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06030154 CITY OF CVPERTINO BUILDING DIVISION PERMIT �NTR�IGQ ,TNT+'O;,R 'IATTO BUILDING ADDRESS: PERMITNO. 10919 NORTHSHORE SQ OWNER'S NAME: PERMITISUEDATE MARRON HONIGMAN 03/27/2006 WN E: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 300 LICENSED CONTRACTOR'S DECLARATION O O O � 1Maffirm s1amun derpmviaons OfY(rommendng o Descripti with Secdo.70no OIAon3rfm.Stainesamd Prvfcuinm.Cods. ndm licenseis in full forceandc((ect. EXTERIOR PATIO LIGHT License Class Lie.N F'NAL EDnZ Dau Contractor ARCHITECTS DECLARATION ��� 2UU6(y Q 1 understand sh nd my plansell M used u public records IT KKK L0 6 1 G t; Lkcnsed Professional i3 OWNER-BUILDER DECLARATION BUILD f, . s Q � 1 I hereby ofOrm Nm I R-exempt from the Conualor'4 License Law for dm Uf i p 0 (ollnwing mmon.(Section 7031.3,Business and PrOdeselnns Code:Any city or county 5 32 which mqulrea a permit v,construct,anct,improve,demolsh.m repair any structure prim to its issuance,also reruims the applicant forurch Permit be file a signed statim id zFF< Net he is licensed puaranuomeprovsiomrfthe ComiacmrtUanseLaw(Chapter 9 Sq.Ft. Floor Area Valuation d� (commencing with Section 7")of Division 3 of the Busi•cem and Professions Code)or N a et be Is exempt therefrom and the basis for the alleged camplodon.Any violadon of Sector,7031.5 by airy appllcantfor a permit subjects the applicant m a civil penalty of um er Occupancy Type tot m thin five hundred dolsn($500I. I,u owner of the property,or my employees with wages u their sole mmpenaadon, will do the work,and Out stmctu a is not intended or oriented monde(Sec.7016.Business and Professions Code:The Commute,Liana Law dins tot apply to an comer of Required Inspections property w ho bui Ida or im proves thereon.and who doess ucb weak himself or through his awn employ=,provided thatatmh improvements arc not Intended oroffeeed forsax.If. however,to building or improvement is sold within one year of completion,the owner- builder will Mw rte burden of Proving Out he did not build or Improve for purpose of sale.). ❑1.as Owner of the property am cxcimively contracting with licensed convenors to cumtmct the pmject(Sec.7044.Business end Prefeubmt,Code:)The Contractor's U. dome Law does not apply to an owner of Impeny who builds or improves Ommon,ad, who contracts for such projects with acomrator(q licensed pursuant to the CmuacaYs License Lew. ❑I am axe tm/yt� ftd �Sec ,9r�^ .B k PC fm W3 moan Owner t F/VI/ltt � t,,-�,' It - —. WORK WS COMPENSATION D LARATIO 1 hereby affirm under pelfty of perjury One of the following declarations: ham and will maintain a CeniOreu of Consent to self-Insure for Worker'sCompen- aetion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is lamed. ❑1 ban and will maintain Worker's Compensation Imuratice.as required by Section 3700 of the labor Code,for the performance of the work for which this permit is ismod. My Worker's Compensation Imurstice carrier and Policy number art: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Inds sef ser need not N completed If the Permit is far one hundred dollao($100) or lata) 1«nify that in the performance Of the work for which this Permit is issued,l dull not employ any person in my manner an as las become abject to the WorkerCompemelion Lemur California.Dau APpil., NOTICE TO APPLICANT:If.after making this Ceninum of Exemption,you should become subject to the Worker's Compensatton provisions of Ne Lahr Code,you most .J O forthwith comply with such Pmvlsiom or this Permit shall be doomed mvokcd. 'Z y CONSMUC ION LENDING AGENCY 'c+ I hereby affirm dol there is a mnsuvcinn Lending agency for de performance Of the work res which this permit is issued(Sec.3097,Co.C.) W Q Lender's Nurse Z Lender's Address V Q I certify that I have read this application and sum that the show:information is II.f-- Correct.I agree to comply with ail city and county ordinances and auto laws musing to 6 V building construction.and hereby amhorvs represernativrs or this city to enter upon the W alovomemioned Property for inspection poorness. (We)agree to ave,indemnify and keep haerokas the City of Cupertino against y liabilities,judgments,costs and expenses which may in my soy accrue against said City U 7 in consequence of the granting of this permit. I� APPLICANT UNDERSTANDS A D WILL COMPLY WITH ALL NON-POINT Issued by: Date FA TI N roofs ppa Signature of Aonl t Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the e,Cupertino m futorc building ec Cimpou toto ordands heallous manurial as donned by the Cupmine Muninpal Cade,Cbeluer 9.13,and the MWN and Safety cede.Section 25537()7 All roofs shall be inspected prior to any roofing material being installed. Cl Yes Will sec applicant or future building Occupant um equipmml or dcricaa which If a roof is installed without first obtaining an inspection,I agree to remove bmrdom air unuminau fined by the Bay Area Air Quality Management all new materials for inspection. uvict7 ❑Yes Nu I bee mad the handlwsmamries requirements underL7upuo15.95 of the Caiifor- nix Health At SafclyCode,Section 75505.35533 md25534,I undminand thatifdm building does not currently have a u iml. Y It s my pomibillly m nedry Ile occupant err the I m n which tr t et rmla ane is mfieamor eta may Signature of Applicant Date' i Owner or euthoriaad agent Dam All roof coverings to be Class "B"or better CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31638030.00 DATE ISSUED. . . . . . . : 03/27/2006 RECEIPT #. . . . . . . . . : 33752 REFERENCE ID # . . . : 06030154 SITE ADDRESS . . . . . : 10919 NORTHSHORE SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MARRON HONIGMAN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0533 RECEIVED FROM . . . . : STANLEY FUELSCHER CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : MARRON HONIGMAN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0533 TELEPHONE . . . . . . . . : ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL __________ _____________ __________ __________ __________ __________ __________ BENERGY PERMIT FEE 1.00 34.86 0.00 34 .86 0.00 BSEISMICRE VALUATION 50.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00' 38.37 0.00 __________ __________ __________ ---------- TOTAL PERMIT 73.73 0.00 73.73 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ ________-__-__---_ CHECK 73.73 4097 TOTAL RECEIPT 73 .73 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL i amCCITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM N# /�` - � �O�JIJ Date: 7BuildingAddress: '^G Mulling Add ess (if dif Brent from building address): 7hn ner' Name: U 1 f l� Phone#: r���n tc �c. _4 - Contractor: `r License#: Contact: Phone 53 Cupertino Business License#: Fax: — Building Pern&Info: Bldg ❑ Elect e/ Plumb ❑ Mech ❑ Job Description: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: n , / l l Occupancy Grou Type of Construction: Please check this box if the project is a second-story addition: ❑ ljj�o'ect Size: Standard ❑ 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 1 of3 CITY OF CUPERTINO " CUPEf�r 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 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 cfm MECHANICAL BREMAHU-IAN 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 2of3 CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 BSWB4 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 Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3