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06050240 CITY OF CUPERTINO ° •^" a�" ` '`''` "�'`` - IIUILDING'DIVISION PERMIT lC �.. ONTRAGTnRINFORMATION �. BUILDING ADDRESS: MBROWN CONSTRUCTION, INC PERMIT No.06060240 10873 WILKINSON AV OWNER'S NAME: PERMIT ISSUE DATE PANNELL DONALD R AND CHARL TTE702 S . DANIEL WAY 06/28/2006 NE: SANITARY NO. CONTROL NO. (408) 260-1260 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 �0, LICENSED CONTRACTOR'S DECLARATION Job Descri tion to F 1 bireby affirm Nat 1 am licensed under provisions of Chapter 9(commencing P ;ZWAuto guide.700Mof Divisor 3 of the Base.and I'mfeaium Code.and my license is n« in full to=andeffeer. ELECTRICAL WIRING FO DIG IX-T-URE IN A SOLATU Dole Clan Contractor pyI t„ Date Carer ECL u B k I) �� As shallRCH use DECLARATION Y j i�a 1 understand my plans Shell w used as public records 'may LicensedPndessionat JUL `V- 2006 OWNER-BUILDER DECLARATION aI bemhy a1Tnm that I am eac.pt Inc.the Conwmors License Law for the D Opp fallowing.anon.(Sccuon RD 1.5,Business and Professions Code:MY city or County um LL which rt9uitel a permit to construct.eller,Imp rne,darrolult,or repair any S1metUm $200 prior to its issuance,also requires 0m applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's Um=Law(Chartn9 Sq.Ft.Floor Area Valuation FFG (commencing with Section 7")of Division Sof the Business and Profession Code)or r3 9 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 70315 by any applicant for a permit subject dm applicant m a civil penalty of r Occupancy Type not more tom five hundred dollars(5500). 0 1,as owner of the property,or my employees with wages as their sole compcnsauon, will do the work and theswcture until intended of offered(01 sale(Sec.7051.Business Required Inspections and Profession Cade:The Contrmmes License law deo toe nst apply to an owner of q p property who builds orimproves t crmr.and who dadsuch work himeelfor through his own employees,provided that such improvements art not intended oruRered forsale.IL however.the building at impmvxmeat is sold within oro year of completion,the owao builder will have Ne burden of proving Nat he did not build or improve for purpose of sak.L 1,as owner of Ne property.am exclusively conuacting with licensed contractors to onwcl the project(Sec.7014.Basiness am Prafetion Cade:)M Contractors U. cense Law does not apply man owner afproperty who builds or improves thereon,and who contracts for such projects with a eonuactor(s)liberated pursmnt m use Contractors Licnu Law. O lam ucmpt/ulmbor Seel B k P c for this Owns ( ,,zwt--�Dau:_MT OPV RKER'SC APE ATIO ECLARATION 1 hereby affirm under penalty of perjury am of the following dalantion: 1 ha.s and will maintain a Certificate of Consent to self-inure far Workeh Compen- sation,as provided for by Section 3700 of the labor Code,for the performance of dic work for which this permit is issued. 0 1 have and will maintain Workch Compensation Insurance,as myumul by Section 3700 of the labor Cods,for the performance al use work for which this permit is issued. My Workers Commas ation Insurance carrier and Policy number art: Cartier, Policy No, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE enter union need nos w completed done p.it is for one huMrtd dollar¢(SIOIB err less) 1 crimp,that in the perfmmancc of the work for which this permit is issued.l shall nal employ any person in mytomato mEe cmbjat O to Workarr Campensa"on Laws of Califamia.Dao � Applicant f 4 / NOTICE TO APPLICANT:If,after making this cnificaic'bf emptian,you should become subject b the Workers Compemation provisions of the Labor Codi,you must .J z forthwith comPIY with such provisions or this permit ahall be deemed revoked. zN CONSTRUCTION LENDING AGENCY [-+ 1 hereby Or..Inst thc.is a construction knding agercy for the a Marmon¢of C the work fur which this ,.it Is issued(Sec.309'1,Ci,C.) 1 Lenders Name z Lenders Address U 0 1 certify that I Mae read this application and sore that the above information is LL F^ comic 1 agree to comply with all city and county ordinances and sure laws relating m 0U building construction,and hereby aurhorire rcpresemativee of Nis city to enter upnn the r W shove-mentioned property for inspection purposes. F G (We)agree to ave,indemnify and keep harmless the City of Cupertino again" r/1 liabilities.judgmena,emu and expenses which may in my way aceta against said City U z APPLICANT UNDERSTANDSNANO WILL COMPLY WITH ALL NO -POINT Issued by: Date d"'�� SOURCE REGV TI Y//// Re-roofs / Signature ofA rcanUConuacwr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building acupml"ort or handle hanrdous material As defined by the Cupertino Municipal Code.Chapter 9.13,and the Heald and Safety Code.Seedocs 35333(1)? ON. All roofs shall be inspected prior to any roofing material being installed. Will the applicmt or future wilding occupant are,equipmen,or dc.iets which If a roof is installed without first obtaining an inspection,I agree to remove emit hit.rdnm aif conaminanti;as defined by the Bay Arta Air Quality Management all new materials for inspection. District? 0 Yes 1 have mad the haaadraa maarialsrtyvirtmcna under Chaparb.95 of the Califer. ria Hcal"SafclYCodc.Suction 35505.25533 and 25534.1 undcsstsM Na,ifNc wilding does not currently hmc a morn at it b my responihdiry mufy the nenuper,of tie reyaim lo W t armlasa arae aril ry. Signature of Applicant Date Owner err aathorized"gen, Dole All roof coverings to be Class "B"or better CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35613024 . 00 DATE ISSUED. . . . . . . : 06/28/2006 RECEIPT # . . . . . . . . . : 35062 REFERENCE ID # . . . : 06060240 SITE ADDRESS . . . . . : 10873 WILKINSON AV SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : PANNELL DONALD R AND CHARLOTTE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : CHARLOTTE PANNELL CONTRACTOR . . . . . . . : CHRIS BROWN LIC # 25108 COMPANY . . . . . . . . . . : MBROWN CONSTRUCTION, INC ADDRESS . . . . . . . . . . : 702 S . DANIEL WAY CITY/STATE/ZIP . . . : -SAN JOSE, CA95128 TELEPHONE . . . . . . . . : (408) 260-1260 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- --- - - --- - - -- --------- ---------- ---------- ---------- ------ -- -- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 73 . 73 0 . 00 73 . 73 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- -- ---------- ----- ------------- OTHER 73 . 73 VISA TOTAL RECEIPT 73 . 73 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL Community Development �i 10300 Torre Avenue [tet Cupertino CA 95014 W Telephone(408) 777-3228 CITY OF Fax(408)777-3333 *UPEkTINO Building De artment JOB ADDRESS: PERMIT # I oS'!.� I�� �K-i✓Is'vn �hJ� OWNER'S NAME: Dok7 a! a C!!q`I PHONE # GENERAL CONTRACTOR: U AX # 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 El 6d f C.. 3 ? 3 rf Z 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 .� CITY OF CUPERTINO p(pCXQ� D ciivoc PERMIT APPLICATION FORM CUPEkTINO 'RWPN # r f /� Date: J u 2,3 2-00(, Building Address: �Il Mailing Address (if different from building address): 87 / Ave Owner's Name: Phone#: ,I e / Contractor: �^ License #: (N fi5 U o,7 '3 0 3 2,Z— Contact: ZContact: Phone: Cupertino Business License#: Fax: Building Permit Info: ejed7fcAk Wiring -fir /i�qhlt� Sold e Bldg ❑ Elect 10 Plumb ❑ Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: 200 2 Type of Construction: �, Please check this box if the project is a second-story addition: ❑ *roject Size: Standard ❑ Large ❑ Major ❑ 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 IM 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 Elee 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of3 a��- CITY OF CUPERTINO bITYOF 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 BOVERUME 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 Pian 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 Lightin 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 MBREMRECEPT Rem Non-Res Appliance ELECTRICAL Pole/Platform Fixture ELECTRICAL Power Device/Apparatus ELECTRICAL T Rc tl, Switch & Outlets ELECTRICAL Relocation of Hood MECHANICAL Repair/Alter Heating MECHANICAL P Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO an"6F PERMIT APPLICATION FORM CUPERTINO dLQuantity 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 Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit. BUILDING BTEMPSVCS Ternp 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