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06090064 CITY OF CUPERTINO HUILDING olvlsloN PERMITT1�T+O,13M-AT19 of BUILDING ADDRESS: PERMIT NO.0 6 0 9 0 0 64 10040 IMPERIAL S InL. OWNER'S NAME: PERMIT ISSUE DATE COMCAST CABLE NE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMITINFO aLDG t� ' EO LECT PLUM (� t� LICENSED CONTRACTOR'S DECLARATION Job Description c p . i U I hereby admin des 1 am Ilwnwd under and Prof ss of GMdm(9 my fist ming vnth Swctan]00U)afDivialon Sof cite Bushman and Prolcsskns Code,and my Ikctm u icy in full rareeaadaffect. , y G7 INSTALLING 25KW DIESEL GENERATOR GROUND LEVEL l.icens�Class L-If) Lic.N Dam (2_Contractor M ARCHITECT'S DECLARATION i�� I undenunJ my plain shall be used u public rtrnrds r6 o Licensed Pmfcssional •y5 OWNER-BUILDER DECLARATION ICC 1 hereby CRm inn i am ucmpl from the ContrnCo e:My c taw for the :CC O following meson.(Sadao RD cos Bualnass and ..dosism Code:My city of aunty e S which requires a permit m corestrwt alcor.morent for such h Permit t ri e a sir any announceent prior miu lensed paha inquires the applicant for mohpcmir torilesigned(Chapter � out he as licensed putsuantmthe Proviswns or cite Conuamri limn¢law(ClaPmr9 Sq.Ft. Floor Area Valuation I� (commandos with Section 7000)o(Division 3 of than airlines and Profassians Cade)or $5000 $ that he is exempt Ihcmrrom and the handl for the alleged exemption.My violation of Sections 7031.5 by any applicant far permit subjects the applicant m a dWl Penalty of APN Number Occupancy Type trot more dun frw hundred dolks(5300). ❑1,as owner at thm property.or my employees wish wages as tech sok compenv0on, will do the work.and the associate is an,intended in Offered fm sale(Sec.7014,Business and Ptafesctons Cade:The CavttaclrfS Litems Law dao sal wpb m an owner of Required Inspections property who builds Or improv thracan arW who duca inch work himrlf or duaugh his own employees,prog or imuwch impmvemmtsaremt intendedoroReted roanawr - bmvcva,dre amthbuilding car impmvcmerst is dust within arc yearOrminPkctm,tlm ownu- "lildssift have the burden of proWng dot he db nm bulb m minnow fa torque at irk.). ❑I.u owesr of Los Property. edcontracting wed )ansedrol- construct dm (Sec.yO .Ehalnet lona contracting Cade:)T1s Contractors coni law does not apply m an owner of property who buims at Improws thrmn,ad, /who conuacer lar such pmjeem with a conttacmNO limited pursuant m We Contractor's O/ Litems,law. ❑I am exempt under Sea ,B B P C for this moan Owmr Dau WORKER'S COMPENSATION DECLARATION O/ 1 hereby slam under penalty of perjury am of don following dedammus: a/.O 1 ham and will maintain a Ceraiacate of Conant to Salf-insure rorworkeYsCompcn- sation,as provided for by Section 3700 an time labor Code,for the Performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,at required by Section 3700 of the Labor Code,I&the performance or the work for which thin permit ie Issued. ' My Writhes Compensation Insurance artier and Policy number are: Cartier. Policy No.: I79 S ZQ_�2 _ CERTIFICATE ONE%EMMON PROM WORKERS' COMPENSATION INSURANCE This section wed int he completed ff the Permit Is forams,hundred dollata(SIM) or Iain) I certify that in the performance of the work for which this Permit is issued.1 shall not Employ any pcnan in any manmrse as m became subject to the Wwwri Comptrmmus, Laws of California.Dam Applicant NOTICE TO APPLICANT:If.after making this Ceniacam of Exemption,you should become subject in the Waher's Compensation provisions of the Labor Cods,,you must .,O forthwith with comply wish Such mvisinm or this permitahall he domed mvokcd. Zi► CONSTRUCTION LENDING AGENCY t•a I hereby aairm that then is a construction lending agency ter the pe,rennawc of - a> Ne work fur which this permit b issued(Sec.3097,Civ.C.) W Lender's Name Z LInder's Md. U0 Q I conily that I have mad this application and sou Nat the as infomatim is W F~ Correct.I agree to comply with all city and county ordinances and sure laws misting to O V building conawctisn,and hereby authorin reprmcnutims of this city to roman olmn the W above-mentiuned property for in3pecdan pur,owi. and ms Inc ty of r Taal liabilitim,judgmcnu.casu nd O.K. nil (We)agree to sam. nwhichmaay Ito any way same gaiml aidsty V z APP L CANToUNDERSTANDS At ND IWILL COMPLY WITH ALL NON-POINT Issued by: Date :.dacfluZd REM TI' — _20 Re-roofs of ApplianaContramar Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof ll the applicant w forum building ampnt uom a handle hamrEoes material by the Caterers Municipal Cade.Chapter 9.12.and the Health and Safety tion 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. Yes �Na dl Ns,applicant nr future building occupant am equipment or dis which If a roof is installed without first obtaining an inspection,I agree to remove emit hmNons airconuminsnuu dcaad by this,Bay Amo Air Quality Management all new materials for inspection. DiwictT ❑Yes NN/y�� _- I have mad the hazardous mamdalsmquimmrnuunikrChapmr6.95af cite Callfm. risHcalshkSafctyCaM.Savau25505.25533uW23534.1un .dthuifdm building dws not cuncndy have a Irani dust It o my resp re hibly in cooly Oi occupant of the require whk mmbemet oar inisgmnccaf&CortiofOccupancy. Signature of Applicant Date Q' Cr-11-ZVjc, All roof coverings to be Class"B"or better Owner mtharizedaccm Data Community Development n 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 j§UPERTIN0 Building De artment JOB ADDRESS: 1 VO t/b fir t19prjcJ )4✓t PERMIT # OWNER'S NAME: pryy1G PHONE # qo j9- 9 GENERAL CONTRACTOR b wt at Et )'H FAX # Y —9/7,W '73 Z 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO •em 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35717076 . 00 DATE ISSUED. . . . . . . : 09/11/2006 RECEIPT # . . . . . . . . . 35979 REFERENCE ID # . . . : 06090064 SITE ADDRESS . . . . . : 10040 IMPERIAL AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : COMCAST CABLE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : JOHN ISAACS CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---------- --- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 5, 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00 BENERGY PERMIT FEE 115 . 56 55 . 47 0 . 00 55 .47 0 . 00 BREMPOWER POWER UNITS 1 . 00 47 . 96 0 . 00 47 . 96 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICOM VALUATION 5, 000 . 00 1 . 05 0 . 00 1 . 05 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 296 . 78 0 . 00 296 . 78 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ------- ---------- ------------ ------------------ CHECK 296 . 78 10010 TOTAL RECEIPT 296 . 78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • a CITY OF CUPERTINO WRIA4 CUPEVINO PERMIT APPLICATION FORM APN# 0 , Date: Building Address: V/ Mailing Address (if different from building address): UD Owner's Name: Phone #:: - C o- ,0„04 Contractor: COMM S License#: 19 ulq 49/ Contact: Phone: vip-H9G-741$ Cupertino Business License#: Sab ry 14AA Fax: y0 S Building Permit Info: x'w 5 11 �N y Z D It5e i_ "re Ao,r , G,,o,,o L.Pue Bld Elect Plumb ❑ Mech ❑ Job Description: Residential ❑ Commercial Sq.Ft. Floor Area: Sq.Ft.: Cost of Project 1 O O d Occupancy Gr p: lu Type of Construction: Please check this box if the project is a second-story addition: ❑ ro'ect Size: Standard ❑ Large ❑ 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/OfFComm/ uasi 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 I Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO CUPEf�F PERMIT APPLICATION FORM QuantityFee 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 Pi in S stem 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 cfin 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 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 Hea ing MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 Q CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM -4lQuantity 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 Inspection 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 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 Chane BUILDING • 3of3