06080223 CITY OF CUPERTINO r BUILDING DIVISION PERMITRISR:
BUILDING ADDRESS: CONSTRUCTION PEaMITN0.06080223
175 CALVERT DR # 10
OWNER'S NAME: PERMIT ISSUE DATE
PACIFIC PROPERTIES BLDG. ) 3490 UNION ST #A QA /9A 2006
NE: SANITARY NO. CONTROL NO.
(510) 490-7911
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
goo LICENSED CONTRACTOR'S DECLARATION Job Description
u�FF I hereby affirm Nn 1 am rumored under provisions of Chapter 9(commencing P
what Section 7")of Division 3 of the Business and Prolamines Code,snd my licensed
�m to full forte and Affect. TI{5 �C� RE-BUILD EXTERIOR BEDROOM WALL TO MATCH EXISTIN
r LJZ License Le.g
;rpp Dam camrmd, Z R. rnozTi;LjCn<N REMOVE AND REPLACE FRAMING, ELECTRICAL & DRYWAL
aARCHrTECTwaS DECLARATION
r < 1 undersond my plans Shall W d As public roods
ra
°o
Licensed Pmfcssional
ty
OWNER-BUILDERma
fo DECLARATION
I Maso aRrm an I em,Bumps from the fessins Ca Licence Law for the
:O O fallowing remora.(Sadao 703 madr,Business and Pm.de Professions Code:Any city or county
Z which rcquirca a periodic cnnstsun,sier.improve,demolish,t or c a air an someone
UMment
priorm itsimwae,elmrequire the iSionanf for suchpormtuofilese Law(Chapter
• G met he leliccnmdPunuontbthe pmvisionsofthe ConuactursUccesc6w(ChSPter9 Sq.Ft.Floor Area ValuatiO6450
1;I (commencing with Scanlon 7000)af DivisA.3.fdbc Bwoamand Pwfessians Code)ur
.- Nm W u emmpt thmaom and the Was far the alleged emmptlm.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant m arnil Penalty of APN Number Occupancy Type
not ream than five hundred dollen(5300). 3 77 5519027 . 00
like.&.
the sad tho my,car ism,
s wploycmwithwagnuatei(ane m .Business
will do Newark,Cache heCorttsrots Licur ,Lawcdfn me sme
70 ad.owner of Required Ins ections
and erty who bu Coat The ws Contractor's Licosa law dam est apply lf an unmet is q P
propertywhobulltle fdcd that
hIMpoandwho Am nor
his
own emplouebiddin or i thauah imPwwmanu are tat es,ofd aroaewa far Own er, 3builder,the ave thi orimprovement4 solaedid ore year ofmprove foron.pts use ofr. //_
builder will have the When of proving Nn W Sia sot build r Improve for purpose of
role.).
❑1,as owner of the property,am exclusively contracting with deemed aenammo to
cunstroct an Mines(Sec.70th,Business and Professions Code)The Commences U.
cense law don not apply to an owner of pmpeny who Wilds or impmm Orman,and.
who contracts for such projects with a comical")licensed purest to the Contractor's
License Law.
❑larnmemptunder See .BAPCfrtisr n
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pemiry of perjury we of the fallowing dalaradaw.
-L)1 haw and will maintain a Ce ftcaa of Consent toself-insurefar WmiceSCompcn-
smion,u provided for by Section 3700 of the Lahr Cade,for dm perlonnanca of me
work for which this permit is isaaa.
I have and will maintain Worker's Compensation Insurance,u requited by Smion
3 of Ne Labor Carle,for the performance of the wart for which this permit is Issued.
My Worker's Compensation Insurance cattier and Policy numbs are:
Currier. PTE �kl N i) Policy Na.: n 1 13a 4- 0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(This section reed not W completed If ths Permit Is(drew,Wndond dolkre(Skil)
car In.)
I certify Out in the performance of Ne work for which this remit is issued.I shall not
employ any Person in any mummer an As k become subject to Ne Workcri Compcma0on
Laws of C.ablomia.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Eamption,you should
become subject m the Workers Compensation provisions of me Labor Code.you mum
.J O forthwith comply with such provisions or the permit shall W domed rewked.
zCONSTRUCTION LENDING AGENCY
y
[ti 1michyafil.mat mart tsa comsuetlno lending agency l'or the perfwmancc of
L#> the work err which this permit Is named(sec.3097,Civ.C.) ,
GQ Lender'¢Name
P z lender's Address
U 0 1 certify that 1 bout reed this application and stun that the aura information is '
{L P correct.1 agree to comply with all city and county ordinances and sole laws relating to
DU building construction.and hereby authari¢e MPrtecnotiws of mil city to enter upon the
Lp] alwvc-mentioned Parretti,for inspection purposes.
(We)agree to mw,indemnify and kap hmmless On City of Cupert n,against
Vp liabilities,Jutlgmeno.co¢m and capenma which may in any way aceme against mid City
U z in consequence of the granting of this permit. )
APPLK# DERSTANi 6.ING WILL COMPLY WITH ALL NON-POINT Issued by: 6i Date
R LATIO /q1 •'}I/Qilr.`4Js
8 d4 I 0 L Re-roofs
Signame f ApplicanaCmanor D
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding occupant more o handle hecardoes material
as acfincd by the Cupertino Municipal Caere,Chapter 9.13,and the Health and Safety
Code,Section 15533(¢)1 All roofs shall be inspected prior to any roofing material being installed.
❑Ye¢ 4NU
Will the applicant or future building acupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha.dous air contaminants a defined by the Bay Arca Air Quality Managcmcot all new materials for inspection.
District?
❑Yn u
1 have mad the hacatdous materials requirements under Chapter 6.95 or the Califon.
nix Health @ SafelyCode,Secdam 25505,15533 and 25534.1 understand tam ifpte Wilding
dew wt currently have a tenan4 mat Ica my responsibility m nadry the acupant of the
M I cry hmum pri issanaaLSCenlllketeefOempmteY. Signature of Applicant Date
Owner authori7nd gent Data
a All roof coverings to be Class "B"or better
FSR Construction, IncPro rr'�10$a� 825/2006
3490 Union Street #A M mwiford@earthlink.net
Fremont, CA 945384365 John's Cell(510)773-0084
Uc#755297 Fax 510490-0966
Phone 510 490-7911
• Emergency Vehicle Damage Repair#102
Customer Project Proposal#
Pacific Property Co. Sage at Cupertino 60821-01/mw
777 California Ave. 175 Calvert Drive
Palo Alto,CA 93204 Cupertino,Ca.95014
Office(408)252-2122
Attn: Rick Bizar Fax(408)252-5677
Phone: (650)796-8180
Fax: (650)213-8849
Accepted by:
Scope of Work Description
Unit#102 Exterior:
AND URUINA
Building E 1)Remove damaged sections of siding,window trim, insul
Bedroom Vehicle Damage Repair and framing as needed aprox 3 sheets 4'x9'
Remove(1)window,replace framing as needed and rese1ATE
new window. Replace insulation,repaper with building ,
paper,replace siding to match existing. Replace trim to
match existing. be kept 0 1 the job lit all times and ft is if,
n•
Interior. !awful to nake any changes or aiteFat
NOW eR ri
1)Remove drywall across entire wall surrounding window."
• Replace damaged framing as needed.We may have to N6,500.00 n,
replace bottom plate and drill in new anchor bolts,we willd to at
epoxy them in. Replace baseboards to match existing. n
Drywall patch,tape and texture to match from comer to approval i I the violation V-1 any proviel
comer.Paint walls and ceiling complete in bedroom J any I
Remove and replace(1)2'long electric base heater E
Emergency electrical work required by Fire Dept.to restore
power to unit prior to repairs. (Sub-Contracted) $ 300.00
Electrical reconstruction—(1)outlet and(1)base heater in
(1)reconnect at panel 650.00
i
Total M _ 04 6,460.00
At"tutW4 `- .
Michael Wiford,Project Manager
Excludes plans,permits,city fees,engineering or architecture fees,special inspections or handling,waste disposal or hazardous materials,
any hidden or unseen damages that are not visible from exterior inspection,any repairs to lines,pipes,or wires in excavation area,all work
not spaded above.
Any finish landscaping or tree work is to be done by others. We cannot ensure health of trees after root trimming.
Plans,permits or drawings will be done on a Time and Materials basis,if required.
Any change orders or additional work are subject to 20%overhead and profit mark-up.
Thank you for the opportunity of quoting this work. We look forward to working with you.
Id•
age I of I
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: 'Blk: Lot: '
APN . . . . . . . . : 37519027 . 00
DATE ISSUED. . . . . . . : 08/28/2006
RECEIPT # . . . . . . . . . : 35791
REFERENCE ID # . . . : 06080223
SITE ADDRESS . . . . . : 175 CALVERT DR # 102
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PACIFIC PROPERTIES (BLDG. E)
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : MIKE WIFORD
CONTRACTOR . . . . . . . : PAUL QUALLS LIC # 28012
COMPANY . . . . . . . . . . : FSR CONSTRUCTION
ADDRESS . . . . . . . . . . : 3490 UNION ST #A
CITY/STATE/ZIP . . . : FREMONT, CA 94538
TELEPHONE . . . . . . . . : (510) 490-7911
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----- ---- - ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 137 . 16 65 . 84 0 . 00 65 . 84 0 . 00
BPERMFEE VALUATION 6, 450 . 00 137 . 16 0 . 00 137 . 16 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 6, 450 . 00 0 . 70 0 . 00 0 . 70 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 242 . 07 0 . 00 242 . 07 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-- --- ------------ ------------ ---------------- --
OTHER 242 . 07 VISA
TOTAL RECEIPT 242 . 07
•
Community Development
10300 Torre Avenue
11
/- Cupertino CA 95014
'" Telephone(408)777-3228
11 11
CITY OF Fax(408) 777-3333
4JUPERTINO
Building De artment
JOB ADDRESS: 115 CAt.VERT PC , PERMIT #
CUe�RT�N�► CA 015014 6d 8-0223
OWNER'S NAME: PAo1 Flt TiE s PHONE # St0 010 - q9 11
GENERAL CONTRACTOR: 5 C-r 1 0 VJ FAX # 5 1 o clo -pq
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
V/ Electrical t_Co El t
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
bwner/Cor?tractor Signature Date
- CITY OF CUPERTINO O(poebo/a-5
CUPEr�TiNo PERMIT APPLICATION FORM
N# Date:
31 —19— c -1 — g — a
Building Address: Mailing Address (if different from building addr ss):
`� C A L V E (rT (z . C U PI; RT C fl 950 , ,+
2-
Owner's Name: Phon #:
Contractor: License#: C�wss Q
ES (Z Co N 5T R-U CT,a Q `15 5 R q Sy . 1613110 (o
Contact: Phone:(5lo� gcto-'9 11 Cupertino Business License#:
00 1 Kr, Fax:(Sjo
Building Permit Info:
Bld Elect ❑ Plumb ❑ Mech ❑
Job Description: E - gu )%-D E,K-M(L) OR BE D 0-00M W��thcl To MAT" C.,(
Residential El , ETR.( t A�- c"P- ll,ommercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Projecjt: Occupancy Group:
aM o'" —'L
Type of Construction: Please check this box if the project is a
H , RE- 6v I L-D, I 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> 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
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY IEnergy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
uanti 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 Tns ection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g 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 Re eat 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 din 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 Furnace> I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Mise Ap2aratus 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 Heatin MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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ago" CITY OF CUPERTINO
CU
PEI�F PERMIT APPLICATION FORM
QuantityFee 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 Seb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection 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 Mechanical sq. 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
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