Loading...
04020163 (3) CITY OF CUPERTINO BUILDING DIVISIONPE ,CO RgACTOR INF BUILDING ADDRESS: ADF CONSTRUCTION 1E11ITN904020163 87-;t WTI.KTNjqr)Lj AIT OWNER'S NAME: PERMIT 155UEDATE P NE: SANITARY NO. CONTROL NO. 4082819177 .. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p 0 0 0 0 dOp LICENSED CONTRACTOR'S DECLARATION JbDescri tion 1 hereby Affirm that I am licensed under prooP visions Of Chapter 9(commencing 7¢, with Section IME of Division 3 ofho Business And professions Code,and my license is n<i �icanI=!4. 9 ' � 8 ' 13ATHROOM UPGRADE &/` Dam Conlncwr ppp ARC ITECI'g DFCLAFA 10 n Jayplans II he�IlRod A��il'IClttAm, LL LICC aC rt01 OWNER-BUILDER DECLARATION (, <I I herebynaso.(Tran on 1 A.1. exempt from the Comns Co License Law far the OD whfollich requires, Tonstr.Bualtmssand ow.deuli C.or Code:Any Or county $ which requires a permit smance,also ro cnmru0.eller,improve,demolish.or repair any mracum rZa Ilior to,k1,liensedprsuarequfires the Applicant for suchpeC.MonceIr m rile cense I .(sentCha mem < (comma cingwidpurstion7nt h)ofDivio115 Of ion3of eBusinsessaLianselaw(Code)or Sq.Ft.Floor Area Va]uahon N MAEh is exgwithherefrom and of basis al Business and Professions Code)or � dot he u exempt therefrom and We bazu for Ne alleged exemption.Any vialatlon of Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil Penalty of 3 5K`N30MA er0 0 Oeeu ane e not mon Nan Bac hundred dollars(5500). P y EYP ❑I,As owner of the property,m my employees with wages As their sole compensation, wilt do Bus work,and the structure is not intended or offered ran sale(See.1044,Business and Professions Code:The Conumlu/s License Law dos oat apply I.An owner of Required Inspections proPertywho buildsorimproves thereon,and whodoessuch wart himsetf orthrough his own employees,provided that such improvemewsare nnlinunded reoffered for Rale If. however,Ne building or improvement is sold within one year of completion.the owner- buildm will have the burden of proving Nat he did not Wild or improa for purpose of Rale.). ❑I,an Owner of Ne property,am exclusively contracting with licensed commemes in construct We project(Sec.7W.Business and Professions Code:)The Contractars Li. cense Law dots not apply m an owner of property who Wilds or improves themon,and who contracts for such projects with A contract")limned pursuant to Ne Contractors " License Law. ❑I Am exempt under Sec. ,B&P C fm thin moon Owner Date I - WORKER's COMPENSATION DECLARATIONN I hereby Afton under Penalty of perjury one of Ne following declarations: have and will maintain a Cemiftcate of Consent to self-lasum fm WarkersCompen- sation,As provided for by Section 3100 of the labor Cade,for the performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation btsun en.As requited by Section 3100 of the LabA Cade,for dga performanec of the work for which this permit is Issued. My WOrk[crs Ombpamixiontmunince artier end Policy man er ace: 1h �2 CERTIFI ATE OFEXEMPI'ION AyJM WORKERS' 3 iaxctionneadnotb3 mlJ if permit isf�c hundred dollars nr loss.) M(fi)pf/a\fe I artily that in We performance of the work for which this permit is issued,I shall not lemploy any person in my manner so As to become subject o the Workers'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:Ir.infix,making Nin CcAfrcate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Codc,you must Oforthwith comply with such provisions or this permit shall W deemed raveled. .zi 2 CONSTRUCTION LENDING AGENCY [r 4 1 Wrathy Allan dim there iso cmuuumm.undingageney for the perfurmence of !Y1­1> the work for which this permit is issued(Sec.3091,Civ.Q 044 ca Lenders Name z Lender's Address U Q I certify that I have reAd thin application and sum Net the be.information is ty H COOCCL I agree to comply with all city and county ordinances and sure laws relating to QU building construction.and hereby Radiation reprceentativca or this City to color upon Ne W above-mentioned property for inspecdon purposes. �"LL (We)agars to Rave,indemnify and keep harmless the City of Cupertino against V3 liabilitlesjudgments,cos'ts and expenses which may in my way Accrue against said City / t,)7 in consequence of the granting of this permit G F7 APPLICANTA41SIDERSTANDS NO WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCER LATIOOS. {,O��G��� r10 L Z(o-D-I Sig t fAppliant/Contractar Data Re-roofs HAZARDOUS MATERIALS DISCLOSER Type of Roof - ✓✓✓vv�" HIthuapplicantorfuture buildingoccupmtstomdrLR dlcharudausmaterial As defined by the Cupenino Municipal Codc,Chapter 9.12,and the Health and Safety Code Sr{pa25532(n)1 - All roofs shall be inspected prior to any roofing material being installed. Ycs Will the applicant or future building occon ni use equipment or devices which -If a roof is installed without first obtaining an inspection,I agree to remove it havardoua air contaminants as defined by Ne Bay Area Air Quality Management all new materials for Inspection. DisViCIT Yes 14Nu I have mad Ne harerdo AaWfials requirements under Chapur 6,95 ofWA Califo> nia Hcalth&SoletyCodc,Sauons25505,25533a d25534.lundcn=dNatif Nc Iselding does not currently 9m A mnam,that it u my res,eachility m notify the occupant of the requite.in,whi aanbe rump ran iasAma ora cem0cam afacupanay. Signature of Applicant Date Cts 3�2 D own ran oraed agcal Date All roof coverings to be Class 'B"or better c)i { 06 r ri N RDANCE* OR N CFS s _Z 3D�EftTINO 1 00ES AND O v7,vyl FCcof I v \ ,Rid- Mus- �. -Fy��FIC'atiGnsft fS��� aiG�4€t e„r. ,n., S t.f �; a'I luras end at t ae gt the �Ieffi R . a 1 F� 4E�g 2 rouPIERjNN q® h-1 p P f (] C, o,1-tm f^fd , r p 3 -q -714 smrr'lvwli Sr p�' Flf Sti©rn�etr wAllS ��� ,-yP 00 ouor t� /I f %r/ 3���©oar, f�, w a C Ari f� fi ty .� Inc s41, ZSI � 'Iii CITY OF CUPERTINO I�m 1 of 1 PERMIT RECEIPT OPERATOR: nancyc COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35613024 . 00 DATE ISSUED. . . . . . . : 02/26/2004 RECEIPT #. . . . . . . . . : 24637 REFERENCE ID # . . . : 04020163 SITE ADDRESS . . . . . : 10873 WILKINSON AV SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : PANNELL DONALD R AND CHARLOTTE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4733 RECEIVED FROM . . . . : LORI FRANCIS CONTRACTOR . . . . . . . : FRANCIS, ALLEN D LIC # 20943 COMPANY . . . . . . . . . . : ADF CONSTRUCTION • ADDRESS . . . . . . . . . . : 6201 SHADELANDS DR CITY/STATE/ZIP : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : 4082819177 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 5, 000 . 00 107 . 00 0 . 00 107 . 00 0 . 00 BPFIXTURE UNITS 3 . 00 24 . 99 0 . 00 24 . 99 0 . 00 BP,LANCHK PERMIT FEE 107 . 00 90 . 95 0 . 00 90 . 95 0 . 00 BPSEWAGE UNITS 1 . 00 62 . 16 0 . 00 62 . 16 0 . 00 BPSEWER SEWER SYSTEM 1 . 00 19 . 98 0 . 00 19 . 98 0 . 00 BENERGY PERMIT FEE 107 . 00 32 . 10 0 . 00 32 . 10 0 . 00 BREMFIXT NO. FIXTURES 1 . 00 1 . 11 0 . 00 1 . 11 0 . 00 PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 11 0 . 00 1 . 11 0 . 00 BREMVENFAN NO UNITS 1 . 00 42 . 02 0 . 00 42 . 02 0 . 00 BREMVENSYS NO UNITS 1 . 00 9 . 50 0 . 00 9 . 50 0 . 00 BSEISMICRE VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 497 . 98 0 . 00 497 . 98 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ �CK _ 497 . 98 7650 TOTAL RECEIPT 497 . 98 r> - ' f�TY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO N Build in Address: ` Mailing Address (if different from building address): 10773 G0 � t Jb�, nn Ow�T ,� nrt a Phone g _ / -?Col tractor. License#: A-OF ST 6 3 a s Contact: Phone:2p-Z -p7?o Cupertino Business License#: 1 r,cii Fax: Zpl - 1 Building Permit Info: Bld lect 2kf Plumb [ p Mec Y Jdb Description: _ Residential o Sq.Ft. Floor Area: $/ q. t.: Cost of Project: '' Occupancy Grou �j Type of Construction: Please check th1s4xox-1f4lwproject is a second-stor addition: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING 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/OfFCOmm/ uasi 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 BMITIGATC I Comm. Housing Mit. Fee BUILDING 1 of 3 ma RTY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEI,TINO Ouantity Fee ID Fee Description Fee Group BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERT]ME Ins ectiori 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 F 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 BPTR4P Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER InstalUAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL ' BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace> 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 Sips, Maz uee ELECTRICAL 2 of 3 *ITY OF CUPERTINO� CITY OF PERMIT APPLICATION FORM CUPEkTINO uanti Fee ID Fee Descri tion Fee Group BREMTHEATR Theatrical Lizhtin2 Fix ELECTRICAL BREMVENFAN Vent Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation S stems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Ins ection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temn Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Elprtrinal -o 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 3 of 3