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06050167r CITY OF CUPERTINO F `j H ? U co y < 7, rn ? QLcndmY z Q f" r..) Cabavomcnumtcd y Z ^ �'� x ' INF,,ORIVIATION - - ` BUILDING DIVISION PER MIT � C,ONTRACTQR BUILDING ADDRESS: LAWSON MARILYN H PERMITNO. 06050167 20627 SUNRISE DR OWNER'S NAME: PERMIT ISSUE DATE LAWSON MARILYN H 06 IV NE: SANITARY N0, CONTROL NO. wRCHTfECT1ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION JOS DBSCr1pUOn I hereby affirm cast 1 me licensed under provisions of Chapter 9 (commencing with smim.7ormaf Divixion 3 of 01 Business and Pmfessium Code,end my license is in full f.meartdcffecs� 2 BATHROOM REMODEL WITH MINOR STRUCTURAL License Clan Leg Dam Ommucher /A. ARCHITECT'S DECLARATIO I 1 undersand my p1. shall W used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 Wrtso .(sere that 11. exempt from the Camme.rs Law for the Any : C following mown. (genian 11131.5, Business and Pm(enho Code: Any city or county which requires a permit re mnawn, slue Improve. li ri mmnum poor mnlicened a..Alva requires Nic h permit e a sig ed for sucCommemiuoicanse Law Sq. Ft. Floor Area Valuation ovisiocant (Chapter thathcisliccnudpunuantbNCPmvisionsafNCConuuur'sliccnselaw(Chapter9 (eummeneing with Swoon T000) of Division 3 of the But. and Pmfessi... Code) m 19 that he u exempt tlmccfrom and ge basis for Ne alleged eaemp hon. Any violation of ApN Number Occupancy Type P Y YP Sccuon 1031.5 by any applicant for a permit subjmU the applicant to a civil penalty of not more than rive hundred dollars (M). I. u owner of the property or my employees with wags u Nei sale compensation, win do thcwart. and the suamam b not intended m offered for sam(Sec. 7(14, Business - Required Inspections q P and Professions Cade: The Communities License law d.es not apply m an awtxr of propany who Wildsmimpron. thcrwn,andwho d«isuch wart himself., dough his Own employees, provided Wt such improvements tie not inmrded aroffesed for sale, If. however. the bending orimp overeat is said within one year of complemm, Ne owner - builder will nate the burden of proving Nat he did saw dud or improve for purp.se of sale.). Q I. a owner of ucdsi corm with licensed comae m pm.70A1 ct . Business rod Py a. es cens Ne (Sec. 101x. ad ns Cade:) The Li - esnjot s; themars, ore Law dao not apply m an wer imPmvu thereon. and. La of property who Wilds who witha rs Licca e.nmcu for such pmjecu with a eanuanar(s) licensed pursuant m Na Conmcmh w License Law. / ❑lam ucmpt undo Set .Bk PC for this reason /b Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby aRrm under penilty of perjury ane of Ne following danlerstions: 1 nave arta will maintain a CeNficou of consenuoself-inure for Workers Compen- sation, as provided far by Section 3700 of the Labor Code. for Ne performance of Ne wort for which this permit u issued. QUI have and will maintain WOrkers Compensation Insurance, as required by section 3100 of the labor Code, for the performance of Ne were, for which Nis Permit u issued. ' My Workers Compensation Insurance carrier and Policy number are: Cartier. iS14 (j T�� Policy No.: CE I CATEF7 OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section nand not W completed if the Permit u (atone hundred dollars (SIM) r or less) I canary than, in du porrmmacec of the work for which fair Permit u issued. I shill m.1 employ any person in any mannersa as m become subject to tM Workers' Compenaauort Laws of California Dau Applicant NOTICE TO APPLICANT. If, after making Nu Ocri ficam of Exemption, you should become subject m the Workers Compensation provisions, of Ne labor Cade. you a= rorchwich comply with such profundm or NU Permit snail W deemed revoked. CONSTRUCTION ON LE lNG AGENCY in a m Tor Ne perfewacme of IWmwhich thi Nazmcrt issued(Sec. , the work fur which this paretic is issued (Sec. 7091, Civ. CJ 3M. Civ. Name Lenders Address 1 cenify that 1 have read this application and suis that Ute .hove information Is correct. I agree in comply with ill city arta county odicureas and some laws relating in - building conswction, and hereby awharim mp.esentrdws of this city to enter upon du property for inspection purposes. (We) agree to save, indemnify and Amp harmless tW City of Cupertino against ts. may in any way acemc against said City in in consequence of Ne isanting of Nu permil ZmandOf this permit. APPLICA NDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date Sl- (/.G G TIONS. �Z— ��SOURCE -1�0�Re-roofs Signuurt of AMINAOUConuactor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof will the applicant or future building accupan SCOM or handle hincommm material As damned by Oil Cupertino Municipal Cade. Chapter 9.13, and Nc Health and Safety code. secaon 25s3z(a)t' 0y.RNo All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit havandoo it conuminanss As defined by the Bay Am. Air Q alit, Management all new materials for inspection. DistricR - ❑Yu No I have mad the hvarMnumamnials requirements under Chapmrb.95 of he Cannor- nuHealth kSafctyCode, Smuom25505.25533 and 15534. I understand Natifthe Wilding dam, cmc cu tIY one • mere that it 4 my responsibility m tmufy the occupant or Ne reyuire�h mm poor of a Cadficam of Occupancy an cwrcam of Occupancy Signature of Applicant Date � roocover All f coverings to be Class "B" or better g owner or awnort . d .sem ' Date CITY OF WUPER,TINO • • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS:// Z06Z oh' r v.Yi 9"5v� PERMIT # 6 �'o," OWNER'S NAME: Q , so PHONE # O$ 26 Z r� i GENERAL CONTRACTOR:ep r, C FAX # 4,9 6 -V6 z I am not using any subcontractors: 0//K 2 22Z 2 Signature Date Please check applicable subcontractors and complete the following information: kd 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 !m 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35910021.00 DATE ISSUED.......: 05/18/2006 RECEIPT #•........: 34456 REFERENCE ID # ...: 06050167 SITE ADDRESS ...... SUBDIVISION ....... CITY .............: IMPACT AREA ...... METHOD OF PAYMENT AMOUNT ----------------- ------------ CHECK 694.50 TOTAL RECEIPT 694.50 • 20627 SUNRISE DR CUPERTINO LAWSON MARILYN H PHIL MAIN LIC # *OWNER* LAWSON MARILYN H 266.76 27.00 3.60 128.04 3.60 38..37 45.39 105.00 38.37 38.37 PD -TO -DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NUMBER ------------------ 2043 OPERATOR: amyw COPY # : 1 THIS REC 266.76 27.00 3.60 128.04 3.60 38.37 45.39 105.00 38.37 38.37 694.50 NEW BAL 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 joluers, ADDRESS ..........: CITY/STATE/ZIP ... RECEIVED FROM .... CONTRACTOR .......: COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ... TELEPHONE ........: �EE ID ---------- UNIT QUANTITY ------------- BPERMFEE ---------- VALUATION 19,000.00 BPFIXTURE UNITS 3.00 BREMFIXT NO. FIXTURES 3.00 BENERGY PERMIT FEE 266.76 BREMRECEPT NO. OUTLETS 3.00 PPERMITFEE FLAT RATE 1.00 BREMVENFAN NO UNITS 1.00 BUSLIC FLAT RATE 1.00 EPERMITFEE FLAT RATE 1.00 MPERMITFEE FLAT RATE 1.00 TOTAL PERMIT : METHOD OF PAYMENT AMOUNT ----------------- ------------ CHECK 694.50 TOTAL RECEIPT 694.50 • 20627 SUNRISE DR CUPERTINO LAWSON MARILYN H PHIL MAIN LIC # *OWNER* LAWSON MARILYN H 266.76 27.00 3.60 128.04 3.60 38..37 45.39 105.00 38.37 38.37 PD -TO -DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NUMBER ------------------ 2043 OPERATOR: amyw COPY # : 1 THIS REC 266.76 27.00 3.60 128.04 3.60 38.37 45.39 105.00 38.37 38.37 694.50 NEW BAL 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 joluers, !3c e D �C%r �Iz 2o627 �'"r'y' �✓ �9.cmo�tic �Q�roo»'1 (�(��lUlih01 6f IrraM),A J rrw�oVt C/c, Gh� S%dw✓r {o d,) j `" 0 I I 610cL r7GQ 4 / (-ehsUr i m pQ{ 6:l J yh S �,� Ifo �x�ovST �un J Dec 20 4-P �fv' C � «� 1 � G le o�'IeSI' h k a)) T ef.4°"5� -FGY{ �Iticr 004 hle Gvo�/S O� ✓ d�OLv✓/ RECF�'VFaD MM ] 2006 0 aw J G o p e O L-10 y- Z • PI MOA (Jq 4T Do r1 0 Zo627 of A gyo'y 1 v�lUlihpl m;A6r il'GMJ�'� J rtmovv C/C15-r &Oe. S Wa II �Oo ht/) wo II m p�cen Srnsor �xho�s� d -an Oho Gv 4m,o f�e lbCa It lyPJa hiocl o ; 1-e -� SI' h d T V /4 pV 6- -JGyl RECEI V tj% MAY l S 2006 54,,7' (06) �iticn�7oa� w�ll /,H�� cvo��t of 4-1 54w,rr 0 f .• L � f MAY 1 82006 0 az�lms, CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 005oIQ7 N# -' Fee Description Fee Group Date: Building Address• 2062- Mailing Address (if different from building address): CV, 7;0/ Owner's Name: M / / /A f i/n LgwS9 Boiler <= 100,000 Btu MECHANICAL Phone #: Contractor: n I) N / ) �rucf�on �+�� BBOILER3 License #: g7�52� Contact: n Phone: hog r� 1114i h Fax: you 265-25" 1 yys-966L Cupertino Business License#: Building Permit Info: cA`broc�w, ry—O w%o dto_l Bldg 0--- Elect [a Plumb l 0-- Mech Job Description: Residential [' MECHANICAL Commercial ❑ Sq.Ft. Floor Area: 52 5$ f f BUILDING BCONSTAX Sq.Ft.: Cost ofProjec Iq 000.00 BCONSTAXBQ Con. Tax for BQ Zone Occupancy Group; _ Type of Construction: 471 roo/h r-, ph aolle- Hotel and Motel BUILDING Please check this box if the project is a second -story addition: ❑ Project Size: Standard O-- _Lar ❑ Ma'or ❑ BELEC1000 Elec 600V <= IOOOA Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK 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 > IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING Li I of3 ciir'or CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description ree t,rou 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 3 BPFIXTURE PbIg 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 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 cfin MECHANICAL BREMAPPLI Ap liance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Li ting 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 Appliance ELECTRICAL BRE OLE Pole/platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rent], Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res A liance ELECTRICAL 2of3 4 r L a�% CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Si s, 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 • 3 of 3