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07020138ed tOC L F :zU. I< CL -z)? ,f"cCr. ram )qC O. ern_ �pC <m Lt " V �=L e~a i�• CITY OF CUPERTINO PERMIT 777-77777777 T ]� ?��TI�A�'TCTR,I�}M.�TION. r BUILLfNG DIVISION BUIL �l� �I G 1�D ESS: U PRUNERIDGE AVE TBD - TO BE DETERMINED PERMIT NO. 07020138 OWNER'S NAME: PERMIT ISSUE DATE JPI CALIFORNIA 02/27/2007 INE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: A BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is LEAK R' �', PA I R S infullfarceandeffect a 2 In lu'1c. Class Lie. art JT 5 a REPLACE SHEET ROCK, STUCCO ADD WATERPROOFING Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure Sq. Ft. Floor Area Valuation prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $30000 that he is exempt therefrom and the basis for the alleged exemption. Any violation of 316450 L 6 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber not more than five hundred dollars (5500)_ .V� ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections q will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does 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.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U - cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Conscnt to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 37 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier. %L/(�Q t riis�xl Z�>60,00 ry No.: s CERTIFICA OF EXEMPTION FROM O COMPENSATION INSURANCE (rhis section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws 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 forthwith comply with such provisions or this permit shall be deemed revoked. y CONSTRUCTION LENDING AGENCY 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.) ~ Lender's Name r C V / Lender's Address is 1 certify that I have ad this application and state that the above information re V correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mcntimncd props coon purposes. (Wc) agree save, ind nify and keep harmless the City of Cupertino against /1 liabilities, jud nls, costs d expenses which may in anyway accrue against said City in consequcp6c of the zraF,6ng of this permit. APPLIC UND ANDS AND WILL COMPLY WITH A LNON-POINT Issued b �: Date SOUR REGU ONS. Re -roof. Type of Roof Stature/ licant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE 11 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)? All roof; shall be inspected prior to any roofing material being installed. C] Yes ❑ No 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 emit hazardous air contaminall as defined by the Bay Arca Air Quality Management i all new materials for inspection. District? ❑ Yes j "� ❑ Vo Ilia dad the ha7aMo6s materials requircmcnts under Chapter 6.95 of the Califor- building niaHcaltltdc Safcty C coons 25505, 25533 and 25534.1 understand that if the does not curcntiy ha a tenant, that it is my responsibility to notify the upant of the rcqui menu whit dist be met prior to issuance of a Certificate of Oc Signature of Appl ieant Date a All roof coverings to be Class "B" or better 0 ner or authorized agent Data CITY OF 'UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRES o l PERMIT # 6l � 0 3 OWNER'S NAME: PHONE # GENERAL CONTRACTORS FAX # I am not using any subcontractors: S ignature Please check avvlicable subcontract s d conivlete the following information: /.,-17 0 . Date Owner/Contractor Signature Date SUBCONTRACTOR BUSINESS 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 Tile Owner/Contractor Signature Date 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Bl --c: Lot: APN 31545016.00 DATE ISSUED.......: 02/27/2007 RECEIPT #.......... BS)00000560 REFERENCE ID # ...: 07)20138 SITE ADDRESS 19508 PRUNERIDGE AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER JPI CALIFORNIA ADDRESS 19508 PRUNERIDGE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: amyw COPY # : 1 RECEIVED FROM ....: RE�EIPT INTERFACE CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: TELEPHONE ........ FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- BPERMFEE VALUATION -------------------- 30,000.00 367.20 ---------- 0.00 367.20 0.00 BSEISMICRE VALUATION 30,000.00 3.00 0.00 3.00 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 477.20 ---------- 0.00 477.20 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER -------------------- ----------------- --------------- CREDIT CARD 477.20 VISA --------------- TOTAL RECEIPT 477.20 CRY OF CUPEkTINO CITY OF C'UPERTINO . PERMIT APPLICATION FORM 010a o X38 CPN # -31 �l f n -46— b I Date: �01. — — 0 17 Building Addres Mailing Address (if different from building Uddress 119 GD8 6,rolh,004 CA /;r -1/d5 y.20.� '/.305 6/0/ Owner's Name: 40 Phone #: x'08 -N73 - 9090 pY /; Boiler > 100K to 500K Btu Contractor: License #: 0 Contact: Phone: y/5-7AIX-o99,C Cupertino Business License#: vle�,Fax: y/5 -SIC -.s-152 Boiler > 1M to 1.75 M Btu Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ElJob Description: �e�t,L ✓c/Oli%i'lo .m+r%•�pc�•Y 6744MW te✓Proof, a�cc�ivo�C��i•Y ' Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: � Occupancy Group: DOS _ r Type of Construction: Please check this box if the project is a El BUILDING second -story addition: troject Size: Standard ❑ Large ❑ Major ❑ BUILDING Quanti Fee ID BAPPLOTHER Fee Description Dther Appliances Fee Group MECHANICAL BBOILERI Bciler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boi: er > 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 Cc n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Ccnstax — Resi/Mobile BUILDING BELEC 1000 E. ec 600V <= l OOOA ELECTRICAL BELEC1001 E,lec'600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING of 3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM .CUPERT'INO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM Nev Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME I ispection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bid Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gz.s Piping System Fee PLUMBING BPINTERCEP Ir. d Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD PI m Check Add Multi BUILDING BPLANCKREP Pl.m Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT �dt of Drain & Vent PLUMBING BPWATER Inst all/Alter Water Pipe PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/ —_ Unit > 105000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Zemodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Rclocation of Furnace MECHANICAL BREMFURNOV Re; o Furnace > 1 OK btu MECHANICAL BREMHEAT :-leater Installation MECHANICAL BREMINHOOD It.stallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rer.i Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Refl, Switch & Outlets ELECTRICAL BREMRELOCA F,elocation of Hood MECHANICAL BREMREPALT R--pair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL of 3 SAwCITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rrid1 Signs Add Branch ELECTRICAL BREMSIGNS Re nodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS 17entilation 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 Electrical sq foot ELECTRICAL EPERMITFEE E lec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbin Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin = Long Range Residential PLANNING ZADDCHG Address Change BUILDING of 3