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08010085 (2) PERTINO 7775,577 F'�'l IG'DIVISZON IN AT CITY OF CU BUILDIN PERMIT ��"'COMTIUCTTP Q09UMA, A AN SUI LITtfiffRESS: PERMIT BUBB RD WARD CONSTRUCTTON 80iOO85 OWNER'S NAME: PERMIT ISSUE DATE WASSON ROGER E AND LILLIAN H 5526 MAPLECREST CT 01/15/2008 NE. SANITARY NO. CONTROL NO, ARCHIMECTIENCINEER: BUILDING PERMIT INFO RMDL LAUNDRY RM,RPLC UTLTY BLDG ELECT PLUMB MECH cmv 1.1�1 Z' LICENSED CONTRACTORS DECLARATION I bunny it Wt I sm ficcessed under provisions of Chapter 9(commancla, -- -----4Gb-DGscription wiNS=don7OM)ofDiviMan3ofNeBusinmod of 'omC and ylit =t uin full face and effacl.,Z /so, Z LIC ., Dal. Co. tl6 [==ARCHITECTSDECI-AiAn y plans shall be taredas Public menX Licensed poulbandmott OWNER-BUILDSR DECLARATION I hereby arrimr hot I A.mount from the Conarouron's License Law for Ne D O following reason.(snedon 7031.5,Document and prolamines Code:Any city or county Z .,slc! which ampone,a permit to consurem,aluer,improve.deartflarda,or repair any structure 4;m prior to its coureacco.also resaires mis applicant for such permit an rile a signed statement thus he is licaroced portuallL W the provisions of the Conarammes Lictume,Law pChipmr,9 Sq.Ft. Floor Area Valuation st (commenting with Scction 7")of Division 3 or the Business and Profmons Code)or Nat l ba Is contain thmorrom and me,basis for the alleged exemption,Any violation of Section 7031.5 by my applicant far a permit sntbjmcu the applicant an a civil penalty of -APN Number Occupancy Type an,come,Was five hundred dollars fl 0 Lu.of the F.P.M.or my cooployeac,with wagon,as their sole compensation, will dot arm work,and the mroseum is Out intended or ff=d far We(See.7044,Basmat and Prallcanderes Codec The Cormanomer',Lomas Law does an,apply un an armut,of Required Inspections Property who Wilds atrimprooness aboacion.and who deusuehwrk Wrialrormouth his man cropkynce,provided that such improvements son no,inboard warranties fmo U. Ne Wilding arrimproveracent is said within man lose,ofacroploona.the awvar- builder wig leve the buresear of proonni,that Is did not build or Improve far purpose of sale.). [3 1,as airier of the property.me sexclusively commuting with focused caurvionam an constrom the project(Sm.700x.Business and Prafeadons;Cordo:)The Com cubes U. muse Law,does mo apply to an crovernar ofmaparty wed Wilde.,improves thention,and who comestm For such projects with amonscloms)licensed P..[to man Centimes '"We"Law. El lanneximpt'verearSec, —.B&PC(.th4.. Owne Dau WORKER'SCOMPENSATION­GEC�RATION 1 Imanclay afflon under penalty of perjury We offt following declarations: Whavems aiiii maintain cmustaimac.con.t to self-Inas reawmicar.compon, ,as provided far by Secdon 3700 of the Labor Cade.for We performance of can work for which mrs,permit is aimed. r-I I leve and will..!.We Wtarktati C..pd.O Inman .as acquired by Section 3700 of me Labor Cooke.rhar We part..anco of the work far which this permit as Issued. ma My Wmams C Peassiductirtsurpacecarricranuiplicy -5 V Carrier: Policy No.: ;FaC- 27. — cExt i?PCATE OF MEM PT70N FROM WORKERS' COMPENSATION INSURANCE (nois socamr,wount wattincompimad franc,Korea Is i.e.hundred deflater(SIM) or but I QWiCV Net in do isileamstram Of me work far which this forms IS Issued.I mail not employ any person in any Water an an W become subject as the Workers'Compensation Laws of California.Dam Applicant Notice TO APPLICANT:If.efur unions,this Cerilficau,of Exemption,you should ,ccomm subim at me Workers Compensation provisions or toc Latin,Cam.year mail Z forthwith comply what Shich provisions W Nu permit Shall W deem est evoked. z 0 . . CONSTRUCTION LENDING AGENCY yI hammy anim tom taccon ir a comarromima lending agency far the performance at > the work:to,which this Permit is named(Sec.3097,Civ.Q Leader Normo :3 z Lander's Add. J 0 1 certify that I have mad this application and sum Wa the seven information Is LT. P correct lagam an comply with all city and county anAreancesand sum laws existing W 0 U building construction,and kmby mmonm representatives of this city to enter aria the LA abone-ninumned Property for marcolon purposes. (We)agree to save,indemnify and laccept bromanimus ft City of Cupertino against liabilities.Judgments,comm y tmormattgainstuddChy in Consequence of the stranim of =1 me,in an APPLICANT UNDER TI�L N07POI Issuedby: Date SOURCEREGOLATIO 7 Re-roofs SignamanofAnplicom On tor' Thea DnUS MATERIALS DISCLOSURE Type of Roof Will du applicant or future building rotational store or larrefix,havandom,namorial a dadatud by the Cupertino Municipal Code.Chapmr 9.12.and dis Hulth and Safety Cook.Section 25532(a)? [_]Y. AN. All roofs shall be inspected prior to any roofing material being installed. %'Iapplicant _ foiling=Opant use equipment w devicas which If a roof is installed without first obtaining an inspection,,I agree to remove 1,contaminants as deflond by dic Bay Am.Air Quality Management all new materials for inspection. "'u", Ne a 0 ya. No ilon", allbolumenj ated�Igq re" U da"Char,0695 fdr.C.1ifor. an ou a .is Health C 25M5 3-d�25 Aterommasadili;ifurt,Wilding ,dms'� an idil the &Sit y ill does n currently Wt' in an 7//,abhor or to that y in. Tricau, Signature of Applicant Date rolum lvpari.r�� cifc�ca ad 4/14 ;X11V1Pdj �T/ 4' Owner or authorizedAll roof coverings to be Class"B"or better alva�` CITY OF CUPERTINO C, OF • CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM 0Z APN# Date: /" /t; `,yi'am / r Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: Pow Contractor: p �/ Phone: `lQtq, 003 wg L //�f� C/vV /vd Fax: Q X933 Contractor License#: Cupertino Business License • Contact: oV �� gZ� g 3�� Phone: Fax: Residential Commercial ❑ Job Description: 7ZV Y ��.5 e®efli,(/ Building Permit Info: Bldg Elect Plumb Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1 FR, HFR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N E 3 Valuati r�; Q. Qv Square Footage: d t? Project Size: Standard ❑ Large ❑ Major ❑ • (alo CITY OF CUPERTINO CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1BTEMPPER Temporary Building Permit (good for B 30 days) 1BBOILERI For the installation or relocation of ea M boiler/compressor to & including 3 horsepower, or ea absorption sys to & incl 100,000 Btu/h (29.3kw) 1BBOILER2 Installation /relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption ss over 100,000 Btu/h 1BBOILER3 Install ation/relocation of ea M boiler/compressor over 15 horsepower to & incl 30 horsepower, or ea absorption sys over 500,000 Btu/h to & incl 1,000,000 Btu/h IBBOILER4 Installation/relocation of ea M boiler/compressor over 30 hosepower to & incl 50 horsepower, or for ea absorption sys over 1,000,000 Btu/h to & incl 1,750,000 Btu/h 1BBOILER5 Installation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption sys over 1,750,000 Btu/h 1BAPPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. lELECINSP Other Electrical Inspections (per hour) E 1MECHINSP Other Mechanical Inspections (per M hour) 1PLMBINSP Other Plumbing & Gas Inspections P (per hour 1MEETINGIHR Application Meeting B a(ME CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEfiiTINO • FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ACOUSTICAL REVIEW JACOUSFDW SFDWL/DuplexNew B 1ACOUSRESAD SFDWL/Duplex-Addition/Alteration B 1ACOUSCOM Multi-Family/Commercial B CHIMNEY'S 1CHIMNEY Chimney B 1CHIMNEYR Chimney Repair B FENCES 1FENCE>6FT Non-masonry, over 6 It in height B 1FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES 1FIREPLMAS Fireplace Masonry B 1FIREPLFAB Fireplace Pre-Fabricated/Metal B IFLAGPOL>20 Flag pole(over 20 ft in height) B 1MODUSTRU Modular Structures B FOUNDATIONS 1FOUNDREP Foundation Repair B 1PILECAST Pile Foundation Cast in place concrete B 1PILEDRN Pile Foundation Driven (steel, pre- B stressed concrete) 3 of 5 CITY OF CUPERTINO CU cion NO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group IGENRES or 1GENCOM RETAINING WALL(CONCRETE OR MASONRY) 1RETSTN Standard (up to 50 ft) B IRETSP310 Special Design, 3-10' high (up to 50 `) B IRETSP10 Special Design, over 10' high (up to B 50' 1RETCRB< Gravity/Crib Wall, 0-10'high (up to B 50 ft 1RETCRB> Gravity/Crib Wall over 10' high (up to B 50 ft SIDING 1SIDEST/BK Siding, Stone & Brick Veneer B interior/exterior) 1SIDEOTHER Siding all other B SKYLIGHTS ISKYL<10 SF Skylight less than 10 sf B 1 SKYL>10SF Skylight greater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'1 B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B 1SRACKS>8 Storage Racks over 8' high (up to 100 B st 1STUCOAP Stucco Applications (up to 400 sfl B additional stucco application 4of5 sonCITY OF CUPERTINO CUPEfZr GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P j lELCPLNCK Stand Alone Electric Pln Ck (hourly) E / 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone I 1BSEISMICR Seismic Residential B 1BSEISMIC0 Seismic Commercial B / 1TRAVD0C Travel &Documentation B 1BUSLIC Business License B • 5 of 5 CITY OF CUPERTINO • 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36211061. 00 DATE ISSUED. . . . . . . : 01/15/2008 RECEIPT #. . . . . . . . . : BS000003691 REFERENCE ID # . . . : 08010085 SITE ADDRESS . . . . . : 1184 BUBB RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WASSON ROGER E AND LILLIAN H ADDRESS . . . . . . . . . . : 1184 BUBB RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4966 RECEIVED FROM . . . . : WARD CONSTRUCTION CONTRACTOR . . . . . . . : DAN WARD LIC # 29277 COMPANY WARD CONSTRUCTION ADDRESS . . . . . . . . . . : 5526 MAPLECREST CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : (408) 823-5305 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 10, 000. 00 1 . 00 0. 00 1.00 0. 00 1ELCPLNCK HOURS 1. 00 122 .38 0. 00 122 .38 0. 00 1ELECINSP HOUR 1. 00 122 .38 0. 00 122 . 38 0. 00 IPLMBINSP HOURS 1 . 00 122 . 38 0. 00 122 .38 0. 00 1PLMBLNCK HOUR 1. 00 122 .38 0. 00 122 .38 0. 00 1TRAVDOC FLAT RATE 1. 00 40 .79 0. 00 40 .79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 531 .31 0. 00 531 .31 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- ---------------, .. -------------------- CREDIT CARD 531. 31 MC - --------------- TOTAL RECEIPT 531 .31 Community Development 10300 Torre Avenue ✓' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 CUPEKTINO ,0 Building De artment JOB ADDRESS: PERMIT# H3 d&a (,o OWNER'S NAME: PHONE # GENERAL CONTRACTOR: gel FAX# R I am not using any subcontractors: OC/ tgnature Date Please check applicable subcontractors and complete the following information 66 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