08100158 CITY OF CUPERTINO ; r•,iee +i ,yr x;,i'A:
BUILDING DIVISION PERNUT . C01vTRACTQR Q�RNIATI N
BUILDING ADDRESS: - PERMIT NO.
11233 LA JOLLA CT GARY CORBETT C0NSTRjJQTTQN 08100158
OWNER'S NAME: PERMIT ISSUE DATE
NE: A O. a@ 8 CONTROL NO.
IN,
(831) 420-1148
ARCHITECT/FNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
a O O LICENSED CONTRACTOR'S DECLARATION
u� 1 thereby affirm Nal 1 am liansnd under provisions of Chapter 9(commercial Job Description
with Scedon7")ofDivlslan 3 of NC Business end Professions Code.and
3 mylice�is
<�,,, nrunmramndcrcecv. B g 44 4ELEC UPGRDE, GASLN 4 KTCHN, LIGHTNG& 1 FLUORCNT
�qz Lmeuse Clasr —
nt-p Dam Con DSC fi`/cLIGHT
!e
7W ARCHITECTS DECLARATION
U1 untdersunJ my Plans shall he uwtl an Public rarorN
g H Licensed Profcnional
IL
OWNER'BUDER DECLARATION
�E 1 hereby+Inion that 1 am exempt Tram On Contractofs License law for the
COO fallowing muam(Seedon 7071.5.Biomass and Professions Code:My city or county
which requires a permit ro conartaL alar.improv.demulah.m repair my ismc me
prior 0 its Issuance.aim m9Y1Rldmappllemt far such Permit in file.signed Bamment
i `e thululalicensed peraaanllamepmaamnsarmeca.tar.sU..L.w(cn,pmr9 Sq.FL Floor Area ' Valuation
yF$ (commencing with Section 7000)of Division Jaf the Business and Professions Code)or 3000
-� that he la exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by joy applicant fm a permit subjects the applicant in a civil Penalty of APN Number Occupancy Type
not more than five hundred delis,(5500). 35621045 . 00
Q 1,u owns of the prvarty,a my emplaym with wages u Neu cote compensation,
will prthcwork,and The
Corelamor's License
Lawdo Torula(See.IO N,Owner of
and Professions code The Contactor'. d.h.Law dam not apply m rt ro uh ser Required Inspections
property who bolltls mimprow thereon.andwho am aauch work himemfor threugh his
hOwn owever.
eWipmHded Out m0himpmvmmts vee not ear ofecvoRered for ale.r.
Wilder the Wilding or Mcto of provinismidwithinarm year of comove for purpose will have the burden of proving that k did nor diad or improv for puryove of
ale.).
Q 1,as Owner of the property am excessively contracting with licensed antraMa to
consensus the project(Sec 7014.Business and Pru(asions Code:)The canuscmfa U.
an=Law does oat appy to an owucr of property who builds in improve,thrtm.and.
who contracts for such projects with a eamsaetor(s)Examined pursuant in the Conujtta/a '
Pena Law.
Q lamexempturedaSec. .B&PCleathareswn
Owns Dau
WORKER'S COMPENSATION DECLARATION
1 hereby air..under penally of perjury oro of the following decluatioas:
uhave and will maintain a Cmificamaf Convent b self-insure ry WartelaCompen-
,u provided for by Section 37()0 of the labor Cotler,for the performance of do
work for which this permit m issued.
0 I have and will maintain Worawes Compensation Insutma,in required by Science
37W of we labor Cade.for the performance of dm work for which this permit is issued
My WarImes Component.4wrarm artier real Policy number am:
Cmim,.5,#LrE FU 147 Policy No.:11 0Ot'lOA-3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thus elan reed not becoupicu l Have permit is fmorm hundred du0iss($100)
or leas.)
1 anify Out in the performance of the work for which this Permit is leaned,I shall not
employ anypermn in my maremr an as in become subject in the Weedura'Compamation
Leave of Caliromia.Dale
A,U.t
NOTICE TO APPLICANT:If.afar making this Ccaifieme of Exemption•you should
execution wbjm or the Worker's Compensation provisions of the Labor Code you a=
.J O forthwith comply with such pmHsiom m this permit mail m domed mated.
Z7) CONSTRUCTION LENDING AGENCY
[•n I be ,affirm this Nem u a cotawctinn kridingagency far the perfuvnmauf
E
We work for which this permit is issued(Sec.3097.Civ.C.)
0 Lender's Name
z Landnes Address
U O 1 aunty this I have mad No application and same Out tins above Intonation.to
Iy^ corrin,l agree to wi
comply th all city and county indictment and sum laws miming in
C)SV' Wilding conswction•and hembymNarim representatives of Nu city to enter upon the
IA shove-mentioned property for inspection pur oms.
(We)agree Or save,indemnify and kap harmless tins City or Cupertino agent
ra'jl liabilities•judgments,tofu and expenses which may In my my acrnrc against said City
U e'Z in consequence of the gronung of Nu permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S— Date
sou REcu no
r-'1_ _ L-44" Re-roofs
Signature of AWlionUConu+cmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIB the applicant m future building occuput tram or hrndle hscommus maurial
u defined by do Cupertino Municipal Code.(Tarter 9.11•and tins Health and Safety
Code.Section 25532(+)7
❑Yes All roofs shall be inspected prior to any roofing material being installed.
to
Willsire applicant or future building Occupant um equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove
It hatrardnus oar cooumbenty u dc(mcd by the Bay Area Air Qusilly Management all new materials for inspection.
w ctT
Cl Y. No
I have red ft mamesiala reWimmcnamtderchapter 6.95ofthcCalifm-
meHealth&SeetyCow.Remain 25505.25533 and 25534.1 undemund this if ft building
dean no,c..dy haw r unant.this Ila my responsibility to notify the Occupant of the
ralube moa(the�mL armiaansrta OAcen""Orala Signature of Applicant Date
owner—anmarirxd n` I d`o e*� All roof coverings to be Class'%?."or better
CITY OF CUPERTINO
•8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35621045 . 00
DATE ISSUED. . . . . . . : 10/24/2008
RECEIPT # . . . . . . . . . : BS000006457
REFERENCE ID # . . . : 08100158
SITE ADDRESS . . . . . : 11233 LA JOLLA CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PEDROTTI DONALD G AND MIRIAM P
ADDRESS . . . . . . . . . . : 11233 LA JOLLA CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4738
RECEIVED FROM . . . . : GARY J CORBETT
CONTRACTOR . . . . . . . : CORBETT, GARY LIC # 21736
COMPANY . . . . . . . . . . : GARY CORBETT CONSTRUCTION
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP : SANTA CRUZ, CA 95060
TELEPHONE (831) 420-1148
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BREMRECEP NO. OUTLETS 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1BSEISMICR VALUATION 3 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40.79 0 . 00
1PGASRES OUTLETS 1. 00 61.19 0 . 00 61 .19 0 .00
1PPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 375 . 64 0 . 00 375 . 64 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 375 . 64 VISA
---------------
TOTAL RECEIPT 375 . 64
•
V
-T*
SHEET'' '
-z
Assessor's Parcel Number:
Name of owner. best
Project address. f I -z 1,-A L—L i/,.
Contact person. <S o.,ke <e_ in P_i�_Tr Phone. Z-1 k A 2c) 1( 4S
Fax.
Net square footage of lot.
i. ExistinR Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
e there at least two 10 foot by 20 foot clear spaces inside the garage? Y iN-
Is privacy protection planting required for the project?
On what floor(s) is work being done? L-r- c- p,
Brief description of work. xti
Code editions: 2008 CBC (Y - N)2008 CFQ,,pj65WAOO8 CMC N)
2008 CPC N)20MAWfibANC61N)HE CITY 01
t;UPEIMNO CODES AND ORDINANCES
Effective 1/1/08 'A
XNED
ihb sot.of plans end specifications MM,
,)a k* on the iob at a!1 times and it is ur,
awful to Makin, ca, or alteration
.)n SM with..u v, w.n permission fron
be building Dep.., CA". i Cupertino.
fhe MMping of lth..s p n rt. specification- 11� ell
'HALL NOT be he.d t, pt mit or to be ii
1ppr"l of.the violation of any provislo• ,
f RnV Cb (),n,nqrirP nr vatc I aJ.
OCT242DD9
Plan Review Process Work Book Page-8-Revised 1/1/08
Its
=ll w Community Development
F' 10300 Torre Avenue
.. , Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OCUPEkTINO
Building De artment
JOB ADDRESS: PERMIT#
2 3 LA Qe7lCot -re-
OWNER'S NAME: -o� PHONE # -3j AAo 4
GENERAL CONTRACTOR: Ec FAX #
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 pp
tals.n(12?
Owner/Contractor Signature Date
DO
«G J CITY OF CUPERTINO
• CUPERIINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # /o n ^ Date:
� ( / / o y� C) o •6 A
Building Address:
L I a L- A
Mailing Address (if different from building address):
Owner's Name: Phone#:
T- ZS-1 tAro
Contractor: Phone: Sal 4z6 ILA`b
GAr,L--/, - Fax: g3 1 4 2® t A
Contractor License#: p -Aq4 3A3
Cupertino Business License#:
Contact: Phone: Q°',( M o t t h,Z
• GnR C GT Fax: U45
Residential Commercial
Job Description:
klae_x tip rr4 ,,Eiz —tae l k- . n
Building Permit Info: 0r-k
Bldg ❑ Elect Plumb Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ HAI ❑ II/III B, IV-HT, V-B [— \`—.3
Valuation: e o Square Footage:
Project Size: Express 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 'B
Revised 10/20/08