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06070120CITY OF CUPERTINOfi EUILDING'DIVISION PERMIT w arr��r.ws•''' `• "" L e` BUILDING ADDRESS: PL BAWAY PERMIT NO. 20111 JOHN DR OWNER'S NAME: PERMIT ISSUE DATE . CARY CAMPBELL 1658 E CAPITAL E 2006 NE: SANITARY NO. CONTROL NO. (408)391-0930 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description P 1 nearby of irm that 1 am I'wznecd under pmvialons of Llapter 9 (Wernme "ll with Section 7010) of Division 3 of the Business and N0004L AsCads. aM my license is I. full fora and Affect. C 76 wf $� ' REPIPE WATER SUPPLY. FROM GALVY TO COPPER AND L Lk.{ Daae REPLACE WATER HEATER TfI.AR g I undersand my plain Nbe used W used w public REard, Licensed Pmfmconal OWNER -BUILDER DECLARA71ON 1 hereby 4MM that I am exempt from tie Contantors License Law for the following moon. (Section 703 1.5. Businae and Professions Code: Any city or county which requires a permit to entrants. alar. impmw, demolish. or repair any inmate prior to is issuance, also acquires the applicant forsuch permit in file a signed statement cWtacuff"lhe. Law (Chapter 9 Sq. Ft. Floor Area Valuatl IS O O O $ viaaf the that be u licensed Pursoant to me pmlom (commencing with Serum 7000) of Division 3 of the Budmaad Pmfesalom Cade) or Mmin, is exempt therefrom and the basis fm the alle{od -aempdm. MY vioiatian of ppj�j j�jl�m CCU anC Occupancy Type Section 703" by IM aPpficmI for a permit mbjau Ore applteant to a civil penalty of not more dol RW hundred dollars (W). 3 6-9 3 3 U 3 6 r O 0 ❑ I, tl PMIKf of the plapVty. W mY Gmplayeel WiUI w9gtl tl UC V Wle CmnPettaaUGe. Required Inspections q P will do the work. and the structueis not intended or offered for Able (Sac. 7044, Business and Prefeadar Code: The Caeuecaes License law dol set apply u r an co mof property who builds or improwes thereon, and who dol amh work himself m through his awnemployees. provided that such imPmanureru as not IneMed araffems! forsale. 11. however. the building or improvement Wald within cam year of completion, the Owner. builder will ban the Emden of proving that he did WE build or improve for purpose of ale.). ❑ 1. As owner of the property, am exclusively contracting with licensed canusohan be conalnnet the pmject (Sec. 7041, Business and Prfesdao Code:) TW Commoner, Li - cents law Macs not apply u a owamof property who builds or ImpmWs tharmn, and, who contacts for such projects with a conummr(,) licensed puramnt to the Carmichael License law. ❑ lamaaemptumse See .B&PCforthisre,wn Owner Gaa WORKERS COMPENSATION DECLARATION 1 hereby alliin under penalty of perjury, am of the following declarWms iof Consent self -insure for WarkeraCompen- I have and will maintain •Cenfrcaa a Mr.%. As provided for by Section 37M of the Labor Code. for the performance of the work for which this permit Is invest. _ L ban and will mainuu Workee, Compereuon Insurensrc, As inquired by Section 3700 of the labor Code, for the performance of Ne work for which this permit is Imm 1. _ My Workers Compensation Wuranmcu/por and Policy number am: Carrier, G f� =P I Policy No.: a CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This sttdm Was not beconplemd if sec permit is farm hunthW dolma (5100) or lea.) w P D 1 anify the, In than Wharem. of the wart far which this permit In Mount, 1 shatl set employ any person in my raoubecomo abjectmhMWmkeo'Compuaadan Laws "California. ^ •.•��ff ApPlhant — NOTICE TOAPPLiCA , 0crm a enfRle,ofilempttan, you Mould become suhio" to the Worker's Compensation provisions of the Labor Code. you mum roMwith comply with men provisions or this permit shall be tamed ranked. CONSTRUCnONLENDING AGENCY 1 hereby alfithi ripe dem is egenry for de performance of s ed (Sec. 30 7. Cis. ' see work for which that permit is lased (Sec. ]09'i, CW. Cd lander, theme Lender, Address I anify that I haws read this aPPlicadon W state dust the aW W information IS ' coma 1 agree m comply with all city end county on irtanm arta sus laws relating a Wilding construction, and hereby authorize repremnutives of this city to enter upon the for inspection above-mcmianed Pantry purposes. (We) age- an aW, indemnify and keep harmless the City of Cupertino against 7 ItabllWeajudgmenhe,costa and expenses which may in any way accrue againstaid City I A consequence of the granting of Nb D WILL APPLICANT STANDS AND WILL COMPLY WITH ALL NON-POIM' ! / Issued by: Date 7_( � `: BOURC U ONS. _ii_�_�/�a�lo6 Re -roofs Type of Roof Slgnume of l�ppliwnVCmuec One HAZARDdUSMATERIAISDISCLOSURE Will the applicant At fuuoc Wilding occupmtatoe orhandle haallou material As de0ned by the Cupmtim Muni ' Code, Chapter 9.13,"the Health and Safety Cone. SaOm 25533(x)7 All roofs shall be inspected prior to any roofing material being installed. I]Yes Nu If a roof is installed without first obtaining an inspection, I agree to remove W911 the applicant or future Wilding mrcupant use equipment or devils which It IM74rdours air comumimnu dell d by the Bay Area Air Quality Management all new materials for inspection. Dimict7 ❑Yes Nu I MW and the homdaus m neriaisrequirermnu under Chapmr6.95 ofthc Califor- niaHealth &Safety Codc, Sectiotu 23503,33533 and 75534.1 undcrsund dmaifthc Wilding rima not current as. that it is my rcs mhI111Y m mdfy rite oaupam of the myulremen ehme m ccfaCeniOcatea(gCcupmmis�� Signa of Applicant Date 7// GGOO��((//D,a' All roof coverings to be Class "B" or better Owner or teem aClOF OPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # y `SUBCONTRACTOR OWNER'S NAME: CA72-12-rtPBF�L PHO # '1q6 --,S7y 3 GENERAL CONTRACTOR: Lr3>a FAX # I am not using any subcontractors: 71(x/ 0 gnature Date and romnlatP the following information: Owner/ tractor Signature '?11 1166 Date y `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 P L uvlx QUA -w4 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ tractor Signature '?11 1166 Date CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36933036.00 DATE ISSUED.......: 07/18/2006 RECEIPT #.........: 35307 REFERENCE ID # ...: 06070120 SITE ADDRESS .....: 20111 JOHN DR SUBDIVISION ....... CITY .............:.CUPERTINO IMPACT AREA ....... OWNER ............: ADDRESS ..........: CITY/STATE/ZIP ... RECEIVED FROM .... CONTRACTOR .......: COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ... TELEPHONE ........: CARY CAMPBELL OPERATOR: amyw COPY # : 2 PLUMB -A -WAY CUONG NGUYEN LIC # 27047 PLUMBAWAY 1658 E CAPITAL EXPWY, #582 SAN JOSE, CA 95121 (408)391-0930 *EE ID UNIT QUANTITY AMOUNT BENERGY PERMIT FEE 1.00 34.86 BPWHEATER PER HEATER 1.00 10.79 PPERMITFEE FLAT RATE 1.00 38.37 BSEISMICRE VALUATION 5,000.00 0.50 TOTAL PERMIT : 84.52 PD -TO -DT THIS REC NEW BAL 0.00 34.86 0.00 0.00 10.79 0.00 0.00 38.37 0.00 0.00 0.50 0.00 0.00 84.52 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 84.52 1716 TOTAL RECEIPT 84.52 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING 11 CUPEI,TINO (WCF CITY OF CUPERTINO PERMIT APPLICATION FORM OWD10120 N# 3W-1,JJ--M Fee Description Date: e?—(j —eek I Building Address: Mailing Address (if different from building address): (I ( 0 >,L Boiler <=100,000 Btu MECHANICAL Owner's Name: Boiler > 100K to 500K Btu Phone #: C�FQ Y C-,tMP6E-t Boiler > 500K to 1M Btu c.(El6 Contractor: pi-U/M rsAWAY g05--39 - 09 License #: 6 Contact: Phone: Boiler> 1.75M Btu Cupertino Business License#: C twi\) (o /)& (/ YEN Fax: 4c) 3 9 I - or1 BUILDING Building Permit Info: z ve 4✓WG i -rte COAL L"y TO CpppF2— fM'D /LE.pLA-�>C- u.�>F/� fif•47E/L. Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: BUILDING BCONSTAXR Residential 55d BUILDING Commercial ❑ Sq.Ft. Floor Area: ELECTRICAL Sq.Ft.: Cost of Project: y 0 ✓ ELECTRICAL Occupancy Gro : OG ELECTRICAL BENERGY Type of Construction: BUILDING Please check this box if the project is a Energy Add Multi BUILDING second -story addition: ❑ ro'ect Size: Standard Lar e ❑ Ma -or ❑ 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/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 BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 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 BP1N£ERCEP Ind Waste Interce for 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 c£m MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace > l 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 Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 1 .J 4 CITY OF CUPERTINO CUPEI�F PERMIT APPLICATION FORM uantity 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 Change BUILDING • 3 of 3