06090070 (2) CITY OF CUPERTINO »'� *t±•" _`° �" -r`•_y
BUILDING DIVISION PERMIT ,CON1CRr�Cx' 21Nk'ORMA,T�( 1V,,
BUILDING ADDRESS: BOLIVAR SOLIS FERMITNO.06090070
10536 JOHNSON AVE!
OW NER•S NAME: PERMIT ISSUE DATE
BOLIVAR SOLI$
NE: SANITARY NO, CONTROL NO,
ARCHITECUENGINEM: BUILDING PERMIT INFO
BO EO PLO MEOCH
op LICENSED CONTRACTOR'S DECLARATION lob Descrl tion
i U I hereby IMM Jm Konrad
ul l amm
under proven"of Chapter 9(coencing P
with Sadon 7M)of Division Sof the Business aM Professions Cade,and my Imams is
! m iarallfameand affect.
INSPECT EXISTING PANEL AND REQUEST METER RELEAS
LIZ Lieeme Clue Lie.g
F p Dam Contractor
7W ARCHITECTS DECLARATION
i I underatanJ my plans shall Ehe used as public records
'G t ; Cleansed Pmtcvianal
• 3 OWNERBUIrDER DECLARATIONclo
i y I booco sa that 11. eumpt form hW Contracture :A License Law for hbo
.00 followingrteasa smakon]OILS,Business and sae.Cannns Calc:And city OF County
e 9 which rtquima a permit m ennwuct utet improve.demnlW,nr repair any Tenure 810
fzi Pnoruiu iensedpaisu require tboapional Of far eehpermfsm Na as Ladatatit-9
C NommencaveJ punuans sohbo of Division
iviauarthecanu inessaJmnusune Chaptor9 Sq.FI. Floor Area /� Valuation
l�$ that he wineing t Section m land of basis n3 nfhW Business and Mynvilatmo Cads)of
that he V exempt there(mm and the baso far she alleged assumption.My Mohtion of
Section 7071.3 by any applicant In,a permit subject the applicant m a cfvll Penally Of -5AP?4MiAbferuu Occupancy Type
not mart data five hundred dollars(SM.
0I,uowerohnepsopMy,mmyemployeewithwageuhneirmicampe Uon,
and
d Prodatnewoansdt,Code:e The Co^uatrbecnmats Lice.
ice arLa.4.Cut aapply to anOwnereof
Required Inspectionsections
property who builds at and who data work h rror tthrough his
own
cro eprovid thatuch improvements are,not imnded ooffeud for ale IL
howae.the building orImpmwment
4 sold within one Year ofCOOPICOOk the
e owr- -
buiMcr will nave hbo burden of proWnB that W did anIt Wild or Improve!m purpose of '
vied.
0 1,as owner of the property,am exclusively contracting with licensed contractors la
construct the proem(Sec.7W.Business and Professions Cade:)The Camramra W.
conte Law data not apply to an owner or property who Wilds ass Impmwu Norton,and
who coanazu fat such project with a eonuanaRU licensed pursuant to the Conuutoes
License Law.
OTom exam ^der e. ,BBPCfar ad n
weer v 71ON Dau
WRKERS COMPENSA DECLARATION
1 hereby affirm under penury of perjury ars or the allowing declamations:
I h...W will munuin a Certifcam of Consent m uhfdnsum for Worker's Compere
aadon,u provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is bred.
0 1 have and will maintain Worker's Compensation Insurance,u required by Section
3700 of Jm labor Code,far the performance of the work for which Nis permit is issued.
My Workart Compensation lura.carrier and Polity number am:
Cartier. Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(The atcd on need ant he com phned If Ne permit is forone hundred dollars($1110)
at less)
I cardty thus in the Performance of the work for which this permit Is issued,I shall am
employ any peram in any oun.r.laas to tome astrim orkcri Co ^n '
Laws of California.Dau l� ` ^ -
Applicants -- -
NOTICE TO APPLICANC If.atter making the,Cenikate of FFC.,ddh.yoG should
baome tubject to the worker's Compensation provisions of the labor Codc,you mar
Oforthwith comply with cash provisinu or this permit snub be darned sew and.
z., CONSTRUCTION LENDING AGENCY
0 I for
which his
Jut pert u s rnnsuucd30 luring egcnry far Nc performer,¢of
C.�., L a work ism which Jds permit t issued l5cc.309'1,Cir.C.1
G Q Landers Name
.7. z Lambert Address
Add
U O 1 earthy that 1 have reed this application abo sum Jut the shove information IF
LS, t- carraL 1 agree u comply with all city and county oninanas and sum laws relating of
0 V Wilding construction,and hereby aushonre mpmaenutive ofthis city to enter upon to
0. ahow-mentioned Property for inspection purrases.
(We)agree to raw,indemnify and kap harmless the City of Capone.against
lubilidu,judgment,cost and expenses which may in any wayaeme against said City
U,z is comegence of the granting of this Permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS, pp �+
bbl/ �+/I Re-roofs
Signstum or AppliunJCorustor
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m future Wilding aaupant awe or handle bmstluu msarial
as&fined by Om Cupertino Municipal Cade.Chapter 9.11.and the Health and Safety
Code,lecloo 111311aj7
[3 yet ��wttL NO
All roofs shall be inspected prior to any roofing material being installed.
Will the aplsliaant ar-t/utum building Occupant
use equipment or deviceswhich If a roof is installed without first obtaining an inspection,l agree to remove
emit heard.u,dr conuminanu a deBncd by the Bay Arca All Quality Management all new materials for inspection.
cutlet?
0Yns �Nu
I have Food dm hvartlau mored-)$myvi omems under Chapter 6.95 or the Califon
me Heaths&SuctyCede,Sections 75505,13553 and 15571.1 adcoand that irhW widies
Jars ant currently haw a wank that It is my responsibility m notify the mcupant of the
rcyulrcmcnt which ns to,metpna m;:;aanm ar.cerdncam aroc
P Signature of Applicant Date
Owner orf ma seem / Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
sm 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37528037 . 00
DATE ISSUED. . . . . . . : 09/11/2006
RECEIPT # . . . . . . . . . : 35988
REFERENCE ID # . . . : 06090070
SITE ADDRESS . . . . . : 10536 JOHNSON AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BOLIVAR SOLIS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . BOLIVAR SOLIS
CONTRACTOR . . . . . . . . LIC # *OWNER*
COMPANY . . . . . . . . . . : BOLIVAR SOLIS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE .
'FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 10 . 00 0 . 50 0 . 00 0 . 50 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
TOTAL PERMIT 73 . 73 0 . 00 73 . 73 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 73 . 73 MASTERCARD
TOTAL RECEIPT 73 . 73
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--------
------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
CITY OF CUPERTINO CjC)q UJI
CUPEI�F PERMIT APPLICATION FORM
14 N# Date: cl II zo06
Building Address: Mailing Address ((if different from building address):
1053 -1-0 510N ME . GUPe�a-I1No CA, 95614
Owner's Name: Phone#:
Contractor: License #:
Contact: Phone: Cupertino Business License#:
Fax:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description: =�IJSQIST�Ntr PANEL �" 2�UrST h1FTt12—( E7LCP6E—,
Residential ^' - ommercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: 10- Occupancy Group:
Type of Construction: Soli S�A3 Please check this box if the project is a
second-story addition: ❑
%ro'ect Size: Standard Laze ❑ Ma or ❑
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
CUPEft,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 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 Stoim/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 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> 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
CUPEkINO PERMIT APPLICATION FORM
Quanti Fee ID Fee Descri tion
BREMSIGNADFee Group
Rmdl Si s Add Branch ELECTRICAL
BREMSIGNS Remodel Si s, Mar uee ELECTRICAL
BREMTHEATR Theatrical Li htin Fix ELECTRICAL
BREMVENFAN Vent Fan Sin le Duct MECHANICAL
BREMVENSYS Ventilation S stems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial
BSEISMICREBUILDING
Seismic Fee Res BUILDING
BSPECIAL S ecial Ins ection BUILDING
BSWIM Swimmin Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Tem ora Bid Permit
BTEMPSVCSBUILDING
Tem Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical s foot ELECTRICAL
EPERMITFEE Elee Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Meeh Permit Issuance MECHANICAL
PPERMITFEE Plumbin Permit Issue
PPLBGPLUMBING
Plumbin Fees foot PLUMBING
PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING
PLLONGRNGR Pi nnin Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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