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06090101 CITY OF CUPERTINO - a, ,�,mss. a� 2"• �"` "''' �`; gee? BUILDING 01VISION PERMIT rottC� CTQ,R Tai ,x .kl'ItJN BUILDING ADDRESS: FISCHER PLUMBING & CONST P"MITNO-06090101 20236 NORTHBROOK S OWNER'S NAME: PERMR L45UEDATE SHARON COLE 2766 SCOTT BLVD 09/14 /9,006 NE: SANITARY NO. CONTROL NO. (408) 727-2426 ARCHRECVENGWEER: BUILDING PERMIT INFO BLDG ELECT PLUMB tu 0 t� MECH l� pop LICENSED CONRACTOWS DECLARATION Job Description V 1 hereby affirm WI 1 an lixomod under provisions o(Cbapmr 9(commencing with Sudan 7000)af Division S afire Business and Pro(essiov Code aMmylicenscu ; N in fullaaaneare C3� INSTALL GAS FIREPLACE INSERT GAS LINE, & ELECTR Z Liana iW Lk.w Co.,.DECLARATION QQ ARCHriECTS DECLARATION i 2� I understand my plans shall W used As politic rpnNs i� -c I .by LicensePtnel 5 OWNER-BUILDER DECLARATION Wrchy al'fim that I am exempl from to Conuactu's License Law for the (/ .po fallowing..an.(Section 7031.5,Business and Pmfeninm Cade:Any city or County 5$? which requires a permit to convect.alcor,haporn,demnlsh.or repair my structure $1200 -zy prior to its issuance.Alan requires the applicant fmsuh permiuo file a signed MWMC t Valuation I C that he isllcemeJpunamltothe p.,i.iamofthe Contractor'sLima.Law(Chepmr9 Sq.Ft.Floor Area 2 (commencing with Section 7000)of Division 3 nfthe Bumumand Profession CndeJ err `i that he m sectors therefrom and the bum far the alleged evmptlu.My vloladan a( Sudon 7031.5 by airy Applicant for a pemW subjects rhe appliaanr to a civil penalty ofer Occupancy Type not mom than five hundred dellen($500). ❑1,an owner of the property,or my employees wit wages As their sets compeavdon, will do Me work AM Am Aware.is at iodated uroffered for We(Sm.7W.Businev Required Inspections and Pm(malam Cade:The ComrxctoYs License Law dose ml apply to an owner of q P property who buildsorimprovesthe men,aM who doessuch work himmlf ar Waugh his own employes,provided thus such Improvements arc not InenMM aroRerad fmsak.If. however,the Wilding or improvement is sold notion am year of coropmdon.the 0w builder will have Use burden of proving that he did vel Wild or improve for purpose of sale.). ❑1.As owner of the property am exclusively convacdng with licensed mnuacbrs as comma the project(Sec.7044•Business and Professions Code:)The Commeah Li. cense taw does at Apply to an owner of property aha Wild,ar hop rves thermn,and, who convicts fm such projects wilt•mmentsm(s)licensed pmwunt W the Conlrctofa us.Law. ❑lam vempl under See .B&P C for this reason On. DAM WORKERS COMPENSATION DECLARATION I buddy affirm under penalty of perjury am of the fallowing declaruionr. I haveand will maintain•Comfiesm of Consent he self-blurt for Worknes Compen. sutian,v provided far by Sudan TIM of the Labor Cade,far the prfame a of Me work for which this pmlt is wood. ❑I haw and will maintain Worker's Compensation Insurance,As enquired by Sidon . 3700.17 the Labor Coda,far the perform.of the work fm which this permit is ivoed. My Workefs sod/qn Imu ee artier and Policy num u tie: Cartier. V G Policy No.: CERTIFICATE OF EXEMPnON FROM WORKERS COMPENSATION INSURANCE (This section need ml W completed If the pmol Is forom hundred dollen($100) fir lass.) I unify that in the performance of the work for which this permit is ivoed.I shall not employ any person in any manner an As to become subject to tW Workers'Compensation ' Laws of CelifarnI&Dam Applicant NOTICE TO APPLICANT:If.after making this CeniOcato of Exemption,you should become subject to the Worker's Compensation previsions of the Labor CMB you most ., forthwith comply with such prov(dWu pm am or iuhall he Conrad revoked. ?O CONSTRUCTION LENDING AGENCY F+ 1 Wroby aflme Also them is a construction lending agency far the orfomme,of rf the work far which this,permit is issued(Sec.3097.Co.C.) 0. Lenders Nurse z Lamim.Addrev U Q I certify that 1 hoe rad this application AM sum this Me show infomradun is coma 1.1ree to comply with all city and county mi inan.a and Atsm laws nelmat an 0 building Construction,and herebyauionim mpreemariva of this City to enter upan the r W move-mcmmnct property for inspaion Purposes. (Wc)agree to save,indemnify and keep humleu tW City of Cupertino..& ran „Fyy liabilide,judgmena,cvts and dApenses which may in any way amue agaimt said City U Z, in consequence of Ne grandag of Wis prtqit. ^ APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGUTATIpN3— q_/T S. / L /f_C� / Re-roofs Sigwum a(A Iam'Cormaclar /— Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will lta applicant a forum building aaepantstom or handle hanNo s matenal As defined by the CupeAno Municipal Code.Chapter 9.13,and the Halth and Safely Cade.Sudan 2553x(,)7 All roofs shall be inspected prior to any roofing material being installed. C]Yen Na Will the applicml or future building occupant and:equipment m deviceswhich If a roof is installed without first obtaining an inspection,I agree to remove emit harardnuA air coommimnu v fined by the Bay AMA Air Quality Management all new materials for inspection. Disuiu7 [I yea Nu I hive road the meardous materials requirements under Chapter 6.95 of the Cahfor. .is Health&SafetyCode,Smile.255)5,25533 and 25534.1 undenrmd does ifthe Wilding dean not currently hove A mnmi,that It is my resp osibility to rally the occupml of the requircmen which t alpnormIssuance Oflon"filcamofOccu ancy. Signature Of Applicant Date 71w, �y All roof coverings to be Class"B" or better Owner or suthoriecd agent Dam Community Development 10300 Torre Avenue . /' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 #UPEkTINO Building Department JOB ADDRESS: PERM1T # zoz3,c 404bro s �^a OWNER'S NAME: f PHONE # 7Z7- Z GENERAL CONTRACTOR 4FAX # 7 - 7 I am not using any subcontractors: /J 17-111- 16 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 CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31639023 . 00 DATE ISSUED. . . . . . . : 09/14/2006 RECEIPT # . . . . . . . . . : 36042 REFERENCE ID # . . . : 06090101 SITE ADDRESS . . . . . : 20236 NORTHBROOK SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SHARON COLE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : FISCHER CONSTRUCTION CONTRACTOR . . . . . . . : TERRY FISCHER LIC # 23896 COMPANY . . . . . . . . . . : FISCHER PLUMBING & CONST ADDRESS . . . . . . . . . . : 2766 SCOTT BLVD CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050 TELEPHONE . . . . . . . . : (408) 727-2426 4kEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 1, 200 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BPFIXTURE UNITS 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00 BSEISMICRE VALUATION 1, 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00 PPERMITFEE 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 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 247 . 69 0 . 00 247 . 69 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- --- - ---- ---- ------------------ CHECK 247 . 69 45097 TOTAL RECEIPT 247 . 69 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 204 UNDERFLOOR FRAME 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS • aTYOFCITY OF CUPERTINO MqCV I CUP kT O PERMIT APPLICATION FORM N# Date: l — /'r 06 Building Address: Mailing Address (if different from building address): Owner's Name: Phone #: Z 53V 7 ?t Il . D G Contractor: License #: Conta : � Phone: 7Z 7-ZNZ Cupertino Business License#: gc 4- ,r /e � Fax: 7Z7-77L Building PJrmit Info: —/ Bldg ❑ Elect 2 Plumb 09"/ Mech [� Job Description: ina ,Jq5P ace �,,rtr Residential S !ih n; e%c Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: �ZoO Occupancy Group: TypfofConstruction: Please check this box if the project is a second-storyaddition: El ro'ect Size: Standard L"J Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM 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 I of 3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM QuantityFee 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 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain 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 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm 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 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 2 of 3 CITY OF CUPERTINO CUPEI-TINO PERMIT APPLICATION FORM Quanti Fee ID Fee Descri tion BREMSIGNADFee Group Rmdl Si s Add Branch ELECTRICAL BREMSIGNS Remodel Si s, Mar uee ELECTRICAL BREMTHEATR Theatrical Li tin Fix ELECTRICAL BREMVENFAN Vent Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation S stems MECHANICAL BS BLVD Scb S ecific Plan BSEISMICOM BUILDING Seismic Commercial BUILDING BSEISMICRE Seismic Fee BSPECIAL Res BUILDING S ecial Ins ection BUILDING BSWIM Swimmin Pool BUILDING BTEMP Tem ora Power ELECTRICAL BTEMPPERM Tem orar Bld Permit BTEMPSVCSBUILDING Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical s foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance PPERMITFEE MECHANICAL Plumbin Permit Issue PLUMBING PPLBG Plumbin Fees foot PLUMBING PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING PLLONGRNGR Plannin 11,2gg Range Residential PLANNING ZADDCHG Address Chane I BUILDING 3 of 3