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08080238 (2) CITY OF CUPERTINO x'�=• �a'wTxx. .i� '�' " �' '^^ BUILDING DI\ZSION PERMIT 1COI RACTOR INFf}RMATI0;1V BUIL 1 R� RFSS:,. PERMIT NO.g9. VI RETHORNE DR TBD - TO BE DETERMINED 08080238 OWNER'S NAME: PERMIT ISSUE DATE MINAMI. KEIKO 08/29/2008 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EIPCI' PLUMB MECH upZ LICENSED CONTRACTORS DECLARATION Job Description O tori a .7 affirm that 13 licensed under provisions ors,Omer 9(commencing P az16 with ScctionTO(kJ)ofDivisian3ofdm BudneywProru,scare eom.aw my license is REPLC FURNC & ADD ON A/C 5qz �i«ll:c°c P3#!tm .g t>��3�7� NOTE: MERCURY MECHANICAL CONTRACTORS PD FOR BUS q Dam Conuacmr `pW ARCHIECrSDECLARATION LIC 8/29/8 uMmns it u,5 7 I moderated my plans shall be mad as Public recoNs JaU k LLO Licensed professional 3 OWNER-BUILDER DECLARATION I hereby a1Rw that I e1.cacmpt from Ne rest ms Co Licenm Law o far Um a O following neamn.(Section'7031.5,Business and Nofcatiues Code:Any oily or county SUK which requires a pramit leconauuct,alms.Improve.demolish,or repair any Wuctus, Zy prior b its issuable.also rtquiresthe applicant for such pewit m file a signed suicment �o thathcislicensedpurwentmNcpmvisionsoftheConeracteriliecomLaw(Chapmr9 Sq.Ft.Floor Area 2000 Valuation Section(commencing with Seon T )of Division 3 of the Business and Professions Codc)or e3$ dot he es ezrmpt therefrom and the basis for the alleged exemption Any violation of SccOon 7031.5 by+try applicant for a Permit subjects the applicant in a civil penalty ofNumber Occupancy ant mom man five hundred deitairsIS 32344009 .E P Y Type 1,a awntt of nine pmprny.a mY wployen wim wgea ns the'v sok compensation, wits do Newark ando: he CoreunoUnmmdeda Law does okpplyi an.Buttr of Required Inspections PO'land predications r ywh obs Codc The Comm�ofs Unci Law don not apply if an owner - q P mum enywyees,dsaimproreach unpr aedwho am,notchwark himselfar throughhis awn ver,ded employees,Provided that,suchis em ets within me year eededmonereG for oleo, - ,... . however,me Wilding m igen omnvd u sold within sem Lear of cwple for the ower- .to.). will have the WNcn of proving mat k did not Wild m improve for purpose of .to.). Q 1,U ownsr of the propenY•am exclusively contracting with licensed mnumb rs m construct me project(Sec.7044,Business and Profession Code:)The Conmcmri Li- cmue law dors not apply m an owntt of property who Wilds or improve thereon,and, w W coouacts for surd projecs wim a conuactor(s)licensed punvan,be the Contrames License law. ❑I am exempt under See .B&P C for this reason Ower Dam W ORKM'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ane of the milawing declarations: 1 ham and will m dream aCoreifinm ofConent m self-inm wfor Wmkcfs Comprn tion,as;provided for by Section 5700 of me labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation I...as required by Semen 37M of the labor Codc,fm me performance of the work,for which this permit u issued. ' My Workers Continuation Insurance cannot and Policy number am: Carrier Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu swoon need not becw pinned time permit Is for ane hundred dollars(SIM) Or Ina) 1 certify met in the perfarmarse W the work for which this permit is issued.I shall nm employmype minmy mamYrm as In temme,mbjectm the Worker'Comperuadon La of fta La App ,nexon Z_ 2 NOTICE CA :IL r er making Nu Ceoficam of mmpbon,you should become s lco b Ile is Coopcwn"provisions of the Labor Code,you must .JZ forthwith comply with men provisions or mis pewit shall W docmed mound. ZO CONSTRUCTION LENDING AGENCY P: I hereby alEw that mem is a construction lending agency for the perfuwanceof ai the work for which this pemut is loved(Sec.STM,Cl,C.) C Q Le der's Name - D Z IOMch Addles . U O i cooly that 1 have read boa application and sum Nat me move information u cawch 1 ayce to comply wim all city and county ordless"T and Wo laws relating m .C) Wilding cownrcuar.red hereby autimn.representatives of this city m east upon the N W above-mentioned property for inspection purposes, to save, t: WO) limilitles,judi�^�Cow andesIscad k¢„min my y.ceme against silesS the City Of CUP011110 al[jt U Z m PLCANmofinegrantingofthis D mit Issued by: Date ^ APPL CANE UNDERSTANDS AND LL COMPLY WITH ALL NON-POINT SOU ULATIONS. Re-roofs / n urno I' ucor u Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will thee CRantnorouse Wildinge.Chaptrore2.and hamdond Safety as defined by me Cupertino Municipal Code.Chapter 9.11,and the HnIN and Safny cerie,section 255Txo+ All roofs shall be inspected prior to any roofing material being installed. Ely. CYN- If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or forum building ones Wnt use equipment or deviw which g P g I he ummus air contsminou as defined by the Bay Area Air Quality Management all new materials for inspection. Viet] //��/� ❑Yes W4 1 have mwl the Wardens mamriaurequireacnu under Chapter 6.95 of the Califea. .is HnW&SafctyCede Sections 25505.25533 and 255M.I uedrmand Nat ifds Wilding _ Jars not nor have.umm,mat it u msponsinility m mtify dm oavpmt car the reqs maatheme 'ar aimenracrnirmamer eapvmy. 8 Signature of Applicant _ Date er cera a eat D,m All roof coverings to be Class'ns'or better CITY OF CUPERTINO • 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32344009 . 00 DATE ISSUED. . . . . . . : 08/29/2008 RECEIPT # . . . . . . . . . : BS000005948 REFERENCE ID # . . . : 08080238 SITE ADDRESS . . . . . : 11061 FIRETHORNE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MINAMI KEIKO ADDRESS . . . . . . . . . . :11061 FIRETHORNE DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0456 RECEIVED FROM . . . . : KEIKO MINAMI CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -------- ------- ----- -------- ----- ----- ---------- IBSEISMICR VALUATION 2 ,000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ].EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 IMPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ].MRRAA UNITS 2 . 00 122 . 38 0 . 00 122 . 38 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1.TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- 'DOTAL PERMIT 286 . 04 0 . 00 286 . 04 0 . 00 MPTHOD OF PAYMENT AMOUNT REFERENCE NUMBER - --------------- -------------------- CHECK 286. 04' #260.6. -------------- TOTAL RECEIPT 286. 04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ----- ------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • C)Sva F CITY OF CUPERTINO t ' FURNACE/AC CUPERTwo PERMIT APPLICATION FORM APN # 3 Z p ff —Do �� Date: <31 / �.C1� 7 I Z Building Address: 110(01 ]=1 RETNORNJE DRIVE Owner's Name: t.1Phone #: KEIKO M� AM� Cg�S� 773 -9333 Contractor: Phone #: 293_XJ XS MEA-4AFax#: (—f 0$) Z9 — 19' Contractor License#: Cupertino Business License #: 693o-n. Contact: Phone #: MATO MINAM I - �z�z� 3o7- 59 Fax #: Building Permit Info: Elect Plumb Mech Residential Commercial ❑ • Job Description: REPGAGEp ht.WAGB '1' APO ON AM CM01710N/N'4 For Residential Installations: Attic Fj I floor 2"d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight(structural tales) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): ZD00. 00 i?ZSID16NTIRt_ t/Q Strapped On Platform Bonded New Location Replacement Project Size: Express Standard ❑ Large ❑ Major❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set& the sheet index. G Revised 6/16/08 CITY OF CUPERTINO FURNACE/AC CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. LMCSUSHTR Commercial Install/Relocate ea M • suspended heater,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea �( heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. IMRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. I MRAPPVNT Residential for the instalUrelocate/or M . replacement of ea appliance vent install & not incl in an appl permit. Quantity Fee 1D Fee Description Fee Permit Type CITY OF CUPERTINO FURNACE/AC • C -01 UPERTINO FEE SCHEDULE Group FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of P 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1BSEISMICR Residential Seismic B IMECPLNCK Mechanical Plan Check M 1 MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type fumace/bumer, incl ducts/vents attached to such appliance up to and • include 100,000 Btu/h 1MFRN>100 Furnace Syst> 100k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h A 1 EPERMITFEE Electric Permit Fee E f 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B • Quantity Fee ID Fee Description Fee Permit Type CITY OF CUPERTINO "Qgl" FURNACE/AC • CUP RTINO FEE SCHEDULE Group AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C Units<= lOk CFM B 1MCRAA Commercial Mech Repair/alt/add M iBSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1BREMAIRHAN Residential A/C units<= 1 Ok CFM B 1MRRAA Residential Mech Repair/alUadd M • / 1BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E r 1MPERMITFEE Mechanical Permit M /p 1 PPERMITFEE Plumbing Permit P 1TRAVD0C Travel Documentation B 1 BUSLIC Business License B • Community Development 10300 Torre Avenue 1 / Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408) 777-3333 qfUPERTINO Building De artment JOB ADDRESS: (',upep Two CA 9.570ILt PERMIT # to 1f2CT90PNE D2lve 08URo0?3 OWNER'S NAME: lce l K o MiWANAIPHONE # 77 3 GENERAL CONTRACTOR: M EEWRY fA6,WAA1 FAX# lam not using any subcontractors: �jZ� Z O Signature Date Please check applicable subcontractors and complete the followinginformation: 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