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05100145 CITY OF CUPERTINO +� ;�� .�; F «� rz F` nu1LmNG DI Islon PERMIT CONTRAGTnR INIrORTWWTION a,.. BUILDING ADDRESS: MI ELECTRIC INC PE""NO.05100145 19821 MERRITT DR OWNER'S NAME: PERMIT ISSUE DATE TRUDEAU HOWARD D JR AND SU ANN5255 STEVENS CREEK 13LV 3QQ 10/19/2005 NE: SANITARY NO. CONTROL NO. (408) 366-0100 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH X00 LICENSED CONTRACTOR'S DECLARATION Z C1 hereby affirm Nns al 1 am]Iceland under provision of Charon,9(commencing Job Description <U with Sccsion]g1U)or Division 3 of NC Busions sill Professions Code,and my license is _tea imm�rorceandeffeet. SERVICE UPGRADE 200AMP 7 O License Class Lk.p 14 ?=� Data Co.Viebr ZZ ARsamllxTS DECLARATION S N< 1 unaersunJ my plans Ehill be LLled u public records � U Licensed ccnuO Pmfcssionel 3 OWNER-BUILDER DECLARATION Orr iM I hereby affirm Nat 1 am exempt from the Conuacsofs License law for On .S i❑o following motion.(Section 7031.5,Business and Pmfcaium Code:Any city or county [0p(� 5$ which requires a Permit so construct,alar.improve,demolish.or¢pair any structure 8900 Z prior to its issuance,also¢quires the applicant forsuch permiuofile a signedtiummem HHo`o Nb at he is licensed pursuant to the provisions of me Contractor's License Sq. Ft. Floor Area � Valuation (commencing with Section 70003 of Division Sof the Business and Professions Code)or +,. a, $ that he u exempt theirmm and de basis for Ne alleged cam peon.Any violation of {�1/ Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of OCCU nor mom than five hundred dollars(SSM). r .P�ane Y Type Lottie work. the motion withwagesaalc(Sete compensation, will aONework and the he Cmi isnotinundetl Lawdoforak(Sec.7 an Business and ny,whiobu Cade:The Cm themoni and 4w does not apply tf rt owner is Required Inspections own employ, buildsidor ed Cat suchimporndwho me ctende oroffeedmuctfor lluough his own employ=,du Wiping oriNalsuchimpmvemmsarcnet eardedoraBuea far sale,If, hdider,Vm ave th6uimProvemmngChat didnot year or completion,Ne owner- ' Wilder will Ww the buNen of proving Nal W did not Wild or improve for purpose of sale.). I,a Owner of the property,am esclusively convecting with licensed Contractors to Met the pro cul(Sec.7044.Business and Professions Code:)The Curvatures U. come Law dos not apply to an owner of property who builds or improves Conon,and. who contracts for Inch projects with a convactorfs)licensed pursuant in the Cumul h License Law. ❑I am exempt under Sec. B&P C for this reason Owner -e �I�L Das W ORS COMPENSATION DECLARATIO 1 hereby affirm under penalty of injury one Of the following d¢larationic 1 have and will amotain aCertifimu c room nit to sel6insurt for Wahces Compen- ation,as provided for by Section 3700 of the labor Code.for the performanm of the work for which this Permit is issued. Q 1 hats and will maintain Wmlaees Compemavon Insurance,as required by Section 3700 of thc labor Code.for the performance of On work for which this permit is issued. My Workers Compensation Insurance Cartier and Policy number art: Cartier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE f russection need not he completed if the permit is Intone hundred dollars(SIM) or Icss.) I ccoify Nat in the Performance of the work for which this permit is lamed.I shall not employ any person in any mannera{� r becolnclsubje m the Workers'Compt,mation lawsca Calif O Date LfLLL``22/ �l Applicant A PPI tC }'ILULer (�✓ NOTICE TO APPLICANT:IL after shaking this provisions of Of Exemption,e.y ushould a m become subject to the Worker's ormpenariia provisions the Nc Labor Coat,you muss .JO forNwithComply with such pmvisinns or Nil permit shallbeaeemcd rewired. z y CONSTRUCTION LENDING AGENCY I-i l hereby affirm Nat Nert is a convection lending agency Tor the Performance of D.i the work for which Nis permit is issued(Sec.3097.Civ.C.) GQ Lender's Name z Undoes Address , V C) 1 ttnify Nat 1 have read this application and sum Nat On above information is L(,F COMM I agma in comply wit all city and county ordinances and sure laws relating to C)V building construction,and hereby authorise representatives of Nis city to enter upon We yshove-mentioned propcny for inspection purposes (We)agree in ave,indemnify ns keep harmless w City ru CupcnstO against i,lC)z incoabi nsequnce or etossing cxpenasmit. may in anyway accnrc against said City in consequence of me grilling of this permit. '-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: Date SOURC REGULATIONS. ala f/vl (7 1�l19 0f' Re-roofs Sign um of ApplicarVC oxetor 7 Das I HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will IM applicant or future building occupant mom or handle hummk us motorial U defined by the Cupertino Municipal Code,Chapter 9.13,and On Health and Safety Code,Section 35532(a)? ❑Yes 59�m All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hamdnus it conumina to as defined by the Bay Arca Air Quality Management all new materials for inspection. Disvict7 ❑Yea )!fNV I have mail the huandnus maurudsmyuiremens under Chapter6.95 of the Califon nu Half&Safely COM,Settio s 35505.]5533 and 25534.1 undcsmond thmifac Wilding does not currently haw a womm,that it 0 my mspornihilily m notify are Occupmr of the myui a which must be mel prior m issuance of a Cadficare Of Occupancy. ��(f— t ll r Signature of Applicant Date o eroramthorncdagentt All roof coverings to be Class "B"or better How To Make Your Dog Come To You Page 15 of 19 CITY OF CUPERTINO okm 1 of 1 PERMIT RECEIPT OPERATOR: christya COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31630033 . 00 DATE ISSUED. . . . . . . : 10/19/2005 RECEIPT # . . . . . . . . . : 31670 REFERENCE ID # . . . : 05100145 SITE ADDRESS . . . . . : 19821 MERRITT DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER TRUDEAU HOWARD D JR AND SUZANN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2441 RECEIVED FROM . . . . : BOBS CONTRACTOR . . . . . . . : HWANG, KEE LIC # 21879 COMPANY MI ELECTRIC INC ADDRESS 5255 STEVENS CREEK BLV #300 CITY/STATE/ZIP . . . : SANTA CLARA, CA 95051 TELEPHONE . . . . . . . . : (408) 366-0100 • FEE 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 63 . 16 39 . 92 0 . 00 39 . 92 0 . 00 BPERMFEE VALUATION 900 . 00 83 . 16 0 . 00 83 . 16 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 152 . 51 0 . 00 152 . 51 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ---------------- -- CHECK 152 . 51 2276 TOTAL RECEIPT 152 . 51 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 , FINAL ELECTRICAL • http://www.clikdog.com/l/new-free-training.html 10/4/05 G(C�� CITY OF CUPERTINO J00)q Cl""OF PERMIT APPLICATION FORM CUPERTINO N# JI, .3O O J?3 Date: Building Address: 1 Me-r r i 0l" Mailing Address (if different from building address): Owner's Name: Phone#: H-owa4A TrVA-ea C4oe 25 7— 6 X03 Contractor: License #: M � 2�IP_avG tic c c=o IL- Contact: Phone: 40P) : _0tCb Cupertino Business License#: e2 "W CSN-q, Faxc�,) Building Permit Info: 5ervi ce u�Gtrrde moo Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential [3( Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Project: qOccupancy hhGro : -a 1r TypEolConstnuLction: Please check this box if the project is a second-stor addition: ❑rotandard ❑ Laze ❑ Major ❑ Quantity Fee fD ' Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BB.OILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1,75 M Btu MECHANICAL BBOILER5 Boiler> 1.75MBtu MECHANICAL' BCONSTAX Construction Tax BLILDING 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 1 CITY OF CIJPERTINO ci OF PERMIT APPLICATION FORM CUPHR.TINO 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 13PBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUNIBING 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 Stone/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUATBING BPWHEATER Water Heater/Vent PLUMING 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 13RENIAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREWURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood INIECHANICAL 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 MECHANTICAL BRENaEPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Ap liance ELECTRICAL 2of3 CITY OF CUPERTINO 116 Stll- CUP CITY OF O PERMIT APPLICATION FORM Quantity 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 AIECII LAICAL 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 I VCS Tem Dist Svcs ELECTRICAL C Business License BUILDING IC Electrical sq foot ELECTRICAL FEE Elec Permit Issuance ELECTRICAL FEE Mechanical sq. foot MECHANICAL TFEE Mech Permit Issuance A'lECFIANICAL FEE Plumbin Permit Issue PLUMBING G Plumbing Fees foot PLUMBING NGC PlanningLR Comme/Multi-Fam PLANNING RNGR PlanningLon Range Residential PLANNING HG Address Change BUILDING • 3of3