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06050173 CITY AF CUPVISION O + � * � BUILDING Dl'�1S10N PERMIT ......... BUILDING ADDRESS: SEARS HOME IMPROVEMENT PERMIT"°-06050173 10540 STOKES AV PERMIT ISSUE DATE OWNER'S NAME: ITO YOSHIAKI AND JOY K TRUTEE283 E. AIRWAY BL 2006 SANITARY NO. CONTROL NO. eriONE: (925) 245-2000 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 10, LICENSED CONTRACTOR'S DECLARATION Job Description to 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ?z with Section 7000)of Division 3 of the Business an �Professions Code,and my license is FASCIA, VINYL SIDING s y in full force and effec 2J j v�Z License Class LM• t 0 Date Contrac�p ARCHITECT'S DEC AT ON C24-,J1 understand my plans shall be used as public records 3 e u Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the p 0o following reason.(Section 7031.5,Business and Professions Code:Any city or county $10022 u m ff which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation prior m its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q xF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt 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 r not more than five hundred dollars(5500). 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044.Business Required Inspections 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.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- 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. r B&P C for this reason t' C31 am exempt undo Sec g` vner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: } 0 1 have and will maintain a Certificate of Consent to self-insure for workers Compen- r sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensadon Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued My Workers Compensation Insur4=carrier and Policy number are: Carrier. V r #%J _ Policy':c�ll CE TIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE ' (Mis section need not be completed if the permit is fa one hundred dollars($100) or less.) 1 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 Ccrtificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Cock,you must ,J Q forthwith comply with such provisions or this permit shall be deemed revoked. Z h-■ CONSTRUCTION LENDING AGENCY F.r rCn- I hereby affirm that there is a construction lending agency for the performance of <Y+> the work for which this permit is issued(Sec 3097.Civ.C.) W A Lenders Name :D Z Lenders Address U 0 1 certify that 1 have read this application and state that the above information is 4L►-, correct.1 agree to comply with all city and county ordinances and state laws relating to 0Ubuilding construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. >"nWi (We)agree to save,indemnify and keep harmless the City of Cupertino against ,Hy to liabilities,judgments,costs and expenses which may in any way scenic against said City U Z in consequence of the granting of this permit. Date r"t APPLICANT UNDERSTANDS AND W1L COMPLY WITH ALL NON-POINT Issued by: SOURCE;Rpr.VLATIONS. Re-roofs Signaturepplicanl/Contr or Dam Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP 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 ^�dc,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Cl Yes [3No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0Yes (3 No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understated that if the building docs not currently have a tenant.that it is my ibility to notify the occupant of the , 11 Date requi which must prior u a Certificate of cupancy. Signature of Applicant "d All roof coverings to be Class 'B or better Date Owner or authorized agent - '` RESIDENTIAL PROJECT COVER SHEET CITY OF CUPEkTINO Assessor's Parcel Number: -3oZrp Name of owner. r o To Project address. S C, 77� Contact person. L 17— Phone. Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? �N Is privacy protection planting required for the project? Y N' On what floor(s) is work being done? Brief descri tion of work. I dST�LL U 2 U C N L c rr L(�C (nI Code editions:2001 CBC (Y~-N)2001 CFC (Y -N)2001 CMC (Y-foo -f PLANS 2001 CPC (Y -N)2001 NEC (Y - N) CHECKED BX DATV, Effective 11/1/02 Ln�_ PLikNNING DEPT. DEPT. OFFICE Copy y, Plan Review Process Work Book Page-8-Revised 4/28/04 Community Development `" w` 10300 Torre Avenue e'llCupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .,UPEI�TINO Building Department JOB ADDRESS: ��� ��� PERMIT � OWNER'S NAME: V T-6 PHONE # - S3 GENERAL CONTRALTO E FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 Own /Contractor Signature Date CITY OF CUPERTINO It-em 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32648005 . 00 DATE ISSUED. . . . . . . : 05/19/2006 RECEIPT # . . . . . . . . . : 34477 REFERENCE ID # . . . : 06050173 SITE ADDRESS . . . . . : 10540 STOKES AV SUBDIVISION . . . . . . . CITY . . . . . . : CUPERTINO AE IMPACT RA . . . . . . . OWNER . . . . . . . . . . . . : ITO YOSHIAKI AND JOY K TRUSTEE ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : TOWN & COUNTRY CONTRACTOR . . . . . . . : MARK C GOOD LIC # 23097 COMPANY . . . . . . . . . . : SEARS HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 283 E. AIRWAY BLVD. CITY/STATE/ZIP . . . : LIVERMORE, CA 94550 TELEPHONE . . . . . . . . : (925) 245-2000 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 180 . 36 86 . 57 0 . 00 86 . 57 0 . 00 BPERMFEE VALUATION 10, 022 . 00 180 . 36 0 . 00 180 . 36 0 . 00 BSEISMICRE VALUATION 10, 022 . 00 1 . 10 0 . 00 1 . 10 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 268 . 03 0 . 00 268 . 03 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 268 . 03 1059 TOTAL RECEIPT 268 . 03 ,t CITY OF CUPERTINO OF PERMIT APPLICATION FORM CUPERTINO APN# Date: 5 12--06 326 - � 8— oaS Building Address: Mailing Address (if different from building address): Owner's Name: Phone #: . r To 4o8 -41y6-qt&3L/- Contractor: _ License#: .SEA(�S I� tm I ESN ! 7.113 "29 Contact: nn Phone: y Cupertino Business Licenset Fax: Building Permit Info: Bld Elect ❑ Plumb, Mech ❑ Job Description: � .S 16iLL f �S'4- A sem(�} ResidentialR�MovG�}O Su BSiW�7�fiJdaD d P(�K� Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if to project is a second-story addition: Quanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 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/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 Elec 600V <= l OOOA ELECTRICAL BELEC 1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 CITY OF CUPERTINO LUPE TING PERMIT APPLICATION FORM Quantity 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 BOVERTIME Inspection 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 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 BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain&Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> 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 2 of 3 CITY OF CUPERTINO C1WOF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, 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 BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection 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 Elec 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 Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3