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06090077 (2) CITY OF CUPERTINO F " f " re . p•" BUII:DING DIVISION PERMIT >C'ONTA2AC',0R II� ,OT2MA' If3N' .t„ •Yra'b'.e .3 av�..w�`�.."n,a BUILDING ADDRESS: SEARS HOME IMPROVEMENT PERMrr N0.06090077 22049 MC CLELLAN RD OWNER'S NAME: PERMIT ISSUE DAUB MOSS JOHN B 283 E. AIRWAY BLYD 09/12/2006 NE: SANITARY NO. CONTROL NO. (925) 245-2000 ARCHITECTPENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 00 LICENSED CONTRACTOR'S DECLARATION ,lob Description WF I hrcby c .(farm she 1 am llcenvcd ud ner provem iaof Chapter 9(ammcneing P IZ�yt wish Scedon70f11)of Division 3 of She Butines,and Prafevsiam Code,and my license inraltrortcandercec -1.7 REMODEL- REFACE KITCHEN CABINETS, INSTALL KITCH `i"""Tas `ld'g 1.211 COUNTERTOP, OUTLETS TO BE GFI PROTECTED, RECONN F DamR_s�Nn40 EC'. Ull DECLAMATION Isal IunderstandmyplansshallbeUsedapublicaccord, KITCHEN SINK FAUCETS . �u .Ot', I .by Licensed Plunal ,a 5 OWNERBUILOER DECLARATION i IKRM1y nlTlrnl that I am eaempl from gm Canaw1or11JCe1,Y U.far dm :20 following mean.(Secdon 7(n 1.5,Business and Pmfessinm Code:My city or aunty fm V which requires a permit to co mot alcor.impose,dcmallsh.or Papalr any atmctum Zr2 prior m its issuance.Stan acquires Use applicants for such permit to file a signed butil Nal M1e elicemeJ pursuant to the Pmvisiamal he Contractor's Lee.law(Chapter 9 Sq.Ft. Floor Area to Valua e� (commenein{with Seden]000)ofDiveion3af die Budneuand Prorasinos Code)or 105 0 ':5$ Nu he is esmpt hn.wfmm and the bous for the alleged esempuon.My violaUa of Section 7031.5 by any applicant Me a permit wbjccu the applicant to a civil penalty of APN Number Oe art�'[Y .at mos than Ove hundred dollars(5500). - ❑1,u owner of tha propmy,O my wplaym wish wga u Uv:U vele ampenauon, ee will do the work.and Urcatmcture 4 ImMmkd Prefaced formula(Sec.70th.Business as Required Inspections and Professiam Cade:The Contractor's Luse law does cot apply to an owner of q P property who Euitds or improve thereon,and who dues such woh himself or through he own employecs,provided that web improvements arc amt Intended orortemd for sale.If, however,the building or Improvement is sold wlthlnam year of campictum.the owner- builder will hale the burden of proving that he did not build or Improve for purpose of old.). ❑1,as Owner of the property am exclusively contracting with licensed conaucters to contract she pmjca(See.7044.Businets and Professions Code:)The Conuacmr's Li- ecce law don not apply an an owner of property who builds or Improve Ummon,and who contracts for such pmjecta with a antructoa(p licenced pursuant m the Cons acini s Lice=Law. ❑1 am attempt under See. ,B d P C for this mean Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty or perjury one of the following declantlom: 1 here and will mainuin•CertiRace of C.Pan nuo slf-amort far Worker's Comp,t- Suion,an provided for by Section 3700 of she Labor Code,for the pe fo mar m of Na work for which this pnmit is issued. ❑1 have and will maintain Worthen Compc=Uon Insurance•as astsmd by Section 3700 of Ne Labe Cade.for the performance of she walk fan which she Permit is Issued. ' My Workees Compuaia lawmen Cartier Iky number Cartier. A[F AN1EA.lCJIyII a CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (thin We6on..deal be completed Kthe permit la fare"hundred dollen(5110) arta&) I arufy that in the performance of Ilse wast for which this Permit is issued.I Shall not employ any person in any mmnerw u b blame wbjecl to une Wofkeri CompenaUa ' Laws of cwifomi&Dam Appliant NOTICE TO APPLICANT:If.after malting this Ceniftease of Faemplion,you should became Subject to she Wariness Compensation provisions of the Uhar Cade,you mea .J O forthwith comply with Such Provisions or this permit shall be demand revoked. Z'` CONSTRUCTION LENDING AGENCY [-r I hershyafflrm all Umrt is.aauuction tending agency for she performance of D > the walk for which Ute permit a issued(Sal.3097.CW.C.) W�Q Lambe:Name a z Lcndere Address U Q I artily that I have mad this application and sum Nu the abase information is D. correct.I agree to comply with all city and county on inames and SUM laws relating to O U Wilding convection,and humbly authodae mPrcsmniws or this city m enter upon the >'a ahow-mcntionod property for inspection puritanical. (We)agree la Saw.indcmmfy and keep harmless the City of Cuprtino against vF„lA liabiliva,judgmenu,coau and eapnsa which may In any way Same again,said City U Z in consequence of the gainung of this permit ^ APPLICANT UNDERSTANDS AND WI L COMPLY WITH ALL NON-POINT Issued by: Date .r 5n/RAE°.SOL \^( f ,•3.T'y 6 �� Re-roofs �L Signuurc Applicanac A oar HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the ale Cupertino no forum building aaupapt r 9.1 ar handle Healloosd Sterial u defined by Ute Cupertino Municipal Cade.Chapter 9.13,and the Health and Safuy Code.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Y. 0 N 41 Will Wo spplicut ar futum bulldin{occupant us cqulpmenl ar devims which If a roof is installed without first obtaining an inspection,I agree to remove emit hamshous air contaminants as Joined by Is,Bay Area Air Quality Management all new materials for inspection. District? ❑Yea ON. I have read Ne hosaNnm materlats mqulsmhnts under Chapter 6.95 of she Dallas. ma Health A safctyCade,Sceuom 25305,25533 and 25534.1 understood We If dm building dna nal currently haw a mnana that It a my responsibility to notify the mcupant or she acquirements aa�met 'mmi once of Ccryto of Occupancy, Signature of Applicant Date ownTurr wihhlarimd qhm Gl7 Data All roof coverings to be Class "B"or better CITY OF CUPERTINO !m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN I . . . . . . . : 35713021 . 00 DATE ISSUED. . . . . . . : 09/12/2006 RECEIPT # . . . . . . . . . : 36000 REFERENCE ID # . . . : 06090077 SITE ADDRESS . . . . . : 22049 MC CLELLAN RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MOSS JOHN B ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : TOWN & COUNTRY PERM. CONTRACTOR . . . . . . . : MARK C GOOD LIC # 23097 COMPANY . . . . . . . . . . : SEARS HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 283 E. AIRWAY BLVD. CITY/STATE/ZIP . . . : LIVERMORE, CA 94550 TELEPHONE . . . . . . . . : (925) 245-2000 �EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- - ------------ ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 10, 500 . 00 180 . 36 0 . 00 180 . 36 0 . 00 BSEISMICRE VALUATION 10 , 500 . 00 1 . 10 0 . 00 1 . 10 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 219 . 83 0 . 00 219 . 83 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER --- -- -- ---------- ------------ ------------------ CHECK 219 . 83 1166 TOTAL RECEIPT : 219 . 83 (Q% CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM APN# Date: 3s - 13- 0?_ -ia- Q6 Building Address: Mailing Address (if different from building address): :;k;L CLELL4AI A8, Owner's Name: Phone #: 0NNd L M0SS - a V68-7 Contractor: License#: 5 1 UE �nry Contact: Phone: Saj-GM-971 Cupertino Business License#: QofSEZTS Fax: i Building Permit Info: i Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: 'RE-FAce K-IT InrsTAL(. tT, Cauv 2 TU - Gv+le7E t Residential Z TECuNNfCT JLLw V-ITSIV" FAGdETS Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: / O ,5OO,va 1Occupancy Grou . Ict Type of Construction: Please check this box if the project is a second-story addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK 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<_ 1 OOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee I BUILDING 1 of 3" kfi CITY OF CUPERTINO CUPEYD PERMIT APPLICATION FORM -QuantityFee ID Fee Description Fee Group BNUCONSM New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical• MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTDAE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFMURE 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 13PLANCKREP 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 efm MECHANICAL BRENLA R IAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL 13REM97JRN Relocation of Fumace 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 BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs,Marquee I ELECTRICAL 2of3 r: CITY OF CUPERTINO CUP Eh;TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Grou 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 I 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