06010051 CITY OF CUPERTINO *"w ' '` '�:
BUILDING DIVISION PERMIT a^aCOT.ICTOR�NFORMr�TION
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BUILDING ADDRESS: V DON CONSTRUCTION PERMIT N0.06010051
PERMIT15517E DATE
ER'S NAME:
JAME FINCH 1469 AMBERGROVE DR 01/10/2006
PHONE: SANITARY NO. CONTROL NO. .
(510) 882-2404
BUILDING PERMIT INFO
----------------
ARCHnECT/ENGINEER:
BLDG ELECT PLUMB MECH
30o LICENSED CONTRACTORS DECLARATION Job Description
�+F I hereby affirm that 1 am limned under provivons of Chapter 9(commencing
with Sidon 7")of Division 3 of the sonatas and Profexiom Code,end my license is
n'la mrdlmreManderrem. REFRAME AND f� ��( }�{�WINDOW AND RESTUCCO
>>Jnn% License Clus ConlnLic.gc.y u� �'�Z 'lf1f ltlTk\ f1 /yYy p
Lqqq Dem ] - i s — G G. mr
3t ARCHITECT'S DECLARATION 11
1 understand my plans shall he used u public records
DL
y c Licensed Pmlcu anal `�� 2006
OWNER-BUILDER DECLARATION D2
I hemhy Affirm the,I am exempt fmm the Coanctois License Law for the _
oOp• folowing¢mmn.(Section7(DIS:Busmassmand professions Code:Any city orcounty - "" --- --- — — - — " -- - --- $4500 — —
s.-a Which mqulrcs a permit m cnnsWq eh.1 top.,dcmalhh.or nepail any structure _
1.-e
poor m its issuance,also requires the applicant for such permit to rile a signed statement Ft.F 0 r (] Valuation
< Nat he is licensed pursuant to the provision of the Coronation's aw(Chapter9 SQ• ❑N A
5? (commencing with Section 7000)of Division 3 of the Business and Professions Canada,
C r3., that he is exempt thexfrom and the Buis fm Me alleged exemption.Any violation or
Section 7031.5 by any applicum for a permit subjecss Me applicant to a civil penahy of r Occupancy Type
not mom Nan five hundred doll..(5500}
❑[,an owner of Ne property,army employees with wages SUMMIT seleeompens.ion,
will do the work.ard the stracture is not intended or oResm forests(Sec.7094.Business Required Inspections
and Professions Code:The Conoscmrs License Law data not apply m an owner of q P
property who build&or improve.Memos,and who doessmh wart himself or through his
own employees,provided that such improvements See nmimended or offered for Sale.If.
however,Me building or improvement Is mid within one year of completion.Me owner-
builder will have Me burden of proving that he did ant Wild or improve for purpose of
talc.).
❑1,as owner of Me property,am exclusively contracting with licensed contractors to
connotes the project(Sec.709,4,Buimu antl Profasomat Code:)The Cor mier'&Li.
came law data nut apply in in owner of propeny.wha Wilds or improves themon,and
who contacts for Such projects with a contrmtor(s)licensed Ferment ro the CantramaYt
Lice.Law
I am exempt under Sce .B k P C far this reSUOn
water Data
WORKER'S COMPENSATION DECLARATION
I hereby edition under penalty of perjury tele of the fallowing decl.atiom:
❑I hew antl will maintain a tion 37 0of thee
for for rforo'S ac of Me
noon,u provided for by Section 3700 of Um IaWr Code.for 0w perfonnanee of Me
work for which this permit is Issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Iabar Code,for the performance of MM work far which his permit i.issued.
My Workers Compenseunn Immuarx,contestant Policy num Wr am:
Cartier: Policy No.:
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(ITh ScUmn nmd not W eemplexd If the partnil I,Imomhundeod doll.,(SIM)
Or leu)
1 certify that in the perfmmance of the work for which this permit Is ismed,1 Shall not
employ any person In any manner an as m became subject to Me Workers Compensation
Laws orcalifomis.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become suhjmt to Me Worker's Compensation previsions of Me fiber Code.you muss
v�. Z forthwith Damply with such provisions or Mi,persalt shall W teamed rewked.
OCONSTRUCTION LENDING AGENCY
[.r IWmby affina Met Mart is a convection lending agency for the perfufmmcc of
a
the work for which this parrot Is issued(Sec.3097,Civ.C.)
{tlQ Lender's Name
d lenders Address
VQ 1 certify Mat I haw read this application and&tate that Me eW w mf xtration is
Ifr P correct.)agtu to comply with all city and county ordinances and sore laws relating to
ts
er Upon
�O building
(We)all.ton.,indhereby authodxecep hanu.ss the this City of
tino ago the
L17 aW--menticaned property for inspection purposes
(~Gla
(We)agree to rove,indemnify and keep harmless w City ru Cupertino against
VI
liabilities,judgments,costs and expenses which may In any way accrvc against mid City
Uin consequence of Megmnting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
�oN -01 t - 10 v 6 Re-roofs
Signature of ApplicanJConuactor D.te
HAZARDOUS MATERIALS DISCLOSURE Type pf Roof
Will the applicant or future building occupant store or handle havamous material
u defined by Om Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.SCUM 2553z(a)7 /� All roofs shall be inspected prior to any roofing material being installed.
❑Yes . M Na
Will the applicant or future Wilding by the B y A equipment car denim.which
If a roof is installed without first obtaining an inspection,I agree to remove
Dist District? cis contaminants u dcrincd by Mt Bay Area Air Quality Management all new materials for inspection.
Dinricfl
El Yes '�•IJu
1 have read the hosaNnus materials requirements under Chapter 6.95 of the Cali for.
ria Health&Safety Code,Secdons 25Yd5,25533 and 25534.1 understand that if the Wilding
does not cuncntly hoc a mnar4 Met It h my rospauihility m notify the accupent at Nc
requirement%which must be met poor to issuance are cenirmm of Occupen'y Signature of Applicant Date
DID N_ yr• I- IG'
o-- U,C AI I roof eoverin2s to be Class"B" or better
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CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35910015.00
DATE ISSUED. . . . . . . : 01/10/2006
RECEIPT #. . . . . . . . . : 32733
REFERENCE ID # . . . : 06010051
SITE ADDRESS . . . . . : 10191 S DE ANZA BLVD
SUBDIVISION . . . . . . .
CITY. . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JAME FINCH
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . CA
RECEIVED FROM . . . . : V DON CONSTRUCTION
CONTRACTOR . . . . . . . : DON VO LIC # 26208
COMPANY . . . . . . . . . . : V DON CONSTRUCTION
ADDRESS . . . . . . . . . . : 1469 AMBERGROVE DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95131
TELEPHONE . . . . . . . . : (510) 882-2404
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 115.56 55.47 0.00 55.47 0.00
BPERMFEE VALUATION 4, 500.00 115.56 0.00 115.56 0.00
BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 0.00
BSEISMICRE VALUATION 4,500.00 0.50 0.00 0.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 276.53 0.00 276.53 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 276.53 VISA
TOTAL RECEIPT 276.53
•
4 CITY OF CUPERTINp�01005)
CUP PL4IT APPLICATION F15RM
10- C)15 Date: I I IU O�
Building Address: Mailing Address (if different from building address):
Owner's Name: Phorie#:
G (65
Contractor: License#:
_ — 10 f 179 ZZ
Contact: Phone;( BIZ-ZI CupertinoBusiness License#:
Fax:
Building PPemut Info: I
Bldg Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential ❑ Commercial [S?-�
Sq.Ft. Floor Area: q.Ft.:
Cost of Proi ect: Occupancy Group:
Type of Construction: Please check this box if the project is a
4-PM 4Z wiwonu) go 12,r-G-rtAfL-4 second-story addition: ❑
ro'ect Size: Standard 0 Laze ❑ Ma-or ❑
uant ity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BB.QILER3. 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
BCONSTA.XBQ 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
f BENERGY Energy BUILDING ,
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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000-1
CITY OF CUPERTINQk
CUPEiP T APPLICATION RM
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 c1h MECHANICAL
BMIAITU ANA/C Units<= 10,000 chn MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways. ELECTRICAL
BRFbMXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BRENUIRNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREIIEIHOOD 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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CWY OF CUPERTINO''�-9
cM 0 PERMIT APPLICATION FORM
CUPERTINO
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 I NIECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
JIBSEMICRE Seismic Fee Res BUILDING
ECIAL S ecial ection BUILDING
WIM Swimmin Pool BUILDING
EMP Tem ora Power ELECTRICAL
PPERM Tem ora Bld Permit BUILDING
PSVCS Tem Dist Svcs ELECTRICAL
SLIC Business License BUILDING
CTRIC Electricals foot ELECTRICAL
MITFEE Elec Permit Issuance ELECTRICAL
RMFEE Mechanicals . foot MECHANICAL
MITFEE Mech Permit Issuance MECHANICAL
MITFEE Plnmbin Permit Issue PLUMBING
LBG Plumbin Fees footPLUMBING
NGRNGC Plannin LR Comme/ Multi-FamPLANNING
NGRNGR Plannin Lon Ran a Residential PLANNING
DCHG Address Chane BUILDING
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