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06050222 CITY OF CUPERTINO �I�,�� BUILDINI DIVISION pER1V1IT C�1R ?R ?�A�'�€�N� <: BUILDING ADDRESS: ROS END IN ELECTRIC INC. PERMIT"06050222 19310 PRUNERIDGE AVE OWNER'S NAME: PERMIT ISSUE DATE APPLE 880 MABURY RD 0-512512006 )NE: SANITARY NO. CONTROL NO. (408) 286-2800 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L (� i 0 z0 LICENSED CONTRACTOR'S DECLARATION I LU Eup I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description E Z u with Section 7000)of Division 3 of the Business and Professions Code,and my license is 'may in full force and cff 8 REPLACE EXISTING MAIN BREAKER 1600Ar 480Vr SQD ss License Clan Llc.hY .� Date CHITECTSDt C-LA TEST FEEDER BREAKERS a< 1 understand my plans shall be used as public records �0.rJ G Licensed Professional o<yaffirmOWNER-BUILDER DECLARATION 4 2 I hereby arm that 1 am exempt from the Contractors License Law for the p o 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 Z Y prior to its issuance,also requires the applicant for such permit to file a signed statement s that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuati$4 4 0 0 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L 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 ofN Number Occupancy Type not more than five hundred dollars($500). 3N606051 . 00 ❑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 o 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 sal&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.). ❑1,as owner or 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 contractors)licensed pursuant to the Contractor's \' r License Law. ❑I am exempt under Sec. B&P C for this reason i 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 Consent 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 inquired by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My W is Comp sation In nce carrier and Policy her are: q Z�J Cartier. PolicyNo.:75;_),, U.R�_t S "1 CERTIFICATE O X PTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for anc hundred dollars($100) or less) 1 certify that in the performance of the work for which this permit is issued,t 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z r"h CONSTRUCTION LENDING AGENCY 1 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.) WR.Q Lender's Namc ]z Lender's Address V 0 I certify that 1 have read this application and state that the above information is w h-� correct.I agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rHt cn liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the ting of this permit. r"h APPLICA RANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE U Tl Re-roofs ' Signature o pplicant/Contracto IDatc HAZARD S MATERIALS DISCLOSURE Type of Roof Will the applicant or f ore 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. [3 Yes L7ryo Will the applicant or future 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? W,0141❑Yes 1 have read the hvardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety ,Sections 25505,25533 and 25534.1 understand that if the building docs nes c vc a L it is my responsibility o notify the occupant of the rcquircmc m t to issuance of a Certif or ancy. Signature of Applicant Date Owner or authorized agent re All roof coverings to be Class"B"or better Community Development "x 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 an OF Fax(408)777-3333 ':UPEkTIN0 Building Department JOB ADDRESS: PERMIT # �cl-�f0 PrrLjner,j2 1 ve 2)-)- OWNER'S NAME: 110 PHONE # -O/ GENERAL CONTRACTOR: - ;V 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 m 2 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31606051 . 00 DATE ISSUED. . . . . . . : 05/25/2006 RECEIPT # . . . . . . . . . : 34554 REFERENCE ID # . . . : 06050222 SITE ADDRESS . . . . . : 19310 PRUNERIDGE AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . APPLE ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : KEN WOLZ CONTRACTOR . . . . . . . : TOM K SORLEY LIC # 10834 COMPANY . . . . . . . . . . : ROSENDIN ELECTRIC INC. ADDRESS . . . . . . . . . . : 880 MABURY RD CITY/STATE/ZIP . . . : SAN JOSE, CA 95133 TELEPHONE . . . . . . . . : (408) 286-2800 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICOM VALUATION 4, 400 . 00 1 . 05 0 . 00 1 . 05 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 74 . 28 0 . 00 74 . 28 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 148 . 14 097 TOTAL RECEIPT 148 . 14 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ---- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL TINO 0 U0561,-� 3WCIF CITY OF CUPER PERMIT APPLICATION FORM CUPEIZTINO APN# '31 Date: S� - Mailing Address (if different from building address): Building Address: N 3 /G � `� r�� hic M Phone#: Owner's Name: / � i �„�-� wta n n> q U� 7 3 l License#. Contractor: lf Cupertino Business License#. Contact: i 1 Phone: '�p$- 63T,"0—1-81 P W � Fax: �� �- RkY /�ooa�4, � Sr Building Permit Info: 1" R�`� �!5 `"—/ 1 esf .e Bldg ❑ Elect Lam' Plumb ElMech El Job Description: Commercial Residential ❑ Sq.Ft.: Sq.Ft. Floor Area: v Occupancy Gr,S2up: Cost of Project- E Please check this box if the project is a Type of Construction: - second-story addition: ❑ f' } Project Size: Standard Large ElMa Jor ❑ Fee Description Fee Grou Quanti Fee ID Other A liances MECHANICAL BApPLOTHER Boiler<= 100,000 Btu MECHANICAL BBOILERl 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 BUILDING BCONSTAX Construction Tax. BUILDING BCONSTAX Ind/Off/Comm/Quasi Con. Tax for BQ Zone BUILDING BCONSTAXBQ BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile ELECTRICAL BELEC 1000 Elec 600V <= l OOOA Elec 600V> 1000A ELECTRICAL BELEC1001 ELECTRICAL <=200A BELEC200 Elec Svcs 600V BUILDING BENERGY Energy Energy Add Multi BUILDING BENERGYADD BUILDING BINVESTIGA Investigation fee 1 of 3 CITY OF CUPERTINO 41F PERMIT APPLICATION FORM CUPER,TINO Quanti 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 Bldiz Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping S stem Fee PLUMBING MBPLANCKADD RCEP Ind Waste Interceptor PLUMBING CHK Plan Check Fee BUILDING E Plan Check Add Multi BUILDING KREPPlan Check R eat Fee BUILDING IPE Re i e Of FixturesPLUMBING AGE Sewa a Disposal PLUMBING BPSEWER Sewers PLUMBING BpSPRINK Lawn S rinklerBackflo PLUMBING BPSTORK 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 Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAppLI Appliance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL :MBREMINHOOD REMFIXT Lighting Fixtures ELECTRICAL EMFURN Relocation of Furnace MECHANICAL MFURNOV Relo Furnace> I OK btu MECHANICAL EMHEAT Heater Installation MECHANICAL Installation of Hood MECHANICAL EMMISC Misc A aratus ELECTRICAL ppp Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Re Al, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPER`F PERMIT APPLICATION FORM 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 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