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06050204 (2) CITY OF CUPERTINOss.� F BUILDIk;DIVISION PERMIT npCONTRACTORiINFORMATION:,t. BUILDING ADDRESS: PERMIT NO.06050204 10571 N PORTAL AVE OWNER'S NAME: PERMIT ISSUE DATE STEWART CHESSEN IF E: SANITARY N0, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 ioo LICENSED CONTRACTOR'S DECLARATION IZ C 1 hereby affirm dist 1 son Recessed under Pmv fhfa of Chapter 9(commencing lob Description <C� with Section 70M)or Division S of NC Business and Professions Code.and my license is '.oro inmBfoteaan,1UPGRADE SERVICE TO 200 AMP vy z License Claes 2'7 I I Lac.N 7 9 2-7 l t Dace Comraemr_ NIA ria /[ ALLIANCE CONSTRUCTION PD FOR BUS LIC 5/23/06 ARCHITECTS DECLARATION I w U I understand my plans shall he used as public records 0 Licensed Professional OWNER-BUILDER DECLARATION iI kmby alarm Nat I am exempt room dm ComrxctaYs License law for the p o following mason.(Section 703 1.5,Business and Pmfcadom Code:Any city or county 3$ which requires a permit to construct,alley,improve.demolish,or mpair any structure an -I6 prior on its Women.aloe requires lk applieamfor Sach permit to Bic a signed statement that he islianuJ pursuanuotk provisions of Jan Conuacmr's License law(CAap¢r9 Sq.Ft.Floor Area Valuati$d000 y (commencing with Section70W)of Division 3 affix Businessand Profession Codc)ur u�3 that he is exempt therefrom and the basis for The alleged exemption.Any violation of Section 7031.5 by atry applicant fora permit subjects she applicanfto a civil penalty of APN NumberOccupancy Type not more than BK hundred douses($500). 31630097 . 00 JUN 6' 2006 I,as owner of the property.err my aeoployxes with wages az their We compensation, will do the work and the stracture is not intended oroffered y and yCade:The Communes Llow does,.1 apply W an owns,of era .1bisills imgtthereonandwhodocssuchwork Mmsalforthrough his Own amployees.provided Bear such nS ire Is sold itartnot intendedma(fared for We.If. Wiidarhowever,The building or improvement b cold within oa yearm completion,pu owner- builder will have de huNen of proving Wf k did Mf NtiW m imprnve!m puryose of tile.). ❑1,as owner of the property,am eaelusivcly contracting with Gamed contractors on construct the pmjm(Sec.7W.B linea and Ptafesvon Cade:)The Cantracmfs U. cease law dose not apply man mmer of pmpeny who builds or improve thereon,and who contracts far such projects with a comramar(s)Gaped pursuant he de,Contractors License law. ❑l am exempt under Set .B&PC for this reason Owner Data WORKERS COMPENSATIONDECI RanON 1 hereby affirm under penally of perjury one of dm fallowing deeluation: I his and will maintain aCeri fin¢of Consent of self-intim far WorkcfsCompen- ution,az provided for by Section 3711 of the Labor Code.for the performance of the work for which this permit is issued. O 1 have and will m.inuin Wmkce,Compcnauon Insurance,as mgfumd by Section 3700 of the Labor Code.for Ne performance of the work for which this permit is issued. My WurheYs Compensation Ino.artier and Policy number arc: - Cvricr. S.r(YT6 �i pts' Policy No.:j U Z L CERTIFlCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thi senior need tat beeompk¢d if the permit is for one hundred dollars($100) a or less) I Certify tha in thc performance of the work for which this permit u issued.)shall nut employ,any person in any mannxru az In kcome subject to the Workers'Compenuuon Laws of California.Dane Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject m the Workers Compensation provision of the Labor Coda,you most .J z foMwiN comply wish each provision or this permit shall he deemW revakcd. z O CONSTRUCTION LENDING AGENCY [-+ 1 hereby affirm that Vert if a conNucdon lending agemy for Jan performance of C the work for which Nu permif ts issued(Ser.3097,Civ.C.) W A Lander's Name z LeMers Address ' U Q 1 comfy that 1 hoe read this appliwion and state Nat the abom information is E' COmect.I agree to comply with all city and county o dinamees and sate laws relating b Obuilding eommoretion.and hereby aufhonre Mprosenutivoe of this city to enter upnn Be, W ahovrmemiuncd prnpeny for inspection pis s. (We)agree 10 save,indemnify and If.the City or Cupcnino against aHi raj) liebiliues.judgmxnu.em dexw ch ay in any way vane againt aid City 'A eonsegmna of theOf= it. ^ APPLICANT UN S AN W COMPLY WITH ALL NON Issued by: Date 2 '� SOUREGU 7 Re-roofs Signmum of Ucandeantracmrm HA RDOOSMATERIALSDISCLOSURE Type of Roof Will de applicant of ream Wilding mcupantstore or handle ha mums material az defined by the Cupertino Municipal Cade.Cbmte,9.12,and the Health and Safety cads.Scxuan 255324)? ❑Ya ONO All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining n inspection,I Will the applicant or future killing occupant use equipment or devices;which g aagree to remove P .nit lovmlous air contaminants ai dchncd by the Bay Ana Air Quality Management all new materials for inspection. District? F1 Yes ON. I ham raid i�lmamnal quirements unJerChapmr 6.95 of the Califor. his Heal" oda ecm 2550 537 and25534.IuMersund tons if she Wilding dna rte corm Y hn renl du heapominity m notify the oavpant Of the Moot � It fuel t f afaaof Cerbfmafearfb]man'CT� Signature of Applicant Date v ///L ow fora thomcdagem D,m All roof coverings to be Class"B"or better CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 4 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31630097 . 00 DATE ISSUED. . . . . . . : 05/23/2006 RECEIPT # . . . . . . . . . : 34532 REFERENCE ID # . . . : 06050204 SITE ADDRESS . . . . . : 10571 N PORTAL AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : STEWART CHESSEN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2447 RECEIVED FROM . . . . : ALLIANCE CONST CONTRACTOR . . . . . . . : LIC, # . COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : �EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BELEC200 METERS 1 . 00 29 . 43 0 . 00 29 .43 0 . 00 BSEISMICRE VALUATION 1, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 208 . 16 0 . 00 208 . 16 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 208 . 16 VISA TOTAL RECEIPT 208 . 16 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT # / 05r-7t OWNER'S NAME: PH NE # Zti( G 9 GENERAL CONTRACTOR: # 3 7 - /( 63 I am not using any subcontractors: Z3 ©C Signature bate 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 SIM CITY OF CUPERTINO CITY-OF PERMIT APPLICATION FORM CUPEkTINO N# / 30 6y-7 Date: Building Address: Mailing Address (if different from building address): o 1�o•,vrrat Owner's Name: ( Phone#: S,nE .- -A rvT .o 3 - 7_4 6 ` Contractor: /� License#: ALA-,LA-,A J.1 c6 C. sT" ✓v, )S 7 b7 7 11 Contact: Phone: V- 3 rd Cupertino Business License#: NAR-If- L}Uuex/Xn Fax: 4de-377 -1665 t,-.3'I J Building Permit Info: 7-6, •a Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: 0o J Type of Construction: Please check this box if the project is a second-story addition: ❑ Pro-ect Size: Standard ❑ Lare ❑ 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 AOL BINVESTIGA Investigation fee BUILDING 1 of CITY OF CUPERTINO aTvW PERMIT APPLICATION FORM CUPEkTINO uanti Fee ID Fee Description Fee Grou 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 BPEA—NC KADD 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 Ston /Rain Water EPLUMBING BPTRAP Kitchen TrapPLUMBING 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 cfm MECHANICAL BREMAPPLI Ap liance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Li ting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> 10K btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc AnnnTatus ELECTRICAL BREMNRApP Rem Non-Res A'nDliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 a�vls CITY OF CUPERTINO CATV OF PERMIT APPLICATION FORM CUPEkTINO 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 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 Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE —Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3