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02090192 (2) Ask CITY OF CUPERTINO " -1" , ' " -` f BUILDING DIVISION P$ T �<C0NTRACTOR INFOR � ION F BUILP6(9N9erSBARRANCA DR TINA & SCOTT BREHMER PERMIT Np2090192 97714�NAfEc& SCOTT BREHMER APPLICAT1919"Y"91"2002 PHONE: SANITARY NO./ TT��77 CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH OK t� 0 1-0, LICENSED CONTRACTOR'S DECLARATION color 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing prl pal <r'8 with Section 70(e))of Division 3ofOnBusiness and Profession,COde,andmylicense is REVISION (ADD ) LV HOUSE USE ONLY a Infull from and erreeL ORIGINAL #02070067r NO NEW PERMIT ISSUED Ft2i Lkcnse Clan Lic.0 0 Z FO Date Contactor ATION Ow-i 1understand my pl ns mall be usedARCHFFECTS Dia public records n O 3 u. OLicenseProfessionalcrved Professional ` OWNER-BUILDER DECLARATION 44 d<p 1 affirm that 1 exempt from the Contraam's License Law for the Masa t'u 6 O o following muon.Section 7031.5.Businss eend Professions Code:Any city or county lie,(Li which Requires a permit m construct.alcor.improve,demolish,or repair any structure $1500 Fit prior to its issuance.also nquims the applicant for such permit in file a signed statement < Nat he is Nor used pursuant it)On provisions of On Comme,tor's License Law(Chapter 9 Sq. Ft.Floor Area Valuation �$ (commend ng with Section 701))nfFjuision3ofthe Business and Professions Code)or 32601007 . 00 n - Nal he is exempt dt m(rom and the haze for the alleged exemption.Any violation of Section 70713 by any applicant for a permit subjecss the Applicant to a civil penalty Of APN Number Occupancy not mom than Oro hundred donn(5500). 101 - FOUNDATION Type ❑1,as owner of the property,or my employees with wages u their sole compensation, will do the work,and the structure is not intended Or offered for sale(See.7064,Business 1:02 PIERS • and Professions Cade:The Contractors Limma,law does not apply ad an owner of 103 - UFER Required Inspections properly who buildsorimpraws dtcmon,and who dm$Swh work himselfor through his Own employees,provided that such improvements ate not intended oroRemd for sale.If, 104 - REBAR however,the building or improvement is cold within one year of completion.the owner- Wilder will have Rheboom of moving thnhedid no,Wild orimprove far puryamof 105 - ANCHOR BOLTS son). 106 - SEWER & WATER 01,as owner of On propt am exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMBING construct be project(Sec.7 ,Business and Professions Code:)The Contractor's Li- can=Law docsnot apply manOwner o(Property who builds or improvesthemon,and 203 - UNDERFLOOR MECHANICAL who contracts for such projects with a contractor(s)lieensed pursuant m the Contractors License Law. 204 - UNDERFLOOR FRAME O l am exempt under Sctx ,B&P C for this reason 205 - UNDERFLOOR INSULATION weer Dare 301 - ROUGH PLUMBING WORKER'S COM PENSATION DECLARATION 302 - TUB & OR SHOWER 1 hereby affirm under penalty Of perjury one of the following declarations: p l have and will maintain a Cenificak of Consent m self-wain for worker:Campeau 303 — ROUGH MECHANICAL sation,as provided for by Seetion 37W or the,labor Coil for the pediment of the 304 - ROUGH ELECTRICAL work for which this reran is issued. 305 - FRAME 1 have and will maintain worker's Compensation Insurance,as required by section 3 O 6 — HOEDOWNS 37M of the labor Calwo Calc,for the performance of the rk for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: 307 - INSULATION Carder: Policy No.: 308 - SHEETROCK CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 309 - EXTERIOR LATH (This section namdnlane completed iftne N.il is rnrone hundred doRars o lgi) 310 - INTERIOR LATH ..ify 311 - SCRATCH COAT ecenser that m me p any of tee work for which chis permit is issued.l snail not 3 13 — ROOF NAIL employ any person in any manner so az m become subject m the Workers Compensation Lows of California Data Applicant 501 - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT:If,after making mss Ccni licate Of Exemption,you should 502 - FINAL PLUMBING ENERGY become subject to the Worker Compensation provisions of the Loom Code,you most pZ forthwith comply with men previsions orthis Permit shall the deemed maakcd, 503 - FINAL MECHANICAL ENERGY Z o CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY F Ihereby afrom thalthemisaconswctionlending agency for the aOformanecof 505 - FINAL ELECTRICAL 9 > the work fur which this permit is issued(Sec.309].Civ.C.)der(Name Un506 - GAS TEST [t] 0 Ua der6Addreaz 507 - FINAL PLUMBING O 1 certify that 1 nave read this application and state that the above Information is 508 — FINAL MECHANICAL Ly F-' ms. w corl agree comply with all city and county ordinances and state laws relating to 0 U buildingconstruction.and hereby authorne representatives;ofdtiscity toenter upon On 5 FINAL GRADE F461 above-mentionedpmmny for InspectionpuHtoses. lO FIN G (we)agree to save,indemnify and keep harmless the City of Cupertino against I G RA liabililies,judgments,costs and expenses which may in any way accrue against mid City 5 N LI WORKS U Z in consequence of the grating of thispermit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date —✓ SOURCE REGULATIONS. Signature O Applicanintncho Date Re-roofs Uc HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building mcupnl stem or handle hamidou material as defined by the Cupcnino Municipal Cox,Chapter 9.12.and the Health and Safety Code.section 25532(x)? ❑r ONO All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air cumam inane as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yu ONO 1 have mail the ha om us materials mquimmenB under Chapter 6.95 or life Califir, nia Health&Safety Code.Sections 255115,25533 and 255)4.1 unxrsland dial if the building Oat not currently have a tenant,mal it to my responsibility m nury the Occupant of the mi,immenB which must be met prior In issuance Oft Cemfcam Of Occupancy. Signature of Applicant Date Owner or authorized agent Date All roof coverings to be Class "B" or better CITY OF CUPERTINO I9m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng: Sub : Blk: Lot : APN . . . . . . . . : 32601007 . 00 DATE ISSUED. . . . . . . : 09/30/2002 RECEIPT 9 . . . . . . . . . : 19879 REFERENCE ID # . . . : 02090192 SITE ADDRESS . . . . . : 10955 BARRANCA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER TINA & SCOTT BREHMER ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : MICHAEL IVERS CONTRACTOR LIC # *OWNER* COMPANY TINA & SCOTT BREHMER ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , • TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- -------- ----- - - -------- -------- - - - --------- ---- - - ---- -- - ------ - BPLANCKREP HOURS 4 . 00 222 . 00 0 . 00 222 . 00 0 . 00 --- - ------ ------ - - - - --------- - ------ - --- TOTAL PERMIT 222 . 00 0 . 00 222 . 00 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ---`-------- - - - -- ---- - - ----------- - -- -- OTHER 222 . 00 VISA TOTAL RECEIPT 222 . 00 • CITY OF CUPERTINO CD 20700 � • CUPEROF TINO PERMIT APPLICATION FORM APN#:,� � 6 —0� —00 -7 ate: Building Address: / 07,5--5- �Ai? IfAAIOS �2 Owner's Name: Phone#: f—=N,B d- OTT T 317—73 Contractor: License#: Contact: Phone#: p act n ! Fax #: g ermit Info: Bldg Elect Plumb ech escription: AID 7W /s pa— 71iWWo 1J Residential: Commercial: Sq.Ft. Floor Area: 5�C $/Sq.Ft.: Architect/Engineer: Valuation: ype of Construction: Occupancy Gro Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances 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 BENEI2GY Ener y BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMMENew Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCUMMP New Comm Plumb PLUMBING /0. lVe� /mer ' Zss 7 7 4,: CITY OF CUPERTINO CITY OF CUPEf�TINO PERMIT APPLICATION FORM • uanti Fee ID Fee Description Fee Group BNUMULTI New Multi-family Res PLUMBING BOVERTIME Ins ecrion Overtime BUILDING BPBACKFLOW Atmo heric Vacuum PLUMBING BPCESSPOOL Cess ool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pbl 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 Re eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewa a Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BP AP Kitchen Tra PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Lnstall/Alter Water Pie PLUMBING BPWHEATER WaterHeater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <-- 10,000 cfm MECHANICAL BREMAPPLI A liance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL BREMFIXT Li hting 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 A aratus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power De vice/A aratus ELECTRICAL BREMRECEPT Rc ti, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BSM PALT Re air/Alter Heating MECHANICAL BREMRESAPP Remodel Res A 2liance 13REMSIGNADELECTRICAL Rmdl Si s Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR I Theatrical Ligting Fix ELECTRICAL 2 of 3 SunCITY OF CUPERTINO • CUPER,CRYPERMIT APPLICATION FORM TINO Quantity Fee ID Fee Description Fee Group BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSF&2FAM Single &2 Family BUILDING BSFNA Single Family New Add BUILDING BSPECIAL Special Insection BUILDING BSWIM Swinuning Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Te!Eporary Bldg Permit BUILDING BTEMPSVCS Te�mp 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 BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I00K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75 M Btu MECHANICAL 3 of 3