08050138 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ckCONTRAC�aT,QR.�IN,F,QItMATIO,N
n
BUILDS: PERMITNG.
.r8f� FSOAKVILLE AVE LIGHTHOUSE ELECTRIC 08050138
NER'I NAME: PERMTr ISSUE DAM
NTCKOLAS VELASTEUI 236 BURNING TREE DR 05/16/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHI=/ENGINEER: BUILDING PERMIT INTO
SERVICE CHANGE OUT 125 AMP BLDG ELECT PLUMB MECH
O O O O
sop LICENSED CONTRACTOR'S DECLARATION
Wm 1 herby affirm thea 1 w Ikenad abler provisiaas of Chapter 9(commcncin{ ^^___.._....� �_-,. _ _„ ,.Iob.Description
ii with Susech'(1k1)of Division 3 ofW Business and Professians Cade,and my lkenmu
_=N in full force R
Z License Chis 11 Lie.• 6sa ��
CFl Dau - /O-jf o-Coouactslj l7N0.Cf-FltK7RrC
��yuu ARCHr1EC17S DECLARATION
p < 1 uMenunJ my plans shall k used no public momsh,
c
5a� Licensed Professional
3 OWNER exempt RmsDECLARATION
I kroby uRrm thus 1 em exempt from the Conualofa Liana law for the
i cto following won.(SwanB, too. p .ckhous Calc:Any city os county
which requires•permit m consumer,plan improve,h permit t fi mpsig ed avunam
j, priwuiuiensed p.alw�oitetk ao for work permit to cook Lacdnatemem
ss< Wlkulicev with
Scedon 7 c provisionsiisio3 Ox of
and enxlaw(C odc)or Sq.Ft. Floor Area Valuation
xl-9 that xis with SeNrom and of basis for
of the Busmen and Professions Code)of
Wt k u exempt therefrom and Um buil for W plkgW eamption Any violation of
Seeks 70313 by arty applicant for a permit subjects W applkal to a civil penalty of APN Number Occupancy 71{ye
W,more than five hundred dollars(351k7). P Y •]P
I,uownorofB pmpeny.mmyemployaawiLh"rAuthekmle=pewadw,
willdoWwork,cod Neswmumuweintendedof.U.rt fwsak(Sec.7W,Businea
and Professions Cade:Tk Characters Lt..law docs not apply m w awns of Required Inspections
propeny wk builds or improve thereon,and who dans such weak himself or through his
own employees,provided Nutsuch improvements K not intended oroBemd for sale If.
bvwew,W Wilding or iron,a prove 4 cold within one yen of improve
for W
builder will have W Mudrat o[proving that k did out build m improve far puryam of
eek).
❑1.an myna of tk proputy.ma exclusively contracting with acensal contraemn m
ceatstrom the project(Sec.toss.Business and Prefundoos Code)TW Commences U.
cense taw dap out apply he an ownor of poaremy who builds or improves thereat. it
who contracts for such projects with•amrmmr(s)licensed pursuant to the Conu Imes
License law.
❑tem eampt undor See .BRpcforthisnumm
Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of Nosey arc of W following decWatiou: -
I bsm.W will munWn s Cenirxsu ofCouent m self-insum for Wodmr'sComNn-
ruion.as provided for by Section 3] of the labor Code,for W performance of the -
work for which this permit is isrued. '
1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 ofthe labor Cade.for the performance of tk weak for which thea permit is issued.
My Workees Campemmion Issuance artier and Policy number are:
Carrier:VAp(An Aw CE Policy No.:(-)UN O L 'I fSY 2 of
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu moment mond wtkcmnpimcd Uthe person uforWe hundred down(SIOM
or leas)
1 eemify that in the pmfeammce of W work for which this permit u issued.I small col
employ any persun in my meaner.as in become subject in tk WorkerChmpenssdhn
Lawn of California.Date
Applicant
NOTICE TO APPLICANT:IC after making Nu Certificate of Exemption.you should
become subject in the Woracei Compensiuon provisions of the labor Code,you hours
.J O fenhwith comply with such provisions or thea permit shall k deemed mvokW.
z " CONSTRUCTION LENDING AGENCY
[+� IMmby dram that dors Is a cousuuctinn leadiol.gency for the perfecounce
�i of
the work for which this permit in issued(Sec.3097,Ci,.C)
erm
Wh Q UndCS Name
Z lenders Add=
U O 1 certify that 1 leve fad Nis application and .in dap on,some information Is
LL ^. correct.1 agree m comply with LI city and county ordinances cows d sum lamining x
Q rV' Wilding construction,ad hereby wlionas mpmacnudves of this city in comrupon Ne
[r7
move-menudgm property far i expenses
poperwhich may
gL (We)agree m ave.indemnify and kap hamkn the Coy of Cupenifm aguest
Z in
aunce of the
tsng of this pe whichmryin aywyamuc agsiustseid City
U Z A conmgucrta of the granting of this permit.
`-' APPLICANT UNDERSTANDS AND WILL COMPLY WTfFf ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. i
Re-roofs
Signature of Applica HAZARDOUS
pas
HAZUt,= MATERIALSDISCLOSUREType of Roof, /
WIII yt e Cupertino
or IMunicipal
uni building oceupae rsore or handle Health
material
u defined by the Cupertino Munici W I Cade,Ghaptef 9.13.aM Ne Health and Safny
. ection M5320)?0y. Ne All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an agree to remove inspection,I
Will the applicant or mwffm��,b000(ding occupant six equipment m devices which P
.nah 11uraNnus in, fiwd by the Bay Area Air Quality Management all new materials for inspection.
❑Yes gf/
I have real the haardousmsmnau mqumemcros undenchapmr6.95 of the Caifw.
me Hal&Safety Code.SeNhns25505,25533 am135534.1 wderstsn lthnifNt building
does teal currently have a keno that it is my responsibility m notify the oaupmt of the
requirements which most be met prior to issuance of a CeruRam of Occupancy.
S ib_oS Signature of Applicant Date
Te
Owns sir wthorvtd agcm Dau All roof coverings to be Class'%4"or better
'
Community Development
10300 Torre Avenue
r � Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
SEUPEkTINO
Building De artment
JOB ADDRESS: I 0 (42_C, 0AIGV1«A aVE PERMIT #
Gu oe276n1 �C- 01S 1'1 d U p O SOl
OWNER'S NAME: rv-i c cLAC L�czA-v7t-7.,F PHONE #4/v s' - V-73 S 3P
GENERAL CONTRACTOR:C.ican4�se czec-/2( FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical �,F H7�fous� EZEc�2r c
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
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36913010 . 00
DATE ISSUED. . : . . . . : 05/16/2008
RECEIPT #. . . . . . . . . : BS000004805
REFERENCE ID # . . . : 08050138
SITE ADDRESS . . . . . : 10420 OAKVILLE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. NICKOLAS VELASTEUI
ADDRESS . . . . . . . . . . : 10420 OAKVILLE AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4519
RECEIVED FROM . . . . : LIGHTHOUSE ELECTRIC
CONTRACTOR . . . . . . . : ALAN FORTIN LIC # 27871
COMPANY . . . . . . . . . . : LIGHTHOUSE ELECTRIC
ADDRESS . . . . . . . . . . : 236 BURNING ,TREE DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95119
• TELEPHONE . . . . . . . . : (408) 590-7565
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 2, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 192 . 08 0 . 00 192 . 08 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 192 . 08 2009
---------------
TOTAL RECEIPT 192 . 08
•
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
�OSO/3�
APN # Date:
-61fCj'-j 3 U►O. cc
Building Address: /042-0 oakMce—AVISFp
C� fev-T/NO r—'A R S-O /
Mailing Address (if different from building address):
Owner's Name: /,.,tcot-As v67.A5reui Phone#:
YoSr - �}s - 893 b'
r
Contractor: G,S�,t�a _e Phone: yo fr- _5-5o - -4-9-T
Fax:
Contractor License #: (�S`U SZ►
Cupertino Business License #:
• Contact: Phone:
Fax:
Residential Commercial
Job Description:
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
I FR, I IFR ❑ 11, 111, V-1 HR ❑ 11, 111, 1V V-N ' 3
Valuation: Square Footage:
260 0 �
Project Size: Standard are ❑ Major ❑
• Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.org 'Z15-
CITY OF CUPERTINO
COF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 BTEMPPER 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)
1 BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3 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
1 BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH 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.
1 ELECINSP Other Electrical Inspections (per hour) E
1 MECHINSP Other Mechanical Inspections (per M
hour)
1 PLMBINSP Other Plumbing & Gas Inspections P
(per hour
[�---t!1KMFE—E—Tr—NGIHR Application Meeting B
CITY OF CUPERTINO
CUCITY
TYOf O GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWUDuplex-Additior/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
]CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
1 FENCE>6FT Non-masonry, over 6 ft in height B
1 FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1 FIREPLFAB Fireplace Pre-Fabricated/Metal B
1 FLAGPOL>20 Flag pole(over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1 FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1 PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
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;CCC'- CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPEI,TINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1 RETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSPIO Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1 SIDEST/BK, Siding, Stone & Brick Veneer B
(interior/exterior)
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>l OSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'1 B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) 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
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CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPEI�TINO
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)
1 WINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
l ELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1 PLMBLNCK 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
1
1BUSLIC Business License B
•
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