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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 1 of 3 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 2 of 3 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 3of3