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06120023 CITY OF CUPERTINO .xxgy BUILIANG DIVISION PERMIT ,�G�NTRACT�C',;R�I IFORIVIA'PIO.N aUILDINO ADDRESS: EAGLE ELECTRIC PERMIT NO.06120023 7491 TIPTOE LA OWNER'S NAME: PERMIT ISSUE DATE MARK & SHELLIE PEERCY 1061 SHAMROCK D 2 2006 NE: SANITARY NO. CONTROL NO. (408) 241-9956 ARCHIiECrfENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 IOp LICENSED CONZACTOWS DECLARATION Job Description %w 1 hereby affirm OI Nat 1 am licensed under pmvisions of Chapter 9(commencing p ;Ino with Section 7000)of Division 7 of the Butirleu and Ptofnaiva Cade.and my license is !�N in full forte and effect. INSTALL NEW 20AMP DEDICATED CIRCUIT AT GARAGE License Class Lie.M %FO Da¢ Conarssaor ARCHITECTS DECLARATION i¢< 1 undersand my plans still W used a public noords 1yU naH LivenseJ Pmfcssiontl 3 OWNER exempt FR in We Common's C 1 hereby.Rare We 1 I.J.exempt sum the Co lions r License Law for We p o following wan.(Section 7 construct, Business and w.deaca Orion:Any city of county oma�i which requite n permit to put.me.alter,improve.h Permit u or repair ed swmum $1455 a�'^ prior W iu issuance,also acquire the aismor m far Cert permit m file i e Law ¢hareem (cameencing it purvans Rode pro vision of We ContrL'ucnsesions Code)or Sq.Ft. Floor Area Valuation CFC (commencing exem with sections it g Inesis f rth al ageBusiness antl in.my Cock)sir ,3� Nat k u rswPt thoefrom and Ne bait for the alleged exemption MY violation of Section 703 L5 by any applicant for a permit subjecd the applicant to a civil penalty of RMbbr U U Occupancy Type not mom this five hundred dollars(SSW). 1,a owner or the property,or my employers with wages as their sole compmuadon, will do the work,and be sractum is act intended or offered for sate(Sm.70U,Business and Prarassiona Cade:The Contractors L16'ee Law dOtl not apply in an oWOG Of Required Inspections Property who battles or improvrs threon,and whodoeseachwork himselfdr through his own cmph yrc,provided Wm such imgommcnu art trot ineMN sir offered foso In If, however,On building or improvement is sold within one year of oomph tion,the own.. builder will have We boom of proving Wine did Out child or improve for purpose of Calc.). 1,as owner of the property,ma euiufvcly contracting with licensed mnuacbrs to coatmm We project(Sec.7044.Business and Pmfesiem Code:)The Compal Li. code law dors oot apply in an owner of prapenY who Wilds or imprisoned demon,and. who contracts for such projeos with a contrenta )licensed present to We Control License Law. ❑l am eempl{T ndo See B A P�C�If,o�}N�iswT/��o-n, owner �l,l l/ Data .{ WORKERS COMPENSA DECLARATION 1 hil a10rso under Pointy offal enc of We following daclaratina: 1 ham and will mainuin aCerdficare of Consenuo self-insure for Workers Compere nation,an provided fee by Section 37W of We labor Code,for We Performance of We work for which this permit is nodded. ❑1 have and will maintain Workers Compensation Insurance,an required by Secvon 37W of We labor Case,to,the performance of We wank for which this .it is iaacd. ' My Workers Compensation Insurance carter and Policy number are: Camey. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE i (This section aced iwtbccompkud ifthe Permit is foone hundred dollars(SIM) or lea.) 1 certify Was in We performance of We work for which this Permit is ismad,1 shall not employ any pcdon iy. rlinamnclmassa c�c and,atotal Wo^nS mhnc�on Iawsef Califol in Ds a U]/f/ Applicant / ��� .--t NOTICE TO APPLICANT;If.after maling this C i cma of Excell You should became subject W We Workers Crmpcnuuon provistrins of We labor Code,you muse .J O froul amPIY with such Provisions or this permit fill k deemed al CONSTRUCTION LENDING AGENCY E-r I hereby affirm Nat Wee is a consuuninn lending agency for We K,furmaace of C.:> We wok for which Nis Permit is issued(Sec.3097,Civ.C.) WRQ Lmdcia Name . ,= Z Under's Address J Q 1 certify War 1 have read this application and sum Nm We abom information is ILU correct.l agree to comply with all city and county notional and Cute laws mladng W O Wilding Contraction,and hereby authorise mprexnorms or Nis city to enter upon the ekvc-ms,judg dPropcny farinaPeNun which may a H y (We)agree to arse,indemnify and k0CP harmless We City of Cupertino against Z in Wecosuand of thiscx,penses which mayin any way accrue against said City A APPLICANT of We running of this DJ)WI V Z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / 2- 1 SOU {GU PpONS. /� i 2/1 a l •ft`�— /19���( J Re-roofs , St Wre of Applicam.00muxwr ®� HAZARDOUS MATERIALS D ISCLOSU RE Type of Roof Will We applicant or lmum building oaupantstore or handle haudous material az Coined by We CuPemed Municipal Code.Chapter 9.12.and the Health and Safety Code. ren 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. Yrs Will On aPplicanl or mlum gilding..Pool ace equipment or devlas which If a roof is installed without first obtaining an inspection,I agree to remove mit hx7�ne air Cannonball a defxd by the Bay Ate Air Quality Management all new materials for inspection. Disu ❑Yrs No Ihavc mwNelda nus aerialsaquircrncnd undcrCWPef 6.95 of Ne Colifor- nuwc iohSafetycad.SeaodxS505.25533w25534.lunderund Wmirtk Wilding Jecs not currently Irani a tenant.Nat it is my respoaibility eonotily dw occupant or de m nuwhlchmusixisma riaWissgaeccafaceatirte,toarCir Y. Signature of Applicant Date r < ,gen D,W. All roof coverings to be Class"13"or better sm Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 4§UPERTINO Building Department JOB ADDRESS: -71jq -rief-o: Larne PERMIT # (.uper- oo ( 2 0023 OWNER'S NAME: e-hIe efc PHONE # 0 - - 5-3 GENERAL CONTRACTOR: FAX # 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 QQ// (/( D..cc ' /;I- Owner/Contractor Signature Date CITY OF CUPERTINO em 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35928007 . 00 DATE ISSUED. . . . . . . : 12/08/2006 RECEIPT # . . . . . . . . . : 36983 REFERENCE ID # . . . : 06120023 SITE ADDRESS . . . . . : 7491 TIPTOE LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : MARK & SHELLIE PEERCY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : SHELLIE PEERCY CONTRACTOR . . . . . . . : ED HANSEN LIC # 25214 COMPANY EAGLE ELECTRIC ADDRESS 1061 SHAMROCK DR CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 241-9956 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ------ ---- BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 BSEISMICRE VALUATION 1, 455 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- - -- - - --- -- -------- -- TOTAL PERMIT 40 . 07 0 . 00 40 . 07 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 40 . 07 2376 TOTAL RECEIPT 40 . 07 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • II CITY OF CUPERTINO .em 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # : 2 Sec : Twp: Rng: Sub: Elk: Lot : APN . . . . . . . . : 35928007 . 00 DATE ISSUED. . . . . . . : 12/08/2006 RECEIPT # . . . . . . . . . : 36983 REFERENCE ID # . . . : 06120023 SITE ADDRESS . . . . . : 7491 TIPTOE LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : .CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : MARK & SHELLIE PEERCY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : SHELLIE PEERCY CONTRACTOR . . . . . . . : ED HANSEN LIC # 25214 COMPANY . . . . . . . . . . : EAGLE ELECTRIC ADDRESS . . . . . . . . . . : 1061 SHAMROCK DR CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 241-9956 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 BSEISMICRE VALUATION 1, 455 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- - --------- TOTAL PERMIT 40 . 07 0 . 00 40 . 07 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -- --------------- ------------ ------------------ CHECK 40 . 07 2376 TOTAL RECEIPT 40 . 07 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ________ ________---_____------------ 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • ( - CITY OF CUPERTINO CITY Or PERMIT APPLICATION FORM CUPEkTINO APN # Date: 3Efl� 28�17 iz- •7 - vlp Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: 1AA Irk he lhe pu rC(. .fm , 0�)`7-5 —�S&2-3 Contractor: License#: — 10 (a!5- �2 Contact: Phone: gpgt,7yh995(n Cupertino Business License#: L34,lar e - Fax: Building Permit Info: am_rsiaI hu1 ,904 p cW atveircult alS- L c Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: i 41SS Occupancy Grou Type of Construction: Please check this box if the project is a second-story addition: ❑ *;r-oiectsize: Standard ❑ Large ❑ Major ❑ 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 > I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO QTY°F PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Grou • 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 VaeLIUM 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 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 Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > I 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 2 of 3 CITY OF CUPERTINO ` 61TMOF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmd] 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 Inspection 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 Mecb 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