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05100082 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT .CONTRAGT®RINEORMATION .z BUILDING ADDRESS: FLORES REMODELING PERMIT NO.05100082 10696 FLORA VISTA AVF, 49 ER'S NAME: PERMITLSSUEDATE LAURENCE MATTEUCIG 781 JASPER ST io/i7 /2n05 PHONE: SANITARY NO. CONTROL NO. (408) 298-4817 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH _op LICENSED CONTRACTOR'S DECLARATION U CI hereby affirm Nal 1 am lissnsed under provisions of Chapter 9(commencing Job Description b with Section 70M)of Division 3 ofthe Business and Professions Code,and my license is c,„ imm�mReand effect.6 REPLACE PLUMB FIXTURES FRONT BATHTUB p,y2? License Class Lie.p S o DOW/I'J Camracma TOILS/SINK/VALVES/REPLACE GREEN BOARD ARCHITECTS DECLAR N - a I undcrsmad my plans shall hC used as public¢cards Jad o Licensed Professional qg OWNER-BUILDER DECLARATION 4<E I hereby affirm that l am exempt from the Convenor's License Law for the a 0 following reason.(Section 7(31.5,Business and Pro@simu Code:Any city or county $0i which retinues a pcmmit to consauxt,alien improve.demolish,or repair any uractuae ZY poor N am occuance.also requires the applicant for such permit to file a signed alumacen sa mat he is licensedpurstan10theprovisionsoftheConmaor''sLicensclaw(Chapter9 Sq.Ft. Floor Area Valuati$IV500 xh$ (commencing with Section 7”)of Division 3 of NC Business and Proressinas Cade)or y — that he u exempt therefrom and the bests for Bre alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred della,,(5300). 01,.owner of he property.car my employees with mages as their sole compensation, 32608043 . 00 will do the work.and Ne structure is not intended or offered for age(Sec.7D14.B weress egU� n d Professions Code:The Con CrCto x License Law does not apply m an owner of Rns property who builds or improve thereon,andwho doeasuch work himselfor through his a, own employ=.provided that such improvements are not intended oraffercd for sale.If, s however,the building or improvement is sold within one year of complcdon,Ne owner. I' builder will bare the burden of proving Nat be did not build or improve for purpose of Noy colt.). 86 ❑1.as owner of the property,am exclusively contracting with licensed contractors 10 ap' .S Q ,mower the Project(Sec.o an owner os and Profesiov Cede)The reanoumr's Li n O�✓ cave law dms or apply m an owner of propeny.who Guild,of imptnays Centra,and yc, who contracts for such Droje<Is with aeontracmr(s)Licensed pursuant to the CeContractors1� License L se Law. ❑14M,:crept under Sec. ,e&P C for Cis reason cr Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury,one of the following dalaratiov: ❑I have and will maintain a Certificate of Covent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I basic and will maintain Wortrr's Compensation Insurance,as required by Section 37W of the labor Code,for the performaneC of the work for which this permit is aimed. My Work es CCo/ry/�eoxruiion lvnaturan1a canner and Policy anumber me- Carei...— J' yam' l—Cl�n P.Ecy Ne.M 4f 1_2 CE= MON FROM WORKERS' COMPENSATION INSURANCE (This section need not bccomplsCd fine permit is for one hundred dollars(SIM) am.) 1 certify that in the Performance of the work for which this permit is issued.I shall not employ any Pearson in any mannersn as to become abject to the Work ao''Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the workers Compensation provisions of are Labor Code,you must Z foMwith Comply with such proviaiov m this permit mall be deemed mound. Z O CONSTRUCTION LENDING AGENCY [— � Ihereby suffifm that Inc.iso covtroction lending agency,or dm performance of (L' Ce work far which this permit is issued(Sec.3097,Civ.C.) lt1 Q Lender's Name D. Lenders Address D U O 1 certify that 1 hats read this application and suite that the above information is Y. F" cancel.I agree to comply with all city and county ordinances and state laws Piano,to U building construction.and hereby mil representatives of this city to enter upon thc r 4[7 above-mentioned property for inspection purposes (W,)agree to an.indemnify and keep hornless Ce City of Cupertino against F' ,0 IlabillGes.judgmenta.Costs and expenses which may In any way acemC agaitat.,it City U Z in consequence of Cc gaming of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR9q REGULATI _ /w�-- /d _r 7_0 S^' Re-roofs r ,SCJ SiorSame,of APDIir HADate ZARDOUS MATERIALS DISCLOSURE Type of Roof Will Cc applicant or future building Occupant am or handle baoNous mucdal defined by Ce CuMnino Municipal C c.Chapmr 9.11.and be Health and Safety ' e.Seedan 15531(.)1 All roofs shall be inspected prior to any roofing material being installed. Ely., Will due applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as dcOncd by the Bay Area Air Quality Management all new materials for inspection. District ❑Ycs 1 have read the hu amousmaterials requirements under Chapmrii.95 of dm Califor- nix H."&Safety Code,Sections 15505.15533 aa115534.1 undersand thuif Cc holding docs not currently have a vernal.Cat it is my.,.ability m ratify th,..Pam of the require m/,y/ Och,hmaatbe MCI Poor missuance ofaCenlficamofOceupxncy. Signature of Applicant Date owner momindagent Dat, All roof coverings to be Class "B" or better • CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN 32608043 .00 DATE ISSUED. . . . . . . : 10/17/2005 RECEIPT #. . . . . . . . . : 31625 REFERENCE ID # . . . : 05100082 SITE ADDRESS . . . . . : 10696 FLORA VISTA AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LAURENCE MATTEUCIG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JUAN FLORES CONTRACTOR . . . . . . . : FLORES, JUAN LIC # 21592 COMPANY . . . . . . . . . . : FLORES REMODELING ADDRESS . . . . . . . . . . : 781 JASPER ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95116 TELEPHONE . . . . . . . . : (408) 298-4817 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL __________ _____________ __________ __________ __________ __________ __________ BPERMFEE VALUATION 7,500.00 147.96 0.00 147.96 0.00 BPFIXTURE UNITS 3.00 27.00 0.00 27. 00 0.00 BENERGY PERMIT FEE 147.96 71.02 0.00 71.02 0.00 BREMFIXT NO. FIXTURES 1.00 1.20 0.00 1.20 0. 00 BSEISMICRE VALUATION 7, 500.00 0.80 0.00 0.80 0.00 BREMRECEPT NO. OUTLETS 3 . 00 3 .60 0.00 3.60 0.00 BREMVENFAN NO UNITS 1.00 45.39 0.00 45.39 0.00 _________ _________ __________ ---------- TOTAL PERMIT 296.97 0.00 296.97 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ------------ __---__-_-------_- OTHER 296.97 VISA TOTAL RECEIPT 296.97 .a.z, Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 4NCITY OF Fax(408)777-3333 EI,TINO Building De artment JOB ADDRESS: PERMIT# 106 i' rL011L41Jc.ST4 fl-U.e �S' /e35a0 'L OWNER'S NAME: PHONE # 319-- 374 ,(— GENERAL 1S= 371GENERAL CONTRACTOR: Fe-of-L-a—s ,-ra-,Moor, FAX # 2t nJ C— I am not using any subcontractors: C- 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 Owner/Contractor Signature Date CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM 4-1 o sig ��- APN # 3 ,26 06r0 44 3 Date: Building Address: Mailing Address (if different from building address): i 0 6 C.Z/ U. Owner's Name: n—rTc—, U c J � r Phone#: q 1-� Contractor: JT License #: /-t L) 0-,v-&rIA)C-- 6'`t 5-6 9G Contact: Phone: 3/S-3 7 cf Cupertino Business icense#: SU P u �O/LAS Fax: Building Permit Info: / Bldg6�' Elect Er Plumb DI Mech L9� Job Description: R F PLA c1E pLu iu g 7AI6- FC V 7fJ rUtF 5 j V FJz-o-X) 73 , Residential L A!/=ry Commercial ❑ ve �c 6aC�X. Sq.Ft. Floor Area: VL- q.Ft.: Cost of Project: ,r7/� Occupancy roufe"p �� Type of Construction: Please check this box if the project is a AML1J second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity 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> 1.75MBtu 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 <= 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 F�. Flrb` CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUIL DING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIIvIE Inspection Overtime BUILDING BPBACKFLOW Atmosphere 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 BPTRAP 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 BREMAIItHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install NMCHANICAL BREMBUSWAY Remodel Busways. ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHA-LAICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPIDIVER Power Devi ce/App aratus ELECTRICAL 3 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHAMCAL BREMRESAPP Remodel Res Appliance ELECTR 1CAL 2 of 3 a"a CITY OF CUPERTINO CITYOF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BRFMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems NIECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECLAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMY Temporary Power ELECTRICAL BTENIPPERDI Temporary Bldg Permit BUILDING BTEMPSVCS Tfmp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. 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 r • 3of3