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BUILDING DIVlS&jN PERK UT
�vCONTRAO QR�M-0
BUILDING ADDRESS:
PERMITNO..
10285 SCENIC BLVD
TBD —. TO BE DETERMINED
08100084
OWNER'S NAME:
PERMIT ISSUE DATE
SHOENHAIR RICHARD T AND
10/16/2008
WAnrvhn
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BURRING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LICENSED CONTRACTOR'S DECLARATION
- Job Description
P
1 bocby affirm that 1 an li¢md maker provisions of Chapter 9 (cammereinj
with Section 7") ofoivwon 3 of Ne Buddem and Protestam Code. and my Heads
RPLC/UPGRD ELECTRCL PNL TO 200AMP PER CEC
in full forte and effect
License Class Lia. e
Dale Contractor
.
ARCHlECrS DECLARATION
1 nonseasonal my plans shall In used as Wblic accords
.
Licensed Professional
OWNER -BUILDER DECLARATION
I bcrehy alrum that I am exempt from the Cro=ta rs U.cnse Law for the
following maven. (Section 913 L5, Business and Professions Cade: Any city or county
which requires a Permit to construct. alter. improve, demolish. or repair any t&cum,
prim m it issuance, also requims the applicant far such Permit to file a signed stat m om
dere Conuaclor's Levine law (Chapter 9
Sq. Ft. Floor Area
Valuation
Nat he is licensed pursuant to the pmvismas of
9 0 0
(commencing with Section 7(00) of Division 3 of the Business and Professions Cade) or
Nat he u exempt therefrom and the bub for the alleged enempdon. Any violation of
3 7 0 2 0 0 AF� Number
Occupancy Type
Seton 7031.5 by any applicant for a permit &bjeet the applicant to a civil penalty of
not mom Nan few hundred doll. ($Sore.
5 5
❑ 1, as owner of Ne property. ar my employees with wagon as their =is campmuation,
Required Inspections
will do the work. and the suuctum b nat Intended or offered far sate (Sec. 7044 Busineon
and Pmfessiam Code: The Conlncter's License law does not apply w an owner of
property who builds m improves thereat n, and who does web work hiwseif or through his
own emplmyot, provided Nat such improvement art not Inmnded aroffted foreside If.
bowewr. On building at improvement I. said wain. mac yet of compledm. the owner.
Wilder will have Ne burden of proving Nat K did set Wild or improve for purpose of
w'10
L u atheep of the conuacdni with contractors
• am uness
-
Cade:) Tie Com IU -
any ) The
Sec.7 Badness rod
came the project (See
tants
in an propertywho thereon, and
ose law dam ore apply er h,
La pmpemy who builds or
re(mpmva
calm contact for sucb paged with acontrxmrts) licensed pmmaum m the Convenors
w air, a re
Laccase law.
am sm'
(�
cl �lnlpa 1tL. 2 D,m D
pI T sr� Mae Qze
WORKERS COMPENSATION DECLARATION
1 hereby affirm maker penalty of perjury arc of the fallowing deelentions
I Law and will maintains a Cmifiom ofC..at w self -moue far Worker's Compen-
suian, as provided for by Section 3700 of the labor Cole, fm the Norman. of the
wet for whim that permit is issued.
Cl I have and will maimein warkeh Compensation Imur . as res aril by Section
3M of Ne labor Code. for de Performance orate wart forwhich this premie b issued
'
My Workers Compecash. loses ee omit and Policy number ac:
Carver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thbwctlan need not bacomplewd If Ne permit Is fmonc hunOmaddoltam (5100)
ar Ira)
1 certify that in the perfommccc of the work fm which Nb Permit b issued. I mall not
employ any personin�aanyy nom nm w`Y),'aWyb�ecome& cl w the worken' Compensation
as"00
cant rj�= a- of, 0 t A VL.
NOTICE TO APPLICANT: If. aver maWng Nis CeniBcam of Eaemplian, you NouW
become subject in the Workers Compensation provisions of the labor Conic, you mum
forthwith comply with such provisions m this perp t mall W deemed mevokcd.
CONSTRUCTION LENDING AGENCY
I hereby affiem tad Nem b a connotation kndins agency for rte performwee of
the wmt for which Nb Permit b issud (Ser. 3097, Civ. Q
dander's Name
,
Lenders Add.
1 certify Nat I live mad Nu application arM sum mho On above Indonesia. b
cmrtct. I apace w comply with all city and coanty onlinamia, and stay laws aching m
Wilding construction, oak hereby &thodse reprnsrattiws of Nb city w cora open the
Property far inspection purposes
(We) agree w ave, iakamrtify and keep harmless On City of Copula. against
liabaites judgments. cow and expenses whim may in any way acesse agdntl said City
in consequence of the training of this pomp
APPLICANT UNDERSTANDS AND ITU. COMPLY WITH ALL NON -POINT
/
Issued by: Date
R ULATI k
I
LA
Re -roofs
Type Of Roof
Si roof Applimn✓CRData
HAZADISCLOSURE
run= Wilding
ll Nor e applicant or forum building occupant scam or
Will e
and
and t Health
Safety az Oc0ne0 by to Cupenimm Municipal Cade. maptef 9.11. and the Health and Salny
Code. Second 255324)9
All roofs shall be inspected prior to any roofing material being installed.
❑ Yon 011.
If a roof is installed without first obtaining an inspection, I agree to remove
Win Nc applicant or plum building occupant use equipment or de.iees whim
kb
int nncd by the Bay Area Air Quality Management
ire hmardnus air comamwu mk
all new materials for inspection.
D str ct7
Yon Nu
I have real Ne hwNom mateiids requirement under Chap crii.95 of the Califor-
mitHealN&SdalyCde, Sections 75505.25533 and75534. 1unMnund Nuiftle building
does tet eunenty haw a tenant that It b my resNarbidity at notify trc..Pwt of the
'
n hich mom rte iSm. of c ricam of Occupancy.
i
Signature of Applicant Date
All roof coverings to be Class'W' or better
mer ar amthanvad agent Data
CITY OF
*UPEkTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Buildin De artment
JOB ADDRESS: �(
PERMIT #� L1
OWNER'S N '
PHONE # Q 2 -
GENERAL CONTRACTOR Q
GENERAL
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
/O to
Date
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-
ankSheet
SheetMetal
Sheet Rock
Tile
/O to
Date
• 4 ITEMS OF 4
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ...I....: 35702005.00
DATE ISSUED.......: 10/16/2008
RECEIPT #.........: BS000006361
REFERENCE ID # ...: 08100084
SITE ADDRESS .....: 10285 SCENIC BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: pdtg
COPY # : 1
OWNER ............: SHOENHAIR RICHARD T AND MARGAR
ADDRESS ..........: 10285 SCENIC BLVD
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2717
RECEIVED FROM ....: RICHARD T SHOENHAIR
CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBD - TO BE DETERMINED
ADDRESS ..........:
CITY/STATE/ZIP ....
TELEPHONE ........:
• FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
1BSEISMICR VALUATION
900.00
0.50
0.00
0.50
0.00
1EPERMITFE FLAT RATE
1.00
40.79
0.00
40.79
0.00
1ERT<200 UNITS
1.00
40.79
0.00
40.79
0.00
1TRAVDOC FLAT RATE
1.00
40.79
0.00
40.79
0.00
TOTAL PERMIT
----------
----------
122.87
----------
0.00
122.87
----------
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
NUMBER
------
CHECK
--------------
122.87
--------------------
#4272
---------------
TOTAL RECEIPT
122.87
s
J
A
•
0 OF
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
U"
APN # _
� 7v U c�,� . Ov
Date:
C7 �
Building Address:
1427-65—
I.LG
Mailing Address (if different from building address):
Ow e:
Phone #:
d '671L eO7 Z
Contractor:
Phone:
Fax:
Contractor License #:
Cupertino Business License #:
Contact:
Phone:
Fax:
Residential Commercial
Job Des c ' ion:
Building Permit Info:
Bldg ❑ Elect
Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
I -A, I -B ❑ Il/III/V-A ❑ II/III B, IV -HT, V -B
` L-3
Valuation:
Square Footage:
Project Size: Express E�Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.org
Revised 7/01/08
Cm of
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1GENCOM
1 BBOILERI
For the installation or relocation of ea
M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw
1 BBOILER2
Installation /relocation of ca
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3
Installation/relocation of ea
M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1 BBOILER4
Installation/relocation of ea
M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1•,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP
Other Electrical Inspections (per hour)
E
1MECHINSP
Other Mechanical Inspections (per
M
hour)
1 PLMBINSP
Other Plumbing &. Gas Inspections
P
(per hour
1MEETINGIHR
Application Meeting
B
E
•
•