08030053 CITY OF CUPERTINO coq_.,,
BUILDING DIVISION PERMITxCCyPt 'RADR�TN '' }.�'Ci, iV ;.,
BUI I ESS: PERMIT NO.
w1E�� NORTHFIELD SQ WETZEL CONSTRUCTION 08030053
WNER'S NAME: PERMIT ISSUE DATE
KATHY WAGNER 4028 LAURELGLEN CT 03/11/2008
ONE: SANITARY NO. CONTROL NO.
(408) 594-0706 '"
ARCHITECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION lob Description
MU I hereby aflim That 1 aro licensed under provisions of Chapter 9(commencing p
with Section 7")ol'Divdaitn 3 ofdw Business and Professions Code.and my license is INSTLD NEW GAS LINE, MVD EXTNG 220 VLT OUTLET
in f 1 forte end If
Z_ Ixense Close Lie.g
Dam Conmmor
e ARCHITECTS DECLARATION
e O I melco and my plans Mall W used an,public records
5 Licensed Professional
y OWNER-BUILDER DECLARATION
Contractors
COO 1 hereby a(Om that I am exempt from the Coniracmra License Law for the
i.O o following mown.(Saito 703 L5.Business and improve,
de tib Code:Any city or aunty
9 its+ which requiem a permit m.i.0c4 aide improve,demnhah,or mash any moment
48
prior inl its imumem.also ensedprsuntto me lW apions ullOf for ochpamr's o rile a License
signedmoment
< thatWiscttsed pursuant 70th)of Division
of thec Business and
bw(Chapter Code)
Sq.Ft.Floor Area 300 Valuation
(co�9 'at M 13 exempth SectiWmfm 70007 of basis n l of the Winged
eaand Proon.My
Code)of
Nat be d exempt thae(mm entl die bats for the alleged eamptitn.My viodtiun Of
Section 7031.3 by any applicant for a permit objects the applicant o a civil penalty ofNumber Occupancy Type
wt mart dun fin hundred dollars($500), 316 3 7 0 3 0 A(��
❑Las owner of the property,a my anplo ces with wags a their ole enmpeeuadon,
Will do thework,and Iheswaum 4.1I.WuJed orortamd forsale(SIL.7044.11usinsa
and Prorssmns Code:The contractors Liam) n Law donot apply to an Owner of Required Inspections
property who Wilds orimpmas themer.and whodoessuchwakhimselfmthrough his
Own employees,provided that such improvements ace notimmaded oronered fssair.If.
la wever,the building or Improvement is old within oro your of completion.the owner
Wilder will have the burden of proving NM be did not build Or improve for purpose or .
ale.).
❑1.as owner of the property w exclusively<onsocims with licensed contractors to
owmet the project(Sec.7044,Business and Pofselos Coda)The Contractors Lt-
came law docs net apply to an owner of property who Wilds or impmw thereon,and,
who contracts for such pmjecu with aco=lor(,)ilwoodpursuant to the Contractors '
Lkeae Law.
❑lerssemptundn See .B&PCfor Nisox.
e Dad
WORKER'S COMPENSATION DECLARATION
./ I hereby affirm under penally of perjury no of the following declanms:
I have and will maintain a CeNfinm of Consent to self-insert for Workes
a provided For by Section 37M of the labor Code,for Ne performm a of the
work for which this Permit is Wood.
❑I have and will maintain Workers Compensation resonance,as required by Section
3M.f the Labor Code,Far the performance ofthe work fawhlch this permit is iasa0. '
My Wmi Compensation Mo..carer and Policy number are: .
Canter. Policy No,:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(lTdxction need not be completed tribe iemitis faashundral dollen(5100)
sir lns)
1 cenify that in kCpprfo we of New which this permit is iamd,1 abet not ,
cmployany rami n mamerw ce subjecltoihe Worious Compensaion
9 f4 114 Z4 z1-tS`gF`—
lawf Of ifomia
Appl'
NOT TO PP A :If.a(a a ti Nis Certificate of Exemption,you should
Eecom sub a Woher's Cp pesetion provisions of the Labor Code,you must
.�z feMwt rept ith such pr can or this permit shall be decreed reveled.
„zt O CONSTRUCTION LENDING AGENCY '
[•i I hereby aRm that them ls a construction lending agency for the performance of
rL tiro work for which this permit is issued(Sec.3097,Cih,C.)
W Q Lender's Name
az Lenders Md.
U Q I certify that l have read this application and rote that the above information Is
U,:•" corrin 1 agree to comply with all city and county on inwaea and vale laws relating to
0 SV-: Wilding construction,and hereby authorize representatives of this city to enter upon the
` W above-mentioned property for inspection purposes
LF^+a (We)ago to ave,indemnify sed kap harmless,the City of Cupertino against
ser ti
liabilities mad expesaw 'Amey in any anyurneagsinat old City
V v,Z in conttquonce of granting of this pe L
u•a APPLI U ERSTANDS L COMPLY WITH ALL NON-P NT Issued by: Date
SO ER A S
Signa App eenuCtn a .d Re-roofs
7(-,JS MATERIALS DISCLOSURE Type of Roof
IR the applieaul fretum Wilding aaupssmmarhaudle haurtltus material
an de ned by the Cupertino Municipal Code.Chapter 9.0,and the Health and Safety
eine,section zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
A
❑Ys
Will the epplicat or future Wilding occupant use equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove
emit haeardous air contmisnty an defined by ace Bay Area Air Quality Management all new materials for inspection. _
Dimia7
❑Yn N
I have mal the haallous materials requim mems under Chapter 6.95 of the Califon- .
nen Health&SalCtyD ScWau25 , 33wd25734.1undcoandthatiftw Wilding
I
not curmnlly ams t i mponsihi by to notify the Occupant n the
require m t ani aCenifin.mtrOcap ry. Signature ofApplicant Date
a horiaedascm d' All roof coverings to be Class'W'or better
• CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . .. 31637030. 00
DATE ISSUED. . . . . . . : 03/11/2008
RECEIPT # . . . . . . . . . : BS000004127
REFERENCE ID # . . . : 08030053
SITE ADDRESS . . . . . : 10833 NORTHFIELD SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KATHY- WAGNER
ADDRESS . . . . . . . . . . : 10833 NORTHFIELD SQUARE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . : JOE WETZEL
CONTRACTOR . . . . . . . : JOSEPH WETZEL LIC # 28698
COMPANY . . . . . . ... . . : WETZEL CONSTRUCTION
ADDRESS . . . . . . . . . . : 4028 LAURELGLEN CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95118
TELEPHONE . . . . . . . . : (408) 594-0706
FEE. ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 300. 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
ITRAVDOC 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
----------------- --------------- --------------------
CASH 122 .87
---------------
TOTAL RECEIPT 122 .87. '
•
0$b� 0 b�3
CITY OF CUPERTINO
® CUPEkTiNO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# Date:
� ( b3 � o3o . o0 3 to Q�
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone#:
Contractor: Phone:
j ,/
Jos Fax:`'Wb Y
Contractor License#:
Cupertino Business License#: G e&`?
9
• Contact: Phone: 4c-s
`1 Vim,
�p Fax:
Residential F1 Commercial
Job Description:
22.0 V& oc�TLc-t
Building Permit Info:
Bldg ❑ Elect [9.- Plumb � Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR E] 11, 111, V-1HR ❑ 11, 111, 1V V-N JL- 7
Valuation: 3� y, Square Footage:
S
Project Size: Standard Large ❑ Major ❑
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BTEMPPER 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 29.3kw
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 Btu/h to
&incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & inc150 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 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
IMEETINGIHR Application Meeting B
QED. CITY OF CUPERTINO
GENERAL
• CUPEI�TINO ABUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group .1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
1ACOUSFDW SFDWL/Duplex New, B
IACOUSRESAD SFDWLDuplex-Addition/Alteraiion B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
IFENCEMAS>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
IMODUSTRU 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
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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
1RETSTN 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
IRETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1SIDESTBK Siding, Stone &Brick Veneer B
interior/exterior
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1SKYL>IOSF 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
allF
CITY OF CUPERTINO
cuPr�GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass B
door ea 8 windows
1WIIVMEWSTR 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
1 STPLNCK-(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
5of5
Community Development
10300 Torre Avenue
, I Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB 10235 6 � PERMIT # 0g O V
OWNAME
: K NA : PHONE #
GENERAL CONTRACTOR c;E' (x5t"Z'1� FAX #
I am not using any subcontractors: 3
Si tune 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 Me
Sheet ock
Til
Ory er/Contractor Signature D e