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08060038BUILDING DIVISION PERMIT BmL9'8YD�µ�GROVE DR LIGHTHOUSE ELECTRIC 08060038 OWNER'S NAME: PERMIT LSEUE DAIS TORREY LEON 236 BURNING TREE DR 06/05/2008 NE: (408)590-7565 SANITARY NO. CONTROL NO. ARCHTIECrfENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uOp LICENSEDCONDtACTOR'SDECLARATION IOMDDSCO Description i� 1 hereby alarm Nal 1 am lim=d under pmvlaiou of Chepwr 9 (commenein6 P with Sacoon7IX10)Of Divismn3ofdw glummer,amd Pmfcuioat Code.andmy license Is PANEL UPGRADE s in fit( and 0 z / n ER z Cicenm 1 LkOa Daw c -OS• Con. ¢� ARCHITECI'SDECLA ATION CC 1mudsul my piano shall be dead u public moans ?aU as Licensed Professional OW NER-BUILDER DECLARATION ji M I bereby of fma Jul 1 am exempt from the Conwactors License Law for the aa following won. (S cdon 7031.5. Business; add Pm(rssinu Cods: Any my or county - 4 2 P which mquims a permit to conwuct alud. improve, demolish. err mpoir any annum _ prior W its issuance. aBu requirestheapplicant farmch permit to Elea signed suwmrnt < that he is peered pursuant o the provisions or the Contractors Licauc law (Chapter 9 .S q. Ft. Floor Area Valuation i�'� (commencing wilts Section7000)of DivisionJnfthe BusinessantlPrafrssiono Cede). $1000 y $ that he u ...pt tharefrm aand the basis for the alleged emmption. Any violation of Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy audit mom than EK hundred dollars (m). 3 7 5 3 9 0 5 3. Pane Y Type wi Luow works. tie pmperry,amy wplaym with eredsssdd(sok compewness will do thecwons and Ne stinum is totinwndetl or offered d Out a(Sea. 7014. weer of mtl orrywh obo CodcThempo mdum ors License law dao wort apply lf rt Owur is Required Inspections propenywho Willsaimpmneu himon.endwho an, note workemict himseeared for ughmia Ma own employees, provided Nat such int I. semenu am net eumded oroRucd Me sale. B, builder, the Wilding orimprovementishat within acyearofimrevefo,theowner- builder will have tbo WNco of proving that k did not Wild Or improve far purpose of ] 1, u owner of the propl eA eulueivelY contracting with [!caved contractors so .1.1 the majea (Seo 7044. Busimv and Prefaaaiono Code:) Tho Contramors L!. cove Law dos not apply into Owner of prepare win Wilds or impvnes thereon, add who contracts for such projects with a eonmador(s) Housed dowun, to the Cordsomes License Law. Ej I oro cramp, under See ,B k P C fm this rescan Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby afnrm under Pool of perjury arc of the following dclarmords: 1 base and will maintain aCertiOww of Consent to elf -insure for WorkersCurtailed. dadon, as pmvWe i for by Section 3700 of the labor Cade, for the perfarmscs of use woh for which this permit is issued. ❑ I have and will maintain Workers Compensation Insurance, as rtyuirtd by Section 3700 of Ne Labor Code, for the padarmance of the work for which this permit is ismetl. My Workers Compensation arts. camior and Policy number art: COMPENSATION INSURANCE mosseetlon need mmthecomplewd if Jan Permit u foram hundred dollars (SIM) or less) 1 certify that in the performance of tha work for which this permh is issued. I shell not employ anypermn in any mmrwrw u to become subject m tie Workae'Compenatinn Laws or California. Data Applicant NOTICE TO APPLICANT: IL a0cr making Nie Contra.. of Frampton, you should bcome mbjen th the Worker" Compensation provision of the labor Cade, you moa .J Z, forthwith cal w!th such Provision or this permit mail bo doomed reroked. 'Z O CONSTRUCTION LENDING AGENCY [—i I hcmhyelTmrm that then kit Imetruc,inn kodingegcacy for the per(umnana of a > Lou work for which this permit is issue4 (See 3097, Cr, C.) 140 Landers Name 0. 7 z Lenders Addw U Q I ce tify Net 1 haus mad this application and snow thud the above iNormation is D. P coneet. I agree W comply with all city and county ONInesKss and snow lows relating W 0UWilding construction, and hereby mthorim representatives of this city W cnwr upon the i' w above-mcntiarwd property for inspection purposes (Woe) agree to ane, indemnify and keep harmless the City of Cupertino against [q liabilities.judgments. cors and eapearl which may In my way accred, against said City U Z in emostaquetice of the granting of this permit. " APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOUR REGULATIONS. 44 Signe-V ":�uPpnkoddd,Armfl,al Date � HAZARDOUS MATERIALS DISCLOSURE Will the applicant or forum Wilding —peva !tom or handle hvallous material as d.fli by tie Cupertino Municipal Cade, Chapter 9.13, and tie Hall anti Safety Code. Section u53$4)7 oi❑Yu No Well the applicant Z' m building occupantoccupantum equipment or devices which t hayartlnu aft conuminnts a defined by the Bay Arca Air Quality Management D mric,7 ❑ Ica I have real the hooddes2maddialS requirements under Chapter 6.95 of the Califor. raiz Health & safety Cade. Sraiao 25505.25533 am125534. 1 undersell out ill Wilding does not cusmndy have • rens., that it u my mspomlbility W andry the occupant of the nequitc5iWideh most be met laiur W I•• arca of a Carofeaw of Occupedc, !7!✓lS 6-S,a,*- Issued by: l/�� Date S Re -roofs !� ✓ Type of Roof All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "" or better • 3 ITEMS OF 3 • E CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37539053.00 DATE ISSUED.......: 06/05/2008 RECEIPT #.........: BS000005005 REFERENCE ID # ...: 08060038 SITE ADDRESS .....: 901 FERNGROVE DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 82.08 --------------- 82.08 REFERENCE NUMBER -------------------- #2024 OWNER ............: TORREY LEON ADDRESS ..........: 901 FERNGROVE CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4664 RECEIVED FROM ....: LIGHTHOUSE ELECTRIC CONTRACTOR .......: ALAN FORTIN LIC # 27871 COMPANY ..........: LIGHTHOUSE ELECTRIC ADDRESS ..........: 236 BURNING TREE DR CITY/STATE/ZIP ...: SAN JOSE, CA 95119 TELEPHONE ........: (408)590-7565 FEE ID ---------- UNIT QUANTITY ----------------------- AMOUNT PD -TO -DT THIS REC NEW BAL 1BSEISMICR VALUATION 11000.00 -------------------- 0.50 0.00 ---------- 0.50 ---------- 0.00 1EPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 TOTAL PERMIT ---------- ---------- 82.08 0.00 ---------- 82.08 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 82.08 --------------- 82.08 REFERENCE NUMBER -------------------- #2024 aut- city OF • CUPERTINO • • CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# �� 3 g O 5 3` 00 Date: Building Address: 01 'FIc r o J e. Mailing Address (if differbM from building address): Owner's Name: Phone #: L.eon 12 40-6 Iti6 `1718 Phone: L4 03 - S all- IContractor:: tai `1 I Y 0CtSe le( � c Fax: Ili$- 3(95-3sXs Cont for License #: Cupertino Business License #: a Contact: -h rlQ, Phone: t{ D 51 q 0 �� S Fax: Residential Commercial Job Description: / ue,,/, Is the project in the Wildland- Urban Interface Fire Area? Yes NO ❑ Building Permit Info: Bldg ❑ Elect C3-� Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 11-B ❑ 11, 111, V-A ❑ 11, 111, 1 V V -B IV --3 Valuation: Square Footage: Uv U. OU Project Size: Standard E Lar e ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: <<�L For help, contact Build it Green at www.builditgreen.org (ed - CITY OF CUPERTINO arror GENERAL BUILDING APPLICATION • CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM ACOUSTICAL REVIEW IACOUSFDW SFDWL/Duplex New B IACOUSRESAD SFDWL/Duplex-Addition/AIteration B IACOUSCOM Multi-Family/Commercial B CHIMNEY'S (CHIMNEY Chimney B ICHIMNEYR Chimney Repair B FENCES 1 FENCE>6FT Non -masonry, over 6 ft in height B 1 FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES IFIREPLMAS Fireplace Masonry B I FIREPLFAB Fireplace Pre-Fabricated/Metal B 1 FLAGPOL>20 Flag pole (over 20 ft in height) B IMODUSTRU Modular Structures B FOUNDATIONS I FOUNDREP Foundation Repair B I PILECAST Pile Foundation Cast in place concrete B I PILEDRIV Pile Foundation Driven (steel, pre- stressed concrete B C 3of5 SaCITY OF CUPERTINO • CUPERTINO GENERAL BUILDING r L r L PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 BTEMPPER Temporary Building Permit (good for B 30 days) I BBOILERI For the installation or relocation of ea M boiler/compressor to & including 3 horsepower, or ea absorption sys to & incl 100,000 Btu/h 29.3kw IBBOILER2 Installation/relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption sys over 100,000 Btu/h I BBOILER3 Installation/relocation of ea M boiler/compressor over 15 horsepower to & incl 30 horsepower, or ea absorption sys over 500,000 Btu/h to & incl 1,000,000 Btu/h IBBOILER4 Installation/relocation of ea M boiler/compressor over 30 hosepower to & incl 50 horsepower, or for ea absorption sys over 1,000,000 Btu/h to & incl 1,750,000 Btu/h 1 BBOILER5 Installation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption sys over 1 750,000 Btu/h I BAPPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. I ELECINSP Other Electrical Inspections (per hour) E 1 MECHINSP Other Mechanical Inspections (per M hour) I PLMBINSP Other Plumbing & Gas Inspections P (per hour I MEETING I HR Application Meeting B SOTAfr . CUPERTINO F_ L F_ L CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type IGENRES or 1GENCOM RETAINING WALL(CONCRETE OR MASONRY 1 RETSTN Standard (up to 50 ft) B t RETSP310 Special Design, 3-10' high (up to 50 `) B ]RETSPIO Special Design, over 10' high (up to 50' B 1RETCRB< Gravity/Crib Wall, 0-10'high (up to 50 ft B 1 RETCRB> Gravity/Crib Wall over 10' high (up to 50 ft B SIDING 1SIDEST/BK Siding, Stone & Brick Veneer interior/exterior B ISIDEOTHER Siding all other B SKYLIGHTS 1 SKYL<10 SF Skylight less than 10 sf B 1SKYL>IOSF Skylight greater than 10sfor structural B 1STAIRS Stairs -first flight/ea addt'l B STORAGE RACKS I SRACKS<=8 Storage Racks 0-8' high (up to 100 so B 1 SRACKS>8 Storage Racks over 8' high (up to 100 st B 1STUCOAP Stucco Applications (up to 400 so additional stucco application B 4of5 CITY OF CUPERTINO • CUCITY TYOF O GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM I WINREP Replacement windows/sliding glass door ea 8 windows B 1 WINMEWSTR New Window -structural shear wall/masonry includes plan ck fee B IEPERMITFEE Electrical Permit Fee E IMPERMITFEE Mechanical Permit Fee M I PPERMITFEE Plumbing Permit Fee P I ELCPLNCK Stand Alone Electric Pln Ck (hourly) E I MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M I PLMPLNCK Stand Alone Plumbing Pin Ck (hrly) P I STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B / I BSEISMICR Seismic Residential B 1 BSEISMICO Seismic Commercial B / ITRAVDOC Travel & Documentation B 1BUSLIC Business License B • 5 of 5 zv_,�;o CITY OF SCUPEkTINO • • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Buildine Department JOB ADDRE S: / A PERMIT # " d'U66b3 oC OWNER'S NAME: p mon PHONE # SVO - S GENERAL CONTRACTOR: / I am not using any subcontractors: /:;, S-6 Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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/ Contractor Signature Date