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0810020202 z V a`> 11Wi C UC UC E Fp U ,vZ CITY OF CUPERTINO+,�..• BUILDING DIVISION PERMIT RCOIT2AGTI pIivANF„UItMATI.,�N BUILDING ADDRESS: PERMTr NO. 20064 JOHN DR TBD — TO BE DETERMINED OR100202' OWNER'S NAME: PERA4[LSUE DATE NE: A 0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO ! -BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACIOaS DECLARATION Job Description 1 hereby Mr.. this 1 w Ikcnad under pmvitionsor Chapter 9 (eommmteing with Salon 70110) of Divldon 5 of dm Rusiness aro Pmfessium Code."my liccma u imfull rorceand ertm GRND SOME EXTNG OUTLETS TO ELECTRCL BOX,, ADD cl". co L Damm`Cm H« Dam a OUTLET FOR RECIRCULATION PUMP ARCHITECTS DECLARATION 1 andercund my plans dull be utetl u While recoNs Lacerated Prefresuonal OWNER -BUILDER DECLARATION 1 hereby affirm Nal l ane mempt from the Canuacto/a License Law for Use following rescue. (section 7031.5. Business and Profusion. Code: Any city or canny which requirca a permit m CensWCL alter. impmte. demolkh, « repair try amnum prior Or iia issuance, also mnunci the applicant for such permit in rile a signed summent Sq. Ft. Floor Area Valuation Nal he is licensed Financial In the p roislo. of the Co.= -S UeC. Law (chapter 9 (commem)ng with suction 7000) or Division 3 of the Business and Pmfmumas Code) ar $600 that he u exempt therefrom and the, basis for the alleged exemption Any violation of APN Number Occupancy Type p y YP Section 1031.5 by any applicant fn a Faunal' SubjecVt thc spplie t 10 • civil penalty of ml mart Nan It. hundred dollars (5300). 36934027.00 I.ummr4 of the prolw+tY.«my wployw with wgn uthe'vaole campemadon, Required Inspections wIII dafework. 7Rad, Baser heCosanals Lusadarawdadseta(5n. aro Professions Crude,The Cmdanm'. Limue Law dun not apply m nth owner of is builds. impmrmth damsuchw«k himselfar duough his propertywhobuilds hapoandwho awo eroployem, provided crib ins are not ear deddo nonmed far rile If. Is sold wits ingorthus Ne builder. the building or Impmwmembmidwithinamyear or unnoted far pose of builder will base the burden of pmvinL than K did rot AUW n improv [« purpose of uleJ. u owner of dm property. am aelusinly contracting with licensed mntractms to construct be project (Sec. 7014. Business sed Professions Cade:) The Contractors L, casae Law does am apply Is se overs of proprny who builds re lntpmvm dmrem, and who contraco for such pmjecte with a con soctor(s) licensed pursuant ta the Contractor's License law. ❑lam uemp' tler .B h PC for Pas n owner Dam l� � O� ' WORKER'S OMP SATION DECLARATION 1 hereby affirm under penally or perjury on of the following dedandot¢ 1 haw and will maintain. CeruOmu ofCo.enl to aelr-insure forWalide.Compen- andim. u provided far by Section 3700 a We Labor Code, for the peAonnane of the wart far whist this permit is issued. ❑ I low and will maintain Weaker', Campe.atim I.., u unrated by Section 37M.fthc later Code. far the parfermuaofthe wart far which this pe. I, is heated. ' My Worker's Compemuion base. carrier and Policy number art: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE md. sed. Icei not becumpkxd Win, permit is from bundauddoNe (SIM) of IML) I certify that in Ne perfoormae of the work for which this permit u issued. I shall nor employ any pawn in any maom.o bjectm W mprnsstlao Laws of Califamis Dam Applicant ✓ G NOTICE TO APPLICANT. If, after making this OcrIificam of Exemption. yob stilmlif Occasion subject m the Workout's Compensation provisions of IW Labor Coda you am ' forthwith Cumply with such proviuons« this pC7R shall be deemed.1ned. 1 CONSTRUCTION LENDING AGENCY ' this Note is • conswNnn ageay for dm performame of 1 herebyrwhich 7. Cry. ' the er'k for whist this pctmil u Issued (Sa.3W7, Civ. C) chdu Larder's Name , Larder's Address , j 1 unify Nat I have read this application and sum than Ne aWve inentatianu ' comm 1 ague m comply with ill city aro county ooitunaa and sum Iowa relaung to building consuuetion, and hereby autharim mprmenu im of this city to enter upon the above-mrrtiaMd pmperty r« im'cuu. Purposes, (We) age to save, indemnify and keep heamle. the City of Cepa uaa against i li.bili6m judgmcnu, emu and expenses which may in any'w'ay accrue agA.l said City in comcqucce or the grantinL of this panniL ' APPLIC� AN�ILL C PLY WITH ALLNO� INT Issued by: Date (/ SOU Re -roofs / !0 7" mO'f Signature of Applicard/0 xtm Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or rut= Wilding «cugn, atom or handle tornadoes material u defied by du Cupenim Municipal Code. Chapter 9.12. and the Health and Wcly Code. Secure25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yu Isk"O If a roof is installed without first obtaining an inspection, I agree to remove Will the a,plicut «futurt Wilding oecupanl are equipment Of &A. which .i' haraoous ter conumirunu as defined by the Bay Area Air Quality Managcmcnl all new materials for inspection. V? DYm C5�u 1 hew mad dm hvandau ms adds rtquirtmenuuMer Chapter6.95 orNeCalifer- nuHealN&Sally Cade. Sec naa 25305, 25533 and 25534.1 undcssund this ifdm Wilding does ml C haw Ima dk dm h h my mihility m maty Ik aaiqund of dte .qui mh m ai a f.ccrdrte.moroccupaycy. Signature of Applicant Date ' -!6 ip All roof coverings to be Class'" or better %q Dam Dim Ownerauthamcd ag m CITY OF'CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36934027.00 DATE ISSUED.......: 10/30/2008 RECEIPT #.........: BS000006511 REFERENCE ID # ...: 08100202 SITE ADDRESS .....: 20064 JOHN DR SUBDIVISION ..... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: MICHAEL TIMPANARO PERROTTA ADDRESS ..........: 20064 JOHN DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4415 RECEIVED FROM ....: MICHAEL PERROTTA 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 1BREMRECEP NO. OUTLETS 1.00 40.79 0.00 40.79 0.00 1BSEISMICR VALUATION 600.00 0.50 0.00 0.50 0.00 1EPERMITFE 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 TOTAL-PERMIT ---------- -- 122.87 0.00 ---------- ---------- 122.87 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT 0 AMOUNT --------------- 122.87 --------------- 122.87 REFERENCE NUMBER -------------------- VISA 0 • CITY OF CUPERTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN #qq3� q 011, O O Building Address: SW W/U vz- :2©06 Gi. n�0 G,4- C}S-orZl Mailing Address (if different from building address): Owner's Name: Ar r amt- -R/-.-?� woo. P� Phone #: 4�8- 4 LF6 —332X Contractor: AT., I AJ97✓a Phone: (wf)776-3y7o yob) 7F2- — 0-73o Fax: -0 k Contractor License #: q( Z I d9m Cupertino Business License #: Contact: N Phone: �-+sk<�d Fax: a - '7 1 ^ o 47) Residential Commercial Lj b�,ce It- L406 -"n1. -'-341a Job Description: _ �20 �"'o SOMrL cF9T.N fr ou-�J�TS . T7J i LAG � d�}L ✓��x F- 0✓L 12F .vZe nfY' oN VOU^ e, Building Permit Info: Bldg [9-- Elect 19 Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ I1/IIVV-A ❑ IUIII B, IV -HT, V -B [/]� 2 -3 Valuation: 1{ ��p Square Footage: Project Size: Express ❑Standard ❑ Large ❑ Ma'or ❑ 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 1 o 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 ea 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 1 MECHINSP Other Mechanical Inspections (per M hour) 1PLMBINSP Other Plumbing & Gas Inspections P (per hour) 1MEETINGIHR Application Meeting B • •