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06120112CITY OF CUPERTI�70 PER — -#q«+''-^'"* C®NTRA TTOR ,NF�ORMAT JON L BUILbING DIVISION 4a„3,°x2if„a_ r a'Px BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: MiRtUtAi lk FAISAL & FARAH MERCHANT 14510 BIG BASIN WAY 12Z20/2006 NE: SANITARY NO. CONTROL NO. (408)999-8721 ARCHITECTfENGINEER' BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description o I krtby affirm all am 1'tcemed under pmvWom of LTapmr 9 (commencing withllto= 100AMP PANEL UPGRADE ndCff=DivisionSoftheBusincasandProfcssiumCode,andmylkcnseu in fan fora and eHeet License Clean contractor Dam con T'DEC( ARCHITECTS DECLARATION 1 unticrwnJ my plans shall M used as public records Licensed Pnafcaional OWNER -BUILDER DECLARATION I kmby eff m the, I am exempt farm the C...,, rs License Law for tM following mason. (Section 703 L5, Business and Professlmu Code: Any city or county which requires a .it m construct almr. Impravc, demolish, o repair any someone prior to its issuance. also requires dm applicant for such Permit o file a signed statement licensed of the Corkadenr's Lt... law(ChaPkr 9 Sq. Ft. Floor AreaValuation ,but he is Pursuant to the pmvismns (commencing with f. Section 700M a Division 3 of don Business and Prosioes Cade) or $1000 10 0 0 that he is comp, therefrom and the basis for the alleged exemption. Any violation of Number ,V64 Occupancy Type Section ]031.5 by any appli.nt for a permit subjects the applkam to a civil penalty of trot roam than faire handled dollars (5500). 3 7 5 2 9 01.0 , 0 1. as nearer of the P.Peny. or my carPbyw with wag. an their sek compensation, Required Inspections will do the work and the structure Isnot intended or oRemd for ask (See. 7044, Business and Pmlemben Cade: The Conuaztues License Law does art apply to an came, of pmpeny who builds or ineir tMseon. and whoduessuh work himselfor dough his own emplayc., provided that each impmvem.0 are not intended oroffered for sal& If, however, the Wildingor impoon mens is said within ore )car of compktim, the awrer- builder will have the When of proving that M did not Wild or improve for purp.e of sic.). \ . as owner of tM property. am udusiv ad contracting with licensed antmcmrs i- nswa da, parjea l5ec. ]044, Buinen and Pro(eations Cade:) TM Canuactors Li- F. ho, apply m an owner of property who Wilds or unproves tlxmon. and who contracts for such projects with a convxsor(s) licensed pursuant ar the, Comaumri License Law. ❑ 'am urAp,under see/, .B B PC's"hum Date WOR% 'COMPENSA O'IFUTCIA—RATION 1 kmby a im under pemlty of perjury one of the fallowing declamdou: ham and will maintain of Consent far a fort ses1 Section37M Code, for Performance as provided for by Seetion 3]00 of the Labor Cade. for the periamana of tM ce of the p work far which this pearl, is lured. ❑ I have and will maintain Workers Compensation Imed., . required by Section 37M of Ne Labor Cade, for Ne performance of do, work far which this .is is issued. My Workers Compensation huurssmc carrier and Policy number am: Cartier. Policy Na.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE . (ITuseaion reed trot kconpkmd if the permit is for ole hunthed ddBara ($100) or less.) 1 certify that in the perforedy�c or tM work fo which this Permit is issued. 1 shall mat in Lawso any person any Maltn.�u az m Wcomebsupjea m the Workers ComPcnudy Laws of Califenda. Date y AA I I (� V ,b �t_� Applicant —I NOTICE TO APPLICANT: If, after this of ExemP a you ushould= become subject, Compensation dartos Compea, visions of ll you muse hal of the Lsflm�mad ' this emvii id i l.ke, • foMwith comply with such Pmviainns or this Pcmit shall W dccmctl revoked. ' j CONSTRUCTION LENDINCAGENCY 1 hereby affirm that Nem is lending agency for tM performance of ! work for which this pearl, u issued (Sec. 3(Nl, Civ. C.) s ed (See. 30 Lender's Nam. Le Lenders Address j 1 certify that 1 have mad this application and area, Nat the above information u ' comet. I agree to comply with all city and county onlinancea and state laws relating to W iltling eonsvu.sion. and hereby authmim ¢pmsemadves of Nis city to enter u,r ,he , above-memidnetl property for inspection I (We) agree to nm, indemnify and keep hamlrss the City of Cupertino against whichpurplaus j may meyin any way accmc against said City expensof incornequuceofth,caatsantl A consequence of the, granting of this permit. this Permit. SOURC Rr UNDERSTANDS AND WILL COMPLY WITH Alit- NOV-POINT SOURC�REGULATIONS. 4,11, Issued by: Date 2� Zs•_v5 Re -roofs Signalumo . u AppltndConaaor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the, applicant or filar=building oceopantsmre or handle hamrdates material as defined by the, Copeland Municipal Code. Chapter 9.13, and the Health and Safety 255320)?)] code,yes �No DYes All roofs shall be inspected prior to any roofing material being installed. 10 Will the applicant or future Wilding eacupant seam equipment of tkviccs which If a roof is installed without first obtaining an inspection, I agree to remove emit hatordnns air contaminants as defirmd by thm Bay Amo Air Quality Management all new materials for inspection. District ❑Yu Nu I have mad the haaandous materials requirements under Chapter 6.95 ofthe Ceifor- niaHad" Safely Cade.Sock.35505,25533 and 35634.1 understand thniftk Wilding do. not �pmntly ham a tenant. that it u my responsibility innotify the occupant of the mgmmnl kwhich muvW a met prior to iuuanofa Ccrtifcamet y. Signature of Applicant Date Ioc J ' All roof coverings to be Class "B" or better Owner or tintalk ant ' Date S CITY OF 40UPEkTINO • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: CA- PERMIT # OWNER'S NAME: P41 S M E 2 C T PHONE Vo GENERAL CONTRACTOR: S FAX # I am not using any subcontractors: rn V.<-d�b 7 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date • 2 ITEMS OF 2 • CITY OF,CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37529010.00 DATE ISSUED.......: 12/20/2006 RECEIPT #.........: BS000000046 REFERENCE ID # ...: 06120112 SITE ADDRESS .....: 18721 HANNA DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: amyw COPY # : 1 OWNER ............: FAISAL & FARAH MERCHANT ADDRESS ..........: 18721 HANNA DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: RECEIPT INTERFACE . CONTRACTOR .......: LA RITA A WILKENS LIC # 21488 COMPANY ..........: SOUTHWEST ELECTRIC ADDRESS ..........: 14510 BIG BASIN WAY CITY/STATE/ZIP ...: SARATOGA, CA 95070 TELEPHONE ........: (408)999-8721 FEE ID UNIT QUANTITY ------- ----------- ---------- AMOUNT PD -TO -DT THIS REC NEW BAL BELEC1001 METERS 1.00 ---------- ---------- 119.88 0.00 ---------- 119.88 ---------- 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 TOTAL PERMIT --------- ---------- 158.25 0.00 -------=- 158.25 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 158.25 --------------- 158.25 VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 501 FINAL ELECTRICAL ENERGY CITY Or CUPERTINO CITY OF CUPERTINO Q(0�2Dj VZ PERMIT APPLICATION FORM PkPN # 375- _ Date: 12 118 200 Building Address: Mailing Address (if different from building address): 19 12 1 14,41I.),vtLIE9 T flu o e Owner's Name: Phone #: r A / F& CNAtvI q U4 I l Contractor: License #: T FLECTkic %/ I Contact: Phone: c108- $bb 6 yzl Cupertino Business License#: E TEV E Fax: BBOILER4 Building Permit Info: 100 Bldg ❑ ElectP Plumb ❑ Mech ❑ Job Description: ADO A,,P Residential 10 E Ll A Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: $6 o00 Occupancy Grou �Z- 3 Type of Construction: Please check this box if the project is a BCONSTAXBQ second -story addition: ❑ roject Size: Standard ❑ Large ❑ Major ❑ BCONSTAXH Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler> LOOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BB0ILER5 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 3 �(, amn CITY Or CUPEkTINO 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 Cess ool 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 cfm MECHANICAL BREMAIRHAN 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 >I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc A paratus 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 I 2of3 F— L L CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity 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 Inspec6on BUILDING BSWIM 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 Mechanical s . 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 3 of 3