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06050249 CITY OF CUPERTINO ' &%^ w BUILDING DIVISION PERMIT 3gcoftf ARTNFORMATION ;- BUILDING ADDRESS: PERMIT NO. CUPERTINO PLUMBING 06050249 0 A PERMITISSUEDATE E. 131.10 DE LL AVE, STE C SANITARY N OL NO. lor ARCHDECIENGINEER: (408) 253-0151b BUILDING PERMIT INFO BLDG EIEC( PLUMB MECH 0 0 0 0 jp LICENSED CONTRACTOR'S DECLARATION lob Description C 1 tachy Affirm deal 1 w Ikenssd under provisions of CMpter 9(rnmmcbeing w wilt Seeuon7fJ(IU)of Division 3 of the Business and Professions Code,and my lice.¢is k and f m . err gz Li a.Ci.zz ; Lk. COPPER REPIPE WATER HEATER :0 Dam Ohmmear v / PE/ WATER DECLARATION I understand my plans shall he used As public records U Liccrucd Professional n 3 OWNER-BUILDER DECLARATION i f 1 botchy al'Orm ter I Am exempt from the Contractor's License Law for to p O following reason.(Section 70313,Business and Professions Code:Any city or county 3 which mquirta A permit to cousuun,almr,'nnpmw,demolets.m repair any vuuaum t prior An in,issuance,elan,rtlance theapplicant forsuch permit¢Ole a signed summer Lj that he is licenmd pursuant to to provisions of de Contractor's License Law(Chapmr 9 Sq.Ft. Floor Area Valuati (commencing wit Section 7000)of Division 3 of the Business and Prafesions Code)m $ to W is exempt sMsefmm and do tun,for the alleged Assumption Any violation of Section 7031.5 by Any appli mat for A permit mbjecu to applicant to•civil penalty of 3Ab � Sr 0 0 Occupancy Type net mom tan Ove hundred dollars(SIM. P y yP ❑L she wr o and gra mane, r my airruncta with wager u Wank (Sec. compewness and dotcwsrlt melte heCmunor's Ladednawdoesered Act apSec.70 an owner of Required Inspections and Property who W Code:The wca den ton.License Law does Act apply lf m owner is q P propertywhobuilds Provided sstemon,andwho da not inwork himself ad ArA gh his mancmplay Wilding pr anmimis mid hart not ear of orsBemd fur sales, Wilder r,to building err improvementg rola whin one year of oomoNon,to owsmr- Ask.). will have to burden of proving drat he did Out build or improve far purpose of sok.). ❑1,as owner of to property am eseluvwly contracting wit licensed contractors to construct to project(Sec.706x.Business and Professions Code:)The Conu¢mfs U. cense Law data not apply an an owner of property who builds or improves th.man,and, who contacts for such pmjam wit a contracmr(s)licensed Parthenon in to Conuabomes License Law. /. ❑IamexemptuaderSec ,B&PCforlhithrtuon Osvrcr Dau .. .(' WORKERS COMPENSATION DECLARATION 1 hereby aRim under pevalry of perjury arc of uses following declarations: hsw end will maintain A Certificate of cement In self-tuure for WoriscYS Compere don.An provided fur by Section 3700 of the Labor Cade,fm to performance of the work far which tis permit is issued. ❑1 have aM will maintain Workeh Compensavan I...As mounted by Section 3700 of dm labor Code,far to perrammee its work far which tis permit is issued. My Workersm sauon Insurance carrier and Policy nuam�ber am Carrier. ra-« Polley No.:A!- %J. lcd4 2X CERTIFlCAM GF Ex MON FROM WORKERS' COMPENSATION INSURANCE (This accuan rmed nine completed if the paoait s far.hundred dollars(5100) Or kis) 1 certify tar in the performance of to work for which tis permit k issued,I shall not employ any parson in my manner¢An to become aubjeet to the Workeri Compemauoo Laws of CallfOnAL Date Applicant NOTICE TO APPLICANT:If,after making tis Certificate of Exemption,you should becemc subject m rite Worker's Compensation provisions of to lab¢Codc,you muss Z forthwith comply it such provisions m this permit mail be der med masked. Q ;y CONSTRUCTION LENDING AGENCY i? I hereffrm by aitat tort seramounted.lendingagmy tc efar perfarmmcf u to work far which dria permit is issued(Sce.3097.Civ.C.) Qlender's Name Z Lenders Add. r Q I cerufY tat 1 have read tis application and sure to tic above affomravon s FcormCL 1 agree to comply with all city and county ordinances and sum laws relating in l C.) building eonswction.and hereby aurhorim mpresanutiwa of tis city to enkr upon the .law-asomm.ed property(or impacts.purposes gys (We)agree to saw,indemnify and keep harmless the City of Copmino against to liabiliata,judgments,Goss and expenses which may in my way Korea against said City J',Z, in consequence of due granting of this permit ^ APPLICANT UNDERSTA D WILL COM LY WITH ALL NON-POINT Issued by: Date G� SOU REGUUTIONSr ��3/-J ' Re-roofs 8igwumof H s ITS MATERIALS DISCLOSURE Dam Type of Roof Will do epplinr Or forum building occupant mom or handle hmardous material As dcli ed by to Cupertino Municipal Code.Chapter 9.13.and the Halt and Safety coM,Section 25532U>+ ❑Ye Rhft`� All roofs shall be inspected prior to any roofing material being installed. Will to Applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove t ea 11 to air contaminants ta dermad by tc Bay Arta Air Quality Management all new materials for inspection. mole" ❑Yen I have real lee W7,m aur mamriak cquimmens under Chapter 6.95 of to Califor- maHultkSeely Code,Savour 25505.25533 and 25534.l understand tat if lite Wilding J nos eurtenrly hove a moannsibility k unary to meupmr of to tmmcnts wnmhmm-he ren pri aOum err OceapmeY. Signature of Applicant Date v owns or vaso agent D,m All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue F Vii. Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 #UPERTINO Building Department JOB ADDRESS: PERMIT # 1128 OWNER'S NAME: Do.. PHONE # 253-c3c,18 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Si a e 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 • � 3i- dam er ontractor Signature Date CITY OF CUPERTINO !m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36207013 . 00 DATE ISSUED. . . . . . . : 05/31/2006 RECEIPT # . . . . . . . . . 34627 REFERENCE ID # . . . 06050249 SITE ADDRESS . . . . . : 1128 STAFFORD DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : DON FERRIE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : FRANK CARDIA CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612 COMPANY . . . . . . . . . . : CUPERTINO PLUMBING ADDRESS . . . . . . . . . . : 1300 DELL AVE, STE C CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 253-0618 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPREPIPE NO OF FIXTURE 9 . 00 81 . 00 0 . 00 81 . 00 0 . 00 BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 242 . 26 0 . 00 242 . 26 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 242 . 26 VISA TOTAL RECEIPT 242 . 26 VOICE ID DESCRIPTION VOICE ID DESCRIPTION502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • CITY OF CUPERTINO ow5o gLLP CITY Oi PERMIT APPLICATION FORM CUPEkTINO N# '31n ` 0 1- 06 Date: 5-31- Oco Buildin Address: L Mailing Address (if different from building address): Owner's Name: Phone #: y0�_- .3, Gr'. Co tractor: License #: q c Contact: v Phone: -2-:5 3-61 Cupertino Business License#: Fax: 2 $3-(3 Building Permit Info: Bldg ❑ Elect ❑ Plumb P'_ Mech ❑ Job Description: Residential D' Co Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: /600 Cost ofProject: 6s oUO Occupancy Group: - 3 Type of Construction: Please check this box if the project is a second-story addition: ❑ roject Size: Standard ❑ Large ❑ Ma or ❑ anti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK 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> I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of3 - CITY OF CUPERTINO CITY'dF 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 BPWATER Install/Alter Water Pie PLUMBING j BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIIZHAN 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 Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/platform Fixture ELECTRICAL BREMPOWER 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 +D CITY OF CUPERTINO cTM°° PERMIT APPLICATION FORM CUPERTINO AkkQuantity Fee ID Fee Description Fee Group lop BREMSIGNAD Rmdl Si s 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 BSPECLAL 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 Mechanical sq. 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