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04100139 (3) CITY OF CUFEIMI 0 CO .TACTORINFOR Ot'N &� sVBUILDING DIVISION PER BUILDING ADDR US: PERMIT N 04100139 35 KENTWOOD AV ER'S NAME: PERMIT LSSUE DATE RODNEY BEAVERS 10/20/2004 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH =oo LICENSED CONTRACTOR'S DECLARATION Io y G I homey arfrm at I am licensed under provisions of Chapter 9(commencing sZw with Section9Wu)of Division Jof the Btair¢ss nrM Profcssiuns Codc.end myliccnu is e �„ in full force and effect. BATHRM REMODEL o,y,? Liccnu Class Lic.M ZI"w Date Contractor ARCHITECTS DECLARATION Y K a 1 understand my plans shall M used as public records ppyytl�tl�aa a U � ILY Sof„ Licensed Professional g� 3 OWNER-BUILDER DECLARATION �nyl.'�YJ Z1 mete affirm on 1 am exempt from me Contractor's License Law Tar Nc 0 o following a sna(Scotian 703L.5,Business and improve. delis Cade:Any city or county K m which rectums a permit to construct,alter,improve,demolish,or repairany.structure 13000 m F? u 2'^ prior In its issuance,also rcyuirehe applicant for such Permit to rile a signedsammcnt R that he is licenuJ pursuantm the provisions of the Contractors License Law(Chapter 9 Sq. Ft. Floor_Area Valuation _s ttF� (enm mooning wi th Section 700))of Diviai nn J of the B usiness and Professions Code)or - y^3 2 that he is exempt dimfroor and the hasis for the alleged exemption.Any violation of Section 9031.5 by any applicant for a permit Subjects the applicant to a civil Penalty of Occupancy.Type Car more than five hundred dollars($500). do ownerof the pmpcny,or is employees withwages r theirsole 0,44.8 Business will do fcwork,endo: structureisnoti Licenetended moffered(m salepplytoin.owneros and enywhobu Code:The Contactor'.Liccnx Law docs not apply to an owner of Required Inspections own c y wba builds or improves thereon.irdprand who does am not won himself or ed for sale. his cmr,hi cbuilding r improvement Nat such improvements arc not ear of d m offered for sale. r- bow eq NeavetebuenofpissaWe did one year of comple forPurdic owe of builder will have the burden of proving Nm he did not build or improve for Purpose of sale,.). kclI,as Owner of Ne property,am exclusively contracting with licensed controcma to met the project(Sec.]Oil.Business and Professions Code:)The Contractor's Li cc nu Law does not apply to an owner of property who builds or improves thereon.and who contracts for such projecur with a conlracmrts)licensed pursuant to IM Contractor's Li,e.Law. Of2hmby Sidc�]Ly .B&P C for this reason ErjUiy �Mrthc lowing declarations: I ham and will maintain a Cenirealc or Consent to self-insure for workers Conver- sation,a provided for by Section 37p0 of Ne Isbor Codc,for the performance of the work for which Nis permit is issued. ❑1 have and will maintain Workers Compensation Insurance.as required by Section J]W of the labor Code,for the performance of the work for which mix perosit is issued. My Worker's Com Pensatiun Insurance Cartier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Conmseetion nccd not M complcod if the permit i5(ar one hundred dollars(5101) +r lost.) 1 ccnify mal m the perrormarice of the work for who h this permit is issued.I shall not mploy any person in any manner m as to become subject to the Workers'Cnmpen5atmed Laws of California.Das Applicant NOTICE TO APPLICANT:If,after making this Confiscate of Exemption,you should become subject to the Woher's Com,nosmion provisions or the Labor Codc,you must Z forthwith comply with such provisions of this Permit shill be deemed revoked. zCONSTRUCTION LENDING AGENCY '[-+'4 l hereby afftm mat mere is a construction lending agency for the peduman¢of C4 > the work for which this permit is issued(Sec.Lri].Civ.C.) tc.) 0 LCdcr's Name 4. Under's Address - V O 1 cenify that 1 have read this application and stale Nat the above information in Correct.1 agree to comply with all city and county ordinances and stare laws relating to O v building construction.and hereby authori in representatives or this city to enter upon the above-mentioned property for inspection Purposes. Fy WC)agree to Save.indemnify and keep harmless the City of Cupemno against O N liabilities,jdlgmenm,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this From it. s—' APPLICANT UNDERSTANDS AND WILL OMPLY WITH ALL NON-POINT Issued by: Date SOURCEREOUy'RONS'. Re-roofs � Type of Roof oy Sin fc pl imanb";n r / Datc HAZr OUS MATERIALS DISCLOSURE Will Ne applmmt or future building occupant store or handle harardoes material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ode.Section 25532(a)9 S� All roofs shall be inspected prior to any roofing material being installed. ❑Yes r�Pu Will the ai Bcantar future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove I P s pan a Air Q omit ha>ardnus air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection. District' ❑Yes �Nu I have read No haiardoux mamrials requirements under Chapter F 95 of the Califor. nix Boutin&Safety Code,Sections 25505.25533 end 25574.I undersand Nat if the handing it not currcndy leve a bensnl,Nal it is my respunxi bil ity m notify did nee.,ant of the rcgdimments ¢hmuetWoclpdort uanccOra Confliction ofOccupamy. Signature of Applicant Date All roof coverings to be Class "B" or better Owner ar tNhmi,e4..af5Dam F • �1 • CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng : Sub: Blk: Lot : APN . . . . . . . . : 35931013 . 00 DATE ISSUED. . . . . . . : 10/20/2004 RECEIPT # • . . . . . . . . : 27512 REFERENCE ID # . . . : 04100139 SITE ADDRESS . . . . . : 1135 KENTWOOD AV SUBDIVISION . . . . . . . CITYCUPERTINO . . . . . . . . . . . . . .• IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : RODNEY BEAVERS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5807 RECEIVED FROM . . . . : RODNEY BEAVERS CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : ® TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- - ------------ - - -------- - - --------- - - - - -- ------- BPERMFEE VALUATION 13 , 000 . 00 201 . 96 0 . 00 201 . 96 0 . 00 BPFIXTURE UNITS 3 . 00 27 . 00 0 . 00 27 . 00 0 . 00 BPLANCHK PERMIT FEE 201 . 96 269 . 52 . 0 . 00 269 . 52 0 . 00 BPREPIPE NO OF FIXTURE 3 . 00 27 . 00 0 . 00 27 . 00 0 . 00 BPSEWER SEWER SYSTEM 1 . 00 21 . 58 0 . 00 21 . 58 0 . 00 BPVENT UNITS 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00 BENERGY PERMIT FEE 201 . 96 96 . 94 0 . 00 96 . 94 0 . 00 BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BREMPOWER POWER UNITS 1 . 00 47 . 96 0 . 00 47 . 96 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 BREMVENFAN NO UNITS 1 . 00 45 . 39 0 . 00 45 . 39 0 . 00 BREMVENSYS NO UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00 BSEISMICRE VALUATION 13 , 000 . 00 1 . 30 0 . 00 1 . 30 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 TOTAL PERMIT 885 . 01 0 . 00 885 . 01 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -------- --- ------ ------------ -- -------- OTHER 885 . 01 VISA TJ&L RECEIPT 885 . 01 - OCITY OF CUPERTINO& j CITY OF PERMIT APPLICATION FORM 9CUPERTINO APN# ( D Date: le9l.701az7o j< Building Address: , �[ / Mailing Address (if different from building address): �s ems!/ GdcMO 6/e_ Owner's Name: Phone#: a - e lel-G10119�j ��,� 0 -3s5`r79 Contractor: 1 License #:P10.377�o Contact:N����� Phone:SS� 9- y6 Cupertino Business License#: Fax: Building Permit Info: ynoa ca4�1 Bld Elects Pl b4[9. Mech-BZZ�N Job Description: 13aPb-44,c pPelrs � � Residential Com e i Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Pr oj ct: /3 V, ' Occupancy Group: r- Type of Construction: _ _ Please check this bo the — is a second-storyaddition: Project Size: Standard ❑ Large ❑ 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 Ooze. OCITY OF CUPERTINCe CITY OF PERMIT APPLICATION FORM CUPEkTINO 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 Storm/Rain Water PLUMBING 40 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 BRENWRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation ofFumace 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 Appliance ELECTRICAL 2 of 3 *ITY OF CUPERTINO* CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity 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 Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary-Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Ternp 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 ZADDCHG _ Address Chane BUILDING 3 of 3 } - �r� min■esr� • i I� a 10-1 Me,111 ■ .� . ................. ME Mm ME MEN No