06050122 (2) CITY OF CUPERTINO
BUILDING DIVISIONPERMIT XOl�IT12r� I'(1R Z xzMaT= olv *„.
R 8•l�"N •ti ,w«: b.^ f^+„9k3Aa cx.i..
BUILDING ADDRESS: E G ELECTRICAL SERVICES PP'LMITNG'06050122
1127 HUNTERSTON PL
OWNER'S NAME: PERMIT ISSUE DATE
DUPORT JAMES R AND JUDITH S 115 SUPERIOR
F: SANITARY NO. CONTROL NO.
(800) 318-1975
ARCHDEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
OM'z LICENSED CONTRACTOR'S DECLARATION Job Description
F I hereby afMn Nw et 1 11¢vd Utter provisions Of CMper 9(enmmeacO
in{
?Z`uf with Samoa 70(10)of Division 3 of the Buttner ad$ofeaduw COM.aM my lkeweI.
;L1N Leon(arta a -lt SERVICE UPGRADE TO 200A �I����®
s'q z Leon — Lr.aAs
h, Dau Goatreernr
ARCHITECT'S DECLARATION,
)�G n I Me nd mY PWtssiWlMuudsspublic rtcnda JUN � - 2006
6
.G Licensed Professional3 OWNER-BUILDER DECLARATION
1 hereby affirm Nm 1 em wempt from Ne Canaectoh License Lew for Ne
:00 following moan.(Soman Tin 1.5.Buttons and Prefcasmns Cdc:Any city or County
5.$g which n uirw a permli m c.ns .4 am4 W prove,dcmol W.or mpolr any muvum 19.0 0
iy prior to its issuanco,else requires tie applicant for Inch permit to Ne A signed amum.m
s� G
Our bus is licensed paramount to On provision of Ne Contractor's Um=Law(Chapter 9 Sq.Ft. Floor Area IOn:;q
2�$ (commencing with Section 7a W)of Division 3 AMA Busineuand Professions Coca)or
y that M b exempt Used=and the bob for the alleged exemption.Any violation of
Section 7031.5 by Ary applicant for a permit teb3ecu me spite”[to•Civil penalty of Occupancy Type
not more Nan Bve hundred dollars(SM
❑1,ae career of the property,or my employees with"Sea u Nair Ink campensdon,
will do Ne wort.and the Namure k not kuoded or offered for We(Sec.7OµBusiness Required Inspections
and Professions Cargo:Tire Contractors Linn eLaw ae does not Apply to an away of q P
property who builds ca improves Herron,and who dace ouch work himself a through his
awn emplayces,provided that Inch improvements Am notinmded aro@sed for We.If.
however,Ne Wilding or improvement is min within ate year of CamPktian.the ownv-
W ild.will hew the Wrelm of proving NM M did not Wild or improve far puTate of
ask.).
❑1.as owner of the property,am walusively contracting with Bamed rnnuacun to
canstrct rise project(Sec.7044.Business ad Profnslmu Cade:)The Continuum's U-
Cams law dean amtapply man ownerofproperty,who Wlidsm Wpmves teseo.,and.
who convects rorsucb projects with a motractar(s)granted Peroral In tM Gendarmes '
License Law.
❑lm exempt ander See .B d P C far this recurs
Owner Data
WORKERS COMPa BATION DECLARATION
I hereby dnm ander pvully of perjury aro of de following dalaraoes:
I aveand w01 maintain•Ceninou of content to Alf-mus,forwohcfscompen-
Amon,As
Taovidd for by Sada.3700 of she tabor Cards.fm Ne Per(-m—of IM
work far mach this permit is issued.
❑1 hoe ad will maintain Worker's Compensation humus,u mquited by Section
37M.fthe aborOmaj Ne cttarmues of Ne wkly which Nin pumiarissncd. '
My Wo Cam enotlanu mco rtier ad Policy n r ave
cmRah It
iv: Policy Z
CERTIFICATE OF EXEMPTION FRO. - ERS
COMPENSATION INSURANCE v
Cnsr teflon reed rot M completed If tM permit bfeaoa hunNddoaen(g tall)
or leas.)
I sanity,door in the performance of Ne work fm which this Permit is issad.l Mall at
employ anypenoa In any manner m As 0 become subject to the Worked Compewdan
Laws of Caifamia Data
IF least
NOTICE TO APPLICANT.IL after making Nb CeNnale of Eumptian.YOU aboum
become subject in the Workers Compensation provisions of We Labor Cade,you muse .
.JO forthwith Comply with such provisions or Nb Permit shall W dared mwMd.
Z^ CONSTRUCTION LENDING AGENCY
[-+ I Worby affirm mu then is•cmmnsetinn kndkg at far the performance of
ai 7 Ne mods for which da permit is Wad(Sec.3097.Ch.C.)
IL3 Q Landers Noone
7 z Lammers Add-••
U0 I Conify Nat I have mad this application AM sum that me cove information Is
tL F comeL i agree to comply with all City and county ordinances end Itsm laws relai.g to
0Ubuilding construction,and hereby authorim representatives Of this city to cmer upon Nc
r LU ahove-mentioned property for inspe7A- h'iLC1'hPm.y
oues
(We)agree to sew,ind.a hamkss tM City of Cupertino agttnst
o-Fi laA IiebilWes,Judgmcnu.cow Intl pein anywyaccrue gaiwt aid CBO
Cm3•`� in cansegncnw of Na gond of NAPPLICANT UNDES COMPLY WITH ALL N -POT Issued by: Date
SOURCEREGULA
Re-roofs
simmurtor AppliandC m Data
ttyy ARDOUS ATERIALS DISCLOSURE Type of Roof 't.a
Wllldeapp6a larfumn,Wilding occupantsomaadle hvadow materiel ,
As dented by the Cupertino Municipal Code.Chapter 9.11.And IM Health and Safety
Cam.Sad..255320)? r All roofs shall be inspected prior to any roofing material being installed.
[:1y.
Will dna applicant m future Wilding occupant ute equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huadnw ser conuminsntt as denncl by than Bay Amo Air Quality Management all new materials for inspection.
District? !,
❑Yes
I new mad Ute mamriaA mquiremevu under Chapura.95afms CAIifoa
.bl5eshek sae 'oas355Q5,25537ad25334.iwdcnund Nmifde Wilding
dao not cum seam4 ma it h my responsibility u madly Ne pant f Ue
rtqube— be=I prior to issuance ofa CertiOcau of Signature of Applicant Date
owarm.at Yaaa ant D All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
r'- Cupertino CA 95014
ii Telephone(408)777-3228.
CITY OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADD S: PERMIT #
OWNER'S NAME: PHONE #zj0Z - — 22
GENERAL,CONTRACTOR: t . FAX #
I am not using any subcontractors: —�
Signature Da
Please check applicable subcontractors ed 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
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36221011 . 00
DATE ISSUED. . . . . . . : 05/15/2006
RECEIPT #. . . . . . . . . : 34408
REFERENCE ID # . . . : 06050122
SITE ADDRESS . . . . . : 1127 HUNTERSTON PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DUPORT JAMES R AND JUDITH S
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : EDWARD GORGINIAN
CONTRACTOR . . . . . . . : EDWARD GORGINIAN LIC # 24831
COMPANY . . . . . . . . . . : E G ELECTRICAL SERVICES
ADDRESS . . . . . . . . . . : 115 . SUPERIOR DR, #C
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (800) 318-1975
�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
BSEISMICRE VALUATION 1, 900 . 00 0 . 50 0 . 00 0 . 50 0 . 00
EPERMITFEE FLAT RATE 1. 00 38 . 37 0 . 00 38 . 37 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 208 . 16 0 . 00 208 . 16 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 208 . 16 VISA
TOTAL RECEIPT 208 . 16
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
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' � CITY OF CUPERTINO DY050 X 22.
CUPEfZTINO PERMIT APPLICATION FORM
N# 0 � � Date:
Building Ad r ss: Mailing Address (if different from building address):
1
Owner's Name: _ Phone#:
1
Co trac r: License#:
LJ
Contact: Phone: 21�)--2222. Cupertino Business License#:
Fax: /�
Building Permit Info: E0UCz —t D L 2CXO/v,
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description:
Residential Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Grou
1100 -
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
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Q CITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM
QuantityFee 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
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
BREMAIRHAN A/C Units <= 10,000 cf n 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
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CITY OF CUPERTINO
CUPERTINO PERMIT APPLICATION FORM
uantity 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 Inspection BUILDING
BSWIM 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 Chane BUILDING
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