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08020095- BUILDING DIVISION PERMITONiR�. UR INFO s - s, BU'Tq�jDpRE$$ ADY OAK IN S TBD — TO BE DETERMINED PUCIVIFT NO. 08020095 WS NAME; PERMITISUEDATE SLATEN LYNORE E 02/14/2008 PHONE: - SANTI'ARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMRINFO BLDG EO PLUMB 0 LICENSED CONrRACMWS DECLARATION lob Description P 1 Wraby affirm Nal I am licensed umlar provisions of Chapmr 9 (commencing wish Section 7000)of Division ofmc Business and Profusion Code, and my license is REPR TERMITE DMG TO FRMNG @UTILTY CLST, TRIM @FRNT InfalLicenlse Ceand.f( Lk.I B g� ENTRY WNDW &TRM @SIDNG NXT TO GARG Dam Conow art ARCHITECTS DECLARATION I understand my plans.h JI he used as public rec urds Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contmcue's License law for dee following mason. (Saban 7ID 1.5, Business and Professions Code: Any city ter county which equines a permit to construct. star. improve, dcmulish. or repair any structure prior to its ismance. also requires use applicant farsuch permit to rile a signed statement that he is licensed he lite of dee Consumer. Licence Law 9 Sq. Ft. Floor Area Valuation punumL provisions (chapter 0d�1800 (Camme.dng wide Sectio" 7000) of Division S of the Business and Prolmhons Cade) or y Nat he u exempt ftMfmm and the basis for the alleged exemption. Any violation of 3 2 3 4 4 0 4 2. Occupancy Type Section 70]1.5 by any applicant for a permit subjccu the aPplkant e a civil Knotty Of mol ream than five hundred dollars (Sore), ❑ 1, as owner of die property, or my employees wide wages as Neo sets compensation, aired Inspections will da Newmrk, and thenmcture is set boatload or offered for said (Swe. 70th, BusinessRe and Prormsions Cade: The Camacror'a dam set apply a an owner of License Law da 9 P property who build, m improves ul .mon, and who does such work Nmself or though his awn employ es, presided that such improvements am not intended oroRered forsam. IL hawever, me building orimprovernow mould within ane ye r ofmmpledon. the owner. builder will have the burden of proving this Im did not Wild or improve for imports of ❑ 1, as canter of the property, am exclusively corseting with licensed connectors e Construct dee project (Sec. 7044, Business and PmRuima Code:) The Communes LI- ceve taw does atm apply b an owner of property who build. or improv thereon. and. who contracts for such Miecu with a contractor(s) licensed pursuant to was Contractor', License Law. .- . ❑ IamexemptunderSa. ,B&PCformlamasen lomer Data WORKER'S COMPENSATION DECLARATION 1 hereby aRmr uMer penalty of perjury and, of me following dechan)on: ❑ I ham and will maintain a Cenifimam of Concent to self-buum for Wmkmes Compm- sound, u provided for by Section 3700 of tie Labor Code, for W performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compemolan Insurance, as required by Section 3700.1dee Labor Code, far we part.... of me work for which this permit is issued. My Worker's Compensation ' 1Insurance 1artier and Policy number sen: (40 Cartier:��- 17iA�t/ Policy N..: DO CEftTIFlCA OE�FE&PTIONFROM OIiKERS' COMPENSATION INSURANCE , (This section once not M cam plead if Ne permit is for ac hundred dollars (S HXE or lest) 1 candy that In the performance of me work for which this permit is bound. 1 shall not employ any person in any answer W as in became subject in the Worker' Compeneen.n Laws of Calif.mis Dam Applicant NOTICE TO APPLICANT. If, afar making this Conificam of Exemption, you mould baeome object in we Wmketo Compensation provisions of me labor Cade. you rens, foMwith comply with such provision or this permit shat] he deemed rooked. CONSTRUCTION LENDING AGENCY 1 hereby &Rpm No men its eonctmawn lending agency for Nc performance of the work for which this permit i, issued (Sec. 3097, Civ, C.) Lenders Name , Lender's Address I certify that 1 have need this application and auto that me above infarnation is toren. I gma to empty with all city and county ommica ea and sum laws relating to building conswetiod, and hereby awhoria representatives of Nis city to aarupm the above-mentioned property for impaction purposes (We) agree to use. indemnify and keep harmless the City of Caperton against Imbllides, judgmenta, casts and expansion which may in anyway acme against aid City I con quenee of dee grating of this permit. PPLI ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date S R EREGUI.ATIONS. Re -roofs Type of Roof � (9' KPQ6:`, Slgnauneof Appiman tamer Dam HAZARDOUS MATERIALS DISCLOSURE Will me applicant or town building o¢upat nom or handle haalloun material donned by the Cupertino Municipal Cade, Chapter 9.12. and the Health and Safety 10 Je, Sccnon 23532(.)? ,(vYO All roofs shall be inspected prior to any roofing material being installed. ❑Yen o If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant um equlpmem or devices which emit haallom air comartmanta as defined by the Bay Area Air Quality Management all new materials for inspection. Diavict7 f ❑Yen Dd Nu I have mad the h cumd. mncrials requirements underchapter6.95 of the CHifor- nia m &Safety Code,Sectioes 25505,25533 and25534. I unrkrsund Naliftda building dans t cu fitly hew a tensa that it u my maponibility a notify we orcupat of the regvinem ren tmmetpnnrtaissuance .ncmnirmam� l�an Signature of Applicant Date All roof coverings to be Class "B" or better owner rr emn.nvaa .gem Dam 04o y CITY OF CUPERTINO • CUPEkTINO GENERAL BUILDING • 0 PERMIT APPLICATION FORM APN # Dat - lq `©e Building Address: a o SS a 5j*0,,o e(�-L Z&Aj Cam AIO Mailing Address (if different from building address): Owner's Name: Phone #: C NaC6 6tAr7J - 8 C ntractor: 23e77r-, �3urcvr.✓b R �ac/LS Phone: Otd5-, y� �_ ?5-0 0 Fax: CDC? Contractor License #: Cupertino Business License #: Contact:: / Phone: clas � cF Fax: Residential A, Commercial Job Description: A?ePA1k -rtF�7i-r r+E Des+ 6E ID eLdrzG- ) TlztM lf- Fnt+.✓r 6;0+72� l✓c,✓op,� ,g,i� —I%ZJ 4 DOMA /1/&Wr- 4U Goya{ Building Permit Info: Bldg jd/ Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): ccupancy Type: 1 FR, 11FR ❑ 11, 111, V-1HR ❑ 11, 111, 1V V -N JA tcecrl 34wiez"t�- X4OO Valuation: Square Footage: /000 — Project Size: Standard Lar e ❑ Major ❑ CITY OF CUPERTINO • CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1 GENCOM 1BTEMPPER Temporary Building Permit (good for B 30 davs) 1BBOILERI 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 1BBOILER2 Installation /relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption ss over 100,000 Btu/h IBBOILER3 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. IELECINSP Other Electrical Inspections (per hour) E 1MECHINSP Other Mechanical Inspections (per M hour) 1PLMBINSP Other Plumbing & Gas Inspections P (per hour 1MEETINGIHR Application Meeting B FJ • CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEESCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM ACOUSTICAL REVIEW IACOUSFDW SFDWL/DuplexNew B IACOUSRESAD SFDWL/Duplex-Addition/Alteration B IACOUSCOM Multi-Family/Commercial B CHIMNEY'S 1CHIMNEY Chimney B 1CHIMNEYR Chimney Repair B FENCES 1 FENCE>6FT Non -masonry, over 6 ft in height B 1FENCEMAS>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 1MODUSTRU Modular Structures B FOUNDATIONS 1FOUNDREP Foundation Repair B 1PILECAST Pile Foundation Cast in place concrete B 1PILEDRIV Pile Foundation Driven (steel, pre- stressed concrete B 3 of 5 CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/SfFee ID 7 Fee Description Fee Group Permit Type IGENRES or 1 GENCOM RETAINING WALL(CONCRETE OR MASONRY 1RETSTN Standard (up to 50 ft) B 1RETSP310 Special Design, 3-10' high (up to 50 `) B 1RETSP10 Special Design, over 10' high (up to 50' B 1RETCRB< Gravity/Crib Wall, 0-10'high (up to 50 ft B 1RETCRB> Gravity/Crib Wall over 10' high (up to 50 ft B SIDING 1SIDEST/BK Siding, Stone & Brick Veneer (interior/exterior B 1 SIDEOTHER Siding all other B SKYLIGHTS 1SKYL<10 SF Skylight less than 10 sf B 1SKYU10SF Skylight greater than 10 sf or structural B 1STAIRS Stairs -first flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 so B 1 SRACKS>8 Storage Racks over 8' high (up to 100 st B 1STUCOAP Stucco Applications (up to 400 so additional stucco application B 4 of 5 11 • • • CUPEPTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1 GENCOM 1 WINREP Replacement windows/sliding glass door ea 8 windows B 1WINMEWSTR New Window -structural shear wall/masonry includes plan ck fee B IEPERMITFEE 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 when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B / 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B • 5of5 • CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT • 0 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32344042.00 DATE ISSUED.......: 02/14/2008 RECEIPT #.........: BS000003949 REFERENCE ID # ...: 08020095 SITE ADDRESS .....: 20552 SHADY OAK LN SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: SLATEN LYNORE E ADDRESS ..........: 20552 SHADY OAK LN CITY/STATE/ZIP ...: CUPERTINO CA, 95014-0496 RECEIVED FROM ....: PATRICK M WHARTON CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ........: FEE ID UNIT ---------- ------------- QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL 1BSEISMICR VALUATION ---------- 1,800.00 ---------- 0.50 ---------- 0.00 ---------- 0.50 ---------- 0.00 1BUSLIC FLAT RATE 1.00 110.00 0.00 110.00 0.00 1SIDEOTHER SQ FEET 1.00 367.00. 0.00 367.00 0.00 TOTAL PERMIT ---------- 477.50 ---------- 0.00 ---------- 477.50 ---------- 0.00 METHOD OF PAYMENT ----------------- --------------- AMOUNT REFERENCE NUMBER CREDIT CARD 477.50 -------------------- MC --------- TOTAL RECEIPT ' 47750 CITY OF , UM TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: s sa 04 A) PERMIT # 0 CPO20o v - OWNER'S NAME: G 4w o2 r$ PHONE # GENERAL CONTRA OR: FAX # C I am not using any subcontractors: a ` fY- 06 Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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