08110004 CITY OF CUPERTINO �' ! .� - • ,> ' k'��'��ry =""rI
BUILDINGQTVISION PERMIT CUNTRAC*TOR I1VI4URMATION .
BUILDING ADDRESS: PERMIT N,
7652 WEST ED —
OW NEWS NAME: PERMIT ISSUE DATE
O : A CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
D O O O
3 0; LICENSED CONTRACTOR'S DECLARATION Job Descrl tion
�mC 1 hereby aRrm den 1 w li¢nsed under providotts a(Chapmr 9(wmmwrias p
ZW with Sceuon 70W).fDivm.m Sof Ne Business Pr essiom Code.tod my licensee
"<<�H mmRfnmewderc IN PANEL UPGRADE — NORMAN GALYEAN ELECTRIC PD
Lice. I and
le.
12(o
F Dam Conmcbr OR BSL 11/3/8 $110 . 00 (01000041752)
`g CHI ECCS DECLARATION
i 2 1 understand my plans shall W used as public records
o.
I:Wo� Licensed professional
OWNER-BUILDER DECLARATION
1 herchy aRrm that I am exempt from the Conuanor's license law for the
00 following mason.(Sectim 70313,Business and Pmfussiom Cade:Any city or county
$ff which requires a permit m caoso at.,after.improve.demal W,or repair any structured
—I„ prim w its issuance,also requires the applicant for such permit refile asignN SWement
m< that he is licermcd pursuant to the provisions ofthe Coovxcmri License Law(Chapter 9 Sq.Ft.Floor Area Valuation
BFO (commencing with Section 7")of Division 3 ofth Businessand Professions Codc)or
f�3 that he is exempt therefrom and the basis for the alleged exemption.Any violavon of 00
Section 7031.5 by any applicant fm a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
rot more dun five Waited dollars(3500} P Y YP
❑I,uowwroftlieptoperty,mmyceplcycmwithwagrsuthevwtewmKmdnn, 36227022 . 00
will do tbework.and tbestmmum v wt mmnded maffetod forule(Snc.70N,Busireas
YW prof e..I.Cede The Cormaemr's License La.daes WE apply In w awlmr of Required Inspections
Property who bWMsorimprmms dve.n,audition dosesuchwmk himselforduough his
own ceploym•provided dor inch improvements art rmsinteMed ooBctod fmnlo U.
however.me building or improvement is sold within arc year of cwpkuon.the owner-
buildcr ,will have the buNut of proving that he did tot build or improve for purpose of
tale.).
❑I.u..,of the property,am exclusively contracting with licensed comnctos to
construct the projea(Sec.7044,Business add Prefessiou Cade:)The Counsellor-,Li-
come law does not apply to in owner of property who builds or improv commit.it.and
who conuaeu for such pmjeeu with a contractor(s)licensed pursuant m the ContracuYs
License law.
❑Iwuwpsunder Sen ,BAPCfortNsmason
Ower Dau
WORKERS COMPENSATION DECLARATION
411 hereby aQm uunder penalty of perjury arc of the following deelamdom:
1 have and will maintain a Certificate of Co.,to self4mour for Worker.Compen-
on.as provided for by Seermn 37M of the Labor Code.fm the performance of the
work for which this permit is Issued.
❑I have and will maintain Wartime,Compeosalian Wizard .as moored by Section
3700 of the tabs Code,for the performanwof0u wool,for which this permit is issued. '
My Worker's Cwpeasation Insurance artier and Policy number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
rlhuxcdwoeedtmt beconplemdifth 'u for.hundrtddolms(SIM)
or lees)
I cenify Nat in N perfomusce a Nis permit is issued.1 shell not
employanyperm inanymen bject to lV rkes'ComRoolon
laws of Califomi .Dem
Applicant
NOTICE TO APP ski Nu Cervi main of Exception,you shwld
beeome subject b the don provision of the tabor Code,you muse
.7z forthwith comPlY with sea or Nu permitshelf hasserted revoked.
.Ely LENDING NDING AGENCY
[n r I hereby affirm that there u a wmtmcunn lending agency for the performance of
athe soh for which this permit B issued(San.3097,Civ.C.)
QLenders Name
Z) Z tinders Address
U Q 1 certify that I have rad this application and sum that the above information is
LL correct.I agree to comply with all city and cowry ordinances and sum laws totaling m
0 Wilding construction.and hereby auharire rtpresenuuva of this city to enter upon the
r a
above. perry a cum purposes
(\ ages m eve,indeWi .,wayseeme.galas
the City of Cupertino against
nF'-tell Iiabili judgmwu.coau andI midCityfing
RSfAN Y WITH ALL NON-POINr Issued by: DateOO
Re-roofs
5�Mm of A tar Dam
MATERIALS DISCLOSURE Type of Roof
t ter
Wilding mcupantsmm or handle huardous material
ud by Cuperimo nicipal Code.Chapter 9.12.and the Health and Safety
C , ction 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
t]Yes
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant are future Wading m'cupant use equipment m devim which g
ft*Ward..ai,emsommu u u defincd by tiro Bay Area Air Quality Manapme.t all new materials for inspection.
I.0
Yes No
Lha dthehauNaumme ri " underChapter 6.95ofthe Califor-
nmHcatitb aftlyCode,Sccuou 34.I undersand that it me Wilding
dote not urendy have a ren repo ility m rotiy the occupant of the
require cnot which t aCcnifcem of panry.�
D Signature of Applicant Date
Owner u oro em Dam' '
All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec.: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36227022 . 00
DATE ISSUED. . . . . . . : 11/03/2008
RECEIPT # . . . . . . . . . : BS000006527
REFERENCE ID # . . . : 08110004
SITE ADDRESS . . . . . : 7652 WEST HILL LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO '
IMPACT AREA . . . . . . .
OWNER KIDD LEWIS L AND CAROL A
ADDRESS . . . . . . . . . . : 7652 WEST HILL LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5057
RECEIVED FROM . . . . : NORMAN GALYEAN, CON
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
eFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- --- ----------
1BSEISMICR VALUATION 3 , 800 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00
1ERT2001K UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
1TRAVDOC FLAT RATE 1. 00 40 . 79 0. 00 40 . 79 0. 00
--- ------- ------ ----------
TOTAL PERMIT 143 . 27 0. 00 143 . 27 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ------------------
CHECK 143 . 27 #7726
---------------
TOTAL RECEIPT 143 .27
•
OkIl0 y
CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN � aa ��a2 . of Dt 308'
Building Address:
lAdddress:
I4 u, Zow r, 0"/ CA 9soo /v
Mailing Address (if different from building address):
OLner'sOC4 am kv�4Phone )/ D
Contractor: Phone: 9 7 8 9 ft
�OL Fax: 1 L�
Contractor License : 33` el
Cupertino Business License#:
Contact: w�I Aw � Phone:
• (`J V V�r Fax:
Residential Commercial
Job Description: n/� A t. / P"'L
"/� eew,
tvY �Vt! ) t.y
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, I-B ❑ II/III/V-A II/III B, IV-HT, V-B ❑� —3
Valuation: gmo Square Footage:
Project Size: Express [K�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.
OPoints Achieved:
For help, contact Build it Green at www.builditgreen.org
Revised 10/20/08