07080014 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
10312 VICKSBURG DR MC SOLkR ENGINEERING 07080014
PERMrr ISSUE DATE
OWNER'S NAME:
DAVID PIETROMONACO 2362 MLSH AVE
SA R CONTROL NO.
(408) 496-6226
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
o a a o
Z LICENSED CONTRACTOR'S DECLARATION Job Description
O
F. 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
U. with Section 7000)of Division 3 of the Business and Professions Code,and my license isSERVICE PANEL UPGRADE-CHANGING WAY SERVICE I S
N in full force and of et.
Z License�Ss Lic.#
a � `�.• BUILT.
p Date O Contractor �� S-_
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
U
'I- Licensed Professional
j OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
ofollowing 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
y prior to its issuance,also requires the applicant for such permit to file a signed statement Sq Ft.Floor Area Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $1200
e (commencing with Section 7000)of Division 3 nC the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of pp�� Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 914 0 0 7AP Number
not more than five hundred dollars(3500).
C]1,as owner of the property,or my employees with wages az their soft compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Conuactor's 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 Contractors
License Law.
I am exempt under Sec .B&P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I ha ve and will maintain a Certificate of Consent to self-insure for Workees Compen-
don,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,az required by Section ,
3 the Labor Code,for the performance of the work for which this permit is issued.
My Worker's C mpe sation Insurance carrier and Policy number are:
Cartier. 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 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 Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
Qforthwith comply with such provisions or this permit shall be deemed revoked.
- CONSTRUCTION LENDING AGENCY
iii 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.)
a Q Lender's Name
Lender's Address
C) i certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and slate laws relating to
Ubuilding construction,and hereby authorize 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
y Co) liabilities,judgments,costs and expenses which may in any way accrue against said City
Z in consequence of the granting of this permit. Date
�. APPLICANT UNDERSTANDS AND W Y WITH ALL NON-POINT Issued t y:
SOURC ATIONS. /l
Re-roof 3 r
gnature of ApplicanitContractor Dam T e of Roof
HAZARDOUS LS DISCLOSURE yP
Will dtc applicant or future but ding occupant store or handle hazardous material
az defined by the Cupertino Municipal Code,Chapter 9.12•and the Health and Safety
Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
O Yes "
If a zoo 7 is installed without first obtaining an inspection,I agree to remove
Will the applicant r future building occupant use equipment or devices which all new materials for inspection.
:mit hazardous air contaminants as defined by the Bay Area Air QualityManagement
District]
C]Yes
1 have rcad'the hazards materials requirements under Chapter 6.95 orthc Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building
docs not currently have a tenant,that it is my r 'h'' io notify the occupant of the Date
reyuircmen must be mel rior W iss to o Occu ancy. nater i e Of Applicant
r All of coverings to be Class"B"or better
O or authorized agent Date
CITY OF' CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 3E914007. 00
DATE ISSUED. . . . . . . : OE /02/2007
RECEIPT # . . . . . . . . . : BE000002241
REFERENCE ID # . . . 0', 080014
SITE ADDRESS . . . . . : 1( 312 VICKSBURG DR
SUBDIVISION . . . . . .
CITY CtrPERTINO
IMPACT AREA . . . . . .
OWNER DI.VID PIETROMONACO
ADDRESS 1C312 VICKSBURG DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014
RECEIVED FROM . . . . : M C SOLAR ENGINEER
CONTRACTOR . . . . . . . : MIKE CLIFTON LIC # 23003
COMPANY MC: SOLAR ENGINEERING
ADDRESS 2= 62 WALSH AVE
CITY/STATE/ZIP . . . : SkNTA CLARA, CA 95051
TELEPHONE (408)496-6226
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
BELEC200 METERS 1 .00 29.43 0 .00 29 .43 0 .00
BSEISMICRE VALUATION 1, 200 .00 0 .50 0 .00 0 .50 0 .00
EPERMITFEE FLAT RATE 1 .00 38 .37 0 . 00 38 .37 0 .00
- ------ ---------- ---------- ----------
TOTAL PERMIT 68 .30 0 .00 68 .30 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 68.30 15909
---------------
TOTAL RECEIPT 68 .30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL
} Community Development
10300 Torre Avenue
Z
gib. .
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: `"•-2 'd 7
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/Contract S' atu.re Date
( CITY Off' (.XPERTINO
CITY OF PERMIT APPLICATION FORM
C UPEITINO
APN# Date:
3�; �? -// 4��0 -) I -,-i-0 7
Building Address: J - Mailing Address (if different from building address):
.'C KS L
Owner's Name: Phone #:
rE�ntTactoi LlceTiSP # _
Cont ct: one: Val- Yf'� s alt Cupertino Business License#:
Fax: �J
-L4J!�7/ _ ,
Bur ding Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description: ,�<<e � u r�y ,L
Residential �j Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
r
Type of Construction: Please check this box if the project is a
second-story addition: ❑
Project Size: Standar. Large ❑ M,-jor ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Bailer<= 100,000 Btu MECHANICAL
BBOILER2 Boilf;r> 100K to 500K Btu MECHANICAL
BBOILER3 Boner> 500K to 1M Btu MECHANICAL
BBOILER4 Boil,;r> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ir:d/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and.Motel BUILDING
BCONSTAXR Cc nstax-Resi/Mobile BUILDING
BELEC 1000 E_ec 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
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