08030093 (2) CITY OF CUPERTINO
BUILDING DIVISION PERNIIT COkVTRACTO NF'ORMATIQN.«
PERMIT NO.
"" TdcAQTl'E ASTINE AVE JEFF HULTQUIST 08030093
OWNER'S bNA�MEE: PERMIT ISSUE DATE
JEFF HULTQUIST 10630 CASTINE AVE 03/18/2008
SANITARY NO. CONTROL NO.
ARCHMECTIENGINEER: BUILDING PERMIT INTO
ADD 2ND ELECTRCL OUTLT IN BLDG ELECT PLI1Ma MEcx
30o LICENSEDCONGIACiOR'SDECLARATION JbDescrition
1 hereby affirm Nat I we licensedmmo
licensed under provision of Chapter 9(co
encing P
z� with Section 70(10)of Division 7 afthe Business and professor Cade,and my licenc in
^ in full form anti c(rWL
Lkenm Class Lk.B
9 Dam Commuter.
e ARCHITECTSDECLARATION
y I undamound my pia Nall W used as public records
J
tea, Licensed professional
.K.Sm OWNER-BUILDER m Ce Cont in
0 1 hereby.Ron that I 1 exempt from me Canu.cmad License Law for the
K.0 allowing e.. (Smarr 78713,Business and ProreloK Cade:Any city or county
$rex which require a pwmit m canmuat alcor.fmpmve,h Permit
m repair ed mm rmu
Z} p o k is li trnKpu R.Guir pmviislaw al farmeh peri a Liccnemrile a rand Wlemenl
€g
took cum,wedpamuotmdwpma,lonardn nee ntmcmr,ua.tms.w(cnrpm 9 Sq. Ft. Floor Area Valuation
Q� (commenting,haisaxe with section ad theof bash f 7 of al Busiegad exem t on.Any vi Cade)or
.. that be Is exempt therefrom mtl the beds far the alleged exemption.Any viol.dm of
Section 7071.5 by my applicant far a permit subjects the appllemrto•civil Penalty of APN Number Occupancy Type
at mom mm Bve hundred dalIsss(5300).
0 I'm ower of llm pmpmy,ormy wnpl.ycm with WSW as du:trmk cmnpenudon.
MDdothewort,mdthe ..Isnotincendedanrreredforwle(Sw.'10N,8WM-•
Yd pmdelflan Cade:The ConnKla g Lease Law dam at apply to ne
m roamer of Required Inspections
property who buiImarimpraw thmmn,aed whodoessuch work himselrarmrouSb his
wn '
oemployrra,provided that each improvements sac net intended aro@retl(wale 11',
however,the building or improvement Is mid within one year of compleaan,the..a,-
buildm will have W burden of pmving that he did at Mid or improve for purpose of
sale.).
0 1.n vets,of the pmpeny,sm exclusively antra mis with licensed mnuwon to
mturmet the project(Sec 704,4.Seamus and profession Calm)Tse Countenances Ili-
am law does not apply to m owner of property who builds or Lmprom,theater.rod,
who contracts for such projects with acomnaor(s)licensed purmam to the Corma uses
License Law.
01 me exemtuner See ,BdPCfathia awn
Owen 4 Dao 3 I$ 0
WORKER P ATION DECL.7RAMON
1 why apron under pe ally o(perjury We of the following deckrWonx
have and will maintain a Cwtifrcam of Consent to self-insure for Warte(sContpen-
Wien,as provided sur by Section 77M or the Labor Code,for the Performance of the
wort for which this permit is issued.
0 I have and will maintain Worker's Compcnuti.n bureaux,a acquired by Section
7700.1'the Labor Code.1.the performance of the work fa which this permit is issued
My Warton'.Campenaaon Iruurvze an.ami Policy number tae:
Cartier. Policy No.:
CERTIFICATE OP EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
mss;smlm Kaci at completed Irate permit Is forane hundred doBan($100)
a Imo.)
1 anify that I.the performaax of the awls for which this permit is issued.1 shall nor
cmplcy any Was.in my manner m as m became subject 'Can IDpenacm
�tligWmlx
AppllCne II
Laws of CaliI.12z 12-1
LEE If
NOTICE 70 ANT: L aver on g this Conipnm of Exemption,you should
became eabJ c Worma's Comps 'don provision,of the Labor Code you mum
.J z fanhwith comply with such provision or Ni,parent sial be darned revoked.
OCONSTRUCTION LFNDINO'AOENCY
F^.^ IWant,.Mmdeal ft.Is.construed..lending agencyratteperformma.1
a> the wish 1'w which this permit Is issued(Sec.ID ,Civ.C.)
WtiQ Lender's Name
z Linden's Addmn
U 0 I certify that I save red Ws appllcmmn and am ttu the above r.finem.U
ILi r^ correct.I gnse m comply with III city ad county ordinance,and mu,IM Riling to
Wilding comtmwian,and bemby authorise representatives of this city to semi upon the
W above-mendmal properly for inspection purposes.
(We)agree m save,indemnify and trop harmless the City of Cupertino against
y limlides,judgmenq coats and expemca which may in my way acro,staiwssid City
V 7 in consequence of the granting of this permit.
r� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCISVLATIONS.
U/ 72 31'd9/0a Re-roofs
sing pplicanUCon�j con Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or Rrture building acupantmore or hndle hate don material
u defincd by the Cupertino Municipal Cale,Chapter 9.11,and the Health and Safety
Cade.Sectmnu57z(a)7 � All roofs shall be inspected prior to any roofing material being installed.
C Yn &N.
WIII the applicant or future Wilding occupant ton equipment or dcvbm which If a roof is installed without first obtaining an inspection,.1 agree to remove
t hraonm air ca.tsminmts as defined by dm Bay Are.Air QLWiiy Management all new materials for inspection.
mixt, �/
0Yn ImNo
I have mad the har dasmamdaIs requ"vemmts undcrCh.pmr 6.95 of the Call("- .
not Health h SafwyOude.Swans 25505.25533 cad 255M.l undvstmd that if ft Wilding
dos Ki currently ham a moon,that It Is my responsibility o Mary the comment of the
requlm n whmhmus,Wraspoor olate. of.Certificate Omp -cate Signature of Applicant Date .
Of e orharimdeg o All roof coverings to.be Class'W or better
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32643028. 00
DATE ISSUED. . . . . . . : 03/18/2008
RECEIPT #. . . . . . . . . : BS000004183
REFERENCE ID # . . . : 08030093
SITE ADDRESS . . . . . : 10630 CASTINE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : JEFF HULTQUIST
ADDRESS 10630 CASTINE AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1313
RECEIVED FROM . . . . : JEFF HULTQUIST
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : JEFF HULTQUIST
ADDRESS . . . . . . . . . . : 10630 CASTINE AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1313
TELEPHONE . . . . . . . . :
® FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 50. 00 0. 50 0. 00 0'.50 0. 0.0
1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0 . 00
1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00
TOTAL PERMIT 82 . 08 0. 00 82 . 08 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 82 . 08 MC
---------------
TOTAL RECEIPT 82 . 08
ao
CITY OF CUPERTINO
® CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN#�� ^ � Date:
(D 3 I $ o $
Building Address:
10 � 3v Cps-rine- Ave.,
Mailing Address (if different from building address):
Owner's Name: Phone#:
J,- -�; H -t- -7 3 2 — '732- -7
Contractor: Phone:
,tl 0 J C
Fax:
Contractor License#:
Cupertino Business License#:
Contact:
'23L7 Phone:
?3 Z-
Fax:
Residential Commercial ❑
Job Description: 1 I
%Kq SCooh� G'.I�c ricw� 0v+ f�e.--� to (ic ck and
J 1 /
v^da.r9r o vtid CO �'�' -1-o re-m a+
Building Permit Info:
J)
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, I IFR ❑ 11, 111, V-lHR ❑ 11, 111, 1V V-N\,N g3
Valuation: .{- 5"O Square Footage:
.o 0
Project Size: Standard ❑ Large ❑ Major ❑
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
IBBOILER2 Installation /relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1BBOILER3 Installation/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
1BBOILER4 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
1 BAPPLOTH 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.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
IPLM 3INSP Other Plumbing& Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING APPLICATION
• FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIIVINEY Chimney B
1CHIMNEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
IFIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>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
IPILEDRIV Pile Foundation Driven (steel,pre- B
stressed concrete
qW
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CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
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
IRETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1 SIDESTBK Siding, Stone &Brick Veneer B
(interior/exterior
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<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'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 so B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 so B
additional stucco application
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+ CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
COPE TINO
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group ]GENRES 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
1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1ELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Plu Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P
I STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
J1BSEISMICR Seismic Residential B
1BSEISMIC0 Seismic Commercial B
/ 1TRAVDOC Travel &Documentation B
1BUSLIC Business License B
•
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