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06090256CITY OF CUPERTINO a ' .�u: s 'h+ `=` f�' '"'"' 4' ' ", �',A - CONTkk5,, 'OR INF0fW, ff BUILIIING DIVISION PERMIT �Y�f :i'��. 'Pr `'4`"9ro`Cre'e^tA iY '�' Fh .Y . BUILDING ADDRESS: WILLOW GLEN ELECTRIC INC PEaMITHG.06090256 20833 HANFORD DR OWNER'S NAME: PERMIT ISSIfEDATE LAXMI MANNED 1085 WARREN F: SANITARY NO. CONTROL NO. (408)289-9725 ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description p 1 Wally affirm that I me licensed under provisions, of Chapter 9 (commencing with Section 70(" ofDivislon Sof the Business and Pro fcuiam Cade. and my license is inmRforceardaffart. 91919 200AMP PANEL UPGRADE License Cys, Lk. Dam Y/i� a Cr � ARCHARCHITECTSSDECDECLARATION ' I understand my plans shall W used u public records Lwmwcd Professional OW CER -BUILDER DECLARATION I In:reby affirm that I am would from the Conu amots License Law for the following reason. (Saauan 783 1.7, Business and Pmfeuiom Codc: My city or county sur. hnpm demolW. wramnrc $2000 which requires a permit in construct. o, or repair any prior to its issumce. alas, required the applicant forsueh permit to 0k a signed statement is licensed Ne the Concur" License Law (Chapter 9 Sq, Ft. Floor Area Valuation that W pursuant o provision of (commencing with Section 7000) M Division 3 of the Rusmms and Professions Code) or w that ha B exempt therefrom and the bull per the alleged emmptan. Any violation of Rg7Kr_U U Occupancy Type Sedan 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of not mom Nan Rve hummed dollars (5300). ❑ 1. u awrcr of tic propmry, or my employe with vym u their mk compemad,n, Required Inspections wiedathewmk-md Wesuumureunmin¢Medmonemdrmmk(SW.70N,Buaircu aw dot apply u ms an muof and Prolamines, Code- The Convolutes U. Lw n oa q p pmpeny who beiksmimprowes thereon, and whodoessuch war shimseJf or though his awn employee, provided Nuauch improvement art mmtktended m,Rered for sale if. however, Ne Wilding or improvement is sold within ors, year of compkdm, the owns, - builder will have the burden of proving tut ha did cot build or Improve for purpose of uk.). ❑ I, as owner of the property, am axclmivcly contracting with licensed con,mtma to controet the pmjem (Sea 7044. Business and Profmsiam Colic) The Cminrur's Li - Mme law dam roti apply to m owner of properly wha Wilds of Improves Centro. and !' d puuantmdte Gnvanah wianclor(a)Ilrenxn who contracts; Uses ch projectsCrnua License Law. ❑lam mempt undm See .B@PCfor Cu renin Q Ower Dow WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the fallowing declarations: 1 have and will maintain a Certdwmd of Consent to ulf-insum for WorkersCompan- sati on,, as provided for by Section 3700 of the Labe Codes, for dta performance of the work for which this permit is Would. I have and will maintain Workers CompensaMm Insurance, as required by Section 3700 M the labor Code. for the performance of the work forwirmh the permit is blued My Worke!r�s CCC on lnsura^nce artier and Polity"'Wr are: V.Ado 10 - - GMer. w'1J (ana/IRrwy Polley Na.: CER7IFlGITE OF EXEMPTION FliOM WORKERS COMPENSATION INSURANCE Obis umion need our becampmed if the permit Is forme hundred Milan (SIM) or leu.) I certify that in the performance of Co work for which this permit is issued,) shall not employ any person in my manmrm as be become subject to Bu Worked Compemadon Laws of California. Dam Applicant NOTICE TO APPLLCANr: If. after making Cu CcniRmte of Exemption, you should become subject w the Workers Gmpennton provision of Ce Latter Code, you most foMwiO comply with such Provisions or this permit shall W doemd mated. 1 ' CONSTRUCTION LENDING AGENCY I hereby alfnm that then is a construction lending agency for the performance of the work for which this permit Is issued (Sec. 3097, Civ. C.) Lenders Nurse Undera Add. j I certify that I have and this application and sem that the shove information is ' correct. I agree m comply with all city and county ordinances and sum laws miming u ibuilding convection, and hereby authorim mpvenutivu of this city to cnmr upon Ce i ahovcmcnimmd pmperty for inspection purposes. (We) age to arc. indemnify and keep harmless the City of Cupertino agsiml liabilidmjudgmenu.casumdespe .hichmayinmywaya..Saim dCity in consequence of tW grantn{ of Cu permit. i APPLICANT UNDERSTA DS AND WILL COMPLY WITH ALL NON-PONT Issued by: - Date f��' 2-? SOy�fR U NS.%- ' 9/87 6 W Re -roofs Type of Roof Slgnaturcof ApplieareVContrsemr Data HAZARDOUS MATERIALS DISCLOSURE Will the applicant or forum Wilding oceupmtnorc mhandk haurdous material as deMcd by Ow Collection, Municipal Code. Chapter 9.11 and dun Health and Safely CaM, Section 23532(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yon Nr , If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or (alum Wildon{ amepant tau equipment or devices which until huardnus air communicates as Mfincd by the Bay Area Air Quality Management all new materials for inspection. District? ` w ❑Yon $f No 1 have and the haurdommeurials rtyulrtmenu underChmmr15.95 of tha carr. nil Hcal" Safety Cade, Seldom 25303,23333 and 27534.1 understood t ua fCe Wilding does na currc try have ant, u It is my responsibility w notify tic oecu cot of the rcyui m hkhm met armitoraneof.CcmficxufC9 .' Signature of Applicant Date 'i All roof coverings to be Class "B" or better Owner armtharvaa agent Dam Community Development 10300 Torre Avenue aClOF Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 WUPERTINO Building Department JOB ADDRESS: a0933 R,,�ra of. PERMIT # 6960,0 OWNER'S NAME: ^XMi AA,%Ane PHONE # GENERAL CONTRACTOR: Mar4 L04�re FAX # I am not using any subcontractors: Ak q11--710 (, Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature 4� o 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 4� o Date CITY OF CUPERTINO Dem 1 of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32630073.00 DATE ISSUED.......: 09/27/2006 RECEIPT #.........: 36225 REFERENCE ID # ...: 06090256 SITE ADDRESS .....: 20833 HANFORD DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: LAXMI MANNE ADDRESS ..........: CITY/STATE/ZIP ...: , OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: WILLOW GLEN ELECTRIC CONTRACTOR .......: LONDRE, MARK T LIC # 15897 COMPANY ..........: WILLOW GLEN ELECTRIC INC ADDRESS ..........: 1085 WARREN AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95125 TELEPHONE ........: (408)289-9725 '9FEE ID UNIT QUANTITY BELEC200 METERS 1.00 BPERMFEE VALUATION 2,000.00 EPERMITFEE FLAT RATE 1.00 BSEISMICRE VALUATION 2,000.00 TOTAL PERMIT METHOD OF PAYMENT AMOUNT ----------------- ------------ OTHER 151.46 AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 29.43 ---------- 0.00 ---------- 29.43 ---------- 0.00 83.16 0.00 83.16 0.00 38.37 0.00 38.37 0.00 0.50 0.00 0.50 0.00 ---------- 151.46 ---------- 0.00 ---------- 151.46 ---------- 0.00 NUMBER ------------------ VISA TOTAL RECEIPT 151.46 VOICE ID DESCRIPTION VOICE ID -------------------------------------------- -------------------------------------------- 304 ROUGH ELECTRICAL 501 505 FINAL ELECTRICAL 0 DESCRIPTION FINAL ELECTRICAL ENERGY CUPEkTINO 1'1 L_ CITY OF CUPERTINO DL009095& PERMIT APPLICATION FORM APN # f� l(/ „ - *Q—D —75 �(J Date: q g-7 oC Building Address: Mailing Address (if different from building address): a 33 �;eJ c . or. Owner's Name- Loxxml me -of.. Phone #: 40I-?77-q1(S Contractor:v1/ow 6-I.tn Fk(kic License #: 51 k �,J j Contaiqt: \\ Phone:Oo-ooga �.u,,2ft. Cupertino Business License#: rj 'MuC12 Fax: a89 -14l -o MECHANICAL Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: aJo "I g5r"t. Residential 14 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost ofPr ' ect: Occupan rou G a,m-s o • o o _ Type of Construction/ Please check this box if the project is a 2- second -story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ BCONSTAXBQ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 0 CUPERTINO CITY OF CUPERTINO 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 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 BR.EMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin 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 Mise 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 OWN CJ d CITY OF CUPERTINO CUPEkTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Branch Vent VD I Scb Specific �1J1Y111 Seismic Fee Res SPECIAL S SerialIns ection BSWIM SWimmin Pool BTEMP Temporary Power Elec _Plumbing Permit Issue Plumbing Fee sq foot ling LR Comme/ Multi. Address 3 of 3 PLANNING