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06060088 CITY OF CUPERTINO o- ,.., -_�,y a� �•^^:t 's -srr + � . ` BUILDCNG DIVISION PERMIT �L1NTR`ACT,, R4iV�`URMATYd, Nv) BUILDING ADDRESS: DEBBIE V. TRAM. PERMIT N0.06060088 10344 N PORTAL OWNER'S NAME: PERMIT ISSUE DAIS DEBBIE V. TRAN 06/12/2006 9E' SANITARY NO. CONTROL NO. ARCNr1ECnENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MEGH 0 0 0 0 tt o p LICENSED CONTRACTOR'S DECLARATION w 1 hereby amtm that 1 am li¢ascd under provisions or Chapin 9(commesming Job Description �iW with Sudan 70M)of Division 3 arthe Busineet and Pmfessiom Code,arm my licence is ;„ in full force andettect. REMODEL KITCHEN/BATHROOMS/RECESS LIGHTS IN LIVI iqz License Class Lc.p ROOM AND BEDROOM. NON STRUCTURAL. NEW WINDOWS . iF Dale Cmdonetm pp ARCHITECTS DECLARATION NEW WATER HEATER i C 1 understand my plans shall be used as public rernrda iyU of Licensed Professional Oe NER-BUILDER DECLARATION 1 hereby aRrm Nm 11. exempt from the f.m.ofs License Law for the D O following mason.(Section](13 1.3,Business and Pmfcssiom Calc:Any city or rounty i$ff which requires a format in construct elle,improve,demolish.at repair any snnum xat priorm its Lssuanm,slsurequires the applicant forsuch permit in rile asignedsmement €� that W is licensed pursuant to the imvisimuar the Corounc.1Lice.Law(Chapter 9 Sq. Ft. Floor Area Valuation j S (commencing with Senior 7000)of Division 3 of the Business and Pmressions Coals)or tp� $6000 _ that he is exempt Iherefram and the basis for Ile alleged exemption.Any violation of I !J Section 7031.5 by any applicant far a permit subjects the applicant in a civil penalty of APN Nurn r u U 0 VJ; UlAm Um U=Xlccupancy Type on,mom Nan Bvc hundred dollars(5300). ❑Las"nor of the properly,or my employees with wages u theusolecampe cal de ThueI I�� will othewoh.andthes.ctumisnotintendedaraffer rorsale(Sec.70".Busi. . Re and Posited..Cae Conumfn rot m s License Law dot apply an a k.of qUlre pe property who Wilds orimpal thereon,endwhe doessuch work himselror though his r'���r heyyl awneer,the es,ping or i grower entissemantssee not intended motioned forsede.due owner,If, haider,win building uimpmvemrmubaldwithinoro year of mporleoon theowner- I�llr-�/F(1 np�)lr�1rr171 116th.)/IJ] Wilder war nave the burden of proving Nat k did rot Wild or improve Cor puryase ar sok.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to mratmct the project(Sec.7060,Business and Pmfrstion Cade:)The Contrum/s Li. ceme law don not apply to an owner of property who Wilds or impmws thereon.and. who conu easfar such Projects with aeonuamar(s)licensed pursuant in the Commutoh License law. ❑I am exempt uncia See .B k P�C far this m�as�a. OWMr j.P l h 1 p Trc..v� Data = WORK 5 COMPENSATION DECLARATION 1 busby afmmnd maker peualty ory,m f perjue of the following declarse iota: ,�I have and will around.a CertiRcam of Comers to self-insure for WorkefsCampen- saion,as provided far by Section 3700 of the Labor Cade,for Ne performance or the work for which this permit is issued. Y I haw and will maintain Workefs Compensation Insvran¢,as rumbod by Semon 37W of the labor Code.for the performance crude work for which this permit is issued My Workses Compensation Imuaatme carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu sections need not kcomplemd if the permit u foram hundred darken($100) or 41i) 1 certify that in the performance of the work for which this permit is issued.I shall not cmployanyperson bjcnm udm in say r as e Worker'Copensation laws of Califomia.MPubc Applicant I� NOTICE TO APPLICANT:If,after making this Cer ificam of Exemption,you should become subject ad the Workeri Compensation provision of the labor Cade.you muse .J O forthwith..Ply with such pmvitimts or but permit Thal he deemre ed rokrd. Z CONSTRUCTION LENDING AGENCY (–a Ihereby a(Rres that there is a construction lending agency for she performance of a> tic work fa Which this permit is issued(Sec.3097,civ.CI Ig) Lendces Name Lender's Addsea U Q 1 century that I have rod this application anW sure that the aurae information is Ly F-' cannot I agree to comply with all city and county ordinances and sum laws relating to 0 Wilding construction,and hereby amhorim mprexntatiwx orchis city no cnmr upon the 0. -hove-mcWiuncd NoNny for borcc m,pis lm.s. (We)ce or In save,,arnifyof this and kcp harsnlcss the City of Cupertino against H to liabiliu(we) memo w.andexpmseswkich maylnarywayay of Cururano ig City U z m consequence of the granting of this fermis. '–' APPLICANT NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SODate URC LA S. d, Re-roofs Sgnaturea ApphcanUConuPt l '��� HAZARD S MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occeupant sae or handle barardom material az defined by the Cap=.Municipal Cade.Chapter 9.11,and Ek Heath and Safety Cada.section 25532(->7 All roofs shall be inspected prior to an roofing material bei. ❑r gNa p p ' y g g installed. Win the, Ieanl or future Wilding accts ant ora If a roof is installed without first obtainingan inspection,I agree to remove crall 1T e e cquipr Co m devices;which g DisuctT rdnm arcanumivanu udc0ne0 by the Bay A.Air Quality Management all new materials for inspection. L..a Oyes 219.. I have rend the harardms materials m ldanda nts unde,Chapter 6.95 of the Califon ria Health h SuretyCadc,Sccti em 15505,25533 and 25534.1 understand shat ifthe Wilding data Out curmnt am a anL Lot 'tum m.1.1.y m mtify the occupant of the regaimmcn trot rte .hCcrtificamararopancy. Signature of Applicant Date Ow.ermauthoriaadagcnt D,te All roof coverings to be Class"B"or better T ';7 Vv 13 ` li, AppRove IN ACCORDANCE WITH CUPERT'NO CODES A CITY 01 1 - AND ORTHE ORDINANCES TE <57— Vv"'n",t p GNE[j BikeSO of '' III Ind kePt on the 'PI job at all times S MUS- Wful to Ind it is ur, same make any change, or alteration, 1 without written AF 7 C. �en Permission fr I building Dept., ori t slam amping City of Cupertino. POrtmo. of this plan n and specification, L NOT be held It 0 Permit or to be of the violation of nj, Cit v nI'Mnanr any p or provisinr Elie l.aw tA 41 0 0- Q � r X11 i"tq:ri++rr �--�Fp�.'L'..A..4;y,?•-''-•„gylx�.t;a :� �:�.':.*<, :::. ct ._...- .....__. „ � �' ON t­ 73 n . .1YS•(rn;aq"'+—Ma+trrw t �.' ". .t'__.:._t;, ':'.is � n1 . � • rr jM4 I . -t 1 m ki s 57 17 1Xl \(1}I�1 'ti Y n �R 71' p o tA z {m m S7 m J L G C Vl o x m N. 21, OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform • A. All the work authorized by this permit B. _ A portion of the work C. None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer(see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be _performed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signature: . �— Date: 1 Z f O C 2 Job Address: 10 5!4 U CJ PO r TA L .F Permit# Any changes to the information provided on this form shall be submitted to the Cit off Cupertino Build Department. • I , . City of Cupertino Building Department CITY OF 10300 Torre Avenue. C U P E i�T I N O Phone: (408)777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect vourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation• contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building pernuts are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street,Sacramento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will r6i be issued until tliewerification is return ed. Very truly yours, Building Department, • City of Cupertino Printed on Recycled Paper TIM ...... IT i;iTa-' LL Ft INI . ....... .... -®r CA %�V3� ..... 0 ^8a +f! 4 # j lJ I 71 � url;Ycr Z • �' � �;sa 'tea • .:,�f,'��r x++m.�,.1x;' 'i2�xc-•a� � I • QSX - • S '-` 01 to Community Development 10300 Torre Avenue P Cu ertino CA 95014 i v Telephone(408) 777-3228 CITY OF Fax(408)777-3333 WUPEkTINO Building Department JOB ADDRESS: PERMIT # 3 ( r 606aa S-� OWNER'S NAME: Q PHONE # S -3376 GENERAL CONTRACTOR: oW 2 FAX # I am not using any subcontractors: y ��- /.Z D (o 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 • /z 0 Owner/ tractor Signature Date CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31629006 . 00 DATE ISSUED. . . . . . . : 06/12/2006 RECEIPT # . . . . . . . . . : 34803 REFERENCE ID # . . . : 06060088 SITE ADDRESS . . . . . : 10344 N PORTAL AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DEBBIE V. TRAN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : DEBBIE V. TRAN CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : DEBBIE V. TRAN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 12, 000 . 00 191 . 16 0 . 00 191 . 16 0 . 00 BPFIXTURE UNITS 3 . 00 27 . 00 0 . 00 27 . 00 0 . 00 BENERGY PERMIT FEE 191 . 16 91 . 76 0 . 00 91 . 76 0 . 00 BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BREMFIXT NO. FIXTURES 17 . 00 20 . 40 0 . 00 20 . 40 0 . 00 BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 -------- -- ---------- ---------- ---------- TOTAL PERMIT 418 . 45 0 . 00 418 . 45 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 418 .45 1705 TOTAL RECEIPT 418 . 45 • CITY OF CUPERTINO (p8g ❑rYOF PERMIT APPLICATION FORM CUPE(\TINO APN# 31 LP- 2'q - CO(-o Date: 6 / 'L -o6 Building Address: Mailing Address (if different from building address): 103L44 0 Po kTAI U Owner's Name: Phone#: o D1✓R-�P,,i <_ %J . -TRP o OS7� 33 Contractor: O /J License#: Contact: Phone:%57-337o Cupertino Business License#: O E,6 61 E U RtJ Fax: Building Permit Info: Bldg ❑ Elect 11Q Plumb Ell' Mech ❑ Job Description: New 03hk1D5W5 FFfs 1� ljVIN�RzvmwIf60RmLIL —Y oh Residential U�Commercial ❑ Ste, Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: poo Occupancy Grou Type of Construction: G� Please check this box if the project is a second-story addition: ❑ Project Size: Standard Do"' Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add MutiBUILDING BINVESTIGA Investigation fee BUILDING • 1 of 3 - CITY OF CUPERTINO CITY 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 Overfime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS as 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 > I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc A paratus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/A paratus 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 CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD -km-dl 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 Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3