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06050250 CITY OF CUPERTINO ,BUILDING DI VISION PERMIT kCLIN7CRACTnR`INFORMATION � + a.Sr-aT BUILDING ADDRESS: PERMIT N0. DANIEL MACKEY C N 0 E: H PL PERMIT ISSUE DAM �E: 2593 TIET ON AVE SANITARY NO Cj 31 2FpMOL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH A 0 LICENSEDCONIRACIOR'S DECLARATION Job Description C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing b with Section 7")of Division 3 of Ne Business and Professions Code.and my licenuu ;„ in(Oil Tarte aM off 3 �= Lison sa'-�--L"." SERVICE UPGRADE TO 100 AMP PANEL .0 Dow !�O(. Contrumr - ARCHrIECfS DECLARATION i 1 understand my plans shall be used u public mcrM s �U J� Licensed Prnfessional O5 OWNER-BUILDER DECLARATION i f 1 hereby ATM that 1 am exempt from Ne Conus is License Law for the O following mason.(Section 7031.5.Business and Professions Code:Any city or county pi which requires A Permit m cowrct.Aber,improve.demolish,nr repair my suuem. prior to its isswnce.aiw requires the applicant for such permit ro rile A signed summer CDthat he is licensed pursuant to the previsions of the Contractor'ElJttnseLaw(Charter 9 Sq.Ft.Floor Area Valuati -� (commencing with Scetion]o0o)of Division 3 of the Business and Professions Code)at 3- than be is exempt thcrtlsom and the basis for the alleged aunption.Any violation of Schon 1031.5 by airy Applicant for apermit subjects Ne applinntm.Civil penalty of N�r�byr 00 Occupancy Type not more Nries an hundred dollau($500} AN zI I,uawtr4 o(Ne popery,aro my rmployar with wages uNe'vsolc eampenution, will de the wart..ndthestructen is not intendedwarterw ferrule(Sec.lou.Brad. Required Inspections And prfeslou Code:The Conuumr's License Law does rot Apply b in owner of 9 P property who builds or improves thermn,and who does such work himself orUuough his Own cmployces,provided Nat such improvements are not inmMN croReteol for tale If. however,the building or improvement is sold within one year of completion.Ne owner. Wilder wiH have the tundra of proving car he did Mt Wild or improve fns purpose of sale.). 71 I,as Owner of the property,am exclusively contracting with licensed conmeton be _ Construct the project(Sec.1144,Business and Professions Code:)The Con akelm's U- C.Taw does.1 Apply or N PM1AS of Property wife builds or Improv ommmn.and, who cornets!m such prejecs with aeWlraeror(a)licensed pursuant no the Conor tE License Law. ❑lam exempt undo Secfor this re.som Dam Owner Dau j WORKER'S COMPENSATION DECLARATION 7 ki hereby affirm under pewlty of Perjry uenc of the following skclararions: here and will maintain a CerllHWle ofCorslnr to self-lnsun for Worker's Conmen- set.u provided for by Scerm.3100 of Ne labor code,for da,performance of the work for which this permit is dm . k1 have and will m.inteln Worker's Compensation Insurance,u required by Section 00 a the,Labor Conk,for me:'for .of Ne work for which this Near,is issued. My WorW,Compensation ghns��urance can.and Policy numrmerx: Canrim:J7MrC1 V1 � Polity N..;-aa-53_9—" CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not W complemd if the Permit is foram,hundred dollar,($109) or less.) 1 certify that in the performance of the work for which this Permit is issued.I shall not employ artyperson In my maneerae as to become subject to the Workers'L'ompcnsamor Laws of California.Dau Applicaft NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject or Ne Worker's Comp:nution provisions of the Lather Conk,you must 0 forthwith comply with such provisions or this Permit shall be deemed m eked. ;y CONSTRUCTION LENDING AGENCY i? I hereby affirm that Nee is a construction lending agency for the Perfortnena of Me work for which Nis Permit is issued(Sec.ID 'Civ.C.) QUnderi Name Z Lender's Address t Q 1 sonify that P have read this application and sate Nu the above information is m coMcer I agree ta comply with all city and county ordinances and sum laws relating to m O building cons uction,and hereby Audsodrz representative of Nu city w enter upon the m Lk( aMve-meminned property for MAMCUon pLOPCAA. 4 (We),gree to ave,indemnify and keep harmless de City of Cupertino against Iiabiiides.judgenums,cons and expenses which may in any way ucne.gaima said City t Z M consequence of the grams.'of Nu permit. APPLICANT UN TA ND WILL COMPLY WITH ALL NO Issued by: Date s CE REGUL 0 \ J�/ Sm Amre of Ap rte en r Data Re-roofs H OUS MATERIALS DI CLOSURE Type of Roof Will the Applu"M or future Wilding occupant awe r handk heardous material As defined by the Cupertino Municipal Code.Chapter 9.13.And the Health And Safety Code,section 35572(A)? C]Y. l�W'o All roofs shall be inspected prior to any roofing material being installed. Will the Applicant or future Wading occupant nae equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it harardnw air contaminants u defined by the Bay Arta Air Quality Management all new materials for inspection. MOM's 0Yes we I have road du hmardow mm6ab mquimmena unnkr Chapmr6.95 of the CAlitm- ni.Nalth&SafetyCode,S .2550525533am125534.1undersandthanif Ne Wilding dors mrtntly h n4 Omuta my Map,muddiity re notify me occupant of the mqu me whit m t, miss ofaccrificateof Ota AOcy. ,I � Signature of Applicant Date Cr wner r authorised agent Date All roof coverings to be Class "B"or better _;,�. Community Development 10300 Torre Avenue V-1 1 Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 WUPERTINO Building Department JOB ADDRESS: PERMIT # /01'3� c 'sir T ( 06 0 s -o 2 T-a OWNER'S NAME: PHONE # 2 GENERAL CONTRACTOR: 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 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 St ature Date CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31644024 . 00 DATE ISSUED. . . . . . . : 05/31/2006 RECEIPT # . . . . . . . . . : 34628 REFERENCE ID # . . . : 06050250 SITE ADDRESS . . . . . : 10133 PARISH PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SCHIFFMANN MARY M ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : DAN MACKEY CONTRACTOR . . . . . . . : DANIEL MACKEY LIC # 22597 COMPANY . . . . . . . . . . : DANIEL MACKEY CONSTRUCTION INC ADDRESS . . . . . . . . . . : 2593 HEBRON AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95121 TELEPHONE . . . . . . . . : (408) 274-6799 •FEE 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 1, 100 . 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 ----------------- ------------ ------------------ OTHER 73 . 73 AMEX TOTAL RECEIPT 73 . 73 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • eb�, CITY OF CUPERTINO CUP fOF PERMIT APPLICATION FORM APN# 3/ S- 1414 cp— . OD Date: (o—/ —v(pL Building Address: Mailing Address (if different from building address): 4133 ?a1,4 5 fJ ec>_ Owner's Name: 11 Phone # Y,/� 1kWt%fXn/W-MQ��I.+ 6` 2-S7- 226o Contractor: License#: �,�..��� ntact: Phone: �-2W-6CG0 Cupertino Business License#: l lV)Ac.L-S-? Fax: 4'76- aW-b •72Z54 Building Permit Info: S « ��, J�- (dD�s�,, Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential PE Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Groin Type of Construction: Please check this box if the project is a rte PE second-story addition: ❑ roject Size: Standard ❑ Laze ❑ 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 1 M 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 1 of 3 C�` CITY OF CUPERTINO PERMIT APPLICATION FORM CUPEkTINO 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 BPFIXTURIE 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 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 A liance ELECTRICAL 2of3 CITY OF CUPERTINO c rroF PERMIT APPLICATION FORM CUPERTINO AkQuantity 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 Inspection 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 ing LR Comme/Multi-Fam PLANNING PLLONGRNGR ing Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3