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07010060 CITY OF CUPERTINO ., BUILDING DIVISION PERMIT C� IrT�t. CTCI�Z I�1R+( RIATIN� BUILDING ADDRESS: PERMIT NO. 22424 MCCLELLAN RD STORM EliECTRIC OWNER'S NAME: PERMIT ISSUE DATE JEFFERY & VIVIAN WIGMAN 16770 M1GNESON LOOP 01/09/2007 ONE. (408) 35E;-8677 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �aZ (� 0 O O LICENSED CONTRACTOR'S DECLARATION =U U I hereby affirm that I am licensed under provisions of Chapter 9(commencing 7 Job Description LU with Section 70(10)of Division 3 of the Business and Professions de,and my license is NEW 10 01,MP SERVICE ADDING ADDITIONAL OUTLETS y in full force and effec D,n? Licenscc s U Lie. 3 7 XITCHEN ONLY 3 F,a Date — — Conlncbr L ARCHITECTSDECLA Tl N j U 1 understand my plans shall be used as public records a H LtcenscdProfessional rn 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 e which requires a permit to construct,alter,improve,demolish,or repair any structure a Z y prior to its issuance,also requires the applicant for such permit to file a signed statement F=o that he is licensed pursuant to the provisions of the Contracwr's License Law(Chapter 9 :;q.Ft.Floor Area Valuation sYi t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $3000 y - 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 35604023not more than APN Number Occupancy Type five hundred dollars(5500). ❑1,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 and Professions Code:The Contractor's License Law docs not apply to an owner of Required Inspections 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.IL 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 Li- cense Law does not apply to an owner of property who gilds 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 Dare WORKER'S COMPENSATION DECLARATION 1 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 required by Section 3700 of the Labor Code•for the performance of the work for which this permit is issued. My Workers Compensation Insu ce reser and Polity number am: Carrier hr-r _Mrand No-L,C I� CERTIFICATE OF EXEMPnON FROM WORKERS' COMPENSATION INSURANCE (This 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 Workcrs'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 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.) W�.Q Lender's Name z Lender's Address U 0 1 certify that I have read this application and state that the above information is Vcorrect-I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorise representatives of this city to enter upon the H aabove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against ,.y In liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit r t APPLICANT UN STAN D W 'COMPLY WITH ALL NON-POINT Issued by: Date ��-�f SOURF ON , f✓ Si of Appli uComractor Dale Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roc f 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)? (3 Yes All roofs shall be inspected prior to any roofing material being installed. Will the applicant or uturc 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? ❑Yes u 1 have read the hazes materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,th it is ponsibilily to notify the occupant of the requirements must a or cc of a Ccrtificite of Occupancy. _..,U Signature of Applicant Date o i-or authorized agent Dare All roof coverings to be Class"B"or better X"C4 CA O P- P�P G�SSP p o2p� � �Vee`��o . 00 (tc Q �0-5e �0-M & S�z (3 , 'N S-6, �ot v, the �,\,Nco� 0 zo vpA d,O Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "WEkTINO Building Department JOB ADDRES : PERMIT # 2 Z( 2- V 07Otl 00 Q OWNER'S NAME: VI 440 LU? PHONE # /v 7- S 7 GE L CONTRACTOR - c c C FAX # L(-)X I am not using any subcontractors: SigAature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical � f 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 / �J �� Own/e'r'/Contractor Signature Date :.Y. rt CITY OF (XPERTINO 0g0100w0 civCF PERMIT APPLICATION FORM CUPEkTINO .CPN# 36V Date: Building Add ess: I Mailing Address (if different from building address): Owner's e. Phone#: Contractor:, License #: r— qX q 7 Contact: Phone:Z/t)2 &Ii I_5 Cupertino Business License#: v(�%^j"') I S 'I 1"� Fax: Building Permit Info: Bldg ❑ Elect :dumb ❑ Mech ❑ Job Description: /-/e(,v `(�t vl J - ' !4` 'l 1 (�t�� C�`S i �► Residential �G ,� h'� "�el / c`e Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Grou Type of Construction: Please check this box if the project is a second-story addition: El ?roject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Dther Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1 M to 1.75 M Btu MECHANICAL BBOILER5 E oiler> 1.75M Btu MECHANICAL BCONSTAX -onstruction Tax BUILDING BCONSTAX In 3/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 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 uz_e CITY OF C UPERTINO CITY OF PERMIT APPLICATION FORM CUPEFTINO Fee Description Fee Group QuantityFee ID BUILDING BMISCELL Miscellaneous Fee BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N.w Comm Plumb PLUMBING BOVERTIME In.>pection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Elf Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Ga.,Piping System Fee PLUMBING BPINTERCEP Incl Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plz n 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 SprinklerBackflo PLUMBING BPSTORM 3torm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT �Jt of Drain &Vent PLUMBING BPWATER Inst all/Alter Water Pipe PLUMBING BPWHEATER Nater Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER AiC Unit> 10,000 cfm MECHANICAL BREM,�p,N A/C Units <= 10,000 cfm MECHANICAL BREAPPLI Appliance Install MECHANICAL NI BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN R elocation of Furnace MECHANICAL BREMFURNOV RClo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BRE MINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL Bpp Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL Power Device/Apparatus aratus ELECTRICAL BREMPOWER ELECTRICAL -7 - BREMRECEPT R( tl, Switch & Outlets ' BIZEMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 11, CITY OF I"UPERTINO CUPEkTiNO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Tr eatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS `entilation 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:ec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE W-ch Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin 7 LR Comme/Multi-Fam PLANNING PLLONGRNGR Plannin;j Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3