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06060253
CITY OFCUPERTINO BUILDIAGD1VISION PERMIT ' ICOk�FTRAG ,nR�INI'�4IZMATION BUILDING ADDRESS: LEHRER NORMAN H AND LENORE PIMITNo06060253 21756 NOONAN CT OWNER'S NAME: PERMITLSUEDATE LEHRER NORMAN H AND LENORE R NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 i00 LICENSED CONTRACTOR'S DECLARATION lob Description F 'F L thereby affirm that 1 an Hemmed under provisions Of Chapter 9(commencing SXVX2 10fallcorce ad )frfDivisia''n^^3 oftheBWnessaMProfGwiavCotls,andmylicevel DING BATH/ATTIC EXHAUST FAN AND HALL SWITCH :g= LiceneCl , —1v Lm.g 5 . Dem • Color sur ARCHltoCl SDECLARATION PEAK ELECTRIC PAID FOR BL 6/29/06 < I undersand my plans shall be used as public records )yU p e Itt; Licensed Professional ��w IN AL OWNER-BUILDER OE CLARATION yyy p �m 1 hereby,IRrm Nal I am exempt from the COnvectaY.License Law for Ins t`g°�'e{'8jll t{jtf� p o following reason.(Section 71311,Business and Professional Cade:Any city or county j$V which requires a permit m convect.alma impmw,demolish,m minor my annum to _Z' prior to ler issuance,also require,the applicant ro,uch permit to file a signed statement < that he is licensedpurvran,tothcpootsionsOftheConvecpfslxmneLaw(ChaPter9 Sq.FL Floor Area J��(, '_ Valuation P2 $ (commencing with Section 7005)d Division 3 urine Businessland Profession,Cade)m Z00 $800 tl that he a exempt aemfrom and the bub for Ne alleged eaempdan.Any violNon of Section 70311 by my applicant are permit mbjecle the appllaant m a civil penshy,of APN Number Occupancy Type not mom than flaw hundred dollars(S500). ❑1,u owner of Ne pmparty,or my employees with wages u tlteb mlc conpensadon, will do the work,and the surectam l Out intended or a(rereA fo sale(Sec,Islas.Butlnea and Professions Code:The ConoecurY Liceme law does trot apply m an owner of Require p O property who builds or im proves themon,and who dopa such walk him a If m through his awn employees,praNded that each imp nth m mmare no,intended aroResed farssl.U. however.the building or lmpmwmen,is mid within am year orcompletion,the Owner, builder will haw the burden of playing that Irc did not build Or improve for purpose of ale.L ❑1,as Owner of the property. am exclusively convening with licensed coteeta=m v m cotmct the project(Sec.Q.Business and Plafea9ov Cade)Ile Contra mots U. cense law does not apply to an Owner of property who Wilds or Improves thereon,and. who contracts for such pmjero with acontnc,ar(s)licensed Pearson u the ConuacerS License Law. ❑I am exempt under See ,B h P C for this reason OwnerDap WORKERS COMPENSATION—DECLARATION 1 hereby affirm under penalty of perjury am of tom following destinations: I hers and will mainuim.Ceraincem of Camara,to self-ovum for War4Y,CamPen- sa0on,ss provided for by Section 7700 of the labor Code,for the performance of But work far which Ilia permit is issued ❑1 ban and will maintain Wo es Compensation IrsPrnnce,as activated by Section 3700.f the lobar Cod.,for the pe fmaranco orae wok farwhich this permit is Wwd My works Compemativ Inmrarute carrier and Policy n am: Gy p Cartier. Policy No.: r o Z CERTIFICATE F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thbuerlam need not he completed if the permit is foram hundred ddln($100) or lye) I certify that in Ne performance of the work for which this Permit is Wwd.i Mail not employ any person In my manerm as In become subject to Me Workeri Cmnpeaiation Laws of Calif Tram.Dam pp Ma NOTICE TO APPLICANT:If,after making this Ccnifl m of Exemption,you should become subject as the Worker's Compensation i mvisiov of the labor Code,YOU must .J O furthwlth comply with arch provisions or this permit Nall brev Ise located oked. z= CONSTRUCTION LENDING AGENCY E.n I hereby affirm the there b a cowmcdon lending agency for the performance of a m++ the work fur which this permit Is Issued(Sec.7097,Civ.C.) WM 0 Landena N,me =z Lender's Ando.. U O 1«nlfy that I haw lead this application and sum t u the allow information is Is.F ccurnm I.gee in comply with all city and county adinsecv and state have reWag to OU building constmm ction,and hereby anlhOnxc mpreseariws Of Nis city to enter upon the U ahove-mentioned Property for ivpecamt Purposes p5. (We)agree m ave,indemnify and kap hums.the City a(C.Plo m.against ti r/f lisblliOe,Judgmenu.coeu and.. whicn ma In my way seep ageivlsdd City U'Gj In conuqueve of the gnn0ng of this It. APPLICANT UNDER TAN D MPLY WITH ALL NON-POINT Issued by:S Date 24�GG APPLICANT SOURCNT UNDER c - Re-roofs shgnarumor AppHcam/Cm Dam Of Roof HAZARDOUS MATERIALS DISCLOSURE Type WIII the applicant,or Tatum building acevpmtamre ar handle harem..material u defined by tit Cupcdno Municipal Cade.Chapter 9.12,and Ire Health and Safety Code.Section 2557x(a)? / All roofs shall be inspected prior to any roofing material being installed. ❑Yes PNu WIII the applicant or future buiiding Occupant use cqulpmcnt or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit bandaus air complainants as dcOncd by 0m Bay Ams Air Quality Mmagcment allnew materials for inspection. Disuin? ❑Yca TNu I haw read the haadom m,mrialsrequhcmenu underCMpur6.95of0mCuifo- nil HcalthB Saloty Code,Sections 25505.25533 and25534.1 underand thatifthe building dos not current] n au I,b my rc,poviblli,Y u notify the mrcupan,nrthe requirements chmv PnarmWamaar,cedBamp SignatureofApplicant Date Owner ar.mmaried,gem l' mm All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue �io' Cupertino CA 95014 Telephone(408)777-3228 Cl OF Fax(408)777-3333 _ #UPEI�TINO Building De artment JOB ADDRESS: PERMIT # 2 1 s von)AV CT 0 6 022s_� OWNER'S NAME: /1,4F. , Rm PHONE # GENERAL CONTRACTO FAX # I am not using any subcontractors: g�� '2 ` Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical 5 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 •29•G� er/Contractor Signature Date CITY OF CUPERTINO om 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35719066 . 00 DATE ISSUED. . . . . . . : 06/29/2006 RECEIPT # . . . . . . . . . : 35078 REFERENCE ID # . . . : 06060253 SITE ADDRESS . . . . . : 21756 NOONAN CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LEHRER NORMAN H AND LENORE R ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5912 RECEIVED FROM . . . . : TOBIN PEAK CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : LEHRER NORMAN H AND LENORE R ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5912 TELEPHONE . . . . . . . . : SEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- --=------- ---------- ---------- ---------- BREMVENFAN NO UNITS 2 . 00 52 . 41 0 . 00 52 . 41 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 269 . 01 0 . 00 269 . 01 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 269 . 01 VISA TOTAL RECEIPT 269 . 01 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • GSA© CITY OF CUPERTINO CUPEI�F PERMIT APPLICATION FORM N# Date: ( 02`l I OU Building Address: Mailing Address (if different from building address): 'Z '?s 6 AJoo Owner's Name: Phone#: S - ' -!� Contractor: � Licen Z R 3 8 Contact: Phone: Cupertino Business License#: N Fax: 408.6�5.9ZZD Building Permit Info: Bldg ❑ Elect Plumb Mech ❑ Job Descript' n: FSC S Y\ N LL S Residential 9- AbI1r-&)G- FAAA Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Pr 'ect: Occupancy Grou . Roo V_— Type of Construction: Please check this box if the project is a second-story addition: ❑ MALL 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> I OOK 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> I OOOA ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATCComm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmos hcric 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 Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10,000 din 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 Mise 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 2 of 3 a CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL 2-1 BREW NFAN 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 Ternp 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 Chane BUILDING • 3 of 3