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07090147 CITY OF CUPERTINO BUILDING DIV13ION PERMIT S �T©R I �RMATIfl * PERMIT NO. BUILD `1919U NILSON CT GT ELEC PRIC 07090147 PERMIT ISSUE DATE OWNER'S NAME: LINTHICUM JAMES A AND CAROL D 6268 DESERT FLAME DR 09/21/2007 SANITARY NO. CONTROL NO. NE: (408) 362-9473 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 m LICENSED ONTRACTOR'S DECLARATION ob Description U1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z v� with Section 7000)of Division 3 of the Business and Professions Code,and my license is UPGRADE MAIN PANEL TO 125 AMP, C HNG SUB PANL TO t=y t. in full force and effec t n? License Class Lic.# 100 t a Dam Contractor ARCHITECTS DECLARATION AMP i < 1 understand my plans shall be used as public records )WU U.y Licensed Professional :O a OWNER-BUILDER DECLARATION j< 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 which requires a permit to construct.alter,improve,demolish,or repair any structure Z, prior to its issuance,also requires the applicant for such permit to file a signed statement ;;q FtFloor Area Valuation s a0 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 . $3800 8 O 0 i t- (commencing with Section 7000)of Division 3 of the Business and Profusions Code)or i 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 penauy of 3264901 9 Number Occupancy Type not more than five hundred dollars(5500). ❑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 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- cense Law docs not apply to an owner of property who builds or improves thereon,and. whocon cis for such projects with a contractor(s)licensed pursuant to the Contractors Lice Law. am exempt n err Sec .B&PC for this Owner Dale ZI WORKERS 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-insum 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 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 work for which this permit's issued,1 shall not employ any person in any manner}y as gecomL�j�Iect to the Workers'Compensation Laws of Califor�' r 7' f' y Applicant � �^ —� NOTICE TO P ANT:If.after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY Fr rte. I hereby affirm that there is a construction lending agency for the performance of _ (Y 7 the work for which this permit is issued(See.3097.Civ.C.) ifa A Lendcr's Name az Lender's Address U C) I certify that I have read this application and state that the above information is c correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. Q. (We)agree to save,indemnify and keep harmless the City of Cupertino against C/1 liabilities,judgments,costs and expenses which may in any way accrue against said City J U Z in consequence of the granting of this permit Date ( �� ►+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOURCE RE U q Re-roofs / Signature of ApplicantAZARactor Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE yp 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)? All roofs ;hall be inspected prior to any roofing material being installed. ❑yes No , If a roof i;installed without Will the applicant or future building occupant use equipment or devices which 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 N6 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements w tch must be met prior to issuance of a Certificate of Occupancy. �7 Signature of Applicant Date ! r' — q-2 f- ! All roof coverings to be Class"B"or better Owner or authorized agent - Jl )V 0/ V -7 CITY OF CUPERTINO err of CUPEl�TINO PERMIT APPLICATION FORM ,PN#3c�, tP q© l j, OD Date: 9— Z Building Address: Mailing Address (if different from building address): -;- I Q g CX w'i I sa�n C'-, Owner's Name: \ Phone#: Contractor- License#: Contact: Phone: ya$- 71, -d 9q 7 Cupertino Business License#: Um Fax: c�If-7 31 Building Permit Info: / Bldg ElElect Plumb ElMech El Job Description: / P r Q n4fl,,a +o !z S c, Residential Ei7/ fit_ SLS a,,_,e 41, '00a,, Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 7 Occupancy Group Type of Construction: r Please check this box if the project is a second-story addition: ❑ project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID ]Pee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Bol ler<= 100,000 Btu MECHANICAL BBOILER2 Boiler > IOOK to 500K Btu MECHANICAL BBOILER3 Boilc r> 500K to 1 M 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 Cor. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Cor.stax —Resi/Mobile BUILDING BELEC 1000 Elc c 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1A3 CITY OF C UPERTINO cuPft�F PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comn. Housing Mit. Fee BUILDING BNUCOMME NE.w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N-1w Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atr-iospberic Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Rf i e Of Fixtures PLUMBING BPSEWAGE Sewage Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM S torm/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 Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C -Jnits <= 10,000 cfm MECHANICAL BREMAPPLI j�ppliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT bighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relc Furnace> l OK btu MECHANICAL BREMHEAT Beater Installation MECHANICAL BREMINHOOD Ing 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 t1, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Reir.odel Res Appliance ELECTRICAL 2 A 3 CITY OF C'UPERTINO CITY OF PERMIT APPLICATION FORM CUPER`TINO Quantity Fee ID :Fee Description Fee Group BREMSIGNAD Rnidl 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 T,-m orary Power ELECTRICAL BTEMPPERM Tem?orary 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 Meeh Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Ph tubing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 of 3 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN . . . . . . . . . 32E49019 .00 DATE ISSUED. . . . . . . : 09/21/2007 RECEIPT #. . . . . . . . . : BSC00002721 REFERENCE ID # . . . : 07C90147 SITE ADDRESS . . . . . : 21E86 WILSON CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LITTHICUM JAMES A AND CAROL D ADDRESS . . . . . . . . . . : 21E86 WILSON CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1245 RECEIVED FROM . . . . : MRE . KELLEY T MUNSO CONTRACTOR . . . . . . . : TOIL: MUNSON LIC # 24731 COMPANY . . . . . . . . . . : GT ELECTRIC ADDRESS . . . . . . . . . . : 62E8 DESERT FLAME DR CITY/STATE/ZIP . . . : SAI\- JOSE, CA 95120 TELEPHONE . . . . . . . . : (4C8) 362-9473 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BELEC200 METERS 1. 00 29 .43 0. 00 29 .43 0. 00 BSEISMICRE VALUATION 3, 800. 00 0.50 0. 00 0.50 0. 00 EPERMITFEE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 70 .72 0. 00 70.72 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 70.72 VISA --------------- TOTAL RECEIPT 70.72 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 `WEkTINO Building Department JOB 1ng CQ �� fir ' l PERMIT # OWNER'S NAME: PHONE # ?7 Z - yqL( GENERAL CONTRACTOR: % L FAX # /70-YV 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 -�N� -07 Owner/Contractor Signature Date