08050234 CITY OF CUPERTINO n �w-itmm. aa��'+Pryx. ~ * k",{ " (� "
BUILDING DIVISION PERMIT CONTRA' INFOR ATIQN a .
amLTIMQ1RESPHAR LAP DR AMERICAN BRANDS 08050234
OWNER'S NAME: PERMIT ISSUE DATE
ROD H00 1029 BLOSSOM HILL RD STE', 3 05/29/2008
NE: SANITARY NO. CONTROL NO.
(408) 265-8000
ARCHrfEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
O O LICENSED CONTRACTORS DECLARATION
Cdo I hmcby affirm that I son ficusucal under previ,imu of Chapter 9(commencing Job Description
e Z`uj with Section 101)(1)of Division 3 of the Business and Pmfessfau Code,and my license is SERVICE UPGRADE TO 200AMP
^may in full forte and oHmt.
y tqz Urcna Class
Des ` Conuacw N
W7W ARCHITECT DECLARg h i
6 1 unaetsund my plans Nall be used as Public recd
`yin^ Licensed Pnefietwea
OWNER-BUILDER m DECLARATION
'C<O I hereby alarm that 1 1. exempt from the Contractor's Licence law for the
i O O fallowing mason Permit
t 7031.5.Business and improve,
de ism Cade:Any city or county
$ which its u issuance.perosr to c ims thea aper.wmpmw,demolish,nr mash any Nament
–iy PriarmitsdForward to to thapions of for wchxaCtoo mfichic La (Chapter
pp < duethisliccnmJpursuantmlhoprovisionsofd¢Canuacmr'sUccuclaw(CTaPmr9 Sq.Ft.Floor Area Valuation
(commencing with Section 7")of Division 3 of the Business and Pmressianu Cade)or $2000
Q
than h is exempt therefrom and the basis for the alleged exemption.Any violation of
Schon 7031.5 by airy applicant for a permit subjects the applicant to a civil penally ofNumber Oeeu ane-Type
not more moo five hundred dollars(S5= 3 2 618 012 .`ff P y
1,as owoes of the property.a my emplayeas WIN wages a thh ale eompenation,
wiB da th warL and th swctua u notinainded moReseO forsale(Sec.701•s,Business
and Pmfesdons Code:The Canmcmes Lt..Law docs rot apply m an owner of Required Inspections
pr n=piohb,pma rimpmes Numn,andwhoda m,in n himwJfar oras .1u
awn employms,pmNaea duusuh impmsemenu are trot inu o(c mplcdon,(c owdeL
however,the haw
ti a or ,improvement is sold within of year of c prove for
the owe of
builder will low de burden of paring that h did trot Wild m improve for puryoa of -
❑1.as owner of the property,am eulusively contracting with licensed mnuactmn to
construct the pmjcm(Sec.1014.Business and Profession Cade:)The Cmtre:tor's U.
dome law does not apply to an owror of progeny who builds or improves thmvn,and
who contracts for such projects with a contractor(s)licensed pursuant to me Camrular's
Liana Law.
❑I am eaerm under See ,B k P C for mit reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
40 1 hereby affum under peoalty of perjury ore of th following decluuiortg
Ihamand WIImalnuinaCersifrneofComentmulf-inumfoe Wo rlCompcn-
salon,as provided for by Section 3700 of the labor Cone,for me performance of the
work for which ads Permit is issued.
O 1 have and will maintain Worker's Compensation Ionone¢,as mquimd by Section
3700 of the Labor Code.for the performance of the work for which this permit is Wood
My Worker's Compewtioo btsu met,carrier and Policy number art:
CaMertTrAC !„n.,,n,.rQL1, PmicyNoA oq"7(X�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sealed need rot h completed ifft permit is Far.hundred dollars($100)
or loss.)
1 certify dust in the performance of the work for which this Permit is ended,)shall not
employ any person in any ands erre as to become subject m th WohenCompenu0on
Laws of Caliromit,Dau
Applicant '
NOTICE TO APPLICANT.If,after making this Ceniftcam of Exemption.you should
bcame subjx m the Worker's Compensation provisions of me Talar Code,you moss
.JO roMwidu comply with such Provisions of due permit shallh deemed invoked.
z y CONSTRUCTION LENDING AGENCY
F— (hereby aR,w dual dere it a consisted.lendingagenry for the porferes.of
CY, the work for which this Permit is issued(Sec.3097,Cih,G
GQ Lender's Name
z lender's Address
V Q 1 certify mat 1 haw read this at,41hatien and sum dist the above informadun is
I3. cortin.l agme,to comply with all city and county mainances and sou laws miming to
building construction.and hereby aummiae repraonudws of the city or chair upon the
rW above-mentionW Property for inspection PURmas
(~4 I%)agree to save.indemnify and keep harmless the City of Cup, against
W IiabilidmMgmenu.carr and expemca which may in any way scerd,Ulost aid City
V z ireonsequcpce of me Lnntin6 of mis garrote.
APPLICANT UND4STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2_Q
SOURCEREG U N5. _
Re-roofs
Sgnuu on air Date
wtu�(or *lsa HAZARDOUS MATERIALS DISCLOSURE Type of Roof
t�'e appliam or future Wilding occupant arc of handle decameter material
as defined by me Cupenlno Minumi Wf Code.Chapter 9.11,and the Ho.hh and Safety
Code.Seedhn u53m)± !! All roofs shall be inspected prior to any roofing material being installed.
Ely. - Atha
wn the a 0aent sir comm bdaain «� If a roof is installed without first obtainingan inspection,I agree to remove
pp g panty A ea Air Qu m JMana Management
P
emit ha menus air contaminants u ac0nea by the Bay Area Air Quality Managemcm all new materials for inspection.
District?
OYca E(Nu
Ihawmelduc maeriaHr immenuunderChapair6.95ofde Uifor- /
nia Hcalth@Safety Code, cdom25505,B533wd25334.1undersundthnifdebuildin
dm mtfunendy Mw l 'n a my rugruibility in mtiry the o¢upast of
mquim inch m t ,rmiauanmaf.ccrtific.aiar(km r Signature of Applicant Date
Ow.bi dna hmi>m.Qent C�Y ai All roof coverings to be Class'j?”or better
CITY OF CUPERTINO
•3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 32618012 . 00
DATE ISSUED. . . . . . . : 05/29/2008
RECEIPT # . . . . . . . . . : BS000004939
REFERENCE ID # . . . : 08050234
SITE ADDRESS . . . . . : 10121 PHAR LAP DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER ROD HOO
ADDRESS . . . . . . . . . . : 10121 PHAR LAP DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AMERICAN BRANDS
CONTRACTOR . . . . . . . : HORST VON BLOES LIC # 22737
COMPANY AMERICAN BRANDS CONSTRUCTION
ADDRESS . . . . . . . . . . : 1029 BLOSSOM HILL RD STE 3
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 265-8000
•
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
lEPERMITFE 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 82 . 08 0 . 00 82 . 08 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ---------------
CHECK 82.. 08 #7557
----------
TOTAL RECEIPT
82 . 08
•
„ - CITY OF CUPERTINO
CITY OF
CU
PERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # ,3 o - / o U U Date:
I
Building Address:
I z I P4a� by D,,,Ve
Mailing Address (if different from building address):
Owner's Name: Phone#:
WW `/v X 0, 7/ S'3
Contractor: / Phone: yob ?6 yood
I IM��'CG✓i !7 llaS Cdr s H c"'f•Ail
/0 1 v55 oM //(2,) S J Fax:
Contractor License#: 5 3q 6 a�
Cupertino Business License#: o., C,le-
Contact:
eContact: S� 11 Phone: c �aG S 80 00
Fax: �FS ?y � b'o C
Residential Commercial
Job Description: � .« r _ aUu 0�,
UP q faoa!k C>
Building Permit Info:
Bldg n— Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
I-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B E�— �L 3
Valuation: Square Footage:
uuU
Project Size: Standard ❑ Large ❑ Major ❑
•
Revised 5/21/08
CITY OF CUPERTINO
CUPEkTiNO 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)
1 BBOILERI 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
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
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 Install ation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
l 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)
IPLMBINSP Other Plumbing& Gas Inspections P
(per hour)
1MEETINGIHR Application Meeting B
;.( � CITY OF CUPERTINO
CUPCITY EYOF GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
IGENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
1 FENCE>6FT Non-masonry, over 6 ft in height B
I FENCEMAS>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
1 PILECAST Pile Foundation Cast in place concrete B
I PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
3 of 5
.Stu CITY OF CUPERTINO
ITY°FGENERAL BUILDING APPLICATION
CUPEf�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
1RETSP310 Special Design, 3-10' high (up to 50 `) B
IRETSP10 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<l0 SF Skylight less than 10 sf B
1 SKYL>1 OSF 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 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
•
4of5
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 W INREP Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR 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
1 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
113SEISMIC0 Seismic Commercial B
1TRAVDOC Travel & Documentation B
1BUSLIC Business License B
•
5of5
Community Development
�e 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
SUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
io l2Arv,4�
OWNER'S N uu PHONE # c 2(, - ou.
GENERAL CONTRACTOR: s FAX #
I am not using any subcontractors: 1 i A 1W o
Siigna6De Daie
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 Signature Date