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07020133 -777777777777777 CIT_YY OF CUPERTINO CRAB jTdR� RAiI`I�N� BUILDING DIVISION PERMIT PERMIT NO. :::— ""J'8Y6TT':OTTERS HATCH TBD - TO BE DETERMINED 07020133 PERMIT ISSUE DATE OWNER'S NAME: 2 2 2 7 MARGARET CHEW SANITARY NO. CONTROL NO. INE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PL MCCH w, LICENSED CONTRACTOR'S DECLARATION Job Description U i= t hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REPLACE .IAS PIPE-FIRE DAMAGE REPAIR WALL ONLY. Z with Section 7000)of Division 3 of the Business and Professions Codc,and my license is =wo in full force and offWILDWOOD GENERAL BUILDING CONTRACTOR PD FOR BUS Lic.tY z License Q � E rp Date ARCHITECTS D CLA ATiON LIC 02/26/07 . ,,� j C t understand my plans shall he used as public records )aU u.y Licensed Professional OWNER-BUILDER DECLARATION } i hereby affirm that 1 am exempt from the Contractors License Law for the p Oa following reason.(Section 7031.5,Business and Professions Code:Any city or county $a, which requires a permit to construct,alter,nprove,demolish,or repair any structure Valuation u' prior u)its issuance,also requires the applicant for such permit to file a signed statement cil Ft.Floor Area "?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �' $4500 tH (commencing with Section 7000)of Division 3 of the Business and Professions Code)or a that he is ezerop,therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3423503 .)W Number not more than five hundred dollars(S500). 0 I,as owner of the property,or my employees with wages as their sots compensation, Required Inspections will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law dines not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors U- rty who s or reon,and who c contraLaw cts for such pnot ly to an owner of rojects with a c ntractor(s)licensed dpursua improves the Contractor's License Law. B&P C for this reason 0 i am exempt under Sec. Date Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ILaws have and will maintain a Certificate of Consent to self-insure Cor Worker's Compen- n,as provided for by Section 3700 of the Labor Code,for the performance of the for which this permit is issued. have and will maintain Workers Compensation Insurance,as required by Section of the Labor Code,for the performance of the work for which this permit is issued. Worker's Compensa�tion insura(nce carrier and Policy number arc: esT �� f k Policy No.: CERTIFICATE OF EXEMPnON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(S100) ss) tify that in the performance of the work for which this permit is issued•I shall not loy any person in any manner so as to become subject to the Workers'Compensation of California.Date Applicant NOTICE TO APPLICANT:if,after making this Certificate of Exemption.you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J z forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY F~t I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) (L)A Lender's Name O+ Lender's Address / U 0 i certify that I have read this application and start that the above information is /. V.� correct.I agree to comply with all city and county ordinances and state laws relating to u 0U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. >" a (we)agree to save,indemnify and keep harmless the City of Cupertino against Mliabilitiu,judgments,costs and expenses which may in any way accrue against said City rA Date U Z in consequence of the granting of this permit. ►+ APPLIC ��TT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b.i: SOUR R GULA'fr S. ,,JJaa//// A f� �•a,._, rAll Signature of Applicant/Contractor Date Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code.Section 25532(a)? i shall be inspected prior to any roofing material being installed. DYes F'° If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which ,mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? E]Yes XNo 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcal Safety Code.Sections 25505,25533 and 25534.1 understand that if the building does n cu ndy have a tenant.that it is my responsibility to notify the occupant Of the Date requi men which m t p. to issuance of a Ccrtiftca of Oc pansy. Signatu:'e of Applicant m All roof coverings to be Class"B" or better Ow r r authorized agent Date Community Development 10300 Torre Avenue ' s{ Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ''UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # I 0 PHONE OWNER'S NAME: Vkka a� (2L,,&.j GENERAL CONTRALTO FAX# 5+4N I am not using any subcontractors: SDate ignature Please check applicable subcontractors and complete the followin information: SUBCONTRACTOR BUSIrIESS 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 ' e Owner�tra r 1r�ature Date CITY OF C'UPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: suew COPY # : 1 Sec: Twp: Rng: Sub: Blk Lot: APN . . . . . . . . : 342:45039.00 DATE ISSUED. . . . . . . : 02/26/2007 RECEIPT #. . . . . . . • • : BS0')0000545 REFERENCE ID # 07020133 SITE ADDRESS . . . . . : 10234 POTTERS HATCH SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER MARGARET CHEW ADDRESS CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2655 RECEIVED FROM . . . . : TBLEIPTOINTERFACE DETERMINED LIC # 00096 CONTRACTOR . . . . . . . COMPANY . . . . . . . . . . : TBE - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY RMOUNT PD-TO-DT THIS REC --NEW-BAL- ---------- ____ ---------- --- ---------- BPERMFEE VALUATION 4, 500 .00 115.56 0 .00 115 .56 0.00 BPGAS OULETS 1.00 5.40 0 .00 5.40 0. 00 BPLANCHK PERMIT FEE 115.56 154 .21 0 .00 154 .21 0.00 BSEISMICRE VALUATION 4, 500 .00 0.50 0 .00 0 .50 0.00 BUSLIC FLAT RATE 1.00 107.00 0 .00 107.00 0.00 1.00 38.37 ---- 38 .37 ------0_00 PPERMITFEE FLAT RATE - --------- ---------- ---------- TOTAL PERMIT : 421.04 0 .00 421.04 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- --------------- ----- CHECK 421.04 1551 --------------- TOTAL RECEIPT 421.04 F REIDE�ITIAL PpJEC EEI3 - CUPEkTiNO Assessor's Parcel Number: — Name of owner. '' Project address. (07-0 'Lf P©k)",/ . Phone. tact erson.�c7='i' �`��� Cin p Fax. r Net square footage of lot. Ex istin Proposed Square footage: First floor: &2es Second floor: _— Garage: TOTAL: --- Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N Is privacy protection planting required for the project? Y N n what floor(s) is work being done? O g�v u c UJU Cc. Brief description of work Je C� CF C (Y -N)2001 C ' Code editions:2001 CBC Y N)2001 2001 NEC (Y -N) 2001 CPC R Effective ll/l/0; AGG��� 4d�S PNp 0/� i � U+ �5 MIF Ana ae acs ,° sa�� . pi P • . Vi �u� �h ne P \0 d ti0 vvi+ fO��� Ai`,ti,: Plan Review Process Work Book Page_g_Rf;vised 4/28/04 w,W Pl•� FW s RE 5 - � � ���� :�Axa�4.a �•�������� � s����. � �� ��'.� m�,. ;� sip .; s � QNOWVVI T2s to OMAN 10204 Potters Hatch Common Fire Damage Repair Wild Wood General Building Contractor, Inc. State License #740660 Dave Bruce, President 927 Aura Way, I,os Altos, CA 94024 Phone/FAX (650)964-9373, Cell (650)438-7544 Proposal & Contract On February 26, 2007 Wild Wood General Building Contractor, Inc. (WWGBC) located at 927 Aura Way, Los Altos, CA 94024, agrees to perform the work described below for, Margaret Lee at 10204 Potters Hatch Common, Cupertino , CA 95014 , telephone number (408)973-1852. Description of work to be performed: 1. Put down protective barrier on floor and move furniture out of the way. 2. Remove fire damaged materials surroe nding the fireplace and up the exterior wall ( interior and exterior ). 3. Replace all structural framing with new materials. 4. Re-attach or replace structural hardware as required. 5. Evaluate gas pipe situation and discus,,; options with homeowner (cut and cap?). 6. Replace wall insulation as required. 7. Replace exterior siding as required. 8. Framing and gas pipe inspection. 9. Hang drywall on interior wall. 10. Drywall nailing inspection. 11. Tape & texture drywall. 12. Paint interior and exterior. 13. Final inspection. 14. Remove all debris and clean. Unless noted, all materials required to perform the work described above will be furnished by WWGBC. All of the above work to be completed in a substantial and workmanlike manner according to the city approved drawings created by WWGBCI and dated February 26,2007. Exceptions noted above in the "Description of work to bE performed", for the price of$4,500.00. A $450.00 down payment is required to initiate work on this contract and due at the time the contract is signed. The balance of payments v ill be made in two (2) installments based on the following: 1. Passing of framing and gas pipe inspection. $2025.00 2. Passing of final inspection. $2025.00 CITY OF C UPERTINO TY OF PERMIT APPLICATION FORM CUPEkTINO Date: / .APN M Adj�r sa• / ailing Address (if different from building address): Building z©`f � � Owner's Name: Phone#: C tra tor: Lie se #:� k Ztact: nn Phone�Sc, ,10� -1323 Cupertino Business License#: G.�c> 05 Fax: Building Permit Info: Bldg ,K Elect ❑ F lumb 0 Mech ❑ Job Description: p V e� �Gg ��s 0.1 a c Residential 9 t-w a a�t/- u).11 b'N J Commercial ElSq.Ft. Floor Area: Sq.Ft.: Cost of Project:4q, p® Occupancy Group. Type of Construction: Please check this box if the project is a second-story addition: ❑ lroject Size: Standard ❑ Large ❑ Ma or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to SOOK Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boil(T> 1M to 1.75 M Btu MECHANICAL BBOILER5 E,oiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Cc n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Ccnstax-Resi/Mobile BUILDING BELEC1000 E ec 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 1 of 3 L e 'I'll CITY OF CUPERTIN O CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantit Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING # BMITIGATC Co nm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Coinm Mechanical MECHANICAL BNUCOMMP \Tew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING _ BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gz s Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plen Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE 3ewa a Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lavin Sprinkler/Backflo PLUMBING BPSTORM Ll:torm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT A!t of Drain & Vent PLUMBING BPWATER Inst,-ill/Alter Water Pipe PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Jnits <= 10,000 cfm MECHANICAL BREMAPPLI J�ppliance Install MECHANICAL BREMBUSWAY R--model Busways ELECTRICAL BREMFIXT L ighting Fixtures ELECTRICAL BREMFURN Rel kation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT H-,ater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC T✓Iisc Apparatus ELECTRICAL BREMNRAPP Rem [Ton-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Re ocation of Hood MECHANICAL BREMREPALT Ref air/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 o.-'3 CITY OF CUPERTINO F O CITY CUP TYO PERMIT APPLICATION FORM Quantity_ Fee ID Fee Description Fee Group BREMSIGNAD Rndl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Fent 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 Electnical sq foot ELECTRICAL EPERMITFEE F;lec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE 1Vl:ech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannir.g LR Comme/Multi-Faro PLANNING PLLONGRNGR Plannin g Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3