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07090119 CITE'OF CUPERTINO BUILDIN(I DIVISIOid PERMITGfll 'TI CTflR IRTIflN• MSS: PERMIT NO. BUtLDJjl��4ESSCASTLETON ST PINNACE ELECTRIC 07090119 L PERMIT ISSUE DATE OWNER'S NAME: ELIZABETH SHASKEY 4718 ME]ZIDIAN AVE STE 123 09/19/2007 SANITARY NO. CONTROL NO. ,NE: (408) 5')2-1564 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p 0O LICENSED CONTRACTOR'S DECLARATION Job Description vF- I hereby affirm that I am licensed under provisions of Chapter 9(commencing ZU with Section 7000)of Division 3 of the Business and Professions Code,and my license is UPGRADE OF ELECTRICAL PANEL. u=y in full force and effect. >^? License Class Lic.# rp Date Contractor ARCHITECTS DECLARATION i a< I understand my plans shall be used as public records eyU U.y Licensed Professional OWNER-BUILDER DECLARATION } I hereby affirm that 1 am exempt from the Contractor's License Law for the jp O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,dcmollch,or repair any structure Z; prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation =0 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ,rq $1200 e.t- (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 of 3562004 Aebl Number Occupancy Type not more than five hundred dollars(5500). 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 oroffered 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 gl ,as owner of the property,am exclusively contracting with licensed contractors to struct the project(Sec.7044,Business and Professions Cook:)The Contractor's Li- chee Law does not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a conlractor(s)licensed pursuant to the Contractor's License Law. 0 I am exempt under Sec. ,B&P C7for this reason Owner41LA, Date WORKER'S-COMPENSATION DECTION I hereby affirm under penalty of perjury one of the lowing declarations: 0[have and will maintain a Certificate of Consent to self-insure for Workees Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor 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 (ibis 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 permit is issued,I shall not employ any person in anym n t become subject to the Workers'Compensation Laws of Calif i Date Applicant NOTICE TO APPLIC :If,after making this Certificate of Exemptio ,you should become subject to the Worker's Compensation provisions of the Labor Cddc.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 ending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 2 Lcndces Address U Q 1 certify that I have read this application and state that the above information is r corcct.I agree to comply with all city and county ordinances and state laws relating to Jbuilding construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. CL (We)agree to save,indemnify and keep harmless the City of Cupertino against tF"t liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit Date `�f APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: URCE GULA ONS. n ,44a,_f,. ' ,e. -ZZ-b Re-roofs Signu of Applicant/Contractor Dae T e of R sof HAZARDOUS MATERIALS DISCL SURE yP Will the applicant or future building occupantstom or handle hazardous material as defined by the Cupertino Mu""Pal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs;;hall be inspected prior to any roofing material being installed. ❑Yes No Will the applicant or uture 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? 0Yes u 1 have read the hazard 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 rcq ' menu which m be met prior w issuance of a ficate of Occupancy. Signature of Applicant Date C� �� _w All roof coverings to be Class "B"or better Owner(oj authorized agent Date - CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEk INO APN# � ,O d q �D 0 O Date: Building Address: :Mailing Address (if different from building address): ls>y C Owner's Name: Phone#: Fly Z�-b�-�-h S��► - f1� `��_�3 �, Cont actor: License #: pity rV4 C/ Contac * n Phone:t/�5"91 56 Cupertino Busines License#: e;44 CO 4e_110 Fax: '/c-,g-_ 9Y'7,-N 50 9 3 5 Building Permit Info: Bldg ❑ Elect LY F lumb ❑ Mech ❑ Job Description: Residential ® r/ E of P,4,, '' Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: �`� Occupab Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bo:ler<= 100,000 Btu MECHANICAL BBOILER2 Boile > 100K to 500K Btu MECHANICAL BBOILER3 Boil-,r> 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 Co:istax—Resi/Mobile BUILDING BELEC 1000 El,-c 600V <= l OOOA ELECTRICAL BELEC1001 Elee 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 CITY OF C'UPERTINO CITY Of PERMIT APPL[CATION FORM CUPEkTINO -Quantity Fee ID -Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM Nevi Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME In,,pection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE FIdg Permit Fees BUILDING BPFIXTURE PbIg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK l?lan Check Fee BUILDING BPLANCKADD Pla 1 Check Add Multi BUILDING BPLANCKREP Plait Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE S,ewa a Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING -B-PSTORNt - Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain&Vent PLUMBING BPWATER Insta II/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Jnits <= 10,000 cfm MECHANICAL BREMAPPLI t�ppliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT bighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relc, Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Iw,tallation of Hood MECHANICAL BREMMISC Vlisc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA RE;location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Rerr ode] Res Appliance ELECTRICAL 2 :)f 3 CITY OF C UPERTINO CUPER�F PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmc l Signs Add Branch ELECTRICAL BREMSIGNS Rem,)del Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE ",eismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem)orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Fusiness 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 Ply;mbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 A3 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35620046. 00 DATE ISSUED. . . . . . . : 09/19/2007 RECEIPT #. . . . . . . . . : BS000002682 REFERENCE ID # . . . : 07090119 SITE ADDRESS . . . . . : 21594 CASTLETON ST SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . OWNER ELIZABETH SHASKEY ADDRESS 21594 CASTLETON ST CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4703 RECEIVED FROM . . . . : HARRY K GREGG CONTRACTOR KEITH COSTELLO LIC # 29357 COMPANY PINNACLE ELECTRIC ADDRESS 4718 MERIDIAN AVE STE 123 CITY/STATE/ZIP . . . : SAN JOSE, CA 95118 TELEPHONE (408) 592-1564 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BSEISMICRE VALUATION 11. 00 0.50 0. 00 0.50 0. 00 EPERMITFEE FLAT RATE 11. 00 40.79 0. 00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 41 .29 0. 00 41 .29 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 41.29 #2056 --------------- TOTAL RECEIPT 41 .29 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ------ ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL Community Development 71N. 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 ClT1f OF Fax(408)777-3333 -,UPEI�TINO Building Department 0.70 0//� JOB ADDRESS: `` PERMIT# OWNER'S NAME: s:��.., ,.1 r_ i��-� %�� `-'r PHONE # 1 X411 -�,12 3, <12 �4 GENERAL CONTRACTOR FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and com lete 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 �y Tile +e Owner/C dnTractor Sign a Date