06060125 CITY OF CUPERTINO ��+ aa•»?tit*'§ �"`
PUILDINGtIVISION PERMIT ' aNTRACTORgINP„ ORMATIONF'�"#,
BUILDING ADDRESS: rxnAr PERMIT NO.O6O6O12S
175 CALVERT DR
OWNER'S NAME: PERMIT ISSUE DATE
S ING Gs 2006
NE: A SANITARY NO. CONTROL NO,
ARCNI'IECT/ENGINEEA: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
app
LICENSED CONTRACTOR'S DECLARATION IObDESCTI IIOn
rd I hereby$from Nn I am licensed under provisions of Chapter 9(commencing p
Z
whin Section 70M)efDh,hwa 3 of the Business and PrafetUum Code.and my Iicmnx 4
^< in roilforteandeIt SS 97 REPAIRING DAMAGE EXITER WALL NORTH BUILDING H
L,C 4 Lic.{
Dam — omsaaar Ac 0 FRAME & SIDING & SHEETROCK
ARCHITECTS DECLIRA716fr FSR CONSTRUCTION PAID FOR BL 6/15/06
1 understand my plans K na shell le used As public mood,
it
k C� Licensed Prof mvaleasl
`y5 OWNER-BUILDER DECLARATION
ConuaON
DS I hereby aRrm NPI 11. exempt Imre the CanuanCo :Any c Law for the
loo followwhich requires,
emitt ]IDLS,Buaiimss And Profession demolish.
Cade:epair ymrnumy
$ which its We a phis,as mnatrm,aixr.improv,demolish,nr e a sir anY swment
prior i its licensed
pure his,requiter the Applicant(or such eactue m cm se Law stammers
< Nolas mman ce witpursuanttoNaproDivision(the oftheBrxmhLicenceTaw(LTapth9 Sq.Ft.Floor Area Valuation
Z5§ (commenringwithSuctionl000)afDivirion3oftheBuaincsaandPro(easians Code)er $8325
$ Nal he is exempt thertfrom and the basis for the alleged rnemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of &jn r Occupancy Type
not mart than five hundred dollars($500).
I,asowms a(Ne pmpeny,amy cmplcysas wirer wageaas,bola sem compensation,
will do the wmk,and th.munclum 4 runkrumded araRered fanale(Sm.l..toaimaa 'ReWired Inspections
and Profesumu Cad.The Commeme,Live Law doss mA apply m an awmr of p
Property who builds or improm Norman,andwhodausuch work hidese5(ar tluau{h his 1 q� 2U�6
ownempleyeca,provided that such improvements am not intended oraffered fersala lL 11 j��e( L o
havers.the building or Improvement is sold within arc year of,e mpletio t,the awmr-
builder will have the burden of proving Nn he did not build m improv far purpose of Le/�\/I'/JItM-11ta
❑I,as owner of the progeny,am acloivcly contracting with licensed contracioa m
construct the project(Sec.7044,owner
of and tr fiessionswho bus Cade)The Cmhxmr4 LI-
ceox Law coca not apply a an owner of property were sed p or improv Centra,and,
who nseuxu for such projects with amntru7ortU licensed pursuant in the Contractors
Am
01A ..laexempt under See .B dPCfar this reason
Owner Date
WORKER'S L'OMPFNSA71ON DECLARATION
1 hereby airs.Omar penalty of pedtay,nm of dx following declantiov:
I hew and will maintain a cmacsm at Cannot to self-imum for Wurkcr'a Compen-
malon,As provided for by Section 3700 of the labor Code,for the performance of the
wart for which this permit is issued.
❑1 have and will chairman Workefa Compensation Insurance.as required by Section
3700 of Ne Lather Cade,far the performance of the work fm which this permit 4lsaad.
My Werk 'Comgensulan tommu and Policy number tie:
Cartier.y�kT�i Tsar //� ren a Policy No.: 7/-7 O O I J Z
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This scmlon need not he complemd If the permit is fmane hundred dollars(5100)
or less)
I anify the,in the performance of 0m work for which this permit 4 issued,I slWl not
employ any panic.in any manmerso As m become subject m the Workers'Compensation
Lawsof Califomia'Dam
Applicant
NOTICE TO APPLICANT.If,after making this Carriacou,of Exemption,you Mould
become subject m the Workces Compensation provisions of Ne Mor Code.you mot
�O forthwith comply with such provisions"is permit shall as deemed revoked.
zy CONSTRUCTION LENDING AGENCY
T hemhy affirm Nu them 4 a mmtrucdon lending agency for the performance of
ai the waste fm which this permit is issued(Sen.3097,Civ.C.)
OW.Q LatWees Name
z Lc.&es Add=
U0 i certify that I have mrd this applieatim and sum that im also.information iv
IL (~ comcm I agree to comply with all city and county ordinances and state laws relating m
0U building construction,and hereby amhorve mpssentaiivh or this city to enter upon the
W above-mentioned pmgerty for inspection purposes.
(We)agree m save,indemnify and kap ha.nlcss Ne City of Cupertino agaltm
U(a/3 in
men0.cnstsing ex penseswhtchmryin mY'a<Y acauc agains,said City
V z A PLICANT of the{renting$(this permit, p-
�' APPLICANT UNDERSTAND LL COMPLY WITH ALL NON-POINT Issued by: Date �—/ J '�
SOUR LAI ON
(�
Re-roofs
Signatureof Appltwn on Data
HAZAR els ATE RIALSDISCLOSURE Type of Roof
WIII the applicant or(Mom building e.Chapter
9,1 or handle haeNdeanmamriai
u deMN by Ne Cupertino Municipal Cade.Chapter 9.11.and tic Health and Safety
Cade,Section 25532(a)T All roofs shall be inspected prior to any roofing material being installed.
❑Yca Mho
Will thea applicant or future building Occupant ass u; If a roof is installed without first obtaining an inspection,I agree to remove
pp { e equipment Qu m device which
emit ict7 o air contaminants u de0md by the Bay Area Air Quality Mwgement all new materials for inspection.
Dis hT
- ❑Y. �No
IIIa.mad the henNsmsmamdab requirement,underChapterG95 afthc Gli(or•
nim Health&Safety Cade,Sredau25505,25533and75534.1undenand Nuifthe building
does,to,Connally haw a moan,to. ' An possibility to todfy the oaupsm a Ne
requirements which musibcmetp' rte ofa CCnilhamapcmpanz' Signature of Applicant Date
6�
owner orsuthorivedagent Data All roof coverings to be Class"B"or better
F Community Development
10300 Torre Avenue
F1 Cupertino CA 95014
H
Telephone(408)777-3228
CITY OF Fax(408)777-3333
IWUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
(f Dr. 6a�d lZ�
OWNER' NAME: PHONE # 6�-10 7 J'- a U /
GENERAL CONTRACTOR: — lo— C b FAX #
I am not using any subcontractors: � i� Qm
Sign Date
Please check applicable subcontractors and complete the following information:
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
CITY _OF CUPERTINO
�m 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # : 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37519027 . 00
DATE ISSUED. . . . . . . : 06/15/2006
RECEIPT # . . . . . . . . . : 34865
REFERENCE ID # . . . : 06060125
SITE ADDRESS . . . . . : 175 CALVERT DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . . } (�•
OWNER . . . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : FSR CONSTRUCTION
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . :PAUL QUALLS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
SFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 8 , 325 . 00 158 . 76 0 . 00 158 . 76 0 . 00
BENERGY PERMIT FEE 158 . 76 76 . 20 0 . 00 76 . 20 0 . 00
BPLANCHK PERMIT FEE 158 . 76 211 . 87 0 . 00 211 . 87 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 8 , 325 . 00 0 . 90 0 . 00 0 . 90 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 486 . 10 0 . 00 486 . 10 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 486 . 10 1551
OTHER 105 . 00 VISA
TOTAL RECEIPT 591 . 10
•
- CITY OF CUPERTINO
RITMOr PERMIT APPLICATION FORM ��
CUPEI,TINO
N# 16 -- 0 P � U15 Date: / r 6 (
/
Building Address: I "1 V!/` Mailing Address (if different from building address):
o
Owner's Nlzmu� G Phone#:
S-A) - �19d -2 9
Contractor: w tel, 0 License#: p7�52 n
`T
Contact: / Phone: /U 49U 7q iI Cupertino Business License#:
q(N f •�k (A�('� Fax: ;;so
Building Permit Info: 7
S
Bldg ❑ lElect ❑ Plumb ❑ Mech ❑
Job Description:
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: ,iF 2 5 Occupancy Group:
Type of Construct ipn; Please check this box if the project is a
12�2- /!' Q,o J1 second-story addition: ❑
ro'ect Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100Kto500KBtu 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
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CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
QuantityFee 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 rinklerBackflo 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
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> 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
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CITY OF CUPERTINO
CUPITY r PERMIT APPLICATION FORM
uanti 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 Mecb 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 Chane BUILDING
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