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06060190 alF CITY OF CUPERTINOCUP � PERMIT APPLICATION FORM APN# ��� Date: 6` 2 /--6 4 Build' Address: Mailing Address (if different from building address): FIW3braP- Owner's Name: Phon AN LAQ Pro ( Aoe 20 -9-7(o 9 Contractor: License#- %JD4 2 CaA,3c co.'ASTt 8 wt6-4-7 Contact: Phone:40p5-9&b-0151W� Cupertino Business License#: Fax: 4d& lo-t Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: FIP,=- eepht2, '10 s M9 f- %-r5aCWt-(AWz-fm LNC Residential ® Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: -e}' tsy' Cost of Projec aXJ Occupancy Group:— Type of Construction: Please check this box if the project is a second-story addition: ❑ Pro'ect Size: Standard ❑ Lar e ❑ Ma'or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 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 BELE C200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 5 . CITY OF CUPERTINO CUP TY0 PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Feel 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 Stonn/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 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Li ting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platfonn 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 2 of 3 • - ® CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM Ouantitv 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 MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool I BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM -TemporaryBldg Permit BUILDING BTEMPSVCS Ternp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mecb 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 Chane BUILDING • 3of3 CITY OF CUPERTINO BUILDINO DIVISION PERMIT . .CC)N"TRAC"Y'CTR TNT`UItM 'T °. x ; ' .•t,y°rka4"",p.'!. s ki BUILDING ADDRESS: JON R CRASE CONSTRUCTION I ffeshin'ND'06060190 21630 FITZGERALD DR PERMIT ISSUE DATE OWNER'S NAME: ANNLAU PROSCENO 164 GILMAN AVE 06/21/2006 NE: SANITARY NO. CONTROL NO. (408) 370-1485 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH igg LICENSED CONTRACTOR'S DECLARATION S UOn 1 bereby affirm that I am IImvW under providov croupier 9(commercing p �Fj with Section 7C(sy)of Divbmm3 of Ne Boom.and Prafctions Cade.a dmylkenaaI. NO in full forecandeffect. S b��-� FIRE REPAIR TO EXT . �R�I��KE FOR LIKE p 3 License Class Lk.N Lys C^- Dem .��r Conuacar •-P17 C4uy yyy... ARCHITECTS DECLARATION --91- 1 understand my plana"be used u public ma nds JUL 10 G Licensed Pmfeui...I rye OO OWNER-BUILDER DECLARATION ���� I hereby Affirms Nn I am exempt from the DECLARATION License law for Uc E C o following reach.(Section 7071.5,Business ad Profession,Calc:My city ar county $5000 $ which requires a Permit a castnmn.after.Improve,demolbh,nr repair any structure _lay' priorIn its Issuance.also requires the Applicant for such permit wBkasignedstammemValuation i thuuislicensedpurauanttoNcprovisionsoftheConuactm'sLicevcuw(chapter9 —Sq- Ft r{� C (commencing with Sado.7000)of Division 3 of Ne Bud.and Professions Code)or S $ that he is esemp therefrom and the baa for to alleged aacmpdon.My violation of Section 7031.5 by any applimt for a permit abjecu the applicauo a civil penalty of Occupancy Type not mom Nan five hundred dollar(5500)• ❑1,u owner of Olt prolmrrYor my wplayw wIN wgn u alma sulemnpewdon, a°Proleessift`ns Co ead�The Con aacnot;L�La does=1 und ,Pay e7 a ow� Required Inspections property who bsildsorlmproves thereon,end who doessuch work himselfor through his own emplayces,provided Oat such Improvements Are,not banded oroQered fusels.If. however,the building or improvement Is sold within one year orencepktia,the owner- could"will have she burden of moving Out An did ret balk or improve for purposes of - sak.). O 1.a owner of the properly,as aacludvely contracting with licensed contractors;to contract the project(See.7044.Buiness and Pmfnaom Code:)M Coauacures U. cense law does act apply m a owner of progeny who bdWs or Meow thereon.ad. who conuacts for such pmjems with a conuanor(U licensed pursuant An the Contu $ License Law. O Imseamptunder See ,B&PCforthumacn Owner Dao WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury,ono of the fallowing declaralome I lave and will maintain a Certificate of Caaent arelf-luum for WorkersCompen- Action,u provided for by Section 7700 of tic Labor Cade.for the performance of the wart[for which this permit is issued. ❑1 have ad will maintain Warker's Compensation Insurance,u acquired by Section 37W of the labor Code,four the perfarmace of the work fa which Nis permit is based. ' My Workers Compensation laumnce artier and Policy number are: CAM... 5714722! fzk. l Policy No.: r>�- L`j�2Gr•!D - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Crhiaaccdmand a,hecompleted uNepermhafaane,hundred da udifilm) or lora) I certify that in the performance of tho work for which this permit is Wood.I shall not employ anyperson in ay manes u In become abject a the Worlmas'Canpenation Laws of CZHf.mbL Dam Appikam NOTICE TO APPUCANP,If,.free making this Omilhade of Exemption,you should become subject in the Workers Compenaadon provisions of the Labor Code,you mat Z forthwith comply with each provisions or this permit shall b:danced revoked. OCONSTRUCTION LENDING AGENCY (r I hereby drum that Nem Is a.0mmu ties lending agency for the perfmorace Or GL9 the work for which this permit is Wad(Sec.3097.Cly.C.) ' QLander,Nam a Z Lad et Address U Q 1 certify that I have read this application end sera Wt the shove information is W carrccL I agree to comply with all city and county ordinances and stem law,mlating in 0U building construction,ad hereby authorize representatives of this city to cncr upon Oc Wabove-mcntiuncd prepay for inspection purposet P. (We)agree to ave•indemnify ad kap harmk n the City of Cupenino against Iiabilides,judgments,cow;ad expenses which may in any ray accme agdnataidCity U ain comequenco of the grating of this permit. F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date .'L L- SWRCE0.EGAllo (0f2,(1&,0 Re-roofs Signuumof APp c emraar Dan HAZARDOUS building A P DISCLOSURE Type of Roof WIII Ne PPllesntorfuwro building oavpatsmre orundlehuallou mamrid u deRned by a Cupenino Municipal Code.Chapter 9.17,and the Health ad Safety cmk.secd..21532(a)I All roofs shall be inspected prior to any roofing material being installed. Ya KNe LWill the applicum or future building oacupa.t ora equipment or devices which If a roof is in without first obtaining an inspection,I agree to remove L haurdou alrconuminants a deMad by the Bay Area Air Quality Management all new materials for inspection. Dis iclP OYa AQNo I haw:read the hunch,mamrials requirements under Chapter 6.95 cribs Cabins. .is Health&Safety Cade,Sectors 2150.5,25533 and 25534.1 undeawd dW lfdc Wilding docs not currently how a mean.that It is my responsibility in notify the eecupat or the mqulumcnu whk muse met r a utomee.racerdfcaor Oceupacy. Signature of Applicant Date Owner or auNatl d em Dam' All roof coverings to be Class"B"or better CITY OF CUPERTINO �m 2 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32647004 . 00 DATE ISSUED. . . . . . . : 06/21/2006 RECEIPT # . . . . . . . . . : 34972 REFERENCE ID # . . . 06060190 SITE ADDRESS . . . . . : 21630 FITZGERALD DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ANNLAU PROSCENO ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : JON R CRASE CONST. CONTRACTOR . . . . . . . : JON R CRASE LIC # 22250 COMPANY . . . . . . . . . . : JON R CRASE CONSTRUCTION INC ADDRESS . . . . . . . . . . : 164 GILMAN AVE CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 370-1485 *EE 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 5, 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00 BSEISMICRE VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 171 . 53 0 . 00 171. 53 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 276 . 53 44260 TOTAL RECEIPT 276 . 53 • Community Development 10300 Torre Avenue aClOF Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 OUPEkTINO Building Department JOB ADDRESS: PERMIT # 'Z U030 D606-0 If v OWNER'S NAME: AN1.)LAO -PeOrc o PHONE O--t48 GENERAL CONTRACTOR:JaN cR,es-- cogs FAX f 3�7o-o2-3p. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 60 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 i/ ✓ Roofing �t=t� 214-17 Septic Tank Sheet Metal Sheet Rock Tile • �n,�Z1�Olo veer/Contractor Signature Date