08030140 (2) CITY OFCUPERTINO •� '� €
BmLo IN
• PERMIT (iT1YT1 '(?KMt�TIgl
BUIL1 G DRESS: PERMIT NO.
c1M��1 DEEPROSE PL ROBERT GIANCOLA 08030140
ER'S NAME: PIEN4f EHUEDATE
MIKE CRAWFORD 384 BREEN RD 03/25/2008
PHONE: SANITARY NO. CONTROL NO.
(831) 623-9245
ARCHI7ECTRINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MBCH
300 LICENSED CONTRACTOR'S DECLARATION lob Description
^� 1 be eby elfin^that 1 am 14.m mod under provisions of Chapter 9(commencing p
with sedan 7mb))arnivilon 3 of the amine,,and Pmrassene Cade,and my license I. INSTALL 3/4 (E) CONDUIT FROM REAR OF HOUSE TO
n :
in full Lk.g FENCE INSTALL 1" PVC WATER LINE FROM REAR OF
C
Dam Centimeter
ARCHnELTS DECLARATION HOUSE
f�� IundcntsndmypWsahatlbeusedupublic recorde TO FENCE
y0 Licensed professional
OWNER-BUILDER DECic Commences
I mrso a0irm the 11. exempt form the Cm nese Co :Any c Law for the
00 following moan.(Saito 7a mer Business and Pre,dwou Code:Any city m county
$ which mquim a permit to contact aims applicant
for such
de permit
t fi epaig any smremm _
zy thatWitsissuamcalmrtquim thehovisios of far each Common's
ofakaaLaw atemmem
< (comae purmial ofDismn.3ofthe the nuacmr'ani¢melsiw(sCode)9 SG.Ft.Floor Area $ Valuation
tham cis,exempt withStation
and
of basis far
thetaeged Business and
on.Any lCode)ar 8�0
Net he ts exempt therefrom and the bol,fm the alleged exemption.Any violNmn of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofppm Number Occupancy Type
not mom man five hundred dailam(5500). 3 6 9 0 5-0 21 :V V'
❑1,uawnmof Nepmpwy.mmywploymawithmg umeirmlec^mpenudon,
wiRdalhewark.andmesvucmmhmtintendedmaRemdfor We(SW.1044,Bamae Required Inspections
end Professiau Code:The CanvacteYs Llama Law'dom Amt apply ine an owner of 9 p
property who builds or improves meson,and wh a does such work Mnarelf orthrouN his
^sun moplaynu,provided ten such irmoreme^u arc ni timended oraifined for We.If.
however,to building orimpmvemmt Is mid within am year of completion,the ownm-
builder will have the burden of proving Nn he did amt build or improve fm purpose of
Ltmm Of dm Property am exclusively continuing with licensed contractors to
tract the project(Sec.7044,Business and profossiou Cade:)The Cmtracka's Lf-
came law dots..(apply in an owner of property who Wild.ar impiewas dmm^n,and,
who armacts for such prolene wit a continuants)licensed pursuant 0 the Contractor.
Licence Law.
❑1 a`
uempt Sec e P for Ws
tem
r
WORKER•SCOM I�An DEO ARATION
I hereby Liam under penalty of"duty am of the following declarations:
❑I have and will maintain a CoNOnm mf Conant in calf-ilium fm Warkeh Compen.
canon,u provided for by Section 3700 of Elie labor Code,for the Performance of the
were for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,u required by Section
3700 of to labor Code,far the peRamume of the wort for which this permit is luted.
My Worker's Compenaada.Inson.carrier cad Policy number art:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
f rthisomme reed not bocomPlim d If the permit is fame hundaNdollan(5101)
m ku.)
1 certify that in the performance of dm work for which this Permit is iacued,I shall net
employ any perm.in mymanmraata me subject to dm Wadmrs'Comleusti^n
Laws of Califamia Oticafter_ -
Applkau
NOTICE TO APPLJCAI : .�cr milting this C^.ifacam of Exemption.you Mould
become subject in use Warted Compensation provisions of the labor Code,you mut
.J O forthwith comply wit such provisions or this permit shall be danced revoked.
„za tiCONSTRUCTION LENDING AGENCY
[••v ItombyalBm dtst there i.acoatswcti.n lending agency for the performance of
(Yi> the work for which this pemit is Wood(Sec.3097,Civ.C.)
QLendcr's Name
]Z lendeesAddmss
U Q I certify that 1 have rete this application and tete that the.hove nomination is
Ig.F artcom l agree to comply with all city and county ordinances and sum laws relating to
QU building convection,and hereby suthadm mpresrnmtives of this city to enter upon the
{T7 above-mendomd property for impantan purpura
C1r (We)agree he ave,indemnify and keep hamleas the City of Cupertino against
M Iiabilitiea,judgmants,cats and"Forms which may in any way season against said City
V 4 in consequence of the&among of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
GULA770 �' Z-t'f�L
SOURCE I
3 Xr
Signatuwrc of Applica —
Re-roofs
HAZARDOUS
MATERIALS DISCLOSURE Type of Roof
Will the applicantmforum buildings.Chaptuaeor and haaadausmateety
defined by tie CupeNno Municipal Code.Chapter 9.11.and de HcatN and Sattty
.Scene.25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yns
WIII the applicant or future building occupant use equipment or dcvima which If a roof is installed without first obtaining an inspection,I agree to remove
cmiL haxardnm air cmmminants u defined by the Bay Ama Air Quality Management all new materials for inspection.
District?
❑Yes
I he.mad the heanduus material,requincracem underChapmr6.95 of the Califor.
nia HealA g[SatalyCNIC,Settle.15505,25533 and 25534.Imakestsnd thetifthe building .
oma not cu arty have a mnanL Nu it h my tespoenhility to..or,dm occupant of the
mquimme whichmmt ��``t ortaissusaeofacomiOcamoto= ams SignatureofApplicant Date
p0r'y �a L 3�1�e All roof coverings to be Class'W'or better
Owner or authaomd agent a—�m' '
® CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:-
APN . . . . . . . . : 36905021 . 00
DATE ISSUED. . . . . . . : 03/25/2008
RECEIPT #. . . . . . . . . : BS000004258
REFERENCE ID # . . . : 08030140
SITE ADDRESS . . . . . : 10131 DEEPROSE PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MIKE CRAWFORD
ADDRESS . . . . . . . . . . : 10131 DEEPROSE PL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JUDITH CRAWFORD
CONTRACTOR . . . . . . . : ROBERT GIANCOLA LIC # 22966
COMPANY . . . . . . . . . . : ROBERT GIANCOLA CONSTRUCTION
ADDRESS . . . . . . . . . . : 384 BREEN RD
CITY/STATE/ZIP . . . : SAN JUAN BAUTIS, CA 95045
® TELEPHONE . . . . . . . . : (831) 623-9245
FEE ID UNIT QUANTITY, AMOUNT'- PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 800. 00 0 .50 0. 00 0 .50 0 . 00
1EPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40 .79 0. 00
1PPERMITFE 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 122 .87 0. 00 122 .87 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 122 . 87 MC
---------------
TOTAL RECEIPT 122 . 87
Y
Y
" CITY OF CUPERTINO
® CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
0/Nd
APN# 1 ()U Date: 31 ,24109
Building Address:/
/0131 Poram , Cuperii.o i cA 95-ol+
Mailing Address (if different from building address):
Owner's Name: Phone#:
TAV GgW44 97Y /04
Contractor: Phone: 461 -0249
Robert 61a6c0� ca hStyucfilon
Fax: e.?I -6Z3-9z 4f'
Contractor License#: 75^4 6 477
Cupertino Business License#:
Contact: Phone: -rW- 676 -4265'
S'Fev2�sa�,u�q
Fax: S70 -440- 8702
Residential Commercial L
(�
ll ea
Job Description: hstal� -/4p �ech✓ cal cohJuirorear o+ tio'„s._ +o Rnce.,
hstaU I " PvPVC_ - I;k� trtrroll rear or kdVrt. +0 ' VhLe—.
Building Permit Info:
Bldg ❑ Elect Df. Plumb ' Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, lV V-N ❑ RP,5iJehfial
Valuation: g00 00 Square Footage:
® Pr�ize: Standard g Large ❑ Major 0
o
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING e
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
IGENCOM
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 ss 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
IBBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
IBAPPLOTH 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) A
1PLMBINSP Other Plumbing& Gas Inspections P
(per hour
IMEETINGIHR Application Meeting B
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
1ACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B.
CHIMNEY'S
1CHIMNEY Chimney B,
1 CHIMNEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
IFENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS 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
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
3 of 5
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION •
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONR
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSPI0 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
1SIDESTBK Siding, Stone &Brick Veneer B •
interior/exterior
1SIDEOTHER Siding all other B
SKYLIGHTS
ISKYL<10 SF Skylight less than 10 sf B
I SKYL>1 OSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
ISRACKS<=8 Storage Racks 0-8' high (up to 100 so B
i SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
4of5
aCITY(Lll
OF CUPERTINO
CUPER° T`INO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group IGENRES or
I GENCOM
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
IELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln 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
1BSEISMICR Seismic Residential B
1BSEISMIC0 Seismic Commercial B
1TRAVDOC Travel & Documentation B
1BUSLIC Business License B
5 of 5
Community Development
10300 Torre Avenue
�. Cupertino CA 95014
Telephone(408) 777-3228
�' IDCITY CP,TINO Fax(408)777-3333
I�1 Building De artment
JOB ADDRESS: PERMIT #
1013] 1�--e prose. PI. J-0Jj014 b
OWNER'S NAME: 7 r4w4rd PHONE # / `C
GENERAL CONTRACTOR: ROo� 6i0lco C9h;lk fie FAX # 9'3/— 3 Zt is
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
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
614L, 3 08 _
O�vner/tontractor Signature Date