06070047 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT .CONTRAC.kTOR"INF�ORMe1.TIO,N
r
BUILDING ADDRESS: PERMIT NO.O 6 0 7 0 0 4 7
10491 SCENIC BLVD
OWNER'S NAME: PERMIT LSUEOATE
REESE, MARY
NE: SANITARY NO. CONTROL NO.
ARCHIIEC(ENGINEER: BUILDING PERMIT INFO
0
BLOC ELECT PLUMB MECH
0 0 0
i00 LICENSED CONTRACTOR'S DECLARATION - lob Description
%w 1 hereby affirm that 1 am li=med under provisions of Chapar 9(commencing
eio, with Section 701s0)af Division 3 of the Business aM Norcssium Code,atW my lkenus
?.N mmnforteaneercas NEW ELECTRIC SERVICE
)2gz Liccnu Clens Lw.a
Z F aDa¢ Contractor
ARCHITECTS DECLARATION
I am< 1 understand my plans shall h,used as pubic raids
)yU
soy
Licensed Professional
S Oat I am exempt
front
DECLARATION
0 C 1
hereby
mhy alarm on I am exempt from the Contou=r's Limns Law for Ne
o O fallowing recon. Pandit t 71131.5 Business,AICLand ere,de ore Cie:Any ciry or county
m which aquina a permit re construct,the applicant
improve,demolish.t or repair any ewmure $500
prior set is issuance.Also require Nc applicantfor such Permit file aaigowJ vase=,=
that he is licensed purulent ano the previsions of the Connector's Liccnu Law(Chaper9 Sq.FL Floor Area Valuation
YFG (commencing with Section 7")of Division 3 of the Business and Prorc4sions Code)or
4�R that he a exempt NCrefram and Be,thus for the alleged cumpdon.Any violation or
Section 7031.5 by my applicant for a permit Subjects the applicanuo a civil penalty of er Occupancy Type
not mom Nan five hundred dollars($500).
❑1,u owner of the property,or my employcu with wages u Nev sulc<ampewtion,
will do the work,and the swnurt is notimended eroRered permi,(Sec.7014.Business Required Inspections
and Pnorevions Cade:The Contractor's License Law does e ns not apply w an owner of q p
praparty who builds or impronhatho mot,and who d=aauhwik himmlfar Waugh his
Own employ=,provided that such improvements are not intended mortared formic.IL
however.the Wilding or improvement is mid within o=year of completion,the owner-
builden will have she Whom of proving that he did not Wild or improve for purpose of
sate.).
❑1,as awowr of the property am Business
exclusively...oressi ng with licensed o mramurs i-
construct La the data
(Sec.s an Bu Of and property
who bei Cade:)The Canmac .. nd
eco contracts law does oat apply je ts owner of propu(s who sedint or"t,toff Norton,ane
wboawLfor such projects with a conuactor(s)licessed pursuant b the Canuutoh
01 am
Law.
❑tom t/ore%-du See 08 Pefm this rtawn .
owOcr /lYlRK
t WORKER'S COMPENSATION DECLARATION
1 thereby alRrm under penalty of perjury now of the fallowing declarations,
1 hsm and will owned.aCerdfcam of Conant w ul6imse.far Workers Compen-
suian,u proviend for by Section 3700 of the Labor Code,for the perfonnatt=of the
work for which this permit is issued. -
❑1 have and will maintain Wmates Compensation I.ra..as rescued by Section
3700 of the labor Code.for she performance of the work fm which this Permit is issued. '
My Worker's Compensation Imwraowe carrier and Policy number are:
Carrier. Policy Nit,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(O suction need not W completed if the Permit is foram,hundred dollars($100)
or less.
1 ccnlfy that in to performance of the work far which this permit s issued.I shall Out
employ any photon in any manyerso ss m be< c subj=I m Ne Workers'Compensation
Laws of California.Data �� 1l��sann
Applicant 7_ {f o
NOTICE TO APPLICANT.IL after making this Chilies¢of Excmrn,you should
become subject in the Worker's Compensation provisions of the Labor Coda,you most
.JQ fmNwith comply with such pmvisimM Or this permit flail the deemed revoked.
zIZI CONS TRUCTIONLENDING AGENCY
[-+ I hereby M.that Nem is a construction lending agency far dw Norman.of
0.ithe work for which this permit is issued(Sce.3097,Civ.C.)
G Q Lender's Name
O z leader's Address
U O 1 ccnify Nat I hoe read this application and saw wt the above information is
Iy F coned 1 agree to comply with all city and county oNimine,sand saw laws uladng m
0U building construction,and hereby amM1ori7e hermsentsons or this city no enter upon tic
aWve-mpro
emiuned perty for inspection purposes.
F., a (We)agree to save,indemnify and kap harmless the City of Cupertino against
limilitiu.judgments,costs and expenses which may in any way amnio against said City
U,Z, in consequcnm of the Snuffing of this permit.
'-" APPLICANT UND DS ��'
AND W COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGUTA ON /
G Re-roofs
Signuum mfApplianVContraccor HAZAItDOUS MATERIALS DISCLOSURE Type
Type of Roof
Will the applicant or future Wilding aaupam aw.or handle haanwas mawrial
as defined by de Cupenino Municipal Code.Chapter 9.11.and Ne Health and Safety
Cmk.Section 13531(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea Cho
Will the applicant or finite Wilding Occupant axe equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvamnus air contaminants u demand by the Bay Area Air Quality Management allnew materials for inspection.
District'
❑Yes Q6Nu
I have mad the hammous rea exhil mquiremorm under Cmp cr6.95 of the Cali(oo
nits Health&Safety Code,Sections 25505,25533 and Z5534.1 undcrsmnd thuif the building
Jots notcm y hast a wnam,that it s my responsibility w nodry Nc oaupmt of dw
mq remnuwhich mus met Prior in issuance of a ccnircale Ofampmry. Signature of Applicant Date
7— !7 DG
Ota,oAll roof coverings to be Class"B"or better
r thori'rnJ acm D=" '
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35706017.00
DATE ISSUED. . . . . . . : 07/11/2006
RECEIPT #. . . . . . . . . : 35189
REFERENCE ID # . . . : 06070047
SITE ADDRESS . . . . . : 10491 SCENIC BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : REESE, MARY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : TERRY BROWN
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
*-E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
______ _____________ __________ __________ __________ __________ __________
BELEC200 METERS 1.00 29.43 0.00 29.43 0.00
BENERGY PERMIT FEE 1.00 34.86 0.00 34 .86 0.00
EPERMITFEE FLAT RATE 1.00 38.37 0.00 38 .37 0.00
BSEISMICRE VALUATION 500.00 0.50 0.00 0.50 0.00
__________ __________ __________ ----------
TOTAL PERMIT 103.16 0.00 103.16 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ --___---__-_-____-
CHECK 103.16 365
TOTAL RECEIPT 103 16
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL
•
- CITY OF CUPERTINO
c'TMor PERMIT APPLICATION FORM
CUPEkTINO
N# 35-7 06- O / Date: j - !t - OCD
Building Address: Mailing Address (if different from building address):
0 1 ScEN -,f0
Owner's Name: P one#:
408 2-'SZ - 397-
Contracto : 1 J License#:
Contact: P' Phone: G /- 3uo Cupertino Business License#:
t=2 u/Al Fax: 400 za- GZv®
Buildind Permit Info: t W S t C1✓ yCrjD o
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description:
Residential Z'� 1QCt,-.3 Sia-\leG Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: 5-0 () Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: Elroject Size: Standard 11 Large El Major [I
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 Elee Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Ener y Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
•
I of 3 1 O I
aip�l� CITY OF CUPERTINO
❑TYOF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
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
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 -10
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 cfrn MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY 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 A2paratus ELECTRICAL
BREMNRAPP Rem Non-Res Ap2liance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPCWER 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
2of3
Zia- CITY OF CUPERTINO
c'TM°F PERMIT APPLICATION FORM
CUPEkTINO
kQuantity 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
BREMVENWS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL S ecial Ins ection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporag 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
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Ran a Residential PLANNING
ZADDCHG Address Change BUILDING
3 of 3