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06080171 (2) CITY OF CUPERTINO >x BUILDING DIVISION PERMIT ' G'O .R"�.C.TR§Il 'UI.2MATI0 -, ,.oma..-•.5_W.. m PERMIT NO. BUILDING ADDRESS: 0 6 0 8 0171 10380 FARALLONE DR OWNER'S NAME: PERMIT[SUE DATE SALLY WEBB NE: SANITARY NO. CONTROL NO. ARCHITECT7ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH is p LICENSED CONTRACTOR'S DECLARATION Job Description W 1 mby snout Met 1 aat Ikensrd under provisions of Chapter 9(comencxing P with Smton7000)of Division 3 alone Business and PrOfessum Code.and my license is ❑m ,n r.11 fame and If L q�� q�(g ADD ELECTRICAL PANEL 200AMP UPGRADE AND ADD o c vector ae�a.� DISCONNECT FOR A/C a' ARCHITECTS DECLARATION 1 unmrauul my plans shall be used u public mcmm h U Licensed Professional than OWNER-BUILDER DECLARATION i I I hereby at,.that 1 am exempt from the Cont actoes License Law for the :0C following mason.(Section 7131.5,Business and Profession Com:Any dry or county '$ff which requires a permit to consumer,afm•improve,demolish-or repair any sauctum micro,its iuuerme.also requima rte applicant forsuch permit to JIM sailboat moeence, that he is licensed pursuant to tiro provisions of the Conwcmr's Lkcnc law(Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Suction 7000)of Division 3 of the Beat.and Pro(casiom,Code)m $3000 t'3$ that he is exempt therefrom and Mm best for rhe alleged exempdom My violation of Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type m,mom than fnva hundred dollars(5500), ❑1,u awns of th¢property,or my employees with wage,u Manuel.compmenden• will do the week.mdthe am=.I.Out imendedoroRered forsele(Sec.7014•Business Required Inspections and Profession Cade:The Comore oYs Limindem wt law derot apply b e ns an.wan of q P Own ertywW Wilra ided shoves Netcom.mdwindless not ImwmkhimaeVor Nrough its ��� ownemployees,provided rotauch ImprovementsarcnotlomndndmaRemdfmugh his however•the building m Wprovemmt is Mid withinarm year of completion,the owner- builder will have the burden of proving out W did mt Wim or improve for purpose of 0 1. / I.u owner Of the Sec.70 am axes ss and concession{Cid:)the comMdars m / mnwm the project(Sec.7014,Business and Professions ri i The Conhe m..and Es cane law rats not apply an..owner ra propmy,wce W d p m Wmow Mtereon,and. who mnuacu for am4 wakes,what mnuxMrtq Ilurue0 pursnm In the ConvanroM1 Lkeuetaw. ❑tom escmpt undo Sea .BhPC fm Nu mason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby ensu most penalty of perjury oro of the following declmadons: I have end will maintain aCerdOute of Content m self-btsure for Workol,Compun- avian.u pmvided for by Section 3700 of the labor Code,her the perfamenm of Mte work for which out permit is issued. ❑1 have and will maintain Warkufs Compensation Inwranm,as mqumol by Section 3700.1'0.Labor Cade,fm the wRomanee of th¢work for which Nis permit is issued. My Workers Compensation huunnce canner and Policy numberam: Cartier. Ft PSS ��+s9. PoIIry No.:--(A&&=—Z.25' 1 CE MCA7EOIPEXEMPf70N FROM WORKERS' COMPENSATION INSURANCE (rossectlon need not W completed:f the permit is froom hundred dollars(5100) or less) I cenify that in the performance of to wart for which this pemit is Issued.I Mall not employ any person in my manneran as to become subject tithe Workers'COmwnsatlon Laws of C31ifomis Dam Appllam NOTICE TO APPLICANT:If.after making this Cmifica,of Exemption,you should become subject to the Workers Compemadon provisions of the tabor Cade,you most .J O forthwith comply with such prevision or this Permit hall W deemed mmkmd. Z► CONSTRUCTION LENDING AGENCY [••� I hereby afllm Mut them is a construction lending agency Indic performance of tY > the work for which this permit is Issued(Sec.3097,Civ,C.) QLenders Nurse - z IemMe,Addrr_p U Q I cortify that 1 have rust this application and sate that the att infomatiun Is U, P comm.l agree m comply wit all city and county Ordinances and sum laws minting to, 0U building consuuctian,and hereby authorim repreacroades of this city to enter upon the W above-ormuuned property far inpecum,pughotes. 0. (Wc)agme m Mm,i sonify and keep hamlets the City of Cupcnino againt rn tiabili,ca Judgmanu.coau eapcY wblchmay litany way accrue against Mid City L'—Z in<onseq"C" ""'I ' gofthtsPermI ,�l�l ., APPLICMn'U ER NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REG O$f�l/0 6 Re-roofs S ilinaturcefyWWA&Contracter Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicant or futere Wilding mcum,Rom or handle harxdon material n dcOmd by the Cupemna Municipal Code,Chapter 9.13•and the Health and Safety Cam,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes KHO 41 Will the applicant or futum building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove emit beamnn air contsmmants as defined by the Bay Ama Air Quality Mangement all new materi f spection. District? ❑Yes QNu •'I hew mad the�hpca rdtm mawrials mquim,mnu unmr Chepmr6.95 of the Califon .T.Health&s YC mumts25505.25s33am123334.1uakrwndtnuthebmding dna not cum t Il m unant.that Lis my responsibility u noury the amupant of the requirement hrA t nortoin..of.C.mr..ZOfOccupane/ Sign a licant Date J [b Ow. Or ed ascot Data All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue 4 ✓ Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 #UPERTINO Building Department JOBDRESS: PERMIT # 1103S -0 06d�01 OWNER'S NAME: ) I v Lde b h PHONE - K`i 16 GENERAL CONTRACTOR: Rbrm k,,v, fIaClel FAX # I am not using any subcontractors: ILS �O G ature Date Please check applicable subcontractors anC m Tete 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 • Owner/Contractor Signature Date CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36929015 . 00 DATE ISSUED. . . . . . . : 08/21/2006 RECEIPT # . . . . . . . . . : 35704 REFERENCE ID # . . . : 06080171 SITE ADDRESS . . . . . : 10380 FARALLONE DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SALLY WEBB ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : ABE ELECTRIC CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE �EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BELEC200 METERS 1 . 00 29 .43 0 . 00 29 .43 0 . 00 BREMMISC FLAT RATE 1 . 00 27 . 58 0 . 00 27 . 58 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0.. 00 BSEISMICRE VALUATION 3 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 130 . 74 0 . 00 130 . 74 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ----- ------- ------------------ CHECK 130 . 74 1003 TOTAL RECEIPT 130 . 74 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • Y % 1 CITY OF CUPERTINO 0(00180 1 CUPEf�F PERMIT APPLICATION FORM N# Date: Building Address: Mailing Address (if different from building address): Fc4rallone Dr CyoA&rA0/'i Owner's-s /e/ Phone#: "00) 73'� B `t\G Contractor: License#: g S 9 3 6 P Lac EGCC7Y', 6�CU�'1f32iliC Contact: Phone: 65'a ?O?-0 k t Cupertino Business License#: b ru Fax: . 02 7.34-9%6 Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: AIDO ELC-,r1r1 "Cc,/6pu^(7/ Upyr.c,, — 2a 6 ^Q Residential ,® &Ad dt'SCOAACC7' fr Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: OccupancyC oup: 3 0o ,� Type of Construction: Please check this box if the project is a second-story addition: ❑ ro•ect Size: Standard Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K 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 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 BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM Quantity 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, Pb1g 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 BPSEWERSewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BRENLkMIAN 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> l 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 App liance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group lip 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 BSWIN4 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 MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING' ZADDCHG Address Change BUILDING • 3 of 3