06050196 CITY OF CUPERTINO +�'"�'R �3Lk�7..^�g�..ww�ao ,� 'X;
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BUILDING DIVISION PERMIT ,#'1kC�k\�Li[Li TORJ FQ _MIATION,�"',
BUILDING ADDRESS: MP3 MASONRY PERMIT NO.06050196
7409 ROL
OWNER'S NAME: PERMITMUEDATE
MORTAROTTI MARK T 4530 FAIRVIEW RD. nc;/23 /2006
NE:
SANITARY N0, CONTROL NO.
(831) 637-6663
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACIOWSDECLARATION Job Description
%diC 1 hereby art,.,bar 1 am licensed under provisions of Chapter 9(eemmeneing
< wiNSectionl? ) hit 3 du Do..mssand Prof ions COMO aul my lice is
< mm�rorecane REPAIR MASONRY �PII �TOR LIKE
igu, Lkcnse Cl L'c.N
p Dau• Conlrubr y
'�',y ARCHITECTS DEC lA 1 /
f < I understand my plans shall he used as Public records
7yU
at; Licensed PrafamocalOWNERJUN 8`- 2006
3 oat
exempt
ER m Me CommION
a 0 I heresy a(Sect on 1 am exempt ram the COntrana o License Law for the
v O following rasa..Permit
t 1(D str Burmese and Re.de ons Code:Any city m county
u m which requires a pnmil m crostrucL alter,impure,dcmoliN,or repair any ammureJR1 III Malk lovt. $7985
prior m its issuance,also requires dm applicant for such permit to lite-signed scaumcm
< Met he is licensed pursuant to MeprovisiomofMeContractor'Lice.Law(Chapur9 Sq. Ft. Floor Valuation
e�G (commeneing with Section 7000)of Division 3 of the Business and Profession Crude)or
i Ota,he is emmpt therefrom and Ne have for the alleged enempdan.Any violation of
Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of r Occupancy Type
not more than five hundred dollars(3500).
❑1,as Owner of the property ar my employees with wages as their mlc compensation•
will do the work and the someone is mt intended an offend fmadc(Sec.7004•Business
and Professions Code The Contractor's License Law dam not apply W sr,owner of Required Inspections
Property who Wilds or improves thereon,andwhat doessuch work himvlforil ough his
awn employee,provided that such improvements tie not intended oroRertA for side.If.
however,Ne building or Improvement is mid within one year of completion.the amines.
Wilder will have the burden of proving dost he did no,Wild u improve for purpose of
sate.).
❑1.as Owner of the propeny,am eschmively contracting with Bcensed mntrectors to
commit,Ne project(Sec.7044•Business and Profasiom Code)The Con meter's U-
carte Law does not apply in an owner of property who Wilds or Improves themon.and
who contracts for such projects with a mntrana(s)licensed pursuant us the Contnemrs
License law.
❑ I am aminpt under Sec •B&P C for this maven
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby a1Rm under pmaily of perjury,one of th e followin`declarations:
1 have and will maintain a Canifnu of come.,an self-insure far Workerscompen-
saian•as pmvidcd for by Section 3700 or du Latin,Code,for the peifoman¢of dte
work for which this permit is issued.
0 1 have and will maintain Workers Compensation huurance,u required by Section
3700 of Ne labor Code,for ted performance of the work for which this Permit is timed
My Worker's Compensation Ins/us�'pcc camcr and Policy imarbbeerr ame
Cartiv 5/TJ E /�hPolicy No.-
CERTIFICATE OF EXEMPTION FROM WORKER W'
COMPENSATION INSURANCE
(Ibis ucUm need our becomplered if We permit Is far one hundred daltus(3100)
or less.)
1 cenify that in the perkmennec of the work for which this permit is issned,[she]not
employ any person in my mannerm u In become subject to do Workers Compcoamon
Laws of Califamia.Dow
Applicant
NOTICE TO APPLICANT.LL after making Nu Ceniraate of Exemption.you should
become suhm to ted workers Compensation provisions or the labor Code.you mon
.J O forthwith comply with such provisions w this permit mail be dmmed mated.
z '—' CONSTRUCTION LENDING AGENCY
h
[—i a foreby whichmthaorm,i hacor(Sce,. ,C h,agency farted perferman¢uf
a> the were for minim this permit h isned(See.3091,ev.c)
iQ Landers Name
7 z ander,Addma
U O I cenify that 1 have load this applicator,and state that the me ve infnrmsdon is
Ptorero.L agree m comply with all city and county ordinances and scale laws relating m
�U building consunmion,and hereby aahoria mpresencati. of this city to enter upon the
r W above-mentioned property for inspection purposes.
(We)agmc to ave,indemnify and keep harmless the City of Cupertino against
vF.r/1 liabilities,judgments.coils and expenses which may in my way attme against Said City
U z, inconugne rthc gmming of his Manic
^ APPLIC NDERS !B ND WILL COMPLY WITH ALL NON-POINT Issued by: Date Jam/
souR u m d 2a/ �� 6 —y-
2 Re-roofs
Sqn tart of Ap o cr Dau
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will the.,Pliant or future Wilding accupanlstom or handle hanNnus material
as dented by Ne Cupertino Municipal Code,Chapur 9.12.and the Health and Safety
Code.Section 0y.25532(a)?. NO All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant r ruwm building occupant use equipment m devices which P g
mit harardnus air conuminanis u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I be.read du rev nu cuuriih require==under Chapter 6.95 of the Califor.
nice Health&SafnYCade.Sectime,25505.25533 and 25534.I undermrd that ifdu Wilding
docs not c ly have a tenant Possibility w notify the oceupa,or the
require w cera anecancerti0camatr npancy. Signature of Applicant Date
Owner or amarired agcnl pn.� All roof coverings to be Class c$c Or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35932002 . 00
DATE ISSUED. . . . . . . : 05/23/2006
RECEIPT # . . . . . . . . . 34522
REFERENCE ID # . . . : 06050196
SITE ADDRESS . . . . . : 7409 ROLLINGDELL DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MORTAROTTI MARK T
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : MP3 ENTERPRISES
CONTRACTOR . . . . . . . : PATRICIA GERE LIC # 27197
COMPANY . . . . . . . . . . : MP3 MASONRY
ADDRESS . . . . . . . . . . : 4530 FAIRVIEW RD.
CITY/STATE/ZIP . . . : HOLLISTER, CA 95023
TELEPHONE . . . . . . . . : (831) 637-6663
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
BENERGY PERMIT FEE 147 . 96 71 . 02 0 . 00 71 . 02 0 . 00
BPERMFEE VALUATION 8, 000 . 00 147 . 96 0 . 00 147 . 96 0 . 00
BSEISMICRE VALUATION 8 , 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 219 . 78 0 . 00 219 . 78 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------ ------ -- ----
CHECK 219 . 78 2543
TOTAL RECEIPT 219 . 78
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
101 FOUNDATION 312 CHIMNEY REBAR & STRAPS
514 FINAL PUBLIC WORKS
Community Development
p
00 Torre Avenue
e
Crtino CA 9 014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
7yb m// tf'OS6/�
OWNER'S NAME: o PHONE # f-3)- 4-37- G4,G 3
GENERAL CONTRACTOR c FAX # /_ G37_ 0 9
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 Signature Date
CITY OF CUPERTINO O1V05010)(p
CfrvoF PERMIT APPLICATION FORM
CUPEkTINO
APN # /Ip„ 32,- O0Z Date: S 2-3 '0C-
Building
pCBuilding Address• - n Mailing Address (if different from building address):
O Cl/
Owner's Name: Phone#: �3
71
Contractor: License#: /
Contact: /� Phone: upertino Business License#:
�f3— Fax:(f3/– (,.37- e"F 97
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Job Description: 6 0 i %2 e) 1771-0 C/1 1 mn e'5
Residential ,f•_.r _ C - Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: �,05. Occupancy?r--3
Type of Construction: Please check this box if the project is a
second-story addition: El
#--
Pro'ect Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERl Bigiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K 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 <= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
AIL BINVESTIGA I Investigation fee BUILDING
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(E . CITY OF CUPERTINO
CRYOF PERMIT APPLICATION FORM
CUPERTINO
Quanti 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 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 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
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Li2htinv 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
B Rem Non-Res AnDliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Dpvirp/Annaratus 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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(+D CITY OF CUPERTINO
biYbF PERMIT APPLICATION FORM
CUPEkTINO
uantity 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
i
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