06080126 CITY OF CUPERTINO
BUILDING DIVISION PERMITCLINTR'[�.CTCTR INkORMATI®N
BUILDING ADDRESS: s MATZ CONSTRUCTION PERMIT'NO.06080126
10574 ORANGE TREE LA
OWNER'S NAME: PERMIT ISSUE DATE
MATULEWICZ MATTHEW 10574 ORANGETREE LIN 08/18/2006
ONE:
SANITARY NO. CONTROL NO.
(408) 257-6376
ARCHRECTIENGINEER: BUILDING PERMTTINFO
BLDGELECT PLUMB MECH
e I� (�
Op LICENSED CONTRACTOR'S DECLARATION
Job Description
mF 1 hereby art,.that 1 am licensed tus er provisions of Chapter 9(commencing P
:Zty with Section 7")ofDiusim 3 of the Butincss and Profecsium Code,and my license is
nfull faesand ofren. Q :3� S 200AMP UPGRADE
i�? Liccnsc Clay LEE.Outhouse,
uth
Dale N /dA'' 7a7Gba ComrazCL
pp ARCNRECTS DECLARATION l�
'i k s 1 and llecom my plans shall be,ouJ u public rtrnrdr ////
pH License)Professional �I /J
S OWNER-BUILDER DECLARATION
1 herehy alum Nat I em uempt from Ne Cantracmrs Liecnu Low far Ne L
p o following mason.(Section 703 L5,Business and portending Calc:Any city or county
5: which roquims a permit to conswct.slat,improve,demolish,or repair any structure $2000
-I< prior to its issuance.au nequims the applicant rot such Permit o file a signed statement
Nat M is licensed purmam to to pnoosiom or tic Contracts",Inmos Law(Chapter 9 Sq- FIoor Area Valuation
(commencing with Section 70110)of Division 3 or the Business and Pro2ssions Cols)or
that he is..in therefrom and the basis for the alici aemption.My violation of
Section 7031.5 by arty applicant far a permit subjects the ayplican m a civil penalty ofAFN Occupancy Type
act mom than five bandied doll.,(SSW).
0 L as mores of the property,or my canployces with wages u their sole compensation,
will do tie work.and the swnom is not intended or offered rot sald(Sec.7014,Business Required Inspections
and Professions Cods:The Contractors License Law does not apply m an owner of 9 P
pmpsny who Wildsorimprove,ft..and whodoessuchworkbimselferthmugh his
cam employees,provided that such impho emmnts are not intended or offered for sale If.
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving that w did not build or improve for Puryaa of
sok.).
0 I,as owner of the property,am exclusively contracting with licensed contractors m
construct the project(Sec.70",Business and Professions Cade:)The Comncmrs U.
cense law dors not apply in an owner of property who Wilds or improves thereon.ad.
who contracts for such projects with acanlrectons)licensed pursuant m Ne Compostors
Leena Law.
0 lameaempaunder Sec. ,B&PCforthisromart
Owner Dae
WORKERS COMPENSATION DECLARATION
I hereby alrum under pemlry of perjury occur the following declarnimts:
1 hsvc and will maintain a Certificate of Convent to selr4nsure for Workces Cormim.
sstion,n provided for by Section 37M of the labor Code,for to performance of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as rtquined by Section
37W of the Labor Coda,for the Nufarmance of the work for which this permit is issued. '
My Workeh Compensation Insurance artier and Policy number aro:
Cartier. K Policy No.: x
CERTIFICATE OF EXEMPTION FROM WORKERS' -
COMPENSATION INSURANCE
(This section need not he completed if the permit is farom hundred dollars(SI W)
less)
1 certify than in the performance of the work for which this permit is issued,1 shall not
employ any person in any mummer an as in become subject at the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cceilca c of Exemption,you should
become subject in the Worker's Compensation provisions of the Labor Code,you mus,
.J O forthwith comply wits ch provisions or this permitshall w dccmcd rtvnked.
Zy CONSTRUCTION LENDING AGENCY
[--t I hereby option that there is a construction lending agency for the perroorance of
!Ythe work for which this Permit is issued(Sec.3097,Civ.C.)
GQ Lenders Name
CL Z Lenders Address
U O 1 codify that l have read this application and sale that tW above information is
U. F^ cores.I agree to comply with all city and county onimances and sore laws relating to
0U building construction.and hereby authorize representatives of this city no enter upon the
} W ahove-memiuned property for inspection purposes
(~ 0. (We)agree to save,indemnify and keep harmless the City o(Cupcmno against
E,, in COiucs,jode Of
astsand axpcmumit. may in any way amore against said City
U z A ePLICAN cs of the graining of this permit. �I/�—
^ APPLICANT UNDERSTANDS AND WILL CO PLY WITH ALL NON-POINT Issued by: Date
SOUR E RE GU TIONS
c-yF`te Re-roofs
Signazum of ApplicaHAZaiRDOU Dale
FInt Edto US MATERIALS occup EEm..1DISCLOSURE Type of Roof
Will the a CuKnl no(arum Wilding e.Capt stem or handle Health and
as defined io the Cupertino Municipal Code.Chapter 9.13,and the Health and Safcry
Code.,orlon 25532(a)7
❑res � All roofs shall be inspected prior to any roofing material being installed.
y ft B
If a roof is installed without first obtainin an ins ection,I agree to remove
Will the applicant or factum building era equipment or Deering which g P g
:mit hmardnm air contaminants ss Defined bby rhe Bay Arta Air Quality Management all new materials for inspection.
Didn't? - / P
❑Yes [INu
1 have mad the h.arM.smacrials requimmenu under chapter 6.95 ofdse Califon
not Health&Safety Code,Sscuons 25505,25533 and 8534.1 understand thaif the Wilding
docs not currently hate a lenanl Out it 4 my responsihility M mtify the atter,.,of the
royui�e/n�tsw�h/k�h�muvmdpnor n„manccafl Reale or Occupancy. Signature of Applicant Date
Z!G/� . All roof coverings to be Class „B”or better
Owns,or.thorived agent Oam
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
46UPEI,TINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: e-, s o PHONE # 2. 5 576 3 > 6
GENERAL CONTRACTOR: ,¢ — u S 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
Electricalttpm-6cO "
rLa-e6(S-t b y-or /J 1531
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
sm 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN 31634018 . 00
DATE ISSUED. . . . . . . : 08/18/2006
RECEIPT # . . . . . . . . . : 35674
REFERENCE ID # . . . : 06080126
SITE ADDRESS . . . . . : 10574 ORANGE TREE LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MATULEWICZ MATTHEW
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : MATZ CONSTRUCTION
CONTRACTOR . . . . . . . : MATULEWICZ, MATTHEW LIC # 5534
COMPANY . . . . . . . . . . : MATZ CONSTRUCTION
ADDRESS . . . . . . . . . . : 10574 ORANGETREE LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 257-6376
•
FEE ID UN-IT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---------- - -- ---------- - --------- ---------- ---------- ----------
BELEC200 METERS 1 . 00 29 .43 0 . 00 29 . 43 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86, 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 2, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
--- - ------ ---------- ---------- ----------
TOTAL PERMIT 103 . 16 0 . 00 103 . 16 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
---------- -- ----- ------------ -------- ----------
CHECK 103 . 16 3548
TOTAL RECEIPT 103 . 16
VOICE ID DESCRIPTION VOICE ID DESCRIPTION304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
•
- CITY OF CUPERTINO Q��IJV
CITY OF PERMIT APPLICATION FORM
CUPEkTINOAd 1k
pp
N# _31w-34--c �O Date:
Building Address: Mailing Address (if different from building address):
i o S .2 51 4 /2 Teefe
Owner's Name: Phone#:
w & 71'r-- /"wIle -Z -63 ? 6
Contract � 3 License#: �S
) .
Contact: !C G Phone: CCupertino Business License#:
Fax: `f '>Z-c10�, Z
Building Permit Info: Z t-2 C' /y [.-( Cc'O PeA
Bldg [IElect al / Plumb ❑ lMech ❑
Job Description:
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy roup:
Type of Construction,- , Please check this box if the project is a
second-story addition: ❑
roject Size: Standard/ffl� Large ❑ 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 IM 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
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armw CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee 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 Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAII2HAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace 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
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am CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, 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 Insection BUILDING
BSWIM 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 Change BUILDING
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