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08030108 CITY OF CUPERTINO �'•=s �.a BUILDING DIVISION PERMIT aCONTRACgTOR INFORMA TION BUILDING ADDRESS: PERMITNO. 10294 MINER PL TBD — TO BE DETERMINED 08030108 OWNER'S NAME: PERMIT Min DAM LOGAN RAM 03/20/2008 NE: SANITARY NO. CONTROL NO. ARC HITECVENGINEER: BUILDING PERMIT INTO BLDG ELECT PLUMB MECH 3CC LICENSED CONTRACTOR'S DECLARATION Job Description rd 1 hereby affirm that 1 am licensed under provision of Chapter 9(commencing - w1th section 7=)of DiviAlom 3 of Ne Business odd Profenal...Code,end my license la infull rerooand effeet. 7� 3BTHRMS,NONN—STRCTL& CHG LITE FXTRS,UPGRD GFI IN q : z seam cl��� -Lk.• 2BTH F, Dom - (f/"-V j- Can r taxa .th.11useoECLAR TIONCONTRACTOR, ERIC TODD ROBERSON CONSTRUCTION, PD I- 1 unMruanJ my plain CHIT ARCHITECTS used as public hG� Licensed preload...I - OW NER-BUILDER DECLARATION <f I hereby affirm that I am exempt from the Contractor's license Law for to COO following mason.(Schon 703 1.5,Business and Profession Cale:Any city or county $ which equines a permh In construct,Alter,improve,demolLsh,or repair any sudctum prior In its issuance.also enquires the applicant for such permit te file a signed statement < thotW tslittneJpuwrnI to the Pmvisionaf the cmdewrLLicerce laapter Law 9 Sq.Ft. Floor Area Valuation go (commends,with section 7")of Diwdon 3a1 the Business and Profes:inn Code)or $10000 Q that he 0 exempt therefrom and do baso for the Alleged exemption.Any violation of Section 1031.5 by arty appllcant for o permit subjects the appli.1 m A civil penalty ofNumber Occupancy T not nam an fsw hundred dollars(5500), 316 4 6 0 2 3 AT pane y ype ❑I,As oweerofdie property,army employees with wages uNeirsolecompenNon, will do the work and Ne structure is not ia¢ndedaro17fored(.Sol.(SaJ044,Business Required Inspections and Profession Cade:The Connector's Llcvsm Law dos act apply An ns an owner of q p property who build.orimprowa Absence,and whodocssuch work himselforderough his own employees.Provided Not such improw eems see not Intended oroQered for ale IL hawewr,the Wilding or Improwment u sold within an year of cumpledon.the owner builder will have the burden of proving that W did ret Wild or leprous,for purpose of ❑suownera(the Property amerofproprty who buids o licensed.thensoon te- SAN VARY construct the project(Sec.7044,Business and Professions Cade:)The Con Wcers Ll. ranee Law does not apply m an owner of property who builds or impnvo Ibcmon,and who contracts for such projects with a contracter(s)licensed pursuant m do Convacsors Lkeme Isw. ❑l Am exempt under See ,B&P C for this reason Owns, Dns W ORRER'S COMPENSATION DECLARATION I hereby aRren under Penalty of perjury,one of the fallowing declamdan: 1 ham odd will maintain A Certificate of Consent to AAK4mum for Worker's Compcn- an,,as provided for by Section 3700 of the labor Code.for the performance of the work for which this permit is issued. 1 haw end will maintain Walkers ComPenatmn Insurance,As required by Section 3700 of the Labor Ccde.for Ne performance of the work for which this permit is Issued. My Worker.Compensation Ino eance oderand Policy number art: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Th6 section need not he completed lithe permit Is frame hundred dollars(SI W) nr lea) I cenify,that in the performance of the work for which this permit Is Wued,l shall not employ any person in any mepTsigat 1'b9 Abject to the Worked Compenadon LAwsaf Calif aDa• O" ( a Applimet _ _ _ NOTICE TO APPLICANT:If,after making this Cendleac of Exemption,you should become subject ue the Worker's Compensation previsions of the Leber Cede,you must .J O forthwith comply with such provision or this permit shall W deemed demAed. Z n CONSTRUCTION LENDING AGENCY [-� .., 1 hereby affirm that them its convection lending agency far the performance of E the work for which this permit Is issued(Sec.3097,Co.C.) 0 Under,Name, Z Lenders Address U 0 1 etreify that I haw read this applintian and sac that the stow,information u IL.F corm.I agree to comply with All city and county ordinances and sac sows relating to DU building eonuncdan,and hereby suthodm depresenmtiws of this city to enter upon the L2.1 ahow,dentioncd property for lnpcNan purposes. G (Wet)agree to a.m.indemnify and keep harmless the City of Cupcnino against rq Iimilides,Judgmters,coin and expenses which may In my way accrue against said City („)Z in consequence of the gaming of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date J^ O SOUR REGULATIONS. •7-2O'o✓ Re-roofs �— SigruurtofApplicanUCon ter Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or fuwre building occupanumre or bamdm haardous material As defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety Code,Scclion 255320)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yo Will the applicant or fume Wilding occupant use cyuipmrnt,dentes which If a roof is installed without first obtaining an inspection,I agree to remove ho'raNeus Air comaminants As defined by the Bay Amo Air Quality Management all new materials for inspection. ric17 [:3y. �,awk,'' — 1 hew dead the hA arduus memrialsoupdrements under Chapter 6.95 of the Califon. ria Health&Safety Cad.,SmWn W05.25533 and 25534.1 undcntand Abukf sire building docs out c...d,haw•tenant,Net it is myrnponib'Hit,m notify the ocup.,of de. deg entswInchma�be�i,toWnancenncertificameGCprL y. Signature of Applicant Date Owner or mNorved agent mm All roof coverings to be Class"B"or better CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg . COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31646023 .00 DATE ISSUED. . . . . . . : 03/20/2008 RECEIPT #. . . . . . . . . : BS000004208 REFERENCE ID # . . . : 08030108 SITE ADDRESS . . . . . : 10294 MINER PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LOGAN RAM ADDRESS . . . . . . . . . . : 10294 MINER PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ERIC TODD ROBERSON CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD. - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 10, 000. 00 1.00 0. 00 1 . 00 0. 00 1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00 1PPERMITFE 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 123 .37 0. 00 123 .37 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD - 123 .37 VISA --------------- TOTAL RECEIPT 123 .37 d CITY OF CUPERTINO CI o • CUPEkTiNO GENERAL BUILDING PERMIT APPLICATION FORM APN# (0 Ua 3 , O (� Date:�� Building Address: /N-l Mailing Address (if different from building address): Owner's Name: Phone#: aer 1 ,�,��G.o��rc•� 7761- 722/ Contractors: Phone: C�ff�— 710 Fax: �OQ ���-1�.�`%✓J Contractor License #: S yy Cupertino Business License#: Contact: Phone: ( , /O— W Fax: Residential Commercial — 3 nay. 1 hrL c�t—c r o1 G Q (� Job Description: �ligN G �/L N!� ,L�of — '�/�j Ud��� ' �✓ y Z114",,AVJ Building Permit Info: / Bldg ❑ Elect Plumb LY Mech ❑ Type of Construction(Usage Class): Occupancy Type: 4 1 FR, I IFR El 11, 111, V-IHR El 11, 111, 1V V-N ( —� Valuation: Square Footage: 0 u2� Project Size: Standard Ej--'Lar e ❑ Major ❑ • CITY OF CUPERTINO CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group IGENRES or 1GENCOM 1BTEMPPER Temporary Building Permit (good for B 30 days) IBBOILERI For the installation or relocation of ea M boiler/compressor to & including 3 horsepower, or ea absorption sys to & incl 100,000 Btu/h 29.31cw) IBBOILER2 Installation/relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption ss over 100,000 Btu/h IBBOILER3 Install ation/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 IBBOILER4 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 IBBOILER5 Installation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption sys over 1,750,000 Btu/h IBAPPLOTH 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. 1ELECINSP Other Electrical Inspections (per hour) E IMECHINSP Other Mechanical Inspections (per M hour) IPLMBINSP Other Plumbing& Gas Inspections P (per hour IMEETINGIHR Application Meeting B CITY OF CUPERTINO CUPEI�F GENERAL BUILDING APPLICATION . ® FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ACOUSTICAL REVIEW IACOUSFDW SFDWL/Duplex New B 1ACOUSRESAD SFDWL/Duplex-Addition/Alteration B IACOUSCOM Multi-Family/Commercial B CHIMNEY'S 1CHIMNEY Chimney B 1CHIMNEYR Chimney Repair B FENCES 1FENCE>6FT Non-masonry, over 6 ft in height B 1FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES 1FIREPLMAS Fireplace Masonry B 1FIREPLFAB Fireplace Pre-Fabricated/Metal B 1FLAGPOL>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 1PILEDRIV Pile Foundation Driven (steel, pre- B stressed concrete 3 of 5 CITY OF CUPERTINO CUPE(�TINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM RETAINING WALL(CONCRETE OR MASONR IRETSTN Standard (up to 50 ft) B IRETSP310 Special Design, 3-10' high (up to 50 `) B 1RETSPI0 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 1SIDEST/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>1 OSF Skylight greater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 so B 1 SRACKS>8 Storage Racks over 8' high (up to 100 B st 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 4of5 tdd CITY OF CUPERTINO CUPEI�r GENERAL BUILDING APPLICATION • FEESCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 WINREP Replacement windows/sliding glass B door ea 8 windows 1 WINMEWSTR New Window-structural shear B wall/masonry includes plan ck fee / IEPERMITFEE Electrical Permit Fee E I 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMPLNCK Stand Alone o e Plumbing Pln Ck (hrly) P I STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone ` 1BSEISMICR Seismic Residential B / 1BSEISMIC0 Seismic Commercial B 1TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5of5 Community Development 10300 Torre Avenue rJ' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 4JUPEkTINO Building Department JOB ADDRESS: PERMIT# 61s r ox- OWNER'S NAME: PHONE # GENERAL CONTRACTOR: // FAX # � Y� I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date