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06070047 CITY OF CUPERTINO BUILDING DIVISION PERMIT .CONTRAC.kTOR"INF�ORMe1.TIO,N r BUILDING ADDRESS: PERMIT NO.O 6 0 7 0 0 4 7 10491 SCENIC BLVD OWNER'S NAME: PERMIT LSUEOATE REESE, MARY NE: SANITARY NO. CONTROL NO. ARCHIIEC(ENGINEER: BUILDING PERMIT INFO 0 BLOC ELECT PLUMB MECH 0 0 0 i00 LICENSED CONTRACTOR'S DECLARATION - lob Description %w 1 hereby affirm that 1 am li=med under provisions of Chapar 9(commencing eio, with Section 701s0)af Division 3 of the Business aM Norcssium Code,atW my lkenus ?.N mmnforteaneercas NEW ELECTRIC SERVICE )2gz Liccnu Clens Lw.a Z F aDa¢ Contractor ARCHITECTS DECLARATION I am< 1 understand my plans shall h,used as pubic raids )yU soy Licensed Professional S Oat I am exempt front DECLARATION 0 C 1 hereby mhy alarm on I am exempt from the Contou=r's Limns Law for Ne o O fallowing recon. Pandit t 71131.5 Business,AICLand ere,de ore Cie:Any ciry or county m which aquina a permit re construct,the applicant improve,demolish.t or repair any ewmure $500 prior set is issuance.Also require Nc applicantfor such Permit file aaigowJ vase=,= that he is licensed purulent ano the previsions of the Connector's Liccnu Law(Chaper9 Sq.FL Floor Area Valuation YFG (commencing with Section 7")of Division 3 of the Business and Prorc4sions Code)or 4�R that he a exempt NCrefram and Be,thus for the alleged cumpdon.Any violation or Section 7031.5 by my applicant for a permit Subjects the applicanuo a civil penalty of er Occupancy Type not mom Nan five hundred dollars($500). ❑1,u owner of the property,or my employcu with wages u Nev sulc<ampewtion, will do the work,and the swnurt is notimended eroRered permi,(Sec.7014.Business Required Inspections and Pnorevions Cade:The Contractor's License Law does e ns not apply w an owner of q p praparty who builds or impronhatho mot,and who d=aauhwik himmlfar Waugh his Own employ=,provided that such improvements are not intended mortared formic.IL however.the Wilding or improvement is mid within o=year of completion,the owner- builden will have she Whom of proving that he did not Wild or improve for purpose of sate.). ❑1,as awowr of the property am Business exclusively...oressi ng with licensed o mramurs i- construct La the data (Sec.s an Bu Of and property who bei Cade:)The Canmac .. nd eco contracts law does oat apply je ts owner of propu(s who sedint or"t,toff Norton,ane wboawLfor such projects with a conuactor(s)licessed pursuant b the Canuutoh 01 am Law. ❑tom t/ore%-du See 08 Pefm this rtawn . owOcr /lYlRK t WORKER'S COMPENSATION DECLARATION 1 thereby alRrm under penalty of perjury now of the fallowing declarations, 1 hsm and will owned.aCerdfcam of Conant w ul6imse.far Workers Compen- suian,u proviend for by Section 3700 of the Labor Code,for the perfonnatt=of the work for which this permit is issued. - ❑1 have and will maintain Wmates Compensation I.ra..as rescued by Section 3700 of the labor Code.for she performance of the work fm which this Permit is issued. ' My Worker's Compensation Imwraowe carrier and Policy number are: Carrier. Policy Nit, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (O suction need not W completed if the Permit is foram,hundred dollars($100) or less. 1 ccnlfy that in to performance of the work far which this permit s issued.I shall Out employ any photon in any manyerso ss m be< c subj=I m Ne Workers'Compensation Laws of California.Data �� 1l��sann Applicant 7_ {f o NOTICE TO APPLICANT.IL after making this Chilies¢of Excmrn,you should become subject in the Worker's Compensation provisions of the Labor Coda,you most .JQ fmNwith comply with such pmvisimM Or this permit flail the deemed revoked. zIZI CONS TRUCTIONLENDING AGENCY [-+ I hereby M.that Nem is a construction lending agency far dw Norman.of 0.ithe work for which this permit is issued(Sce.3097,Civ.C.) G Q Lender's Name O z leader's Address U O 1 ccnify Nat I hoe read this application and saw wt the above information is Iy F coned 1 agree to comply with all city and county oNimine,sand saw laws uladng m 0U building construction,and hereby amM1ori7e hermsentsons or this city no enter upon tic aWve-mpro emiuned perty for inspection purposes. F., a (We)agree to save,indemnify and kap harmless the City of Cupertino against limilitiu.judgments,costs and expenses which may in any way amnio against said City U,Z, in consequcnm of the Snuffing of this permit. '-" APPLICANT UND DS ��' AND W COMPLY WITH ALL NON-POINT Issued by: Date SOURCEREGUTA ON / G Re-roofs Signuum mfApplianVContraccor HAZAItDOUS MATERIALS DISCLOSURE Type Type of Roof Will the applicant or future Wilding aaupam aw.or handle haanwas mawrial as defined by de Cupenino Municipal Code.Chapter 9.11.and Ne Health and Safety Cmk.Section 13531(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yea Cho Will the applicant or finite Wilding Occupant axe equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hvamnus air contaminants u demand by the Bay Area Air Quality Management allnew materials for inspection. District' ❑Yes Q6Nu I have mad the hammous rea exhil mquiremorm under Cmp cr6.95 of the Cali(oo nits Health&Safety Code,Sections 25505,25533 and Z5534.1 undcrsmnd thuif the building Jots notcm y hast a wnam,that it s my responsibility w nodry Nc oaupmt of dw mq remnuwhich mus met Prior in issuance of a ccnircale Ofampmry. Signature of Applicant Date 7— !7 DG Ota,oAll roof coverings to be Class"B"or better r thori'rnJ acm D=" ' CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 3 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 35706017.00 DATE ISSUED. . . . . . . : 07/11/2006 RECEIPT #. . . . . . . . . : 35189 REFERENCE ID # . . . : 06070047 SITE ADDRESS . . . . . : 10491 SCENIC BLVD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : REESE, MARY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : TERRY BROWN CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : *-E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ______ _____________ __________ __________ __________ __________ __________ BELEC200 METERS 1.00 29.43 0.00 29.43 0.00 BENERGY PERMIT FEE 1.00 34.86 0.00 34 .86 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38 .37 0.00 BSEISMICRE VALUATION 500.00 0.50 0.00 0.50 0.00 __________ __________ __________ ---------- TOTAL PERMIT 103.16 0.00 103.16 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ------------ --___---__-_-____- CHECK 103.16 365 TOTAL RECEIPT 103 16 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL • - CITY OF CUPERTINO c'TMor PERMIT APPLICATION FORM CUPEkTINO N# 35-7 06- O / Date: j - !t - OCD Building Address: Mailing Address (if different from building address): 0 1 ScEN -,f0 Owner's Name: P one#: 408 2-'SZ - 397- Contracto : 1 J License#: Contact: P' Phone: G /- 3uo Cupertino Business License#: t=2 u/Al Fax: 400 za- GZv® Buildind Permit Info: t W S t C1✓ yCrjD o Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential Z'� 1QCt,-.3 Sia-\leG Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 5-0 () Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: Elroject Size: Standard 11 Large El Major [I 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 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 Elee Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Ener y Add Multi BUILDING BINVESTIGA Investigation fee BUILDING • I of 3 1 O I aip�l� CITY OF CUPERTINO ❑TYOF 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 Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING -10 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 cfrn 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 A2paratus ELECTRICAL BREMNRAPP Rem Non-Res Ap2liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPCWER Power Device/Apparatus ELECTRICAL' BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 Zia- CITY OF CUPERTINO c'TMOF PERMIT APPLICATION FORM CUPEkTINO kQuantity 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 BREMVENWS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL S ecial Ins ection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporag 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 Ran a Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3