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08050219 CITY OF CUPERTINO � BuaDINGDIVIS50N PERMIT O`t 4�iTRACTOR'IiN U�RM'AT OIY lz PERMIT NO. Bu'I'YM�Fsi.INDA VISTA PL DEN—MART: STRUCTURAL 08050219 iNER'S NAME: L - PERMIT ISSUE DATE SRINIVASAN 2316 HEARTHSONG CT 05/28/2008 ONE: SANITARY NO. CONTROL NO. (209) 727-4144 ARCHI'IECT7ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uOp LICENSED CONTRACTOR'S DECLARATION Job Description 4 b C 1 hereby Won Nu 1 am licensed none,Pmvisau of ChaPmr 9(commencing P C� wits Section 7")ofDmson Sof Ne Buaixar fcssiam Inde hccnm is ELECTRC PANEL UPGRADE TO NEW 125 AMP ^ a. in full forte and License Clue Lk.g t7W an HIIIECT'SDECLARAnoN I understand my Plans shall k used u Public retards C6U s Licensed Prefessional OWNER-BUILDER DECLARATION .� 1 hereby affirm Net I am catmpt from the Contractors Licenm Law for the L e O following(Cable.(Section 703 L3,Business and PNIe0.VUN Cade:Any city or..toy 5m_ which requires a pemtit as coMrvct,slier.im mon,demNLrh,or rcpeir any Hruchou 2i Priormitsiceuance,alsmote,res tic applicant forwch perm',ro8k,signed aukment x < tsetheislicensedPurwantmtseProvisionsoflkConnector''sUcenseLaw(Chapter9 Sq.Ft. Floor Area Valuation �ro (commencing wits Section 7")of Division 3 of the Business and Professions Code)or $1800 e 5$ that k la ea er pt tM,refmm and be,buss for the alleged eanmpoon Any violation of Section 7831-5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy hot mom than 8m hundred dollva(SM. 35608008:17NType 0 L u owner of the property,m my employees with wagesu Ner.wle compeuedon. will do the work.and the suuclom is not intended or offered for sale(Sac.70th,Business usd Professions;Cade:Then Canu,cmrs License Law dens rot apply in an..of Required Inspections property who builds or imposes tsercon,and wk doessuch work h imsel f or through has own employes,provide l that such lmprovemeu are not intended aroRered furcele.If. however.Ne building or improvement ksold widen mm year of completion,Ne owner- builder will bane the hordes of proving that k did but boob or improve for purpose of ask.). .. ❑1,as..of the propeny,am exclusively contracting with licensed mntramun to construct the project(Sec.]ON,Business and Pmfurions Code:)The Cromemrs U. ceose Law dors no,apply an an owns of property who builds or improves thereon,road. who conusects far such projero wits a ronvanorts)licensed purwant m tic Conusemh exempt under ,B&P C for this msson WORKERS A0SATID ON 1 krcby aBirm under Ponsay of Perjury one of tic following dsclaruions: ❑Iloveartswillmsnuinaeeniri=ofC=nimselfiuumfar Wo SCMPen- andim u pmvidW far by Stction 3788 of date L bar Code,ret the p Ad..ance of tic work for which this prmft is issued. 0 1 ban and will mumsln Worker's Compensation Insurance,u required by Section 3M of tic Mbar Cade,for the performance of the work for which this permit is iceued. My Worknrs Campensadw fnstans t carrier and Policy number,rs: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE an lcsssection(Nis section ncd nk cot completed If tic permit is for one hundred dollars(SIM) 1 cenify thnt in the performance of We wart for which Nis Permit u issued.l snail an, creploy any person in anY manner an u an become subjec,an the Workcn'Compensatian Laws of California.Dau .�., , NOTICE NOTICE TO APPLIe Vochs If.Con making Nu Ceniftcau the Esemption,you nshould mesa become subject y it Workers Compensation provisions of the lake Cade you muss ,J 2, foMwith comply with such provisions or this pemni,.Wll k dcemW mwkcd. r z O CONSTRUCTION LENDING AGENCY t-r r I kmby affirm dual Nen is a conswctirm lending agency for tic pertormance,of (f a the woh for which than permit or ivueE(Sec,3097,Civ.C.) W�Q I<ndcrf Narrac Addo mn Aaercar J � z tse U O 1 certify Nu I have read this applieuian and sou Nu the thew information u ... LL F coven.l ague an comply with all city and county ordinances and anis laws rnlating w ' .O U .turn-gconstred no road ay fenny auhonr mored, erns of Nu city menter upon the akve-mcnGuned Property for inspection m Kaman HC (We)agree to cent,indemnify and keep harrokce tic City of Cupertino against to lie....mxd..ftbcdes,judgments.cests red j.fLh ueswhich may in any way acctuc agsnsl.ceid City U z in comequcnce a(Nt granun of Nu perm's J APPLICANT UNDER S AND COMPLY WITH ALL NON-POINT Issued by: Date s0 GUL `� Re-roofs Signuum ofApplion anuacur peak HAZARDOUS MATERIALS DISCLOSURE Type of Roof Wllltheapplicantorfutwcbulldin cuPantuomarlundk humdous makrirtl u defined by the Cupenl.Munid ode.Chapter 9.11,and date Holts and Safety .station zss3x(,)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes No If a roof is installed without first obtainingan inspection,I agree to remove Will the applicant or forum build' bceupan,use equipment or devices which P g omitDistrict'? es sir canumiruots u utl by 8u Bay AmaAir Quality Manage all new materials for inspection. emit hal Dyes Nu I have need the krvdau materialsroquircments under Chapmrti.93 a(thc Csifory nk tkalts&S,fcoyCade x33(13, X.lunticrstsndthuifdte building does no,cunendy kve tsar' my -bility u mtify the occupant of the mquim which t ' rmiss a a ignature of Applicant Date Iter ar,trtharlRd gen, pate All roof coverings to be Class'n:t'or better 5kGC:J CITY OF CUPERTINO CUPERTFINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: 256o Building Address: C-4 ca, {�- �cmC Mailing Address (if different from building address): Owner's Name: Phone#: ',.c—.. 75 ,ui �4 1(og - �, Z Contractor: Phone: Ap (ppm 6 2-y7 _ tM Ick e-(Q a-aA Fax: 10Y - 7Z7— 249-4/ Contractor License #: 91Z 6/6 z Cupertino Business License#: • Contact: --'10cRU1dcoh Phone: Fax: Residential Commercial Er Job Description: Is the ro'ect in the Wildland-.Urban Interface Fire Area? Yes ❑ No Building Permit Info: Bldg ❑ Elect>� Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-Njj'101 IIIIII _AW ❑ I1�111 '. ' : R� Valuatio ISquare Footage: I Project Size: Standard. Large ❑ Ma or ❑ • Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.buildit reen.or ISM,- CITY OF CUPERTINO COF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1BTEMPPER Temporary Building Permit (good for B 30 days) 1BBOILERI For the installation or relocation of ea M boiler/compressor to &including 3 horsepower, or ea absorption sys to & incl 100,000 Btu/h (29.3kw) 1BBOILER2 Installation/relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption ss over 100,000 Btu/h 1BBOILER3 Installation/relocation of ea M boiler/compressor over 15 horsepower to & incl 30 horsepower, or ea absorption sys over 500,000 Btu/h to & incl 1,000,000 Btu/h 1BBOILER4 Installation/relocation of ea M boiler/compressor over 30 hosepower to & incl 50 horsepower, or for ea absorption sys over 1,000,000 Btu/h to & incl 1,750,000 Btu/h 1 BBOILER5 Installation/relocation of ea boiler or--M refrigeration compressor over 50 horsepower, or ea absorption sys over 1,750,000 Btu/h 1 BAPPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. 1 ELECINSP Other Electrical Inspections (per hour) E I MECHINSP Other Mechanical Inspections (per M hour) I PLMBINSP Other Plumbing & Gas Inspections P (Der hour 1MEETINGIHR Application Meeting B CITY OF CUPERTINO CUP TYOFFINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group ]GENRES or 1GENCOM ACOUSTICAL REVIEW IACOUSFDW SFDWL/Duplex New B IACOUSRESAD SFDWL/Duplex-Addition/Alteration B IACOUSCOM Multi-Family/Commercial B CHIMNEY'S ]CHIMNEY Chimney B 1CHIMNEYR Chimney Repair B FENCES 1 FENCE>6FT Non-masonry, over 6 ft in height B 1 FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES iFIREPLMAS Fireplace Masonry B 1 FIREPLFAB Fireplace Pre-Fabricated/Metal B 1 FLAGPOL>20 Flag pole (over 20 ft in height) B 1MODUSTRU Modular Structures B FOUNDATIONS 1FOUNDREP Foundation Repair B 1PILECAST Pile Foundation Cast in place concrete B 1 PILEDRIV Pile Foundation Driven (steel, pre- B stressed concrete) 3 of 5 G�- CITY OF CUPERTINO CUPCITY EYOF GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM RETAINING WALL(CONCRETE OR MASONRY 1RETSTN Standard (up to 50 ft) B IRETSP310 Special Design, 3-10' high (up to 50 `) B 1RETSP10 Special Design, over 10' high (up to B 50' 1RETCRB< Gravity/Crib Wall, 0-10'high (up to B 50 ft 1RETCRB> Gravity/Crib Wall over 10' high (up to B 50 ft SIDING 1 SIDEST/BK Siding, Stone & Brick Veneer B (interior/exterior) 1 SIDEOTHER Siding all other B SKYLIGHTS 1 SKYL<10 SF Skylight less than 10 sf B 1 SKYL>10SF Skylight greater than 10 sf or B structural ISTAIRS Stairs-first flight/ea addt'I B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B 1 SRACKS>8 Storage Racks over 8' high (up to 100 B st) 1STUCOAP Stucco Applications (up to 400 so B additional stucco application 4of5 ECS`- :� . CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEf�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1WINMEWSTR New Window-structural shear B wall/mason includes plan ck fee IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P l ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourly-stand alone / IBSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B I1TRAVDOC Travel & Documentation B 1BUSLIC Business License B • 5 of 5 Green Building Plan Check Index of Green Building Points/Categories A. Category Example of an Index or Table of Green Plan Sheet or Page Points Building Points Categories that must be shown and referenced on the Project Plans See below B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points 11. Permeable Paving, Note L-1 2 points C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points 5. Use Truss with heels, (detail) S-2 2 points 6. B. OSB Sheathing, detail S-2 2 Points E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points 4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points 5. Tankless W.H., (Note/Spec.) A-2 2 points 11. A 2500 Gal. Tank, (Note/Spec L-1 10 points G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A3 1 point 3. Ener Star Refrigerator, (Note/Spec.) A-3 1 oint P. Other 1. List Green Features on Plans I A-1 1 point TOTAL POINTS1 40 points • • Plan Review Process Work Book Page-12-Revised 3/25/08 Green Points Rating System for Remodeling Projects • Due to the diversity of remodeling project types,assigning a'total points'value to a project to be considered environmentally friendly is not feasible. However,25 measures have been highlighted to signify that every effort should be made to incorporate them into your projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with ease of implementation and relative low cost. These measures can be used as a starting point for'greening'your project. A.Site INPUT ResDulces Energy IAD/Heafth 1.Recycle Job Site Construction&Demolition Waste 65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts D 2.Salvage Reusable Building Materials 4 Resource pts y=yes 0 3.Remodel for Mixed Use,Adaptive Reuse,and Histodc Preservation 4 Resource pts y=yes 0 4.Protect Native Soil 2 Resource pts y=yes D 5.Minimize Disruption of Existing Plants&Trees 1 Resource pt Y--yes D 6.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0 7.Protect Water Quality with Landscape Design 2 Resource pts y=yes D 8.Design Resource-Effcient Landscapes and Gardens 4 Resource pts y=yes p 9.Reuse Matedals/Use Recycled Content Materials for Landscape Areas 2 Resource pts_ y=yes D 10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0 11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes 0 1 1 1 B.Foundation 1.Incorporate Recycled Flyash in Concrete • 25%Recycled Flyash=2 points;Add 1 point for every 10% increase of fiyash,up to 5 points up to 5 Resource pts 0 2.Use Recycled Content Aggregate 2 Resource pts y=yes p 3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes p 1 1 1 C.Structural Frame 1.Substitute Solid Sawn Lumber with Engineered Lumber J 3 Resource pts y=yes 0 2.Use FSC Certified Wood for framing (For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0 3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y=yes 0 4.Use Web Floor Trusses 2 Resource pts y=yes 0 5.Design Energy Heels on Trusses 6'or more 2 Energy pts y=yes 0 B.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y--yes 0 7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0 8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y--yes 0 9.Use Structural Insulated Panels(SIPS) a.Floors 3 Energy pts y=yes D b.Wall 3 Energy pts y=yes 0 c.Roof 3 Energy pts yq'es 0 .10.Apply Advanced Framing Techniques 4 Resource pts y--yes 0 11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0 a.Subfloors (• 1 Resource pt y=yes p b.Sheathing_ _ ` 1 Resource pt y=yes p 1 1 INPUT Resources Energy [ADIHealth enor Fimsh :,1.Use Sustainable Decking Materials. ; a.Recycled content 3.Resource pts y=yes 0 • I b.FSC Certified Wood j 3 Resource pts y=yes 0 '2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y=yes 0 13.Install House Wrap under Siding j 1 IAQ/Health pt y=yes 0 4.Use Fiber-Cement Siding Materials { 1 Resource pt Y--yes 0 E.Plumbing 1 Install Water t Heaer tacker _ J 1 Energy pt y=yes 0 2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0 3.Retrofit all Faucets and Showerheads with Row Reducers. a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0 b.Showe heads(1 point each,up to 2 points) Up to 2 Resource pts. 0 4.Replace Toilest with Ultra-Low Flush Toilets (1 point each,up to 3points) __ J Up to 3 Resource pts. 0 5.Install Chlorine Filter on Showerhsad 1 IAQ/Health pt y--yes 0 6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 0 7.Install(Nater Filtration Units at Faucets (2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0 B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yesv.tiemncai D 1 1 i (1Install Compact Fluorescent Light Bulbs(CFLs) . .(6 bulbs=2 points,l0 bulbs=3 points,12 bulbs=4 points) ! Up to 4 Energy pts. 0 • 2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to 5 points) Up l0 5 Energy pts. 0 3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts. 0 4.Install High Efficiency Ceiling Fans Adth CFLs (1 point each,up to 4 points) Up to 4 Energy pts. 0 t 1 1 G.Appliances f[1.Insta`ll Energy Star Dishwasher~ 1 Energy of y=yes 0 2.Install Washing Machine with Water and Energy I Conservation Features 1 Energy pt y=yes 0 3.Install Energy Star Refrigerator 1 Energy pt y=yes 0 4.Install Built-In Recycling Center I 3 Resource pts y=yes 0 H.Insulation 1.Upgrade Insulation to Exceed Title 24 Requirements a.Walls 2 Energy pts y--yes 0 b.Ceilings 2 Energy pts y=yes 0 2.Install Floor Insulation over Crawl Space 4 Energy pts y--yes 0 ,N3.Install Recycled-Content,Fiberglass Insulation with o Added Formaldehyde —j 31AQ/Health pts y=yes 0 4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0 5.Use Cellulose Insulation a.Walls 4 Resource pts y=yes 0 • b.Ceilings 4 Resource pts y=yes 0 6.Alternative Insulation Products(Cotton,spray-foam) a.Walls 4 Resource pts y=yes 0 I).cemngs 4 Resource pts y=yes 0 1 1 I.Windows • 114PUT Resources Energy iAQ1HeaIjM 11.Install Energy-Efficient Windows a.Double-Paned 1 Energy pt yeses 0 b.Low-Emissivity(Low-E) 2 Energy pts Y--yes D c.Low.Conductivity Frames _ 2 Ener is 9Y P Y Yes D 2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0 1 1 1 J.Heating Ventilation and Air Conditioning ,f-1,Use Duct Mastic on All Du—Joints _ 2 Energy pts y=yas 0 2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0 3.Vent Range Hood to the Outside 1 IAO/Health pt y=yes 0 4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0 5.Install Solar Attic Fan 2 Energy pts Y=yes 0 6.Install Attic Ventilation Systems 1 Energy pt Y--yes 0 7.Install Whole House Fan 4 Energy pts Y--yes 0 S.Install Sealed Combustion Units a.Furnaces 3 IAQ/Health pts y--yes 0 b.Water Heaters 3 IAQ/Health pts y=yes 0 9.Replace Wall-Mounted Electric and Gas Heaters with Through-the-Wall Heat Pumps 3 Energy pts y=yes 0 10.Install 13 SEER/1 1 EER or higher AC with a TXV 3 Energy pts Y=yes 0 11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yas 0 12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0 • 13.Retrofit Wood Burning Fireplaces a.Install EPA certified wood stoves/nserls 1 IAQ/Health pt y=yes 0 b. Instal/Replace Dampers 1 Energy pt y=yes 0 c.Install Airtight Doors 1 Energy pt y=yes 0 14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0 15.Install High Efficiency Filter 41AQ/Health pts y--yes0 16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0 17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes p K.Renewable Energy and Roofing 1 ! 1 1.Pre-Plumb for Solar Water Heating 4 Energy pis y=yes 0 2.Install Solar Water Heating System 10 Energy pts Y--yes 0 3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0 4.Install Photovoltaic(PV)System (1.2 kw=6 points,2.4 kw=12 points,3.6 kw=16 points) _ Up to 16 Energy pts p r--— �6.Select Safe and Durable Roofing Materials _ 1 Resource pt y=yes 0 7,Install Radiant-garner - 3 Energy pts y=yes p 11 I 1 L.Natural Heating and Cooling 1 1.Incorporate Passive Solar Heating 5 Energy pts y=yes p 2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes p 3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes _ p • 1 1 1 M. ndoor Air Quality and Finishes r1.Use Low/No-VOC Paint - .: 1 IAO/Health pts y=yes 0 • 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 13.Use Low/No VOC Adhesives - _ _ _ 3 IAQ/Health pts y=yes 0 4.Use Savaged Materials for Interior Finishes 3 Resource pts y--yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQMealth pts y--yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 j7.Seal all Exposed Particleboa d or MDf _ _ `� 4 IAQ/Health pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 31AQ/Health pts y=yes 0 1 1 1 N.Flooring 1,Select FSC Certified Wood Flooring _ 8 Resource pts y=yes0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts Y--yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 51AO/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 Total Points A 1 1401 130 57 • Total Points Project Received: 1 0 ip , D G:datarprogslgreenbuildmgguidelineslremodelersigreenpoinisf nal2.12.04prole:ted.xls • CITY OF CUPERTINO • 3 ITEMS OF 3 '� • PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 35608008 . 00 DATE ISSUED. . . . . . . : 05/28/2008 RECEIPT # . . . . . . . . . : BS000004911 � REFERENCE ID # . . . : 08050219 SITE ADDRESS . . . . . : 22096 LINDA ,VISTA Pf, SUBDIVISION • . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . : Q , OWNER . . . . . . . . . . . . : SRINIVASAN ADDRESS . . . . . . . . . . : 22096 LINDA VISTA DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4022 RECEIVED FROM . . . . : MARK DAVIDSON � CONTRACTOR . . . . . . . : MARK DAVIDSON LIC # 30008 , COMPANY . . .•. . . . . . . : ,DEN-MARK ;STRUCTURAL ' ADDRESS 2316 HEARTHSONG CT CITY../STATE/ZIP . . . : RIVERBANKSCCA 95367 • TELEPHONE . . . . . . . . : (2t09) 727-4144 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ----- ----- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 1, 800 . 00 .6;. 50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 .79 0 . 00 ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 82 . 08 0 . 00 82 . 08 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CASH 82 `08 ---------- , . TOTAL RECEIPT 82 . 08 , • � o h tp «a t •