03040084 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR�INFORMATION 'K
Bffli`c'Y'TttNDY PL TIMBERLINE BUILDERS INC PERMIT"°.03040084
&11111ME8CARLAT 22850 ASPEN DR. "ER " N,7717/2003
ey NE: SANITARY NO. CONTROL NO.
(650) 868-5291
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u0o LICENSED CONTRACTOR'S OECLARAT hap
I notchy affirm that I am f he Bu under nrovixions or Chapter 9(commencing Job Description
with Section] fDivisianJa(fec Business and Professions Code,and mylicenm is
mmummeanercdm REVISION-MINOR STRUCTURAL/IN HOUSE USE ONLY
to IJcdna class
Dam canwemr NO NEW PERMIT ISSUEDs ORIG. #02080091
ARCHI S t.ARATION
dg 6
or
Il Yens he tiro u yGgA dgB .
ioto
� Licensed Professional V /
3 OWNER-BUILDER DECLARATION
E I berth,aMo.that I am exempt from the Comncmes License Law for the
O O following mune.(Section 7031.5,Business and Professions Code:Any city or county
k$ which rtyuir"a permit to ennsuucu,a@q imonvc,demolish,nr repair any suunme
yZY prior m its issumec.also requiset do applicant for such permit to Ole a signed imumenl
-pp that he is licensed famarmnutoun,pmvimmmofthe Comment's License U.Cut9 Sq. Ft. Floor Area 50n
C� (commencing with Section 70M)of Division 3(I(the O usucks and Poland sCnilc)nr
y W I he is exempt therefrom and he buts for the alleged exemption.Any violation of
Section 7071.5 by arty applicant for a penniuubjecu the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred d.11...S500).
P y YP
01.as owner of the propeny,or my employe"with wages u dow sold mmmanation, 35624004 . 00
will do the.,it.end Ne muctme is net muchded or offered for sale(Sec.70",Business
and Professions Code:The Coneactor'a License law does net apply in an owner of Required Inspections
property who builds or improver thereon.and whodom such warkhimretferlhroughhis 101 - FOUNDATION
own employees,provided tbasuch improvements art not in¢odedoroRened forsalc.If. 102 — PIERS
however,me building or impamwmenl is sold within one year of completion,Ne owner-
buuder will haw the burden of proving mat he did not build or improve for purpose of 103 — UFE R
sale.). 104 - REBAR
0 I,as owner of the progeny,am exclusively contracting wife licensed cormactom to
consumer the project(Sec.7044,Business and Professions Cade:)The Comommr'a Ll. 105 — ANCHOR BOLTS
carte taw docs not apply to an owner of progeny who builds or improv"themon,and, lO6 — SEWER & WATER
who reamers for such prejecu wife a canaactor(s)licensed purmant to the Conuaaoi s
' m exLicenae Law.
❑1 eempt under Sec. .B A P C for this moon 202 - UNDERFLOOR PLUMBING
203 - UNDERFLOOR MECHANICAL
nor WORKER'S COMPENSATIONDECLARA°TION 204 - UNDERFLOOR FRAME
I hereby affirm under penalty of perjury ane of the following declarations: 205 - UNDERFLOOR INSULATION
❑Inaeandwinmain,maeeniresteafcan<mto B.inaamfarwakncaman 301 - ROUGH PLUMBING
union,as provided for by Section 3700 of the Labor Codd,for the performance of the 3 02 - TUB & OR SHOWER
..,it far which this Baron is issued.
0 1 bars and will maintain Worker's Compensation hoorah,Is acquired by Section 3 03 - ROUGH MECHANICAL
3700 of the Labor Codd,for me performance of the work for which this permit is issued. 304 — ROUGH ELECTRICAL
My Wmim's Compensation Insurance carrier and Policy num ram: 305 — FRAME
Ca Policy No,. _
c CERTIFICATEOFEXEMPf10NFl6 WORKERS' 306, - HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(This senium sed not he complain!if the Marge is for one hundred dollars($100) 308 - SHEETROCK
nr
less.)
I certify feat in the performance of the work mr which shin perrnI,is issued.I man of 3 09 — EXTERIOR LATH
employ any person in any mmmrm a j"uoI workers'Compdnsation 310 — INTERIOR LATH
Laws of C.Ii .O. am
Applicem 311 - SCRATCH COAT
NOTICE TO APPLICANT:If,after making this min"aal Exempuon,you sl Id 313 - ROOF NAIL
become subject to the Workers Cam Kristian previsions of me Usair Code,you must
Jo mm
nhwicomplywithsuchprevisionsorthisprootshallhedeemedrevoked. 501 - FINAL ELECTRICAL ENERGY
'� " CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
'd+ � Ihereby am.mal more its construction lending agency for the pdTfurame,of 503 FINAL MECHANICAL ENERGY
!Yi me wank fur which oris pclmit is issued(Sce.30,37,Civ.CJ
VA q mcrsName 504 - FINAL BUILDING ENERGY
= z Irn
cAddrtss
505 - FINAL ELECTRICAL
U C) 1 ccnify mat I have road this appiieuion and sate that the above informetiun is
U.
correct,I agree to comply with all city and county eNtnanttf and mate laws relating to 506 - GAS TEST
building connection,and hereby somans rposesenutiws of air city to soar upon the
O� ono.d.menaonddnmpenyfor insp"lianparposes. - FINAL PLUMB NG
H6. (We)agree to save.indemnify and keep hmmless the City of Cupertino against 0 8 - F I AL
rq liabilities,judgments,costs and expenses which may in my way scenic against to City 5
JZ, in consequence of me granting of this permit.
"-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: _ ING Datef;3
SOUR E EG LAT ONS
/•lA2 9 Re-roofs 514 NAL PUBLIC WORKS
nature of Applicam/Comncmr Da t02 - ROOF PLYWOOD NAIL
HAZAR USMATERIALSDISCLOSURE Type ofRo
Will Nc vppli"re or
meraldm cupam Bart of hand
banrdous material 03 - ROOF BATTENS
asOrnddbytheC, in niuipa otic.cnaptsr9.12..adthe Health and Safcty 6 46 - ROOF IN-PROGIRESS
Code,Section 25572(3)7 All roofs sha a inspected prior to any roo mg material being installed.
❑Yes
Will the applicant hr ret a
to
ing occupant use equipment ordcvices which If a roof is installed without first obtaining an inspection,I agree to remove
( „h haaamous air contammma cfined by the Bay Area Air Quality Maragdmdm all new materials for inspection.
District?
OYcs No
I have mail the Ito Liu amrialsmquimmenuunder Chaplerfi.95ofthe Cali(on
m.H"Ilhk Safety Codc.Sccti 505,25533md2534.lundcramdthnifthchuildint
Jas not caren0y haw a¢nanr, a its u my fespomiM1ility n nntily the cecupml of and
oximmmcnswhich mon m ' rani ante of a Ccnlfraw oogres, Signature of Applicant Dale
ow raulhoriredaFcm 'fit e/ All roof coverings to be Class "B" or better
CITY CF CUPERTINOsxn->3�+nxm,awg4a
BUILDING DIVISION PERMITCONTRQ,CTQR INFO$MATIQ
811° °/k9°RANDY PL TIMBERLINE BUILDERS INC PERMRNO'03040084
W—WiME$CARLAT 22850 ASPEN DR. PERNT"`EYED"17/2003
PHONE: U 4
(650) 868-5291 SANTfARY NO. CONTROL NO.
ARCHITECT/11NGINEER: _ BUILDING PERMIT INFO
BLDGELER PLUMB MECH
30o LICENSED CONTRACTOR'S DECLARATION O
I hereby affirm tha l am licensed under pmvhdom lir Chapter 9(commencing Job Description
Z111%Section] fDivishm 3ofte Blood i ate Pmrfeaiuu Code,and my licanml
c� iicene, , ercea 573 2_A.,$!8 REVISION-MINOR STRUCTURAL/IN HOUSE USE ONLY
j z 2111% z
°a ARCH °nPICPe"j`t1ATION NO NEW PERMIT ISSUED, ORIG. #02080091
✓1 ung,nyn m plan,appl he as pLyA�rtttRd,
I, licencou ME,
OWNER-BUILDER DECLARATION
+� E I hcrchy from that I am exempt from the ConuacmrY Llceac Law for the
i O O following maser.(Section 7131.5,Business Intl P efculmu Code:Any city or county
$ which requires a Permit or etxuuucL alter.mission.demol'tah,Or repair my structure
F3Ln prior in its Issuance,also polues the Applicant for such Permit to file I Signed element
gg G IMEheldicensedpuraumttothe provisioanftMContrmmr'sUee.Law(Chapter 9 Sq.Ft. Floor Area Valuation
a=F� (commencing wit SecdotE7000)of Division 3ofihc Bu,incalnd Pwfwious Code)or
.. that he is aempt drmfrorn and the bull for Use aimged assumption.My violadon of0
Section 7071.5 by my applicant for 4 permit mbjecu the applicant an a civil penalty of doll.($500).
not moAPN Number Occupancy Type
re than fin hundred
❑I,u owner oftha pmPmty,or my employes with wages as dmirmle compensation, 35624004 . 00
will do dm work,and the s"mum u rot inMed d oronemd far tele(Sec.70M,Buainw
W Profen ions Code irm
The Cenmfs License Law don Out apply m an owner or Required Inspections
Property who Wildsm Imprints;tereon,and wMdoessuchvmrk himselforthmugh his 101 - FOUNDATION
Own employes,provided thaalch lmprowmenu are not Intended proffered forale.IL r w102 - PIERS
however.er.the building or Impmwment is mid within one you of cnmpleden,to owner-
buildeill haw the burden of preving tat M did rot Wild u Improw for purpose of 103 - UFER
,x1,1.
REBAR
❑1,uownsoofthe Sec.70.am.Business
comracting with:)The Ceonumronm 104 - ANCHOR
censwfthe does
on,apply an an
rof and who onist Will
Im Mmdurto.Li- 105 - ANCHOR BOLTS ra-�
caw Mwdaesr Such Pytean ith a cbmeencls coca sedpure imp row Lemon,and, 106 - SEWER & WATER (,f
Who conccu for Such pmjeN wird acenuulor(q licensed purwant b to Conuatofa �J
"°`mow' 202 - UNDERFLOOR PLUMBING
wcaemq undo Sa ,B&PC(or thisrecon
Dow 2,03 - UNDERFLOOR MECHANICAL /\
WORKER'S COMPENS;MONDECLARATION 204 - UNDERFLOOR FRAME v
I Mmbyafirm under penalty of Perjury one ofte following dCdu 0= 205 - UNDERFLOOR INSULATION
❑I how and will maintain a CeNfiau of Consent m self-insure for Worker',Compen- 301 - ROUGH PLUMBING
ation,Is previded be by Section 3700 of the labor Code.for the performance of to 302 - TUB & OR SHOWER
work for which this permit is issued.
❑1 haw and will maintain Werkcfs Compensation hauranee,as required by Section 303 - ROUGH MECHANICAL
3700 of to later Code,for the Performance of the work for which ibis permit is issued. 304 - ROUGH ELECTRICAL
my Wohe aCompenution Lnntt artiu ate Pollry�num�rue: 305 - FRAME
CERTIFlCATEOFEXEMPf10NFA0 ORKER 306 - HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
r Icim(This,ccnnn need ret he completed[film Tom[[is for we hundred dollars($IM) 308 - SHEETROCK
1 certify use,in the p.fomunce or the wart for which tis Permit is Issued,I tail nm 309 - EXTERIOR LATH
Laws of Cdl�fomi4.p.E mutecr w,�� b;<atmutht��,,wmrker;Compensation 310 - INTERIOR LATH
NOTICE (aA17aa'�,7�— 311 SCRATCH COAT
NOTICE TO APPLICANT.Ir.aMr meting dust>nifli Facmp inn,you Meow 313 — ROOF NAIL
become subject m des worker's compensation previsions of top taper,Code,you moa
zpf°")'witcomply wit""hP`°vi'1°°I°`tis pennit'hfl WdxmN'ev°tcd. 501 — FINAL ELECTRICAL ENERGY
CONSTRUCTION LENDING AGENCY 502 � - FINAL PLUMBING ENERGY
r
Fthe IMrwhich mtate.hscd(ScE.07Mll.,C.) ryfmNeperfwmantto( 503 - FINAL MECHANICAL ENERGY
IY.r,7y Lc work for which this permit is issued($a.31191,Clv.CJ
W LendeY,Name
Lender'IACdrea
JZ) 504 - FINAL BUILDING ENERGY
t�p IanifyNflhawesdthisappllcWonandmtathnNeahowinfotmulenl 505 - FINAL ELECTRICAL
U.!" cone.1 agree or comply with all city um county oNinuus,and cu laws mming t 506 _ GAS TEST
Q [V^
building concoction,and hereby mtodm mprueneadna°f this city m cntrupon the FIN L PLUMB NG
W ahove-mentioned PMPeny for Inspection PurpaeL
a
We)ep ro lo saw,Indemnify and keep harmless,the City of Cupertino against 0 8 - F I AL
sr V) IlabilWu,jud$menta.cmu and Capt.,which may In any way amus°&goint aid City
in cowquenee of the gai of this permit, 5
APPLICANT UNDERSTANDS AND WILL C MPLY WITH ALL NON-POINT Issued by: ING Date
SOUR E EC LA ONS
9 Re-roofs 514 NAL PUBLIC WORKS
esmefAppfieanaconuscto, Da p2 - ROOF PLYWOOD NAIL
HAZA US MATERIALS DISCLOSURE Type of RO b
Witt the applicant err uUW;Idin cupantaore er rile haardou,matadai o3q - ROOF BATTENS
liedio to Cupertino mole. CTa"Er
9.13,adthe Health andSolely 60 b - ROOF .IN-PROGRESS
Section 25533(.)7 All roofs sha a ins inspected nor to an room material beim
❑res R p p y g g installed.
Will the applicant br Tut W ing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit th rdnus air contaminants Med by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ya NO
Ihm mW the Mardi coal mquimmenta under Chapter d.95o(the Califor-
McHealth kSfetyCode,seed 5115,35533 and 35574.1 uncerand that lfthc building
dues not curentiy haw a 2 a It l my m,poalhilky,te notify the occupant of to
mqu; men which not re ' rtui strucoor.ccnili'moyocculmou. Signature of Applicant Date
?�
r atedvcd Isere All roof coverings to be Class "B"or better
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng : Sub: Blk: Lot :
APN . . . . . . . . : 35624004 . 00
DATE ISSUED. . . . . . . : 04/16/2003
RECEIPT # . . . . . . . . . : 21623
REFERENCE ID # . . . : 03040084
SITE ADDRESS . . . . . : 11477 LINDY PL
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER YUVAL SCARLAT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4814
RECEIVED FROM . . . . : TIMBERLINE BUILDERS
CONTRACTOR . . . . . . . : WILLIAM WILSON LIC # 24010
COMPANY . . . . . . . . . . : TIMBERLINE BUILDERS INC
ADDRESS . . . . . . . . . . : 22850 ASPEN DR.
• CITY/STATE/ZIP LOS ALTOS, CA 94024
TELEPHONE . (650) 868-5291
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---- ------ ------------- ---------- ---------- ---------- - - ------ - - ------- - - -
BPLANCKREP HOURS 2 . 00 111 . 00 0 . 00 111 . 00 0 . 00
---------- ---------- ------ ---- -- - - ------
TOTAL PERMIT 111 . 00 0 . 00 111 . 00 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 111 . 00 4913
TOTAL RECEIPT 111 . 00
•
City of Cupertino
Plan Check Transmittal
Permit# 03040084 Control# 12091
Project REVISIONS-SFDWL Plancheck# 1
Address 11477 LINDY PLACE FileDate 4/16/03
Owner SCARLAT
Description
Plan Check Status (attach comments and return to Building w/th plan set)
Plan
Dept check# Date Due Date Staff Comment Date Approval?
ASE 1 1 4/16/03 1 4/30/03 1 1 ❑
Assessor 1 1 4/16/03 1 4/30/03 1 1 ❑
Additional Plan Check Fee ❑ Hours
Planning Fees
Housing Mitigation Fee Amount
Heart of the City Specific Plan Fee Amount
G
I L�
y
bits , 22 131 a I
IRTY OF CUPERTIN
CUPEIOTINO PERMIT APPLICATION FORM O �
APN# Slo ' 2y, QD y Date: { & po3
Building Address: I I LI 11 L I W-9 H PcA4_e/ G(j pay12"r.l O 1 CJi
Owner's Name: Phone#:
YVVa-1, o,-
Contractor: License #:
j�e�u►-1�..�. � ��s � � 5 3 L G S8
Contact: j Q� Cupertino Business License#:
Building P it Info: h
ME e Elect ❑ Plumb ❑ Mech ❑
Job Description: R$1 NO Q ST1?—%)Crv4eq--
Residential C� S%Ag 1 Dii S . Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
Illype of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> IOOK 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
AL BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
#2, 2z
1 of 3
J
. fITY OF CUPERTINO
cryo PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
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/AlterWaterPie 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
BREMFDCT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> 1 O 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
2 of 3
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CITY OF CUPERTIN !
CUPEYOF PERMIT APPLICATION FORM
Quantity— Fee ID Fee Descri tion Fee Group
BRENTOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc fl Switch& Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BRENEPALT R air/Alter Heatine MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Sims Add Branch ELECTRICAL
BREMSIGNS Remodel Signs,Mar uee ELECTRICAL
BREMTHEATR Theatrical Li htin 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 S ecialIns ection BUILDING
US—WIm Swimmin Pool BUILDING
BTEMP Tem orar Power ELECTRICAL
BTEMPPERM Tem or I Permit BUILDING
BTEMPSVCS Tem 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 Issuance PLUMBING
PPLBG Plumbing Fee s foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3