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04030159 (4) CITY OF CUPERTINO BUILDING DIVISION PERMI . COiTiAC)ItX � BUILDING ADDRESS: PERMIT N0. ANDERSON INSTALLATION 04030159 OWNER'S NAME: PERMIT ISSUE DATE NE: SANITARY T OL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH p t� 0 0 0 LOO LICENSED CONRACfOWS DECLARATION i I hereby grim that I sen licensed under provisions of Chapter 9(commencing Job Description u< with Section 7").fDivision Sofm.Business ared Profession,Code,and my license is < in full foam and orfocL LIcensecias, Lic.x WINDOW UPGRADE q Dam Contractor ARCHITECTS DECLARATION I undmatand my para shall be used as public records u. 1L ensed Professional OWNER-BUILDER DECLARATION 4 1 Wahy from Nal I am exempt fru.the Contramors License Law for the a0 following reason.(Section 7031.3.Business and P eficaS Ins Code:Any city or county $ which requires a Permit to convect,elmr.Improve,demolish,ser term,my structure prior to its issuance,she requiems the applicant for such permit to file a signed statement �< that he is liccmod raiment In the provisions of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area Valuatl n $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he Is exempt therefrom and the basis for time alleged exemption.Any violation of Section 7031.5 by any Applicant for a permit subjects the applicant to a civil penalty of 3 (�Iy2Tger 0 0 Occupancy Type eat moa Nm five hundred dollars(5500). ❑leas owner of the property,.my amployco with vngeam their cele componution, will Pr Bmwons endo:TheCmiaeotinkndad Lt.ddfoual Apply In in Required Inspections and anywhona Cade:The Canfeearer's License Law dace not apply lf rt owner of q P manproertywha s,preceded met himprove ets dorsa innandk mroffrarthrough his ownemployees,provided pr suchimprovemanuareneyou afcoro@ad for sale.B, _ however,He haw Lim or improvement Is mid within one you ser improve for Ne owom- builder will have the boNm of proving Hat W did not build m improve for purpose of samJ. / ,u owner of ct property,am exclusively confessions with licensed Cameraman's U. ��/O� "w s La the project(see.7040,owner or and professions Code:)The Cs daemon. Ld who lawdotsnotapply.en ownerof enclady who Wildsarimprows Contractors who contracts for pmjeeu with a eanvactor(q licensed pursuant to tie Contndori License Law. ❑1 am exempt under Sec. - B k P C for this mason nee � —on.227 10'1 •WORKER'S' P A 1 hereby of iren under Penalty of perjury ore arms fol ins decimatimm I haw and will maintain•CertiOcee of Consent to self-insure for Worker's Comped- . moon,as provided for by Section 3700 of ie IsWr Code,for the performance of da work for which this permit is issued. ❑I haw and will maintain Worker's Compensation Insurance,an required by Section 37W of me Leber Cade,for He perfurmanee of the work for which this Pemdt Is issued. My Workers Compensation Insurance cannot and Policy number me: Canter: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need notheeompleted time permit is fmanebundred dolls.(SIM) or lees) Ocenify that In He perfmmance of the work for which this permit is issued,l shall not employ any person in my mmnerm An in Wmme.ubjectu to Workert'Compensation Laws of Califomia.Data Applicant NOTICE TO APPLICANT.If.Arm,making this Cenifica c or Exemption,you should Accome subject to the Worker's Compensation provisions of He Labor Code,you mum .7. Z forthwith comply with such provisions or this permit shell W deemed revoked. z O CONSTRUCTION LENDING AGENCY [-t 4 I hereby affirm tot Hem Is a construction lending agency for tie performance of i rl> the work fur which this permit is Issued(Sec.3097,ON,C.) W Q Lender's Name Lender's Address U Q T codify that I have sad this application and sum Har the above Information is tar cadecL I agree in comply with all city and county ordinances and mute laws reading in Q building convection,and hereby authorise representatives of this city.cuter upon He W above-mminkmed property for Inspection purposes. Lyv W (We)agree to saw,indemnify and keep harmless the City of Cupertino against );y`yam Iiabili0es,judgments.costs and expenses which may in any way accrue against mid City U APPLICANThis permit. in eOf the Ing Of t UNDERSTANDSAND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE ULATIONS. : - 3))7/0y 17 Gy Re-roofs gnatu.of APPlimmUCco wr ate HAZARDOUS MATERIALS DISCLOSURE Type of ROOF Will the applicant at future building occupammore or handle havrdous material an defined by IW Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Cade,Socctim.25532(,)7 All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardaus air contaminants an defined by He Bay Arca Air Quality Management all new materials for inspection. I9ri.0 m5/�,, ❑Yes No I have mad the hazardous materials requirements under Chapter 6.95 of me Califor. nia Health k SafmyCode.Sections 25505,25533 and 25534.1 undersand me,ifine Wilding dace not currently haw a Wrest,that it W my responsibility a artery He mcupent or me requiter equire nuwa nmpemetpn 0 SS AA, or. III amafaap3 . Signature of Applicant Date a�C1l6L t,7 t Owner �rnrama eae�5 �/ eerie„`-� /1�7'U l All roof coverings to be Class"B"or better lf-ULA L,U I 1J i I-KK3 Q 6U'6U- V11QK, vILLry- �r� t( U<9l X255 -- 650) r �� y ro o vh rppPROVS0 fq'ACCDRDO C WITH THE CIIY'0A .� GllP.ERTIN C o DATE t- a MUST This set of Pl�r'� �d 'pe "c a Ion be kept on ?hNlob at ap a as and it is un lawful t� N. any, �as or alteretion� e it out WN,- the Permission frgn the y I ing Dept., CitY of r rtino. The stamp' of this plan an, sped heinar. gllpl.l N0T be held to Permit or • _--------__...___._. aonreval of the violation of 011V sron r nnv City Ordinance or Mate -aw cp � . Lj � MAR 17 2004 � • 3o so � s1�d�rLy in ARCHITECTURAL APPLICATION Nome of Association: VJ E a 1 MCLQ1 RA R K. V I )_ 1 A me of Owner(s): f) I I A 1p 0 & I?A) L� Address of Unit; R' 8G RPI RK C_Q Cliff C-1'i i ti Work Phone: _ Home Phone:`�i��� `� — C I Applicant agrees and understands.that the application does not fulfill all 19 ktghe;con �nse�neats for an ap- proval. In addition to this completed "Archirectural Application" form, the 3 liensColn to (ime Architectural Feview Committee (and/or Board of Directors) a set of plans and spedficahodtst houuirgthture, kind, shape height, materials and locations of the proposed architectural alteration. It is also understood by the applicant that the submis- Sion must be in writing. There may be additional information required as deemed necessary to make a decision. Until All information is submitted to the committee, the application will be deemed to be incomplete and the application will stand unapproved. Llu.s ' 5e.e- wt1'o_t.-hu1 P`1,05. (`�) ,. O�NF.RAL DESCRIPTION OF PROPOSED WORK(INCLUDE DRAWINGS, IF APPROPRIATE) 0 RI(kc e 01 a;,nfjn(0 'i RMJ Dlz to JeNOr 1Ai +k iYJrj n/ykJ J-00y', i,Y't1Vy flrlti. .�� o1 5��r��,41„ rl�nnr lrni rr:�n�'2r r•,� �;vin� 're;r,rnn ^� y4 �J ,, r+�;,,,,i 'lQi. �'�,u't�, 4�v?wld I�ruvP IS � f1QY1,1,� d9{- qli�Y2 Nr1�il . TYIr `.�llYV1J1,�(zP C, ', `�Ir Cl<_i^ ��� •���"nG �ocILJ cA_:1(7 Vii' C ri Applicant agrees and understands that, in the event the modification is approved by the Committee or Board, that they may impose "Special Conditions" of construction and maintenance on the approved work. Any special conditions shall ttached and be a part of the approval. Any deviation from the approved plans, specifications or special conditions cause the permit to terminate and become null and void. Applicant agrees and understands that failure to conform to these requirements will be automatic authorization by the applicant to have the work brought into conformance with the approved plans, specifications, and specal conditions. Applicant further agrees and understands that all costs in- curred by the Association as a result of bringing said work into compliance shall be a charge against the owner's lot. Such costs shall include costs of construction, reconstruction, administration, fees, attorney fees and reasonable cou t costs, if incurred. It is also agreed that no work will be initiated which would be a violation of any of the provisions of the Association's Declaration of Covenants, Conditions,.and Restrictions or any applicable building code;be an annoy- ance to the residents, or increase the cost of insurance. Applicant agrees to indemnify the Association against any and all acts or claims arising in connection with the improvement, including but not limited to any and all acts, omissions, or claims arising in connection with the approval, construction, operation, maintenance, repair, use or removal of the im- pruvem°at, including attorney fees and costs of litigation in connection therewith. Applicant agrees that, in the event the application is approved, all maintenance, repair or replacement of the approved item will be the sole responsibility of die unit owner and further that any expense incurred by the Association that is the direct or indirect result of the ap- proved change shall also be the sole responsibility of the unit owner. All work should be initiated with consideration of the grounds, esthetics, time and noise factors. Applicant understands that all necessary permits and approvals from mu- nicipalities or other jurisdictions are the sole responsibility of applicant and that Committee/Board approval of this ap- plication is subject to the applicant receiving all such necessary permits and approvals. Applicant agrees too/the foregoing conditionsand accepts those conditions as evidenced by the owner's Signature: -7 =9,1-=9,I.uv-CG.� ,o, .� � Date: rRUSE OA'LY: OVED: 1/ 1 Den ied: Date: Signed: t l Z 0 CITY OF CUPERTINO I* 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng : Sub: Blk: Lot : APN . . . . . . . . : 35610019 . 00 DATE ISSUED. . . . . . . : 03/17/2004 RECEIPT # . . . . . . . . . : 24861 REFERENCE ID # . . . : 04030159 SITE ADDRESS . . . . . : 8086 PARK VILLA CL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER QUINTERNO PAULA J ET AL ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1125 RECEIVED FROM . . . . : PAULA QUINTERNO CONTRACTOR . . . . . . . : JOHN SCALMANINI LIC # 22780 COMPANY . . . . . . . . . . : ANDERSON INSTALLATION ADDRESS 696 AUZERAIS AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95126 TELEPHONE . . . . . . . . : .E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL --- ----- -- ------------- ---------- --------- - ---- ------ - ------- -- ------- --- BENERGY PERMIT FEE 117 . 00 35 . 10 0 . 00 35 . 10 0 . 00 BPERMFEE VALUATION 6 , 000 . 00 117 . 00 0 . 00 117 . 00 0 . 00 BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00 BPLANCHK PERMIT FEE 117 . 00 99 . 45 0 . 00 99 . 45 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 252 . 15 0 . 00 252 . 15 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ------------- - --- ------------ ------------------ CHECK 252 . 15 1017 TOTAL RECEIPT 252 . 15 • (P A, aquiv -, WITY OF CUPERTINO♦ CITY OF PERMIT APPLICATION FORM d CUPEkTINO N# 0 �_ G Date: Building Address: Mailing Address (if different from building address): aY i` r 9501 Owner's Name: Phone#: Po uA uiYno yon aS - 0501 Contractor: License#: . hder5oh w` 160r Contact*4 11 D. _ 3 a o Phone: Cupertino Business License#: Q 2S Fax: Building Permit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential ❑ ��� �� Comm cial Sq.Ft. Floor Area: $/Sq.F .: Cost of Project: -x-�._-,� �. Occupancy Group: U v CJ Type of Construction: Please check this b the is a second-story addition: uanti Fee ID =50OK Description Fee Group BAPPLOTHER liances MECHANICAL BBLDGFEE ts . foot BUILDING BBOILER1 0,000 Btu MECHANICAL BBOILER2 to 500K Btu MECHANICAL BBOILER3 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 - - _...Ener - - - - - BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation£ee BUILDING BMITIGATC Comm. Housina Mit. Fee BUILDING ot3 `.s— i WITY OF CUPERTINO* CUPEI�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description .Fee Group BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTMIE 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 rinklerBackflo 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 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM13USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace 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 BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs,Marquee ELECTRICAL 2of3 *CITY OF CUPERTIN40 CUPEf�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMTHEATR Theatrical Ligbting 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 Temp 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 i 3 of 3