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06030141 (4) CITY OF CUPERTINOrp sew.' ? --Mnsekr izF �' BUILDING DIVISION PERMIT" ,£CONTRAiCT) RNIFORMATI.- r� ; BUILDING ADDRESS: ' PERMIT NO. 10371 MANN DR OWR'S NAME: PERMITESUBDATE ELLIOTT KATHLEEN A 10311 MANN DR. 03/23/2006 PHONE: (408) 930-6786 SANITARY NO. CONTROL NO. ARCHITECTIENGINECR: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH G7 I� 0 0 30j LICENSED CONTRACTOR'S DECLARATION lob Description 1 thereby*from thm 1 Aum]!caused under provisions M Chapter 9(commencing P with Sation 7")of Dio.br 3arlhe Businessmd irmfcssinna Coul my license is infull form and offem, REVISION-ADD OUTLET/SHOWER STALL Lt...Class Lie.. ORIG PERMIT #06020172—NO NEW PERMIT Dune Contractor. ARCHITECTS DECLARATION a 1 understand my plans shall he used as public records DSU Licensed Pmfcssional g g OWNER-BUILDER DECLARATION 0<� 1 hereby a1Rrm that 1 am exempt from the Contractees License Law far the p0 following mason.(Scene.7031.5,Business and Pmfessluns Code:Any city or county $9 which requires a permit to construct,altar,improve,demolish,or repair any structum �y prior in its issuance.also requites the applicant for such Permit a file a signed sutemem Valuation �< that he is licensed pursuant m the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $ (commencing with Section 7000)of Division 3 of the Business and Pmreuiom Code)or — Nat he is exempt therefrom and de basis for the alleged exemption.Any violation of Seniors 7031.5 by Any applicant for a permit subjects the applicant to a civil Penalty ofp7�t y�sµy{ CCU araC P y Type .at than Bve handled dollars($500). m m (]I,as owner of the property,or my employees with wages u their sole compensation, will do the work And thesrucmIn is not intended or offered for sale(Sec.7044,Business Required Inspections end Platinum.Cade:The Connector,License law does not apply e m owner of q P pmpeny who buildsorimprnves Nerson,and who doessoch work himself or through his awn employees,provided that such improvements arc not intended oroRered for tele.if, however,the Wilding or improvement is sold within am year of completion,Ne owner. builder will have the burden of proving that he did not Wild or improve for purpose of sale.). 25 Las mvmr of pe propcny,em exclusively smum lg with licensed clumucmra to consumer he project(Sec.7044,Business and Professions Cade:)The Contractor's Ll- came law does not apply to in owner of property who Wilds or improve theme,and, who contracts for such pmjcm with a conuactar(s)licensed pursuant at Yee Conmcrah License Law. I Am exempt under sec, / .B&PCfor Nisreame Data 31 6 WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury meet the following deelasatimr. ❑1 has and will maintain aCertlfieam of Cement a self-mum fm Warkar'aCompen- salion.As provided for by Sedan 37011 of the labor Code.for the performance of on, work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Sedan 37W of the Labor Code,for to performance of the work for which this permit is issad. My Workers Compensation Insurance carrier and Policy number All: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not beeomplened if the permit is for omhundrad dnl]an($100) or less.) 1 certify that in the performance of the work for which this permit is load,I shall not employ any person in Any mannerM As to become subject to the Worker'Compensation lawsof California.Date Applicant NOTICE TO APPLICANT:If,after making this Cmifcate of Exemption,you should became subject to the Worker's Compensation provisions of the Labor Code,you muss �O forthwith comply with such nowitinm m this permilshellW rimmed Invoked .'�iy CONSTRUCTION LENDING AGENCY E.a Ihereby Mr..thatthe.i,A eonmuctlan lading egme,for am performance of �i the walk far which this permit is issued(Sec.3097,Civ.C.) - W Q Lender's Name Z) Landers Address UO I lcnify that 1 have read Nis application and sum that the shove information b IL E� correct.l agree to comply with all city and county ordinances and sure laws relating to 0 U building convection.and hereby amhorrm mprmentntives of this city la tale,upon the L7a .hove-mentioned property for inspection purposes. LL (We)agree to save,indemnify and keep harmless the City of Cupertino against Babilitinjudgments.coats and expenses which may In anyway Alcorn against said City U In consequence of the granting of this Permit, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU E REGULATIONS. f�✓l �.�jGt ✓z Iz�oL' Re-roofs Signature of Applicanr/Contrmtor Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occapanlslam or handle terminus macdal defined by NCupertino e Municipal Code.Chapter 9.12,Audi the Health and Safety an,Sedan 255320)? All roofs shall be inspected prior to any roofing material being installed, ❑Yes �Nr Will the Applicant or future building on,upam use equipment or devices which If a roof is installed without first obtaining an inspection,l agree to remove emit hoemdous all contaminants As ddired by the Bay Am.Air Quality Mmagamenl all new materials for inspection. Gloom? ❑Yes wk— Ihaw mad the haeNnusmateriabraquiremmumderClue er6.95oftheCabler- no Heal"Safcty Code,Se dons 25505,25533 and 25534.[understand thmif the building does not tu,CAlly have a*nam Not it is my responsibility to nasty dM ow.Panl of the nquimmcnu which must be mer prior to issuance of a Certificate of Occupancy. Signature of Applicant Date' Owner�r a�tthnd,ca stent Date All roof coverings to be Class"B"or better ,t 1 I I TF X1,11 14 1041 LI ftG p0� 1 f ' I i I - 7 J/ ZY I I-i i CITY OF CUPERTINO I� 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 2 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 32645028.00 DATE ISSUED. . . . . . . : 03/23/2006 RECEIPT #. . . . . . . . . : 33711 REFERENCE ID # . . . : 06030141 SITE ADDRESS . . . . . : 10371 MANN DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . - OWNER . . . . . . . . . . . . : ELLIOTT KATHLEEN A ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1139 RECEIVED FROM . . . . : KATHLEEN ELLIOTT CONTRACTOR . . . . . . . : ROCKY LOWELL LIC # 26049 COMPANY . . . . . . . . . . : ROCKY LOWELL CONSTRCUCTION ADDRESS . . . . . . . . . . : 10311 MANN DR. CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 930-6786 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPLANCRREP HOURS 1.00 87.14 0.00 87.14 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 87.14 0.00 87.14 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 87.14 VISA TOTAL RECEIPT 87.14 • WOOD CITY OF CUPERTINO PE T APPLICATION FO (2609 014'1 CUPERjINO © 66 �. ar ? -Z N# 3210 . Z15 D� Date: 323-v G Iildin Address: Mailing Address (if different from building address): 311 PG1AA �er's Name: Phone#: ale i -I—f g �qd Contrac r: License#: 1OL-owo►1 Z 60a Con�jtact: � � nn'' Phone: q'�3 clSq Cupertino Business License#: QDC, I'OC� Fax: BuildingnnitInfo: —S�. add oc.=k-�n� sho�rq— S`ia�t( , Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Proi ect: Occupancy GzguD- Type of Construction: Please check this boa if the project is a second-story addition: ❑ jWject Size: Standard ❑ Large ❑ a'or ❑ Quant Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> LOOK to 500K Btu MECHANICAL BBQILER3, Boiler'> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1:75141 Btu MECHANICAL BBOILERS Boiler> 1.75MBtu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ nasi 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 1:11 Y llf' �.e�s r✓r�i�,...� . CUPEfZTINO pE4HT APPLICATION FO!�LM uanti Fee]ED Fee Descri tion Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. HousingMit..Fee BUILDING BNUCOMME New Comm Electc ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCO Q%l New Comm Plumb PLUMEING BOVERTDYM Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cess ool PLUMBING BpEg11g EE Bldg Permit Fees BUILDING PFIXTURE Pb1 Fixture PLUAIBINNG B FIXTg Gas Piping S stem Fee PLUMBING BPGABPINTERCEP Ind Waste Interc BUILD for BUILDING PLUMBING BPLANCHK Plan Check Fee B BPLANCADD Plan Chock Add Multi BUILDING I{ BPLANCRREP Plan Check R eat Fee BUILDING BpREpIpE Re i e Of Fixtures PLUMBING BPSEWAGE. Sewage Disposal PLUMMIN'G BPSEWER Sewers PLUMBING BPSPRIrTK Lawn S rinkler/Bac1cB0 PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENf Alt of Drain&Vent PLUMBING BPWATER Install/AIter Water Pie PLUMBING BPVJHEATER Water Heater/Vent PLMOING BPWSVCS Main Water Service PLUMBING BREINSPECT Re' moon Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL' ��jANt A/C Units<= 10,000 cfm MECHANICAL B BREMAPPLI Appliance Install _m_CHANICAL BREMBUSWAY .. Remodel Buswa s ELECTRICAL BREMFIXT Li tin Fixtures ELECTRICAL BREgURNr Relocation of Furnace MECHANlCAI BRF,MF NOV Relo Furnace> I OK btu f CACI B e,T Heater Installation BREnIINHOOD Installation of Hood 11>ECHANICAI B Mise Apparatus ELECTRICAL BREMNRApP Rem Non-Res ADDliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL MpOW ER Power Device/A ar BREatus ELECTRICAL BRENIItOW Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BpEhU�BpA•T Re air/Alter Heatin h'LECA2,nC B �q�S r�pp Remodel Res Appliance ELECTRICAL • 2 of 3 f (:qT ' OF CUPERTINO CUPE�INO PERAHT APPLICATION FORM ti Fee ID Fee Description Fee Grow) BREMSIGNAD Rmd1 Si Add Branch ELECTRICAL BREMSIGNS Remodel Sigas, Mar we ELECTRICAL BREMTHEATR Theatrical Li tin Fix ELECTRICAL BREMVENFAN Vent Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation Systems A7ECEANICAL BSC13LVD Scb Specific Plan BUILDING BSEISAIICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Impection BUILDING BSWI% Swrimmin Pool BUILDING BTEMP Tem ora Power ELECTRICAL IERM Tem ora Bld Permit BUILDING VCS Tem Dist Svcs ELECTRICAL IC Business License BUILDING RIC Electricals foot ELECTRICAL ItEE ElecPermitIssuance ELECTRICAL gEE Mechanicals . foot MECHANICAL TFEE A4ech Permit Issuance CAL TFEE Plumbin Permit Issue PLUMBING �} Plumbin Fees foot PLUMBING RNGC Plannin LR Commel Multi-Fam PLAN�'ING RNGR Plannin Ln Ran a ResenaPLANNING CHG Address Chane BUILDING • 3of3