06050243 CITY OF CUPERTINO
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BUILDING DIVISION PERMIT' # � � "' '`
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BUILDING ADDRESS: PERMIT NO.
WILLOW GLEN ELECTRIC 06050243
oWfQfi8A4jLMARTINWOOD WY PERMIT ISSUE DATE
AVE SANITARY N®,Cj 30 20 *L NO,
ARCHITEC IENOINEER: —9 72 5 BUILDING PERMIT INFO
BLDG EO PLUMB 0
>Zp LICENSED CONTRACTORS DECLARATION JobDescri tion
C i bcrcbY afRrm
that 1 w Bested boder pen aimu of Chapter 9(rommmems P
w with Section 70013)ofDivisim 3o1'the B.dnem and Proumed—Code,and MY license is
i in full fors and effect. S ff� r(�v
a nm":a Lle'♦ ^2�9�g ` 200A PANEL UPGRADE IlFll� pq�}-3
Contractor Wr/!v4 G r O
ARCHITECTS DECLARATION
i< 1 understand my Plans dull he umd aspuhlie retards
,U I'tAI t)
,t; Limmcd Pmssi
fconal JUN 012006
OWNER-BUILDER DECLARATION
i S 1 bctcby ani.that 1 em escmpi from Che Cortisone,License law for the
o fallowing mason.(Section 703 1.5,Badnm and Profession Cade:Any city or county
$ which requires a permit to conwuq eller.hnpmw,demnl W,or mPair any stmaure
[�^ priorin its Issuance.Man requires she applfanl for such permit to rile a signed Sul"mem
dW he is licensed pwaunl to the pronsiom of the Commune'Lrmase Law(Chaplu 9 Sq. Ft. Floor Area a'
(commencing with Section 7000)of Dindon 3 of the Business and Profession Code)m
is$ that he u Concept therefrom and the base,for the alleged exemption Any vloatme of pp�.L �ugh�
Emotions,Emotions,7031.7 by any applicant subjects;the applicant M a civil pwlly of 3V;S3 3Sr. 00 Occupancy'I)'pe
not mart than Ow hundmd dollars(SM
❑1.u manes of t e popery,m my mapioyen whh arapn u ueb wle mmpe.sadan,
windathewart,andtbesrmmumunmim"Medmaeemdfmsale(Sec.7044,Budrcn Required Inspections
and ProRWan de CaThe C.uwLicenseLiceLaw does esrcet apply to an awr of q P
property who builds or impmwa shmmn,aha oho don such work hhnself orNmogb his
own employees•provided that such Improwmanu sre not Intcnde0 moRud forsale
If.
however,the building or Improvement is old within one)eat mamnpletion.she.
Wildas Will law,de harden of proving that he did an udW m Improw fa pumuse of
sale.).
❑1.u owner a the property,am eadusinly contracting with Ilemaod connotations b
mnWcl the project(Sec 7044,Business aha Profnslom Cade)The Contractors Li.
mese Law does not apply to an owner of property who Iu1Ws or improves demon,shod.
who contacts for such pmjeeu wish s convumr(s)Ilan ed pursuam to Ne Carmsheme.
Litems Law.
[3I we eumpt undo See .B&P C for Chis reams
OwnerDau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of the following,dmlandotts
ve and will eammin a CenlOcam ti
of Consent sal6lasom for Wokcr's Campen-
on,u provided for by Scotian 3700 of the Labor Cade,for she pednnowe of tha
work fm which this permit is issued.
0have and will maintain Workers CompnuWan Insurance,u required by Section
.1 the tabes Code,for the performance of the work far which this permit is issued
My Workers Compensation Lawrance carrier and Policy number am:
Grim: ✓3F+6 CO,. Policy No.: 172-12'UOc1
CERTIFICATE OF EXEMPT10N FROM WORKERS'
COMPENSATION INSURANCE
rrhusoctien need not becomplced If the permit Is forma,hundred dollars($100)
nr leas.)
1 mrufy that in the Pat..ance of the work for which ala permit u Wised.I shall nm
employ any person in my manmrw u In become subjml to the Worken'Compenuti"n
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:If,after making this CeniOcam of Exemption,you Mould
become subject to the Woken Compensation provisions of the tahor Code you mug
O forthwith Comply with such provisions or this permit shall he doomed rooked.
"-t CONSTRUCTION LENDING AGENCY
I hereby affirm that Nem is a construction lending agency for she performance of
> th,wash for which this permit Is issued(See 3097.civ.C.) '
QIander'a Name
t
Undoes Address
t Q 1 certify that 1 Mw mad this City
and
shod sun saw the show m missing to
t barrecL 14rs to comply with all Wy and eoumy atim of and sun uvn r open
to
t dhow-mentioned
hereby auuon preprnenu0ws of this city mener upon de
W ahoy(We)&Z d to ertysaw for Inspecindemnify
lamp ha
(We)agree m uba indemnify and keep harmless the City of Cupertino id City
Z incoidequamcc of the
of this
may In any way acme against said City
1 z A APPLICANT
of esu Ranting of this D WILL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 3,'�L
SOUR ECULATIONS. .- 2&�
Re-roofs
Sigroode of Appi D e
to &A3A ALS DISCLOSURE Type of Roof
Will tie applies fu bullEinp oceupamstoremluodlc hasardou¢aerial
u ddOned by thc Cupertino lunicipai Code.Chawr 9.12.and tie Hnith and Safmy
Code.Section 25532(x)7 �Tva9 All roofs shall be inspected prior to any roofing material being installed.
❑Yes U
Will tie. want or future building occupant ace If a roof is installed without first obtaining an inspection,I agree to remove
PP i W equipment m tkrlm whish
hazardous air cmumin"u a dcimad by the Bay Area Air Quality Mampemeat all new materials for inspection.
g n?
❑Yes ablp,
I haw mad the henNmsn oedaurequirenenu un ti C7upruG95of the Califor•
nia)kalth&Safciycode, 'w25303.25533aod27.534,lundrnundunirde building
does not currently
he
a u g It u my responsibility to notify the occupam of the
mqu' ntswhkhm metpdo,Inismnaa aeeNW.e.roce.panry. Signature of Applicant Date
r sham - ant All roof coverings to be Class"B"or better
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36935035 . 00
DATE ISSUED. . . . . . . : 05/30/2006
RECEIPT # . . . . . . . . . : 34617
REFERENCE ID # . . . : 06050243
SITE ADDRESS . . . . . : 106.84 MARTINWOOD WY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BOMMARITO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : WILLOW GLEN ELECTRIC
CONTRACTOR . . . . . . . : LONDRE, MARK T LIC # 15897
COMPANY . . . . . . . . . . : WILLOW GLEN ELECTRIC INC
ADDRESS . . . . . . . . . . : 1085 WARREN AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 289-9725
•EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BELEC200 METERS 1 . 00 29 .43 0 . 00 29 . 43 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 102 . 66 0 . 00 102 . 66 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 102 . 66 11616
TOTAL RECEIPT 102 . 66
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
______________--------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
Community Development
10300 Torre Avenue
J' Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
.UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
(( l� nwGo� W� OGdSo2-�
OWNER'S NAME: F v Jti i PHONE # - 8 9 -
GENERAL CONTRACTOR: OU Kleti cj6e FAX # yfJ�-6`I�-G0�2
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 / P n ik
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 S
Owner/— ature Date
ei CITY OF CUPERTINO nUOG
CUPEf�F PERMIT APPLICATION FORM
N# 30- 3-5- -D35 Date:
Building Address: U 1 Mailing Address (if different from building address):
10694 N\ a �Cnd
C�l (,uc
Owner's Name: Phone#:
�Avl 1 c>ri 1�,rI � 2 S 2 — � /
Contractor: License#:
vl/ w Gln Z/ OS Inc 5 q l8
Conta �( Phone: 6Yo-00 Cupertino Business License#:
\ Fax: Zff- `//U
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description: 2G0f,� er-,el V (G e-
Residential M Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: lel,
C)QO Occupancy Group
Type of Construction: Please check this box if the project is a
121-1 second-story addition: ❑
ro'ect Size: Standard ❑ Laze ❑ 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/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
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amN CITY OF CUPERTINO
CUPER,TINO 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
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 Instalt/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 cfrn MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace > 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 I Repair/After Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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CITY OF CUPERTINO
CUPEf�r 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 Insection 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
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