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07010099 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 1979 OAKDELL PL RACHEL it OWNER'S NAME: PERMIT ISSUE DATE RACHEL & CHRISTOPHER SHERWOOD 01/18/2007 JNE: SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description i u F I hereby affirm that I am licensed under provisions of Chapter 9(commencing INSTALLATION ON OF 15 RECESSED LIGHTS =Z with Section 7000)of Division 3 of the Business and Professions Codc.and my license is H in full force and effect. ? License Class Lic.# 3-z Date Contractor ARCHITECTS DECLARATION 0 U 1 understand my plans shall be used as public records o. iG H Licensed Professional n y< OWNER-BUILDER DECLARATION <2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the i 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 Z} prior to its issuance,also requires the applicant Cor such permit to rile a signed statement S Ft.Floor Area $2622 Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q SE[_—$ (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 32639001 . Number Occupancy Type not more than five hundred dollars($500). ❑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 Required Inspections and Professions Code:The Contactors 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 dp 7as owner of the property,am exclusively contracting with licensed contractors to construct the pmjcct(Sec.7044.Business and Professions Code:)The Contra ctoes In- cense law docs 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.exempt unP c. B&P C for this reason Owner ( Date E OMPENS ON DECI,�RATIQN- I hereby iii under penalty of perjury one of the following dec ons: Q 1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Q I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the tabor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION 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 won for which this permit is issued,I shall not cmploy any pc anncr so as tolittime subje Wo ompensation Laws of Calif ANYTA Applicant NOTI A :If,afteT AMA 41 IA ux r making this Cenifica emption,you should become subject the Worker's Compensation provisions of the Labor Code,you must ,2 forthwith comply ith 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 ai the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name az Lender's Address U C) I certify that I have read this application and state that the above information is V.►+ comeL l agree to comply with all city and county ordinances and state laws relating to O Ubuilding construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. >-h W (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities'dgments,costs and expenses which may in anyway accrue against said City V Z in co ce of the granting of this rmiL / 4 Date 0� AP IC ERSTANDS A WIL COMPLY WITH ALL NON- OINT Issued b): so RC Re-roofs Signalu p NContractor HAZARDOUS MATERIALS DISCLC) Type of Roof Will the applicant or future building occupant store or hand ous material as defined by the Cupertino Munic'al Code,Chapter 9.12,and the Health and Safety ctiae,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. QYcs �=o 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 contaminaas find by the Bay Area Air Quality Management all new r iaterials for inspection. District? nts ❑Yes Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building ofmly have a icna t,that is my responsibility to notify the occupant of the q w ' t prio issuance of a Certificate fcapon Date Signator(:of Applicant own r tin atithorizcd agent - --�,a��.. All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 7UPEkTINO Building Department JOB ADDRESS: PERM a l D U �1049 O*Aefl OWNER'S NAME: file ff PHONE # 0 GENERAL CONTRACTOR: 5 ; FAX # � I am not using any subcontractors: /,! -Y Si,nature Date Please check applicable subcontractors and com-:)lete the following information: 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical (� �p 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 kv7 Own / ontractor Signature Date CITY OF C UPERTINO 00qq PERMIT APPLICATION FORM CUPEkTiNO APN# Date: Build" Address• Mailing Address (if different from building address): Owner's Name: Phone#: �— n Chri V ontractor: License#: �hri �CruVvo� C nt : Phone: ' Cupertino Business License#: Fax: • Building Permit Info: ih 1 I ,I6 VOK � �l� 0� Cl �(�G�� � �(Ut Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description- Residential Residential L�' Commercial El Sq.Ft. Floor Area: 01A Sq.Ft.: WA Cost of Project: # i Occupancy Group: /l�1/1 � 1 L T e of Constructio Please check this box if the project is a second-story addition: ❑ Project Size: Standard R Large ❑ Maior ❑ Qu-a—ntity Fee ID Fee Description Fee Group BAPPLOTHER ether Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boilcr> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 E: iler> 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 <= I OOOA ELECTRICAL BELEC1001 E1ec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING of 3 ,M7 CITY OF CUPERTINO CUCITY OF 0 PERMIT APPLICATION FORM Quantity Fee ID Fee Description_ Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Corim. Housing Mit. Fee BUILDING BNUCOMME T ew Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW A'mospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gz s Pi ing System Fee, PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING, BPLANCHK Plan Check Fee BUILDING BPLANCKADD PI in 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 Lxvn SprinklerBackflo PLUMBING BPSTORM Storni/Rain Water PLUMBING BPTRAP Kitchen Trap '�' PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Insi:all/Alter Water Pie PLUMBING BPWHEATER Nater Heater/Vent PLUMBING BPWSVCS Plain Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER ASC Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C.Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL / BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN R,-location of Furnace MECHANICAL BREMFURNOV Re to Furnace> IOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rein Non-Res Appliance ELECTRICAL BREMPOLE P:)Ie/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc Al, Switch & Outlets ELECTRICAL BREMRELOCA 'Zelocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 N k( 'F CITY OF CUPERTINO �No( C W bF PERMIT APPLICATION FORM CUPEkTiNO ,--Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rrzdl 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 remporary TemporaryPower ELECTRICAL BTEMPPERM Temn orar 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 PLEONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3