06080171 CITY OF CUPERTINO >x
BUILDING DIVISION PERMIT ' G'O .R"�.C.TR§Il 'UI.2MATI0 -,
,.oma..-•.5_W.. m PERMIT NO.
BUILDING ADDRESS: 0 6 0 8 0171
10380 FARALLONE DR
OWNER'S NAME: PERMIT[SUE DATE
SALLY WEBB
NE: SANITARY NO. CONTROL NO.
ARCHITECT7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
is p LICENSED CONTRACTOR'S DECLARATION Job Description
W
1 mby snout Met 1 aat Ikensrd under provisions of Chapter 9(comencxing P
with Smton7000)of Division 3 alone Business and PrOfessum Code.and my license is
❑m ,n r.11 fame and If L q�� q�(g ADD ELECTRICAL PANEL 200AMP UPGRADE AND ADD
o c vector ae�a.� DISCONNECT FOR A/C
a' ARCHITECTS DECLARATION
1 unmrauul my plans shall be used u public mcmm
h U
Licensed Professional
than OWNER-BUILDER DECLARATION
i I I hereby at,.that 1 am exempt from the Cont actoes License Law for the
:0C following mason.(Section 7131.5,Business and Profession Com:Any dry or county
'$ff which requires a permit to consumer,afm•improve,demolish-or repair any sauctum
micro,its iuuerme.also requima rte applicant forsuch permit to JIM sailboat moeence,
that he is licensed pursuant to tiro provisions of the Conwcmr's Lkcnc law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Suction 7000)of Division 3 of the Beat.and Pro(casiom,Code)m $3000
t'3$ that he is exempt therefrom and Mm best for rhe alleged exempdom My violation of
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
m,mom than fnva hundred dollars(5500),
❑1,u awns of th¢property,or my employees with wage,u Manuel.compmenden•
will do the week.mdthe am=.I.Out imendedoroRered forsele(Sec.7014•Business Required Inspections
and Profession Cade:The Comore oYs Limindem wt law derot apply b e ns an.wan of q P
Own ertywW Wilra ided shoves Netcom.mdwindless
not ImwmkhimaeVor Nrough its ���
ownemployees,provided rotauch ImprovementsarcnotlomndndmaRemdfmugh his
however•the building m Wprovemmt is Mid withinarm year of completion,the owner-
builder will have the burden of proving out W did mt Wim or improve for purpose of
0 1. /
I.u owner Of the Sec.70 am axes ss and concession{Cid:)the
comMdars m /
mnwm the project(Sec.7014,Business and Professions ri i The Conhe m..and Es
cane law rats not apply an..owner ra propmy,wce W d p m Wmow Mtereon,and.
who mnuacu for am4 wakes,what mnuxMrtq Ilurue0 pursnm In the ConvanroM1
Lkeuetaw.
❑tom escmpt undo Sea .BhPC fm Nu mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby ensu most penalty of perjury oro of the following declmadons:
I have end will maintain aCerdOute of Content m self-btsure for Workol,Compun-
avian.u pmvided for by Section 3700 of the labor Code,her the perfamenm of Mte
work for which out permit is issued.
❑1 have and will maintain Warkufs Compensation Inwranm,as mqumol by Section
3700.1'0.Labor Cade,fm the wRomanee of th¢work for which Nis permit is issued.
My Workers Compensation huunnce canner and Policy numberam:
Cartier. Ft PSS ��+s9. PoIIry No.:--(A&&=—Z.25' 1
CE MCA7EOIPEXEMPf70N FROM WORKERS'
COMPENSATION INSURANCE
(rossectlon need not W completed:f the permit is froom hundred dollars(5100)
or less)
I cenify that in the performance of to wart for which this pemit is Issued.I Mall not
employ any person in my manneran as to become subject tithe Workers'COmwnsatlon
Laws of C31ifomis Dam
Appllam
NOTICE TO APPLICANT:If.after making this Cmifica,of Exemption,you should
become subject to the Workers Compemadon provisions of the tabor Cade,you most
.J O forthwith comply with such prevision or this Permit hall W deemed mmkmd.
Z► CONSTRUCTION LENDING AGENCY
[••� I hereby afllm Mut them is a construction lending agency Indic performance of
tY > the work for which this permit is Issued(Sec.3097,Civ,C.)
QLenders Nurse -
z IemMe,Addrr_p
U Q I cortify that 1 have rust this application and sate that the att infomatiun Is
U, P comm.l agree m comply wit all city and county Ordinances and sum laws minting to,
0U building consuuctian,and hereby authorim repreacroades of this city to enter upon the
W above-ormuuned property far inpecum,pughotes.
0. (Wc)agme m Mm,i sonify and keep hamlets the City of Cupcnino againt
rn tiabili,ca Judgmanu.coau eapcY wblchmay litany way accrue against Mid City
L'—Z in<onseq"C" ""'I ' gofthtsPermI ,�l�l
., APPLICMn'U ER NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG
O$f�l/0 6 Re-roofs
S ilinaturcefyWWA&Contracter Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or futere Wilding mcum,Rom or handle harxdon material
n dcOmd by the Cupemna Municipal Code,Chapter 9.13•and the Health and Safety
Cam,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes KHO 41
Will the applicant or futum building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit beamnn air contsmmants as defined by the Bay Ama Air Quality Mangement all new materi f spection.
District?
❑Yes QNu
•'I hew mad the�hpca rdtm mawrials mquim,mnu unmr Chepmr6.95 of the Califon
.T.Health&s YC
mumts25505.25s33am123334.1uakrwndtnuthebmding
dna not cum t Il m unant.that Lis my responsibility u noury the amupant of the
requirement hrA t nortoin..of.C.mr..ZOfOccupane/ Sign a licant Date
J [b
Ow. Or ed ascot Data All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
4 ✓ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#UPERTINO
Building Department
JOBDRESS: PERMIT #
1103S -0 06d�01
OWNER'S NAME: ) I v Lde b h PHONE - K`i 16
GENERAL CONTRACTOR: Rbrm k,,v, fIaClel FAX #
I am not using any subcontractors: ILS �O G
ature Date
Please check applicable subcontractors anC m Tete 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
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Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36929015 . 00
DATE ISSUED. . . . . . . : 08/21/2006
RECEIPT # . . . . . . . . . : 35704
REFERENCE ID # . . . : 06080171
SITE ADDRESS . . . . . : 10380 FARALLONE DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SALLY WEBB
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ABE ELECTRIC
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BELEC200 METERS 1 . 00 29 .43 0 . 00 29 .43 0 . 00
BREMMISC FLAT RATE 1 . 00 27 . 58 0 . 00 27 . 58 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0.. 00
BSEISMICRE VALUATION 3 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT : 130 . 74 0 . 00 130 . 74 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ----- ------- ------------------
CHECK 130 . 74 1003
TOTAL RECEIPT 130 . 74
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
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Y % 1 CITY OF CUPERTINO 0(00180 1
CUPEf�F PERMIT APPLICATION FORM
N# Date:
Building Address: Mailing Address (if different from building address):
Fc4rallone Dr CyoA&rA0/'i
Owner's-s /e/ Phone#: "00) 73'� B `t\G
Contractor: License#: g S 9 3 6
P Lac EGCC7Y', 6�CU�'1f32iliC
Contact: Phone: 65'a ?O?-0 k t Cupertino Business License#:
b ru Fax: . 02 7.34-9%6
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description: AIDO ELC-,r1r1 "Cc,/6pu^(7/ Upyr.c,, — 2a 6 ^Q
Residential ,® &Ad dt'SCOAACC7' fr Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: OccupancyC oup:
3 0o ,�
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro•ect Size: Standard Laze ❑ 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 Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
Quantity 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 Inspection 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 Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWERSewers 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 HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BRENLkMIAN 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
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 App liance ELECTRICAL
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CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
lip 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 Insection BUILDING
BSWIN4 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 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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