06030015 CITY OFCUPERTINO 0
BUILDING DIVISION PERMIT �i 1 'rRACTOMNEORMAI
BUILDINO ADDRESS: PERMIT No.0 6 03 0 01 CJ
10130 CRESCENT RD
ER'S NAME: FERMITLSSfB3DATE
TOY ANTHONY AND CHAN GRACE K 03/03/2006
PHONE: SANITARY NO. CONTROL NO.
ARCHrIEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30p LICENSED CONTRACTOR'S DECLARATION O
et 1 hereby affUm that 1 Am licensed under provisions of Chapter 9(commencing Job Description
wide Section 70p)(1).lDivision 3.1'the Busineuand Professions Cade.and my licema la
n in full forte andeRec, INSTALL SIDING {y�V E�YIt7 N'���WCOD SIDING
jNZ Dianne Clue Com •✓•++ a/�a
' Dau e'S DECLARATION
�t]f"' fYF�j��
As shall used
DECLARATION
I undttwnd my Pum Nail W used u public recnrN
'5a
Licensed ud Pmfcssional puce
LduD
OWN -BUILDER DECLARATION
COO hereby aGirm on I am eBusin from Ne casions C s License Law for the
COO following mwoa permit
h 7 construct,
t,After and n.Professions Code:Any city or county R m
S$ which acquires a permit ac aMmc,Blur,improve.demolish,t,nr wash any awmum uJ $1200
_fit
prior miuissuance.
ensedralso
nantto ma the
osAsioeantfor.C.mromee will.te a signed(Chaps em
< dw WiadittmeJ pursamlwlhc provisuns of Nc Conuasufeluxmclaw(CMPwr9 Sq.FL Floor res' Valuation
i5$ (commcnciny with Section 70001 of Division Sof tim Business and Professions Code)of
Nat he lo tumFt therefmm and Ne basis for IW alleged exemption.Any violation of
Section 7031.5 by any applicant For A permit subjects the applicant As a Civil penalty of 3 U14 MIRSer V U Occupancy Type
AM mart Nan Rw hundred dallars($SOY,
❑1,as owner of the property,or my employees with wages An their sale compensation,
will do the work,and the strvcwu is not intended or offered for Asia(Sec.7044,Business Required Inspections
and ProRas11 Code:The Canwecur's License Lew Oats not apply u e an owner of q p
property who builds or Im prows Nemon,and who does such work himself or through his
own employee,provided that such Improwmenu are not Intended or offered fns at-.if.
however,the building or improvement is sold within ow yea of completion.Ne manm-
Wlldec will love the hatch of proving that W did not Wild or Improve fns putpos,of
1.u nwmer of the property,.B uness And contracting with:)Th ed conwmors U.
mmwm dem protect(See.n an Business and ny-who
Cade:)The Cam eater. mi
whoa Taw doe not apply je eco owner of properlpwho Wilda or improves Comm ted,
who conwcu for such proJecu with a conwcmr(s)Tissued pursuant u the Contructoh
License Law.
❑I Am escmpt no m Sea �_.B k P7C�far this r�eas�.osn
vner Dau 3-3 -c>6
RKER's coA PENSATI N DECLARATION
1 hamby IBiw under penally of peyuay oro of tisc fallowing dechuntimta
❑I ban And will maintain A Certificate o(ComenUoul6imum fns Workeh Compen.
sation,As provided for by Section 37M of the labor Code,for tie porformena of the
work for which this Permit Is Issued.
D 1 have bad will maintain Worker's Compensation Inurua,as required by Section
3700 of NC labor Code,for the pmformutw of she work for which this permit is loud.
My Worker's Compensation Insuraneo artier and Policy number am:
Caller. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(fair umia need Prot W cunpltted if the permit B forane hundrtddollan($100)
or las)
I certify that in den performance of the work for which Nis pomp is leaned,T shall not
employ any Person in any mann sauubedon subject 1.dee Weakerr'Compenaadon
Laws of Califom(ADom
wr• I '
Appliunl //
NOTICE TO If,`a�(scr matin dee Certoro of of Eaempuon.you should
become suomp y dee Worker's Comporua is provisions of 0e labor Code,you muss
,J O forthwith amply with such provisions or Nu Permit shall W deemed rewtrd.
z` CONSTRUCTION LENDING AGENCY
(-s IhorebyaOlrm Nat Nem is a construction lending agency for the performance:of
D:> the work for which this pewit is issucd(Sec.3097,Civ.C.)
W� Lender's Name
z Lender's Address
U Q 1 cerdfy that 1 haw:read this application and sum that the aWve information is
It, ansa I ages to empty with all city and county ordinarcee and slow laws minting he
0 building construction,and hereby authorise mpresautiwa of this city mentor upon an
shove-mentioned pmpcny for inspection purposes.
EE (We)agree to save,Indemnify And kap harmless the City of Cupertino against
)y liabilities.judgmenu,cents and continues which may in any nay ucmc agolmt sold City
in consequence of the granting at perms
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGULATIONS
•,-G2 G l 3 - 3 -06 Re-roofs
Sign a of ApplicanVCawcm Dau
HAZARDOD MATERIALS DISCLOSURE Type of Roof
Will the Applicant Or future Wilding occupant amt or handle havrdow material
As deBwd by the Copan..Municipal Code.Chapter 9.11,and the Heahh and Safety
cadaecd
s .nzs53z(e)7
❑Ye gk6 All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit mardaas air conuminanu As de0ned by the Bay Area Air Quality Management all new materials for inspection.
Maniel? —✓✓
❑Yes �U
I boo mad the huaAmu matriali nequiremenu under Cha pwr 695 of Ne Cali for.
ria Hcal"SardyCode,Sections 25505,25533vW25534.I understand Jmifthe Wilding
Jen not currently haw a scram,that It is my mapomehility As Poultry dee oceuput of the
require lowhachmass be .rWissuance of,Ocei0awafoccupency. Signature of Applicant Date
Ownor or Authorized agent Dow All roof coverings to be Class"B"or better
CITY OF CUPERTINO
I 1 of 1 PERMIT RECEIPT OPERATOR: bethe
COPY # 2
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 32616045.00
DATE ISSUED. . . . . . . : 03/03/2006
RECEIPT #. . . . . . . . . : 33445
REFERENCE ID # . . . : 06030015
SITE ADDRESS . . . . . : 10130 CRESCENT RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TOY ANTHONY AND CHAN GRACE K
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1051
RECEIVED FROM . . . . : GRACE TOY
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP .
TELEPHONE . . . . . . . . :
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ---------- -
BENERGY PERMIT FEE 83.16 39.92 0.00 39.92 0.00
BPERMFEE VALUATION 1,200.00 83.16 0.00 83.16 0.00
BSEISMICRE VALUATION 1,200.00 0.50 0.00 0.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 123.58 0.00 123.58 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 123.58 159
TOTAL RECEIPT 123.58
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Community Development
10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408)777-3228
�U n C��I A I O Fax(408)777-3333
fC I�1 Building Department
JOB ADDRESS: r PERMIT # Co30oIS
I o 13o Cre5cen O
OWNER'S NAME: - c c e To PHONE #
GENERAL CONTRACTOR p ^, t G ,� FAX #
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
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/Contrfor Signature Date
.. CITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
Obo3 pDlS
N # 312� —J� _07J�L Date: 3 - 3 — o6
Building Address:/a 3 CI'eScevt/ �G{ Mailing Address (if different from building address):
Owner's Name: `c c Phone#:
2S 7
Contractor: I f v�cti an License#: 7
i s Coes ��q�5'
Contact: Phone: rjC�� 2 Cupertino Business License#:
W Fax:
Building PemritInfo:�t�5/wi,ma ovev T(fS 1NP Woo S( UG ` s--tC^A,^WS
Bldg 0-' Elec�� Plumb ❑ Mech ❑
Job Descriptio
Residential W Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
Cost of Proiect: ZUO Occupancy Gra:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro'ect Size: Standard ❑ Laze ❑ Ma'or ❑
uant ity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BB.QILER3. Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1-.75*M Btu MECHANICAL
BBOILER5 Boiler> 1.75MBtu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi 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 Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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r CITY OF CUPERTINO
CU19 0INO PERMIT APPLICATION FORM
QuantityFee ED 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
BOVERTDvIE Inspection Overtone BUILDING
BPBACKFLOW Atmospheric Vacuum . PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
MIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHI{ 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 rinkler/Backflo PLUMBING
BPSTORM StomVRain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER InstaWAlter 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
BRENLA KHAN 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 > l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BRENOMC 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
BRENMSAPP Remodel Res Appliance ELECTRICAL
2 of 3
CITY OF CUPERTINO
CUPEi�TINO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHBATR 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 Lispection BUILDING
BSYVTM 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
EPERMTTFEE Elec Permit Issuance ELECTRICAL
WERMFEE Mechanicals . foot I MECHANICAL
MPERMITFEE 114ech Permit Issuance MECHANICAL
PPERMTTFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Foe sq foot PLUMBING
PLLONGRNGC Planning LR Comma/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
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