06090016 CITY OF CUPERTINO
BUILDING DIVISION PERMIT I2INF'QRMAT.CO
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BUUDINGADDRPSS: HOME IMPROVEMENT BUILDING p"""rNo.06090016
1582 MORNING SPRING, CT
OWNER'S NAME: PERMIT ISSUE DATE
JAMES CHUM 4250 WESSEX
NE: SANITARY NO. CONTROL NO.
(408) 265-7626
ARCHITECTMNGINEEK: BUILDING PERMIT INFO
BLDG 0 ELECT� PLUMB
MECH0
p LICENSED CONTRACTOR'S DECLARATION - Job Description
ix 1 hereby&in=met 1 sm lieavd under Provisions of Caper 9(ammmang p
i< with section 70M)ofDivision 3ofOm Budross and Pre(adou Code.sitl my licenmb
,a infullmmeameRncye �yC12�5Z SIDING REPLACEMENT
i v2 Z Licenn Clan /S Lit.
I� Dam Contractor
ARCHITECTS DECLARATION
I Underwood my plana shall k used u public records
s CCClll
Licensed Professionalm OWNER-BUILDER DECLARATION
I�9 I hereby affirm that 1 em exempt from the Cenaact01's License Law for the
,p o following mason.(Section 7011.5,Business and Professions Code:My city or county
S$ which mqulma a permit m conam¢t, [Mr.hnpmw,demoibh,or repair my suunum - $25000
-Zsn prow m its issuance,Stan acquire mkapplieans forvech permit to file asignud,u arem
< Mat he is licensed puns ,to Me provisionalof the Committee,License Law(Career9 Sq.Ft.Floor Area Valuation
i5i (coma wn th
tWSection7000)af Divuine e WPm
icn3ofBuifcs Om Cade)w
dot be b attempt therefrom and the bub fun the alleged eaempdom MY vmladen of
Scalon 7031.5 by any applksm far a permit subject mk Spplkant to a civil P—_IIY of r U Occupancy Type
not mom than gun hundred dollars(SSfD).
❑1,as owner of the property.ar my employees with wages as thebmle compenudon,
andell r that Wars molt he ComknwsLicenseraw ed data fY apply
7044.BYLwa\ Required Inspections
and property
who
Code:The Coeemon,License law data rot apply lf an o sin is q p
Own emy who bmfIdo i improvesch Iren,and wbo dossuchwaryhammerer through his
Own empkycWipmWor i that such Improvement ase not ear ofe woiemd the Owner.
however,Ne building or improvement lamed a did one year ofimproo for theOwner.
Or
Sale). will have gc herdcmt of proving Nat k did em bons at improve far purpose of
Sale).
/ y
❑I,u owner of the property am esdusively cOOWcfing with Biased mntractma m
euutct the project flee 7044.Busima and Professimu Cade)The Cmt»no/s Li- ^
meas law owe not apply to an awns of propmy who builds or imposes Osten.real
who eact
cfor such projects HN etra
annortU Ilcvueo pvant m aothe Cameramen ar', /
l am Law.
0 lam /
suempm underSec, .BBPC(ar this muco
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ons of the fallowing oeclandees:
1 tan and will maintain a Certificate ofGonsens to self-iuum for Workcr'SCompm-
sation,as provided for by Section 3700 of the labor Cade,for mk Performance of the
work far which this Pemtit is issaed.
❑1 ave and will maintain Workees Compens udnn Insurance,as;mytvm by Section
3700of the Labor Cade,fun Me performance of the auk fwwhich than Permit is blued.
My Wwkaes Com arts bavmma 'er aisd Policy nvaher>R:
Ca Policy No.:196 C-C�
CE •CA P EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thin secret need multeaampkmd If tic permit Is foronehundrd dollen(SIM)
.,less.)
1 eatery Chet in the performance of the wart for which this Permit is issued.l shall not
employ any person in my mannerm u m become subject to Me Worth Comp nommen
Laws of California.Dam ,
Applicant
NOTICE TO APPLICANT`.If,after making this CemRac of ate rra o t,you should
become subject to tic Worker's ComPemUon provisions of the labor Coe,you mat
Oforthwith comply with Such provisions;or this Permit mall k tlmmed mated.
zi
. CONSMUCf10N LENDING AGENCY
�
C•+ I hereby alarm that them b 4 couutcUnn lending.pcy,run the Perfwmence of
Wv > the work for which this permit b laced(Sec.3097,Civ.C)
W1W Q Lenders Name
a z Lender's Addma
U O 1 comfy that 1 ave read this application and sum that the ahem infomatie Is
D.P comet.1 time an comply with all city and county ordinances and Sum Mo,muting to
O U building construction,and hereby authwim representatives Of this city to enter Oman the
a about-menguned property for Impaction pugmses.
(We).gree to um,indemnify and Soon harmless the City of Cupertino,against
wN dabilidu,juogmet,cama and e.pcn.0 which may in any way aC,meagWnsl mid City
U z in consequence of the granting of this Permit. ��_ G
�-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIO
Re-roofs
Signarurt of pplkmgConumser c
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the ippliam or future W ILIMg eceupanLaore or Mole haumom mammal
as defined by the Cupenino Municipal Code,Chapter 9,11,and the Health and Safety
Code,section 1553x.)7 All roofs shall be inspected prior to any roofing material being installed.
Cl Y..
Will the applicant or future building Occupant um equipment w devices which If a roof is installed without first obtaining an inspection,I agree to remove
mh ammou,air centime manta as&,ilmusl by the Bay Ams Air Quality Management all new materials for inspection.
District?
❑Ya Nu
1 ban mail the bmammusmuMah requirement mmkr Chapmr695 Of the Califur.
US Halo&SsfctyCoe,Sectiwt25505,25533 mW25534.I undcrnud thnifmk building
�0-., Comedyhat,Nat It b my responsibility m amgfy the oaupant of the
'ran facertincamaf0capacy. Signature of Applicant Date
Dam All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
r ; / Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4§UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT # .
C-7- 060 -? 00 � (�
OWNER'S NAME: PHONE # S"-
GENERAL CONTRACTOR: Xw
AA -- FAX#
I am not using any subcontractors:
gnature 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
bwner/Contractor Signature Date
CITY OF CUPERTINO
sm 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36652036 . 00
DATE ISSUED. . . . . . . : 09/05/2006
RECEIPT 4 . . . . . . . . . : 35896
REFERENCE ID # • : 06090016
SITE ADDRESS . . . . . : 11582 MORNING SPRING CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JAMES CHUM
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : TONY GUIDOTTI
CONTRACTOR . . . . . . . : TONY GUIDOTTI LIC # 27139
COMPANY . . . . . . . . . . : HOME IMPROVEMENT BUILDING
ADDRESS . . . . . . . . . . : 4250 WESSEX DR.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95136
TELEPHONE . . . . . . . . : (408) 265-7626
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---- - -------- ------- --- ----- ----- ------- - -- ---------- ----------
BENERGY PERMIT FEE 331 . 56 159 . 15 0 . 00 159 . 15 0 . 00
BPERMFEE VALUATION 25, 000 . 00 331 . 56 0 . 00 331 . 56 0 . 00
BSEISMICRE VALUATION 25, 000 . 00 2 . 50 0 . 00 2 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 493 . 21 0 . 00 493 . 21 '0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ----- - ------ ------------------
CHECK 493 . 21 3282
TOTAL .RECEIPT 493 . 21
•
gt 5��alr- CITY OF CUPERTINO O(MODID
CUPI PERMIT APPLICATION FORM l
N# � Date: S
Building Address: Mailing Address (if different from building address):
Owner's Name: Ch Phone� _ _
Con actor: / License#:
r
Contact: Cupertino Bu„sincls L' nse#:
Fax: I
Buil ng 15ermit Info:
Bldg 8_� Elect ❑ Plumb ❑ Mech ❑
Job Description: J �
Residential /��(ate Commercial ❑
Sq.Ft: Floor Area: v Sq.Ft.:
Cost of Project: Occupancy Group:
,3
Type of Constructio Please check this box if the project is a
L&Lsecond-story addition: ❑
ro'ect Size: Standard 14� Large ❑ 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
ip
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CITY OF CUPERTINO
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING '
AD
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 rinkler/Backflo PLUMBING
BPSTORM Stonn/Raln Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 efin MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation ofFumace 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 Repair/Alter Heating MECHANICAL.
BREMRESAPP Remodel Res Appliance ELECTRICAL
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GQ CITY OF CUPERTINO
CUPEI�F 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 Inspection 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 Ran a Residential PLANNING
ZADDCHG Address Change BUILDING
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