Loading...
04080092 (2) CITY OF CUPEWrINO ""``- BUILDING DIVISION p�-r$jy� CONk'®1,2MA�N . �$�. Z✓� ..a..xa�,V '.3r ^sof,iO RM BUILDING ADDRESS: ^\ PERMIT NO. 04080092 "140 UNIT-RD PT_ OWNER'S NAME: PERMITLSSUEDATE PHONE: SANITARY I ONTROL N0. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 app LICENSED CONTRACTOR'S DECLARATION Job Description p 1 hereby affirm Nal 1 Am licensed and r proviaiou rf Chapar 9(mmormaeug OCU with S�Op6]Ofm)rf Divi.ion]af the Burand Pmfcssiuu Code.and mylicenu is '"?� in fullllf�arce antic ^ 'mar, manG co�tXaea� Ple(pC� 4 REPLACE SHOWER/NEW VALVE _ "0e'" ONTRACTOR: KRUEGER KONSTRUCTION . ARCHI SDEtW1.�ttATION ' d al dot I e 1 he d ea Mbfic records Oy 30G ens ^ 3 •OWN Exempt frDECe ContrON 3 e E 1 thereby on 11. exempt from the L'anl,emr'b License Law for the 3:2C following moon.(Section RIS syr t.Business And improve, nu demolish,oc:Any tiny m county z�m which tequints a pewit a ennstruoL plic imprnw,h permits or repair any structure Fit prices its issuum,xamoll.netitunesthe theapplieut foe such permit micesaLow(humem < (commencing withSeuion7")pmviaiauofNriveBuuuranicenulsw(C ode) 9 Sq.F[. Floor Area Vanua[ 000 a $ (eommencexempt Section and th basis for th the Business and Proon.Any ladon or y Nat he r campy thcntfmm and the aper for be alleged exemption.Any violation of Sccdon]0]I3 by any applicant for apewlt subjects the epplicmuo Advil Penalty of APN Number Occupancy Type not mom Nan five hundred della,($5Mx v ❑I,uownuaf Ne Pmpeny,emy employee.with wagetu Heir uleemnpenution, 32653023 . 00 swill do NAwah,and Ne Awnttmt n.t intended oroffemd foraale(Sec.]094,Business .red Pmfossiasu Code:That Canlraamra Lime Law does not apply to an owner of Required Inspections property who builds mimprovee themon,and who COCA such work himself or through hit own ver.the h employee,providedImprovement Np ouch improwmenu tie nal intended araRentd for Gln Ir, however,oebuildingdethatsuh imissaid mmwithinone yeardcompletion,Neowner• builder will have she burden of proving But,he did not Guild or improve for purpose of tile.). L or owner of du Sec.7 ,am exclusively contracting with Tba ConMAcAmn u construct thees not apply Ax in Business and Pmfuoom COCA:)ThemQuetor'a Li• who orm dope not apply u ts owner of property who builds or improvss centro.and who con U..for such projects with aconuacyor(q licensed Pursuant to one contractor's Lice Law. A,under See ,B h P C you this uazon Own Dau - OMP SATIONDECLARATION w I hereby eRiunder penalty (perjury one of the following daclaraionsc I have and will maintain a CeNfieau of Cement to self-inure for Wpkefs Compco- smion,At provided for by Section 7700 of Ne Labor Code,for Ne Performance of the we*for which this pewit is Banco. ❑1 have and will maintain Worker's Compensation Insurance,As required by Section 5700of the LaWr Coda,for the po fowmce,of the work for which this pewit is issued. My Worker's Compensation Insurance canner and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE f@r seeian raced natbecomplcutl R th lewit is!Drone hundred Mr.(SIM) nr lets.) I camfy Net in the performance of Ne work for which this pewit is issued,I shall not emplayany person Moan m.Mpto bcmtpcfubjcct to the Warkeri Compeuadon Law.of CarirOOD OY APPHAM, NQftCE TO APPLICANT:IL after making Nr Ceniacme of Exemption,you shnZ be �yllt/bjcct to Nc Worker's Compensation proviiou of the Ichor Coda.you mut co iwt mply wish such Invariant or this pewit shall he dcemcd revoked. O' CONSTRUCTION LENDING AGENCY E-t I hereby affirm that Nem is A cmmmctinn lending agency for the perfurmanm of C> du work for which this permit r itwed(Sec.3097.Civ.C.) W Q Landers Namc z !mice.Add.1 V Q 1 certify Nat 1 have fad Nis City and coup and sou Nm Ne above information misting 10 0 f-^ coned I gnte ct comply with all airy and county oNinmtts and sou laws moping to Q V 1howngcraiMcd construction,and hereby auNon inmpreuntatives of Nis City menur open du W above-(Weiagree to ave,rty for demnify anpkToua. gy (Wc)agree m sevq indemnify and keep harmless the City of Cupertino egeinn y liabilitiesjudgments.costs �addacapensu which may in My way acme against aid City V inconugMAUNDerrJ�geeSTppNDS is D WILL COMPLY WITH ALL NON-POINr Issued by:9 Date { s RC R 4 '( S. I Re-roofs new of pplicanUCom or Dem NAZAR OUSMATERIAlS015CLOSURE Type of Roof . Will the applicant or future building occupant store orhandic hazardous mourial at defined by the Cupertino Municipal Cade.Chapter 9.11,and the Health and Safety Code.Section 1s55xe.j] ❑Yu Na All roofs shall be inspected prior to any roofing material being installed. Will the applic t oa rebuilding oavpant ute cquipmcnl or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hacsrdous air malaminanIs defined by the Bay Arca Air Quality Management all new materials for inspection. Druict4 ❑Yes No 1 haw mad the huardnus materials requimmenta under Chapter 6.95 of the Califon duty Cade.Sections 15505,15573 and 15574.1 understand the if the building ,hasnot cow ly ha a tenuk Not i 1 ms ibilitym notify the mcupant of Nc requirement Bich At etpd tarmtccar ccnifieateoraapaney. /Signature of Applicant Date own namrriv ant' Date 2tC r All roof coverings to be Class"B"or better CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32653023 . 00 DATE ISSUED. . . . . . . : 08/12/2004 RECEIPT # . . . . . . . . . : 26646 REFERENCE ID # . . . : 04080092 SITE ADDRESS . . . . . : 10140 UNITED PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ALISON MATHIAS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5712 RECEIVED FROM . . . . : KRUEGER KONSTRUCTION CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 3 , 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BPLANCHK PERMIT FEE 83 . 16 110 . 98 0 . 00 110 . 98 0 . 00 BPSEWER SEWER SYSTEM 1 . 00 21 . 58 0 . 00 21 . 58 0 . 00 BPVENT UNITS 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00 BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00 BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BREMPOWER POWER UNITS 1 . 00 47 . 96 0 . 00 47 . 96 0 . 00 BREMRECEPT NO. OUTLETS 2 . 00 2 . 40 0 . 00 2 . 40 0 . 00 BUSLIC FLAT RATE 1 . 00 100 . 00 0 . 00 100 . 00 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 540 . 90 0 . 00 540 . 90 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 540 . 90 2381 TOTAL RECEIPT 540 . 90 -, �1 *CITY OF CUPERTINO� CUPIT EI�F PERMIT APPLICATION FORM APN# Building Address: Mailing Address (ifr rent frbuilding address): D 1 C 0 e Name: Phone#: I So,J / s Vo733 abs 7 ontr or: Li en #: 2u&C "710110 Contt: Phone:(,57-/0,) Vh?'-0.10V Cupertino Business License#: D C 2 Fax: c 743-�l i Si Building Permit Info: Bldg 2' Elect ❑ Plumb Mech ❑ Job Description: NGv V41,Vii; Residential PRL % S wei2_ Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: to? Cost of Project: o� Occupancy Group: 30 c — Type of C struction: Please check this box if the project is a 00 e — second-story addition: ❑ Project ize: Stan Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 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 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING ff 1of3 r. �� _% OCITY OF CUPERTINOO CUPEI�TINO PERMIT APPLICATION FORM QuantityFee 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 At 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 rinkler/Backflo 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 BREM 3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > 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 24 BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance I ELECTRICAL 2 of 3 W OCITY OF CUPERTIN(* oo CUPEI�TINO PERMIT APPLICATION FORM uanti 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 BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inection BUILDING BSWIM Swinuning 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 ZADDCHG Address Chane BUILDING 3 of 3 —Ml^tvcr�, VAwP , ZN!STAI( FCZPPROVED 7 Ip ACCORDANC WITH THE CITY Oh CUPERTI C SES AN ORDINA CES )ATE CON )'IGNEU Thi. ,et sans and specificabons MUST 11 .pt on the job at all times and it is un lawful to make any changes or, alterations on without written permission from ha building �luuvcv! 'nns u ,,,be he GFS al f the violati n of any �rovlslona env Ci rdmanc or )rate O N k 00 Shower Tub/Shower 2"L�x35\ 60"Lx30"W j R RECIE /o(VO UA-71 rE 6 pz.Acr�:—O! CIT, Of pEpA c o pmt i NC-) I CA a�uppolg