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06050203 CITY OF CUPERTINO BUILDIjVG DIVISION PERMIT C�l1ITktACTaRIIRMiTI�IY� BUILDING ADDRESS: MICHAEL BASS PERMIT NO.06050203 10408 JUDY AVE OWNER'S NAME: PERMIT ISSUE DATE GARY MOUNTAIN 950 DR )NE: SANITARY NO. CONTROL NO. (408) 314-4422 ARCHrfECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a a o 0 O p LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing t'a int full force anadw)of t,vision 3 of dtc Bus�cr artd 7III ions Code,and my licen in :�z License (� f w.N L.fj(( Sb.7/ �J INSTALL FURNACE-ASC-TANKLESS WATER HEATER t-in Date Contracol� ARCHITECTS DECLARATION 2-4 < I understand my plans shall be used as public records �po,U e u.y Licensed Professional O OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 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 $4600 prior to its issuance,also requires the applicant for such permit to file a signed statement c=< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation at- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of r 0 0 Occupancy Type not more than five hundred dollars(3300). 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 Contractor's License Law does not apply to an owner of q P 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 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. 0 I am exempt under See B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declat��y p J I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation, ompen sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 6 \ y 0 1 have and will maintain Worker's Compensation Insurance,as tequ d by Section 3700 of the Labor Code,for the performance of the, for which this1#1111it is issued. My Worker's Compe 'onand Policy number are: Carrier. Policy No.: ��~� ERTIFICA F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) ' or less.) 1 certify that in the performance of the work for which this pe itis issued,I shall not employ any person in any manner _tobcco�c ser Workers'Compensation Laws of Califoartit Mlle .� C� Applicant /.9A�OJ A— can TO APP NT:If,a aking this Ccrlificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z" CONSTRUCTION LENDING AGENCY (~-c 1 hereby affirm that there is a construction lending agency for the performance of Q!..� the work for which this permit is issued(Sec.3097,Civ.C.) ALender's Name 2 Lcndees Address U 0 l certify that 1 have read this application and state that the above information is [3.►� correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon.the U above-mentioned property for inspection purposes. /117 (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Z c"r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALN-POINT Issued by: Date S Z SOU E LA S. r Re-roofs $jgnaturc of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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)? All roofs shall be inspected prior to any roofing material being installed. ❑yes o Will the applicant Cuture building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes I have read the hazy cots materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant.that it is my responsibility to notify the occupant of the re utrem which m}trk�p met or o issuance of a Certificate of Occupancy. q� ignature of Applicant Date All roof coverings to be Class 'B or better Owner or authorized agent Date CITY OF CUPERTINO 1 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37510002.00 DATE ISSUED. . . . . . . : 05/23/2006 RECEIPT #. . . . . . . . . 34531 REFERENCE ID # . . . 06050203 SITE ADDRESS . . . . . : 10408 JUDY AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : GARY MOUNTAIN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : MICHAEL BASS CONTRACTOR . . . . . . . : MICHAEL BASS LIC # 27570 COMPANY . . . . . . . . . . : MICHAEL BASS ADDRESS . . . . . . . . . . : 950 DRY CREEK RD. CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408)314-4422 rEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00 BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMHEAT NO OF HEATERS 1.00 7.02 0.00 7.02 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 178.04 0.00 178.04 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 178.04 MASTERCARD TOTAL RECEIPT 178.04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 r,UPEkTINO Buildin De artment JOB ADVRFS PERMIT # r OWNER'S NAME: , /L vLG s7 _ PHONE # 57/ 3 y Z GENERAL CONTRACTOR: ^1 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 Owner/Contractor Signature Date CITY OF CUPERTINO ITYoF PERMIT APPLICATION FORM CUPERTINO ` APN# Date. 6". Building Address: V Mailing Address (if different from building address): Mer's Name: Phone#1 I Contractor. License#: Contact: Phone 3/yy-IZ Cupertino Business License#: Fax: I_1q U 5� Info: lJBuildng Permit 43 1S i S , S 10e,s : 6S it/<� Lc L _ ,s' , . :•�i�rZ Bldg ❑ Elect ❑ Plumb Mech Job Description: Residential�— Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: j44Ati� t2'�""`''�� Please check this box if the project is a .4 second-story addition: El Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 <= 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 CITY OF CUPERTINO ` *CPERMITPERMIT APPLICATION FORM k CU QuantityFee 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 BREINSPEC.T Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Li tin 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 BREN,INRAPP 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 2of3 CITY OF CUPERTINO OF PERMIT APPLICATION FORM CUPEI�TINO )uantity 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 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 Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing 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