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08020158 CITY OF CUPERTINO .fix �,ww.yf = BdILDING DIVISION PEjjly[j'j` kC01R.�ICTOR�I�N�1`QRMATT.(3'rt•1!� BUILDING ADDRESS: PERMIT NO. 10665 MORENGO DR TBD - TO BE DETERMINED 08020158 OWNER'S NAME: PERMIT ISSUE DATE DALE BAEK 02/25/2008 ONE: SANITARY NO. CONTROL NO. ARCHIIECrfENGINEER: BUILI)ING PERMIT INFO RE-CONNECT MAIN SERVICE -BLEG ELECT PLUMB MECH O O O O 300 LICENSED CONTRACTOR'S DECLARATION sed1 beach,affirm That I m licensed under prosdaloma of Chap.9(cammencing -•^^^^ Ob Description with Section 7000)of Division 3 ofdm Busiaca and ProfeWon%Code.and my license is In full races and efram ?0Z License Class Lk.6 S Dam Contractor e ARCHIIECPS DECLARATION y I undenund my plans shall be used as public records • .., 540 Licensed Profound ansl r„ OWNER-BUILDER DECLARATION <� I hereby alirn Nat I am exempt from the Conoactars License Law far the COO following wan.(Secdon 7031.!,Business and Professions,Cade:My city or county 53 ff which acquires a Iwrnt(u cov4ue6 alcor.improve,demolish,or repair any structure Z pdorua its tssuance.alsurequires the applicat forsuch Permiuofileasigaed comment FFq< that he is licensed personal to to provisions of Ne Contractors Liaxnsc Law(Chapmr9 Sq.Ft. Floor Area Valuation 3� (commencing with Section 7000)of Division 3 of the Business and Pretensions Code)or 3 that he Is exempt therefrom and the balk for the alleged eumptlon.Any violatfon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type trot mace that five hundred dollen($1110). P Y YP ❑1,a awrmr of use Property.or my wPloyea with wages at their sale.,.do.. will do the walk•lad the swmuac 13 not intended or offered flit We(Sex.TOM.Business and Profession Cade:The Cankactah License Law does act apply to an owner of Required Inspections property who builds arimpmves thermal.and whodue ssuch work himWfmthrough his awe employees,provided that such improvements art nolinu ubcd oraffered for Wu if, however.the building or Improvement is sold within arm yeu of completion.the owner. Wilder will have the Widen of proving that he did not build or Improve for purpose of akJ. ❑1,u awrcr of the property am a tchatively contracting with licensed a uarnn b construct the project(sec.7014.Busmea,ad Profasams Cade:)The Ceasctors Li- . cense her deal not apply in a owner of property who builds et improves thereon.ad tsproject, ent who comment such projecwith a ramdO licensed p. mn latae CantruMes IJceve law. ❑lam exemIn rSm .BB P C for this moon Date WORKERIiCOMPENSAMONIDECLARATION 1 hereby affirm under Faulty of perjury am of the following declamations: ❑1 have and will malnsaln aCWficate ofC...I to self-Imam for Wmkera Compen- atioa,u provided fm by Section 3700 of the Labour Code,far the Maintenance of the wart for which W permit u issued. ❑1 have and will mainuin Wmkers Compensation Insurance,as mquircd by Secdon - 3700 of dte labor Cade.for the pMarmace of the wart for which Nu permit la loved. My Warbles Compensation Issuom..trier and Policy number ate: Caries. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE rlhts saUan need not bccomplemdif tie permit l,rare ehundred doom RlaOl of leu.) I.oily that in the per an.of the work for whim Nis ermit is issued.I shall not employ any person in mater. become abject the Worken'ComperuNan laws of Califo Appliwa NOIICETO P CANT:IC slier making citifies¢of Exemption,you shouki - become abject u the Warkeh Compeaadom provisions of the labor Cade,you must .J O faMwiO permit comply with such prevision or this peit shall W domed revoked. CONSTRUCTION LENDING AGENCY [•+ Thereby affirm that them ts•comuecdon lending agency for the performance of fY,? the wart for which this permit is issued(Sec.3197,Civ.C.) Wlenders Name M Q Z lancers Adder U O l cenify that 1 have rnd this application and sum Nu the above information is .O Ecorrect.1 agree in comply with ail City and aunty ordinances and slim laws mialing at building convection,ad hereby athodm mptesenudves or this city to enter upon the [t7 shove-mentioned property rot inspection purposes gy (Wc)agree m ns..indemnify and keep hmmlen the City of Cupertino against (ZI liabilities,judgments.cases Mal cape••"•which may in ay way aceta agarol card City U Z in consequence of the grating of this permit. ^ APPLICANT_4NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2— 2,/" - SOUR CATIONS, ^ are cart ter Appllca blConuecto! \ / Dad Re-roofs ta HAZARDOUS MATERIALS DISCLOSURE Type of Roof / Will the applicant or future building aavp.L rose or handle lut ver•maurial u defined by tie Cupertino Municipal Code.Chapter 9.11.and the Health and Safety Cade,section zs5324>7 ❑Yes ❑No All roofs shall be inspected prior to any roofing material being40 Will the applicant or forum building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove emit haatdan air comandr a s u defend by the Bay Area Air Doubly Management all new materials'for inspection. District? ❑Yes ONo 1 have mad the ha>ydmumamriaHmquimmenu under ChMM6.95 of the Califor- niaHWth&safer Sm3,.M505. SJJ ad25334.Turamnundthalftic Wilding deal no{{{,,,cmmwrrr555nnn ave a tear,Net It u m spomihility to notify the accupat of the reyuirtfka� muubenmt pdmroits facetwaswora.pae. Signature of Applicant Date Owner or authorind agent D to All roof coverings to be Class"B"or better • CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37534014. 00 DATE ISSUED. . . . . . . : 02/25/2008 RECEIPT # . . . . . . . . . : BS000004019 REFERENCE ID # . . . : 08020158 SITE ADDRESS . . . . . : 10665 MORENGO DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DALE BAEK ADDRESS . . . . . . . . . . : 10665 MORENGO DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : AMKO CONSTRUCTION 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 200. 00 0. 50 0. 00 0. 50 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 1TRAVDOC FLAT RATE 1. 00 40.79 0.00 40.79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 122 . 87 0. 00 122 .87 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 122 .87 1053 --------------- TOTAL RECEIPT 122 .87 • • CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37534014 . 00 DATE ISSUED. . . . . . . : 02/25/2008 RECEIPT # . . . . . . . . . : BS000004019 REFERENCE ID # . . . : 08020158 SITE ADDRESS . . . . . : 10665 MORENGO DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DALE BAEK ADDRESS . . . . . . . . . . : 10665 MORENGO DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : AMKO CONSTRUCTION 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 200. 00 0 . 50 0. 00 0. 50 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 1TRAVDOC FLAT RATE 1. 00 40.79 0 . 00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT . 122 . 87 0. 00 122 . 87 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 122 . 87 1053 --------------- TOTAL RECEIPT 122 . 87 • INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: SylviaM Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37534014 . 00 . INVOICE DATE. . . . . . : 02/25/2008 REFERENCE ID # . . . : 08020158 SITE ADDRESS . . . . . : 10665 MORENGO DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DALE BAEK ADDRESS . . . . . . . . . . : 10665 MORENGO DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . TELEPHONE . . . . . . . . : • FEE DESCRIPTION DUE FOR --- AMOUNT DUE PAID BALANCE --------------------------- ------------- ---------- ---------- ---------- SEISMIC RESIDENTIAL PRINTING PERMIT 0. 50 0 . 00 0 . 50 ELEC PERMIT ISSUANCE PRINTING PERMIT 40.79 0 . 00 40 .79 PLUMBNG PERMIT ISSUE PRINTING PERMIT 40. 79 0 . 00 40.79 TRAVEL & DOCUMENTATION FEE PRINTING PERMIT 40.79 0. 00 40 .79 ----- 122 . 87 0. 00 22 ---- - 87 acl;o CITY OF CUPERTINO CU ERTINO GENERAL BUILDING PERMIT APPLICATION FORM Dai i5� APN# J UId 00 Date: Building Address: ioa - AIOI rF UC7-0 Mailing Address (if different from building address): a dr o D/Z Owner's Name: Phone#: Contractor: Phone: Fax: Contractor License#: �f-3 SZ? Cupertino Business License#: • G i0. Contact: Phone: Fax: Residential El Commercial Job Description: `'��� �,L,--�Y2��P�5�s"�'•c �Yl/�Gi%4,.� ��.F✓`i Ge._ Building Permit Info: Bldg ❑ Elect QI/' Plumb f71i Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1 FR, 1lFR ❑ 11, 111, VAHR ❑ 11, 111, 1V V-N Valuation: Square Footage: Project Size: Standard [q' Laze ❑ Major ❑ • CITY OF CUPERTINO CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM IBTEMPPER 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 29.31cw 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 Btwb 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 1BAPPLOTH 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. IELECINSP Other Electrical Inspections (per hour) E 1MECHINSP Other Mechanical Inspections (per M hour) 1PLMBINSP Other Plumbing& Gas Inspections P . (per hour 1MEETINGIHR Application Meeting B CITY OF CUPERTINO • CUPERTINO GENERAL BUILDING APPLICATION FEESCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ACOUSTICAL REVIEW IACOUSFDW SFDWL/Duplex New B IACOUSRESAD SFDWL/Duplex-Addition/Alteration B IACOUSCOM Multi-Family/Commercial B CHIMNEY'S 1 CHIMNEY Chimney B 1CHIMNEYR Chimney Repair B FENCES IFENCE>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 CUPEI�TINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM RETAINING WALL(CONCRETE OR MASONRY lRETSTN Standard (up to 50 ft) B 1RETSP310 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 fl 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 SKY >10SF Skylight greater than 10 sf or B structural ISTAIRS Stairs-first flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B 1SRACKS>8 Storage Racks over 8' high (up to 100 B ::]_ st 1STUCOAP Stucco Applications (up to 400 so B additional stucco application • 4of5 CITY OF CUPERTINO CUPEf�F GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group IGENRES or 1 GENCOM 1 WINREP Replacement windows/sliding glass B door (ea 8 windows IWINMEWSTR New Window-structural shear B wall/masonry includes plan ck fee IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M / 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P 1STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B / 1TRAVDOC Travel &Documentation B 1BUSLIC Business License B • 5 of 5 Community Development J 10300 Torre Avenue lCupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 �CUPEKTINO Building Department JOB o&S-ESS&O/2 C7 U vl PERMIT # OWNER'S NAME: PHONE # 0 3/ GENERAL CONTRACTOR /�eg FAX # 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