06090045 (2) CITY OF XPERTINO
BurLolNCDrvIsloN PERMIT �QNTRrS��ORIN ORMXV'10NN
BUILDING ADDRESS: PERMITNO.06090045
10161 MACADAM LN
OWNER'S NAME: PERMIT ISSUE DATE
ENGELI GAGAI
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EO PLUMB MEOCH
LICENSED CONTRACTOR'S DECLARATION lob Description
u I hereby alarm tint 1 am licensed under provision of Chapter 9(commencing
with Schon 7000)of Division 7 afthe Business and Profession Code,arld my license is
mua mnmaemde 4 ADDING A/C
;qz be Lk.a
Cons,5CL
7W ARCHITECTS DECLARATIO i
j < I understand my plans shall an need As public records
r t;
Licensed Pmf.ianal
3 OWNER-BUILDER m the Com ION
0 1 hereby.(Sere on 1 1. exempt from the C csons o License Law for my
:00 o following recon.(Section 7fn str Easiness and Pmfostinn Cale:Any city or rummy
j$ which its s u n Permit re construct,alma imprnw,demolish,or mash ed mmmum $5400
.z.e priar ause scamanaalmmquirestha visions
far Commuch m's License,
Charon
,1Emment
� that he la lkencJ purtuent tottepmvision of the Contracmrs lSccnse law(Cheptm9 Sq.Ft. Floor Area Valuation
l (commencing with Section7ro0)nf Division 5 of the Bu,hummnd PrafGsinn Code)or
$ that he is exempt A=fmm and the basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of r U U Occupancy Type
not mom Nan Rw hundred dollars(5500).
❑I.As own..of the property,or.,employ.withwail..u Nelr,ole cesn'rsadon,
will da dmwGkmdthe.uumumis.tinmadedor.ff, d tersak(Sec.7044,Busi.a Required Inspections
and Pmfexslon Code:The Controcmh License law dm oat apply m wt
an rcr ns of q P
property who bulld.orlm,bovG titeman,and who doesseth amsk himself..rhmugh his
awnempleym,proNMJthissuchImpmwmmsarenminMM er OfflMfws B.
however,the building or improvement is mid within orc year of campktrc,the builder will will haw the burden of proving that he did eat build or improve for purpose of
sale.).
❑1,As..or the property..m exclusively mmumming with licensed aaa amers m
construct the project(Sec.7044,Business and Profession Cade:)The Conaano's U-
ccnse law does not apply m an owner of property who builds or Impmsea Noreen,ad.
who contracts for such projects with a centrarter(s)licensed pursuant m the ConuacmYs
LheGe Law.
❑14M exempt under See ,B k P C far Nis mason
OwnerDECLARDam
WORKER'S COMPENSATION ATION
1 hereby affirm under penalty of perjury rete of the following declemtion:
I have and will maintain aCmlfiGte of Consent to self-kium for Workers Compen-
scion,as provided for by Section 5700 of the labor Code.for We performance of the
work for which this permit is issued.
ave end will maintain Workms Compensation Insurance,As amm ed by Section
7110 of the labor Code,far the perfarmaneeof the wart for which this permit u issued
My Worker.Campers than M.mrarta Greer yyww Polity number am:
tamer.Ter�VaGT� /,�.�Yel oifta
CE CATE OF EXEMPTION FROM WORCERT 'S'
COMPENSATION INSURANCE
(This section need notaecomplesd if rhe Permit Is furan hundreddallam($10)
or Ims.)
1 certify the,in Ne Performance of the work for which this permit Is Issued,I shall not
employ any person many manner an as to become subject to the Worker'Compcmar an
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.IL after making this Cenificate of Exemption.you should
become subject m the Worker.Compensation provision or the labor Coda you most
.J 0 forthwith comply with such provision or this pe
rmit shall be deemed revoked.
z r~N. CONSTRUCTION LENDING AGENCY
(..t I barony alrum that there u a mnartxdnn lending sgency for the performance of
a the work for which this permit is issued(See.5097.Clv.C.)
W�Q Landers Name
z Lenders Addmss
U 0 1 cmify that 1 haw read this application and slate that We show in[..WO,4
V. f correct.l agree to comply with all city and county ordinances and,tsm laws mlating to
O U building convection,and hereby aartarim representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify And krep harmless the City of Cupertino against
o-F.r h liabilities,judgments,toss and GpcGG which may In any way accmc against said City
U Z in consequence of the granting of this permit. /
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: Date v
Sou CEREGU TIONS.
9 7�0(o Re-roofs
Sign um of Appli tlComma taraam
xAI Ron 1,Il .7ERTALS DISCLOSURE Type of Roof
Will Bre appliGntor future:Wilding aavpantslae rehandle havrdon,memrid
As de0ned by tite Cupertino Municipal Code.Chapter 9.13.and the Health and Safety _
Cade.Section 25532(0)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea (�o
Will the applicant o fret lam building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit nuumloG air cmuminanu as defend by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yea
I havcmad thehaxdo amasrialsmquimmenuundcr Chapmr6.95afNeCalifor-
niafkalthgc S.f,I,Codc,Sredms25505,25533 and25534.I ovum and thmlfihc building
dm not currently haw a tenant mat Itis my responsibility m nutty the cupent of Jur
m menu`hk ustbcmet ri wiuuanreofaccnincamofgrymany. SignatureofApplicant Date
ow or amtneriacd ant / D All roof coverings to be Class"B"or better
r Community Development
10300 Torre Avenue
3 Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
10161 (960 roodY
OWNER'S NAME: IF— i PHONE # -/DB - cZS` — q/8
GENERAL CONTRA R: -t FAX#
I am not using any subcontractors: .4111 06Z&44e 14 D(;P
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
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36901054 . 00
DATE ISSUED. . . . . . . : 09/07/2006
RECEIPT # . . . . . . . . . : 35943
REFERENCE ID # . . . : 06090045
SITE ADDRESS . . . . . : 10161 MACADAM IN
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ENGELI GAGAI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : AIR QUALITY HEATING
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- ------- ------------- ---------- ---------- ---- ------ ---------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 5 , 400 . 00 0 . 60 0 . 00 0 . 60 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 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 162 . 03 0 . 00 162 . 03 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- -- - --------- ------------------
CHECK 162 . 03 52592
TOTAL RECEIPT 162 . 03
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
C d CITY OF CUPERTINO
FURNACE/AC
WUPEkTINO PERMIT APPLICATION FORM
APN# �7 ` D O Date: 00
Building Address:
,S"0/v
Owner's Name: Phone:e CL ara- g
i
Contractor: V Phe: License#:
_ ag r g
r LIG. / 0
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg Elect Plumb lJ Mech �n
Job Description:
Residential Commercial ❑
For Residential Installations:
Attic ❑ 151 floor ❑ 2nd floor❑
Adhere to min set back requirement
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occuygoup:
11 � nsN Occupancy
Strapped U On Platform El Bonded U Sq.Ft. Floor Area:
New Location Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
/ MPERMITFEE Mech Permit Issuance MECHANICAL-
--I PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING