPT #. . . . . . . . . : BS000003691
REFERENCE ID # . . . : 08010085
SITE ADDRESS . . . . . : 1184 BUBB RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WASSON ROGER E AND LILLIAN H
ADDRESS . . . . . . . . . . : 1184 BUBB RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4966
RECEIVED FROM . . . . : WARD CONSTRUCTION
CONTRACTOR . . . . . . . : DAN WARD LIC # 29277
COMPANY WARD CONSTRUCTION
ADDRESS . . . . . . . . . . : 5526 MAPLECREST CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 823-5305
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 10, 000. 00 1 . 00 0. 00 1.00 0. 00
1ELCPLNCK HOURS 1. 00 122 .38 0. 00 122 .38 0. 00
1ELECINSP HOUR 1. 00 122 .38 0. 00 122 . 38 0. 00
IPLMBINSP HOURS 1 . 00 122 . 38 0. 00 122 .38 0. 00
1PLMBLNCK HOUR 1. 00 122 .38 0. 00 122 .38 0. 00
1TRAVDOC FLAT RATE 1. 00 40 .79 0. 00 40 .79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 531 .31 0. 00 531 .31 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ---------------, .. --------------------
CREDIT CARD 531. 31 MC -
---------------
TOTAL RECEIPT 531 .31
Community Development
10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
CUPEKTINO
,0
Building De artment
JOB ADDRESS: PERMIT#
H3 d&a (,o
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: gel
FAX# R
I am not using any subcontractors: OC/
tgnature Date
Please check applicable subcontractors and complete the following information
66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date