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06070030 (2) CITY OF CUPERTINO - "'" °'"'� "' "- T()R INFeOtMA C BUILDING DIVISION PERMIT reCONTRA,G��, `+ -2N'�i' Y9ti BUI LDING ADDRESS: CHARLES, E PERMIT NOO6O70030 7617 ELDERWOOD CT PERMTI ISSUE DATE 'NER'S NAME: HANSON CHARLES E 07/07/2006 ONE: SANITARY N0, CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: 'BLDG ELECT PLUMB MECH 0 0 0 0 :gp LICENSED COMRACTOR'S DECLARATION lob Description 1 hereby affirm that 1 em lka.a under provimme of CMptef 9(commencing with ll f... .deffAfDivuionSofNeBusinessand PrufcssiomCode.mdmylicenmis KITCHEN REMODEL - NON STRUCTURAL in full force snd effect. j ? License Class Contractor Mq Datc ComDECI 7W ARCNf1ECTS DECLARATION )yV m 1 undersand my plans obeli he used m Public rtcmds e C LicensedPmfessianal cx3OWNER-BUILDER DECLARATION <f I hereby aRrm that I am omp,Imes the Contractor's Ueenae Law for do D o fallowing remon. pann(Section construct, Business and Profession Cock:Any easy or c me $27500 '29which requires a permit m cnnswct.tlur.improve,dcmaluh,at repair any sWetam prior to its issuance.also requires the applicant farsuch permit an file a signcdsummem Valuation < that he ialiccnscd rampart,the provisions of Ne Contractor's Lknm law(Chaptcr9 Sq.Ft.Floor Area D (commencingheI. xawithherefore And of basison3afdueged Axaend Professions Code)or Nat io u campy any Applicant and or buns for ub alleged eumprion.Any violation of act a7dis .5byhunapplicantforap4rmilmbjecuNeapplicanuo•civilpenaltyof er Occupancy Type nos more Nan five hundred dollen(5500). 1,u owner o(Ne Proprny,m my onploym with wa d far Nle(Sm.compcns Business will do Ne work ande, oConunor'.Lien Law Sol apply 1014,Business Re aired Inspections and property who Cotle:Tile Conuumrs Liwue law dors ret apply lf an owner of q P ownenywho.,pr mad bar SuNerromandwhodoes AMnotihwarkh roffeas through his awn employees,lding r improvement Not such Imps old wit ase notyounded art anion.for sale t. however,Ne building or en Is sold within ars you or improv for Ne owner- bullder will have the burden of proving Ns he did not build or improve for purpose of , I,a owner of the Sec.70Property,em rdmors and contracting with licensed contractorsisu c strum the project(Sec.]044,Busltof and Profnsaui Code:)The Co dent... n sena law does oat apply w an owner of pmpeny who builds or improv¢Neseon,and. 1 Libe cense a.. farsuch gvjeeu wiNaeonvacurts)Iiunsed pursuant aNe Canuacmh Lice Law. r ❑lam¢crept under See p—�-- 08 PCfor as.ream weer I�+'I J� S A� Dau WORKER'S OMPENSATION CI-ARATION 1 hereby AM.under penalty of perjury am of the fallowing dealac ions'. ❑1 have and will maintain a Cerificau of Conmm to ulf-insure for Worker's Compen- sation,as provided far by Section 3700 of the Labor Code,far the Pat(..ancc of Ne 5rk for which Nis permit is issued. 1 have and will maintain Worker's Compensation Insurance.u required by Section 00 of Ne labor Cade,fm the performance of the work for which this Permit is issued. My Wastes Compelwuan Insurance major and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not he completed If the permit is far am hundred dollars(SIM) Ices) I terrify that in the Performance or the work for which this permit is lamed,I shall not employany parent in any manmran AS in become sapiectm Ne orkcp Co ....too Laws of CallfffmaD �/� ' Applicant �f _'.- - �d F�sb NOTICE TO APPLICAM'.If,after makinyf Nu Certificate of EsemPlitu.you should became subject to the Warkera Compemadat Prowlar s of the Labor Code,you mus OfoMwidt comply with such movisians.1 04 permit shall the domed ambled. z N CONSTRUCTION LENDING AGENCY [r • I herby affirm Nal Nem is s ed(Sec.30 lending agency for J¢perfunnance of W to work fur which 0tls permit is anus.(Sec.J097,CO.C.) WLenders Name Q z Leaders Add. U O 1 certify that 1 have mad this application and state that Ne above information I- U, sW F coram.I agree to comply with all city and county onlinanceS and state laws relating to 0 building construction.a ad hereby aushorine rcpocscmativesof Nis city to enter upon be W movc.mcntioned penny far impacam pugmacs. (We)agree to save,indemnify and keep harmless the City of Cupenina against „f"4 rrA Iiabiliimpolgmentacosts and expenses which may in any way acerae against mid Gry U in consequence of the granting of this Permit. ^ APPLICANT UNDERSTANDS AND WILL MPLY WITH ALL NON-POI;;IT Issued by: 6a Date SOURCE REG7Tj0 . / Re-roofs Sigma¢of App Ican'Commcuo Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne appliCrA m Tama building accupamsmm art handle hvardms material as de0ned by the Cupertino Municipal Cade,Chapter 9.12,and the Health snd Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yea Na 1 Will the applicant or future building asvpant use cyulpmcnt m devices which If a roof is installed without first obtaining an inspection,I agree to remove emit ha armus air contaminants as a lined by the Bay Arca Air Quality Management all new materials for inspection. Dl5lrlCl] ❑Yes I have read the hoordnus materials mquiremcnu under Chapur6.95 of Ne Califon nia Health&Safmy Cade,Sectims25505.25533 and]5534.Iundenund Notifdm building docs Out cy t have a tone.Nu1yn my respomihility Ire nudly Nc cupent of Ne require ant ichmus melpry4WiematmofaccnlrmtearoccapartI" Signature of Applicant Date �Dul/� 7/7zM All roof coverings to be Class"B"or better Owner or auth.ri.d Spent Dau CITY OF CUPERTINO lam 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35929017 . 00 DATE ISSUED. . . . . . . : 07/07/2006 RECEIPT # . . . . . . . . . : 35144 REFERENCE ID # . . . : 06070030 SITE ADDRESS . . . . . : 7617 ELDERWOOD CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : HANSON CHARLES E ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : CHARLES HANSON CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : HANSON CHARLES E ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 27, 500 . 00 349 . 92 0 . 00 349 . 92 0 . 00 BPLANCHK PERMIT FEE 349 . 92 466 . 97 0 . 00 466 . 97 0 . 00 BSEISMICRE VALUATION 27, 500 . 00 2 . 80 0 . 00 2 . 80 0 . 00 BENERGY PERMIT FEE 349 . 92 167 . 96 0 . 00 167 . 96 0 . 00 ELECTRIC SQUARE FEET 135 . 00 10 . 80 0 . 00 10 . 80 0 . 00 PPLBG SQUARE FEET 135 . 00 10 . 80 0 . 00 10 . 80 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMFEE SQUARE FEET 135 . 00 10 . 80 0 . 00 10 . 80 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 1135 . 16 0 . 00 1135 . 16 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 1135 . 16 3955 TOTAL RECEIPT 1135 . 16 I • I • G '' RESIDENTJ PROJECT COVER SHEET ' CRY Of a Y.T F. L � eft{ t'i r- ��' � (,,— CUPERTINO eek Assessor's Parcel Number: 3�� — Z /U/f 1 Name of owner. Project address. 76'o/ 7 6554—�oe-O C7- Contact person. G'f/i9�LLr—S hone. Fax. Z S a- 3 SC9 Net square footage of lot. C Existing Proposed Square footage: First floor: /fs Second floor: Garage: SSU U TOTAL: Z�Lr✓ U • Are there at least two 10 foot by 20 foot clear spaces inside the garage? /YY N Is privacy protection planting required for the project? Y I �/ On what floor(s) is work being done? Ft Brief description of work. Code editions: 2001 CBC (Y -N)2001 CFC (Y -N)2001 CMC (Y-N) 2001 CPC (Y - N)2001 NEC (Y - N) iN ACCORDANCE WITH THE CITY OE SUBMITTAL CUPERTINO CODES TD ORDINANCES )ATE '7 #1 This se �wl RECEIroo6 D ED This set of plans and specifications MUSS oe kept on the job at all times and it is un ! lawful to make any changes or alteration, JUL 0 7 OFFICE -COPYm same without written permission iron. •me building Dept., City of Cupertino. ' rhe stamping of this pian and specification ;HALL NOT be held to permit or to be ar rpproval of the violation of any provision ,f anv rfy nrmnance or gate Law. Plan Review Process Work Book Page-B-Revised 4/28/04 0 ATY OF CUPERTINO 000100 3O CUPEkTiNo PERMIT APPLICATION FORM Date: eq APN# 3 S z� G� � , � ele Building Addr ss: Mailing Address (if different from building address): Owner's Name: Phone#: 9W ZS S 5 q�;16 Contractor:, License #: y!/�S 75 fINT-lo� re 1- opr762 6o#J-5 7 Contact: Phone: oy SjI/U Cupertino Business License#: -7-G N Fax: Building Permit nfo: Bldg Elect Plumb Mech Jobs Residential Commercial ❑ Sq.Ft.Floor Area: /U/; Sq.Ft.: Cost of Project: g7!5_067 5 67 Occupancy Group: Type of Construction: Please check this box if the project is a KITCNc%/J 2i=LftUI�C� second-story addition: El Pro'ect Size: Standaz Lar e ❑ Ma'or ❑ uanti 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 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu . MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX lnd/Off/COmm/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <_ IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 GCp- CITY OF CUPERTINi CUPE�TINO PERMIT APPLICATION FORM Quanti 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 BOVERTIME 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 Plan 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTR4P 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 Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 ar STY OF CUPERTINO CUPEI� PERMIT APPLICATION FORM uanti 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 Insection BUILDING BSWW Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL S MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING 3 S� PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Ran a Residential PLANNING ZADDCHG Address Chane BUILDING 3of3 CITY OF CUPERTINOv' Waw,ad„tsas x a t -BUILDING DIVISION PERMITwC01�ITRAGfi(1RT1�IF�URMA"C ,01� BUILDINGADDRESS: ON CHARLES, E PERMITNO06070030 17 ELDERWOOD CT R'S NAME: PERMn iSS 1E DATE r HANSON CHARLES E 07/07/2006 i ONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 30o LICENSED CONTRACTOR'S DECLARATION IOb Description ii I hereby affirm that 1 sm licensed under pmvisiona of Chapter 9(commencing < with Section 70M)of Division 3a(Ne Bus•-..and Prolmaose Cods,and my license is .'gym infull ramnandefreet. KITCHEN REMODEL - NON STRUCTURAL i M z License Clan Lk.a p Dak Contractor 7W ARCHITECTS DECLARATION f e< I undersand my pians shall be,used as public rtcordu e G In Licensed Profcnsianal OWNER-BUILDER DECLARATION I hereby affirm that I am exempt(ram the Contractors License Law far the 0 o fallowing recon.(Seedun 7(D1.5,Business and Profession Cade:Any city at county 3$ which requiresa pclmit to eomWc4 alum,improve,demolkh,or mput,any s uctum $27500 prior N its issuance.also requires Ne applicant for each permit to file a signed sammem He that he isBcemcdpursuant toINprovision ofthe Commences lhellmLew(Chapter 9 Sq.Ft.Floor Area Valuation $ (commencing with Section 7000)of Division 3 of the Business and Pm(whas Craft)or .- dui he b exempt therefrom and Ne bub far the alleged easmpdan My statedne of Section 7031.5 by any applicants for a permit subjects the applicant to a civil penalty of er Occupancy Type nos more Nm five hundred dollars(SSW). 1,as owner of W property,or my employees with wages as Neo sets compensation. will do the work and Ncawcmm b act intended or oQtaW for sale(SecJON,Business Required Inspections Nd Profession K Cade:The Canabes Li-M Law m w loIps apply an owner of 9 P property who bu ills a im pares thereon,and ahadoes such warthimself m through his awn employees,provided that such Improvement am not branded uroRered intends,If, however,the building d improvement is sold wiNinawe year of completion,the carrier. builder M0 have dm burden of proving Ws he did roe ddb or improve for purpose of , 1, as owner of Ne property.ran exclusively connecting with licensed contractors In c tract the project(See.704x.Business sed Profession Cade:)The Contraencrs U. cense law don not apply to an answer of properly who builds or improves theman,and who conuacb far such projects with a comaecter(s)licensed punnet to an,Contractors Licence law. l am aempl undm Sec B k P this reason -7 r Cluvr� Data ob LCD WORKBIA 0.5 COMPENSATION CRATata 1 hereby dorm under penury of perjury awe of Om following dalua0aa: 1 have and will maintain aCerdficem ofCmuem to self-inure fns WorkeesCampen- sati e",u provided for by Secdan 3700 of the Labor Cade.for the performance of the workavwhteb Nis permitb Weed. I [ Uo ❑1 have and will maintain Workers Came of then rkfar which u acquired by Satin �w®? My oNeiabd Coca,far Nepance caner and wry number aNis pemlil41aue0. My Wortees Compensation llwlmnm earrid and Polity number sae: Cartier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need Incl becompleu:d If tha permit is faros,hundred dralan($1 010) or ka.) I anify that in the performance of the work for which Nis permit is IaacE,l Mail an employ any person in any manner so to to become Iata��jj�S.,,,C pensation Laws of Caiifamia rte` -��toNe 6se NOTA al NOTICE TO APPLICANT Worl If,aimsmatln Nb Cm00caof of Labor odyou should = bnednc subject to the Wohere Campcmnln provisions of the land Cade you muss .JO foMwiNcomPlY with such provision dNb permit Nall nth dcemW rtvv7kW. 'y .~N., CONSTRUCTION LENDING AGENCY [-I 1 hereby eM.dins Nem b•contrucdnn lending agency for the performance of lYi r7 the work fur which dtia permit b issued(Sec.3W7.Civ.C.) ' W� 0 Undoes Name } z Lueders Addma U Q 1 cenify Nat 1 haw mad this application aha sum Nn Ne W.information to IL (✓ torten.I agree to comply with sit city and county ordinances and sale laws totaling In OV building construction,and hemby authadm rep,esenmivcs of Nis city to enter upon the U above-mentioned property for inspecdon purposes. (Wo)agree to ave,indemnify and kap hanmlea the City of Cupertino again, y Iiebiltdes.judgments.cru and eapemu which may In ay way acarus ,.I=said City t„)7 In consequence of the Snenung of this patois. 47 APPLICANT UNDERSTANDS AND WILL MPLY WITH ALL NON-POINT Issued by: Date SOURCEREGUrs Re-roofs Signalumor Appi�VConuecwr Dow HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tho applieantor fuwmbuildinga wtstomorhandkhaardausmamAg 11 by the Cuperliwe Municipal Calc.Chapter 9.11,and the Health and Safety x"on 33377('17 ��`111 All roofs shall be inspected prior to any roofing material being installed. "'a Ya to Will the eppfiwt or future building occupant uses equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit haardna air concealments a @rind by the Bay Area Air Quality Management all new materials for inspection. District? Oyu 1YU I have mad the bawdamsmemdals mqubcmenuumkr Chepmr6.95 ofLhe Caitror- nbHwIN9Safcry Codc,Ssdon25%5.27533aed25534.iund d diwifNs building dare net c have a o" Nal my responsibility to modify tip aaup o"of the regmre chmn met misaenccaraccruncamo(Ocavw� Signature of Applicant Date utter,. 727/0, All roof coverings to be Class"B"or better Owner or authorized agent Dam'