08030187 CITY OF CUPERTINOt ;.: .�.•F-Ar„aam ' ` �'+" � �� ""
BUIL�INC DIVISION PERMIT CON'CR:ACTOR.4NFQjRMA JQN
s .'d: `9�K,in ..m,-a?4 &k ro.n�.•z-0�hs,?¢s' t^' u'dlNr �o n,
PERMIT NO.
Bu1LQMff RhINDELL WAY NOR—CAL CONTRACTORS 08030187
OWNER'S NAME: PERMIT ISSUE DAIS
JAMES & MARILYN HARSHMAN 1747 ALMADEN RD. #13 03/31/2008 -
NE: SANITARY NO. CONTROL NO.
(408) 629-5123
ARCHITECT/ENGINEER: BUrIDING PERMIT INFO
BLDG ELECT PLUMB - MECH
3; LICENSED CONTRACTOR'S DECLARATION lb Description
u� I hucby alBon that 1 am licensed man Intonations of Chapter 9(mmmo
cncing
m wi kCLim70W)afDivision3oflhcButin wdPmfcuionsCoda.m.,oy,ecrum a METL STDS FOR FRMNG, ELECTRCL,GAS LINE ADTN,GRNT
^< in full foam and effect.
Li...Class Lk.{ CNTR TOP,WTR &DRAIN FOR SINK
3 t- Dam.Contractor
ARCHITECT'S DECLARATION
1 understand my plana.hall rte used as public records
�yU
ycLicensed Professional
H Oat I am empt from
DECLARATION
y I Mmny.(sero oro 1 em.umpm from th r Gonion Co License: nycity
o (or the
O O fallowing muco^. .roll 1 11DL5.Business andmm nnefeasium Code:Any miry ar county
$- which requiws a e.adve le nft alter.Improve,h mons,I fie a.ir any structure -
ii thatkirrsuance,aru learn.toththeismaanl for huchpermitm1came,g.dautement
a Nommand nwithSeeamblMpmvivision3.a:Conucmr'alx'c�6onsCommr9 Sq.Ft. Floor Area 6000 Valuation
(cor Its aexe pthSraftm Y000)th basis n3 m aneeged exahnd Pro(eu vi Cnde)of
S Wt Sectio u ea1.5 b any apron and the aper fa Ute tuft eamant to Any violation of
not a 7031.5 w tory red dolts for a parol,subjects Ute applicant •dull penalty of Number Occupancy Type
trot more thtan nun e.mmma amlat,(scam. 36219032!��
L ss ewnm of the Pmpeny,a myotmancct with wa{a u Use ade(Sec.campewUon.
will dmthe wert,and thesVucbmruch's Lia Law doed femtapply in anowne4. rof Required Inspections
and property
wh bat Code:The Contactor,Uceme law dopa not Apply to an owner is q P
ountem•.'Ito s.pro orimpmwa Uteceon,anawho dooaaucnwork himselfedthrough Ma
ownemploym,proriaed Nat auto improwmmu tee not ear ofo meBuW fm tram It.
builder.Ne building nimpmwmmnIceholo withinamyeaofmmaw,forthe owmr-
bullder will low tite Wrdcn of proving Nm h<did mm Wiles or imprme(.r Puryou of
JR(l.u Drone of the property,.m eaeausiwly contracting with Beamed contractors in
'mobstruct She project(Sem road,Business and Pruresdona Coda:)2yn Cwtra ores U.
comm law does act apply in an owner of property who builds or improws them en,and
who contracts for such projects with a conIOm.Rs)licensed pursuant to Inc Gnuatoes
Utero.L.w.
❑lam mammuunder
,Bt:PCfor .
Owner '—i .0
OR 0.'S A HI ECLARA 0 '
I hereby alarm under penalty of palmy oro of the following declumierte
rm .
haand will maintain Certificate of Consent u, If.I..fmWertcracompen-
umbo,u pmvided for by Section 5100 of the Labor Code.for as performance of the
work for which this permit r issued.
❑I law and will maintain Workers Compensation Insurance,as rmuired by Section
IW of the Labor Code.for the perfompnee of the vert for which this permit is Issued
Workers Compseem..lmuana carder atm Policy number are:
.ices Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(fhruction need not M completed lank Permit Is formte handed dollars(1101)
or leu)
I cmUfy them in the Mrermattoo of the war or which a permit r Issued I Nall nm
tmployanypeunn in any ma
n. re pcmadon
Laws of Calife ta
Fi
A"Brutem
NOTICE TO :If,.f Int Nr Gninau of Eacmpdon,you shoal
become rob' workers Compcaaation pmnsiera of IM labor Cade,you most
.,z forthwith comp Y with such prevision.or Nis panni,shall he doomed mekcd.
Z
CONSTRUCTION LENDING AGENCY
ryes lhewn SITZ.that them r.eomtructinn kndin a
l� Y { .) for thte perfomma of
0.';> th t wort for which VUs perch r issood(Sec.7097,civ.C.1
GQ Lenders Nurse
T') z Lender's Address
U c 1 cavity that 1 haw marl this application and hum that the avow information Is
D. mrmm.I agree b comply with W city and county ordinances and that laws totaling in
.8 building construction.and hereby audience rtpmaenutiwa of this city to enter upon the
W shove-mare oned property for impaction purposes
gy (Wo)grce b ssw,indemnify and kap bumleu the City of Cupertinoaglainat
r/) incoisarrumnoNacasu and capcmu which may In any way game a6aimtaaid City �j
(„)t�7 AcPLICANT erda{ranOnt o! nnit e't�T—
APPLICANI UNDER ST L COMPLY LL NON-P01 Issued by: Date
RECULAW
4" ose
Re-roofs
Snate a A iesnV anaaeb
HAZARDOUS MATERIALS DISCLOSURE Type of Roof _,-
WiR Ne applicam.,to.building a eopenutme m hurdle heard..material
u dcRud by Ute Cupertino Municipal Code,Chapter 9.12.and the HWth and Safety
cwk, Dyenvssz(a)a
❑Y. All roofs shall be inspected prior to any roofing material being installed.
o
Will the applicant or future building asupam..equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t hramn.air conumirunu as defined by the Bay Asea Air Quality Manage..., all new materials for inspection.
mdcmr
C Ya u
I hawmad he haaamn matedab aqui uunrlerC2upter6.95ofNeGlifor-
H.Ith@S.fmyOxac ectios ama25554.I thaifde Wilding
m1 cumentiY haws y mqumiMiny ratify that osuP of thte
whim p5e eseawccettce mateerO gnature of Applicant Date
car rate me.d.gmt All-roof coverings to be Class'¢"or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
• Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36219032 . 00
DATE ISSUED. . . . . . . : 03/31/2008
RECEIPT # . . . . . . . . . : BS000004318
REFERENCE ID # . . . : 08030187 ...
SITE ADDRESS . . . . . : 7818 ROBINDELL WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JAMES & MARILYN HARSHMAN
ADDRESS . . . . . . . . . . : 7818 ROBINDELL WAY
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5015
RECEIVED FROM . . . . : JAMES H HARSHMAN
CONTRACTOR . . . . . . . : KENNETH SILVA LIC # 26158
COMPANY . . . . . . . . . . : NOR-CAL CONTRACTORS
ADDRESS . . . . . . . . . . : 1747 ALMADEN RD. #B -
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 629-5123
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 6, 000. 00 0. 60 0. 00 0.60 0 . 00
1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
1PPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
1TRAVDOC FLAT RATE 1. 00 40.7.9. 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 122 .97 0. 00 122 .97 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- --------------- --------------------
CREDIT CARD 122 .97 MC
---------------
TOTAL RECEIPT 122 . 97
•
a.nig'. CITY OF CUPERTINO
• CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
• APN# , a �` / D -3Dater
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone#:
Contractor: Phone:
Fax:
Contractor License#:
Cupertino Business License#:
• Contact: one:
Ph
7Fax:
• Residential Commercial El
Job Description: /� �;�?z �f��s-,�x
Building Permit Info:
Bldg ❑ Elect ❑� Plumb lg� Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR❑ 11, 111, V-lHR 11, 111, 1V V-N E9, �Z_— 3
Valuation: / j' Square Footage:
Project Size: Standard Large ❑ Major ❑
•
I •
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1BTEMPPER 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 29.31cw)
1BBOILER2 Installation /relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss 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
1BBOILER4 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
1BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH 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.
IELEC1NSP Other Electrical Inspections (per hour) E
IMECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P •
(per hour
1MEETINGIHR Application Meeting B
cm3 CITY OF CUPERTINO
CUPEGENERAL BUILDING APPLICATION
fZTINO
• FEESCHEDULE
uantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
I CHIMNEY Chimney B
1CHIMNEYR Chimney Repair B
FENCES
IFENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
IFIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
IPILECAST Pile Foundation Cast in place concrete B
IPILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
3 of 5
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 11) B
IRETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSPI0 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-1 O'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high(up to B
50 ft)
SIDING
1SIDEST/BK Siding, Stone &Brick Veneer B
interior/exterior
1SIDEOTHER Siding all other B
SKYLIGHTS
1SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF 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
I SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 so B
additional stucco application
•
4of5
G� CITY OF CUPERTINO
CUPEf�F GENERAL BUILDING APPLICATION
. FEE SCHEDULE
uantity/Sf Fee ID Fee Description Fee Permit Type
Group ]GENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass B
door ea 8 windows
1WIIVMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
/ 1EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
/ 1PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMPLNCK 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
1BUSLIC Business License B
• 5of5
���' Community Development
130 Torre Avenue
f�V3:/--. Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPEkTINO
Building De artment
. JOB ADDRESS: PERMIT #
/ rh -Y p61 v O 30
OWNER'S NAME: ��✓� J —j)?N t PHONE #
GENERAL CONTRACTOR: /-/Dr — G.cA -- FAX # 2Q— 6
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
• j3 c
Owner/Contractor Signature D e