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06010092 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION . �x>9z..?? .moi§, A6z,4€�„ *4sfFe n•-t BUILDING ADDRESS: PERMIT NO.0 6 010092 031 V ER'S NAME: PERMIT IS5UE DATE DAVID PIETROMONACO 01/18/2006 NE: SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 °00 LICENSED m,met I CONTRACIOR'S DECLARATION Job Description �w❑ I hereby)(firm Nat I a'n if Oc Hu under provisions of Chapter 9(commencingsis P iW with Section 700dq of Division 3of the Busine>s and Professions Code.and my license is �„ imfell fn...ndeffect. REPLACE WINDOWS & SLID. DOORS D Z Liccnac Class Lk.p �r0 Da¢ Contrutne q ARCHMICl'S DECLARATION W U 1 understand my plans shall W used u public records I a G y Liecucd Posfessi...I i OWNER-BUILDER DECLARATION aP 1 hereby atLren that 1 am exempt from the Contractors License Law for the 00 following mason.(section 7031.5.Business and Professions Calc:Any city or county <m which mOuhes construct.a permit to construct.alterstructure.improve.demolish.or repair my structure $4706 ymi prior to issuance.also require the the applicant for such Permit Glc a signed saement E�0 that W is licensed pursuant to the provisions of the Cortmcmr's License Law(Chapter 9 Sq. Ft. Floor Area Valuation YI- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therc(rom and the buffs for the alleged exemption.Any violation of Section 7031.5 by any appliert for a permit subjects the mt to a civil penalty of er Occupancy T e rot mom than fin hundred dollars(M). Y P ❑1,as owner of she property,ar my employees with wages as their mlc compensation, will do Ne work,and the structure is not intended or offered for age(Sec.7064,Rusineu Mt!Professions Cods:The Contractor's License Law does not apply m in owner of Required Inspections ' property who builds or improves themon.and who does such work himself of through his . own employcu.provided that such improvements ere not intended or.ffemd fora4.If. // / however.however.the building or improvement is mid within one year of completion.the owner- / builder will ban the burden of proving that he did not build or improve for purpose of � ❑1,as owrcr of the properly,am exclusively contracting with licensed contractors In, J� construct the project(See.7044,Business and Professions Code:)The Contrimm's Li- cense law does not apply to an owner or property who builds or improves thereon,and who contracts for such projects with aconeacmKs)licensed purmann to the Contractors License Law. 1 im exempt under S R&P C for this moon er ! Date WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty of perjury one of de following declarations: 2nsI have and will maintain a Certificate of Cuomo to self-insurtfor WoftesCompen- i.n, provided for by Section 3700 of the labor Cade,for use performance of rhe work for which Of,permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the labor Cade,for the performance of the wort for which this permit's issued. 'Y'orl,ees Compensation Wunnce carrier and Policy number art: Comer. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not W completed if the permit is for one hundred dollars(SIM) Pr Mss.) 1 cattily that in the per(onmance of the work for which this permit is issued.I shall not employ any person in any raw sou m becomesubjectmlm Workers Co�pensad.n Laws of Californ'a.D / �')'y-/moi NOTICE TO APPLICANT.If,after making this Cenirmace or Excmp o,you should become subject to she Worker's Compenation previsions of the Labor Code.you must JO forthwith comply with such provisions or this permit shall W deemed revoked. Z i� CONSTRUCTION LENDING AGENCY C,rIhereby affirm that Nem is a constructon lending agency for the perfomnanm of the work for which this permit is kaucd(Sm.3097,Civ.C.) fo)z Lender's a z Lender's Add Addreas U Q 1 certify that 1 ban read this application a"state that the above information is I,. F collect,I agree to comply with all city and county oNinancn and sate laws relating to OV building construction.and hereby hmire crmsenmites of this city'.Order upon thc H y )hove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Z in Consequence, judgments, expenses which may in any way accrw against said City V z m APPLICANT ofthegranting of this permit. APPLICANT UNDERSTA DS AND WILL COMPLY WITH ALL NON-POINT Issued by: D91��(aate /� F--o l SOURCE RF,b'tULAT10 % `n/ Re-roofs Signature o(AppbcanVC.ntrxton Dade HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will etc applicant or forum building a O.P.M.1me.,handle ha�cus material eGncO by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety 0 ea 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ❑N. If a roof is installed without first obtainingan inspection,I agree to remove Will Ute applicant or furore Willing arupam use equipment or Ucvicrs which P g 7�2_1" a/Mons air contaminants as defined by the Bay Area Air Quality Management all new materials for Inspection. n? ❑Yes C)No 1 have mad the hzvaNnus materials mquimments under Chapter 6.95 of the Califor- aith&Safely Cods,Sections 255(M 25533 and 25534.1 undersand than if thn Wilding ot currently haw a terant that it is my responsibility io notify the xupam of the enmrs,whigtmns tpoortoissuanceor.ccruricamof000 q Signature of Applicant Date Man °� Owner ormm.rnedagent te All roof coverings to be Class"B"or better f / JA N • 4�x 1 0 2006 ���/ Work 0 Room Kitchen 0 O Computer Room Living Room Bed- OA ON— room E 2 Brief Description of Work for 10312 Vicksburg Dr (APN: 369-14-007-00): Replace existing windows/Doors with new units. Bed_ All new units are double pane and will have Low-E glass. They will fit into A roomaster existing rough openings in the M 1 framing. Bedroom The exception is that the window in To Street Bedroom 2 is currently a type B and will be lowered 1'and replaced with a type A to meet newer egress codes. 0The existing header will not be changed. Units to be installed as flange fastened new units, not retrofit style. A Window: 96"W x 47"H (XOX) C Window: 24"W x 36"H (X) 0 Sliding Door: 144"W x 96"H (OXXO) B Window: 96"W x 36"H (XOX) p French Door: 72"W x 78 3/4"H (XX) • CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36914007 . 00 DATE ISSUED. . . . . . . : 01'/18/2006 RECEIPT # . . . . . . . . . : 32852 REFERENCE ID # . . . : 06010092 SITE ADDRESS . . . . . : 10312 VICKSBURG DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : DAVID PIETROMONACO ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3320 RECEIVED FROM . . . . : RENA TAKAHASHI CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . • TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 115 . 56 55 . 47 0 . 00 55 . 47 0 . 00 BPERMFEE VALUATION 4 ; 706 . 00 115 . 56 0 . 00 115 . 56 0 . 00 BSEISMICRE VALUATION 4 , 706 . 00 0 . 50 0 . 00 0 . 50 0 . 00 BPLANCHK PERMIT FEE 115 . 56 154 . 21 0 . 00 154 . 21 0 . 00 ---------- ---------- ---------- - --------- TOTAL PERMIT 325 . 74 0 . 00 325 . 74 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - --------- ------ ------------ ------------------ OTHER 325 . 74 VISA TOTAL RECEIPT 325 . 74 • '(LrxTY OF CUPERTINO CUCITY TYOFFINo PEA �T APPLICATION Fo�� /� o�2. in 6 o v Building Address: 3/I Mailing Address (if different from building address):� Owner's Name: V10 PICPf6 M&JACK Phone#- 1, 37-17 Contractor: P.0 License#: I1LV-1G o6� (u z1/NO Contact: gc--k'A- -wASrt l Phone: 'K S1 -7 8"t 1 . Cupertino Business License#: wiwF� Fax: N(A--q) Building Permit Info: f2t�p4cr, Cxrs- INC- Ur�gacJs 2s�l�icn� Bldg 21 Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential m Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost ofProiect: 0 eg Occupancy GrouD: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard E— Large ❑ 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 B1301LER3 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 BINVESTIGA Investigation fee BUILDING 3 k—s Z 1 of 3 yf.� CITY OF CUPERTINO cuP TYOF PE •nJ T APPLICATION FAM uantity 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 BOVERM4E Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 Cbeck Repeat Fee B=ING BPREPIPE Re i e Of Fixtures PLUISIBING 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 InstaU/Alter Water Pie PLUMBING BYWE EATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAHU AN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance lnstall MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREN=AT Heater Installation MECHANICAL BREIYIINHOOD Installation of Hood MECHANICAL BREMIvIISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREN20LE Pole/Platform Fixture ELECTRICAL BREMPOWER Power DeAce/Apparatus ELECTRICAL BREMRECEPT Rcpt , Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 M',' SITY OF CUPERTINO ��rro PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 BUII,DING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporag Power ELECTRICAL BTEMPPERD4 Tem ora Bld PerBUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electricals foot ELECTRICAL EPERMTTFEE Elec Permit Issuance ELECTRICAL MPERN FEE Mechanicals . foot 2�CHANICAL MPERMI I Mech Permit Issuance MECHANICAL PPERMTTFEE Plumbin Permit Issue PLUMBING PPLBG Plumbing Fees foot PLUMBING PLLONGRNGC Plammn LR Commel Multi-Fam PLANNING* PLLONGRNGR Plannin Lon Ran a Residential PLANNING ZADDCHG Address Change B=ING 4� • 3of3