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