08110100CITY OF CUPERTINO',rzeb?.xn
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COTi'Ts "S T, 100 ORNMT-10N
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMIT NO.
10591 FARALLONE DR
TBD — TO BE DETERMINED
nR110100'
R'S NAME:
PERMIT ISSUE DATE
SA Y CONTROL NO.
ARCH=fENGINEER:
BUILDING PERMIT INFO
SERVICE UPGRADE
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLAItAnON
o
Job Description
p
Warned under provisions of Chapter 9 (Commencing
1 boto, w Warn
reby affirm is 1
with section 7") of Division Sof Ne Businnvand Rofeumns Code. sqadmy license, u
in full forte and effect. �
License Clan Lim ll Y
Dam g% Comment,G
ARCHITECT'S DECLARATION
I understand my Plantsshall bo used as public msorda
Licensed Professional
OWNER -BUILDER DECLARAnON
I botchy aRm that I am e..mpt from the Contractors License Law for one
rollowing muon (Sad= 71131.5. Business and Professions Cade: Any CRY W County
which pope. • Permit an cunalmcl. after. home. demolish, or repair any stmbm
prior an its M1{VaMe. SRU requires Ne applicant for Such permit la rile a signed sWemcm
Contrac=,U.. Law 9
Sq. Ft. Floor Area
Valuation
that k is licensed pursumt on Ne pmvivou of the (Chapter
(mmmcn<Ing with Suwon 7ODD) of Division 3 of the Business and Profession Code) or
this W is edompt therefrom and Ne basis fel the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant fel a permit subjects thc applicant b a Civil penitY of
=t mom dun five h=dmd doll. (ML
l,uow=rof Nepmpmy.mmyempl ymwith +gnuN,: wlecomp radon,
Required Inspections
andthe an Business
Rmes awddusset
heCom a(Sec.an
andoNeworis,
code The c=vacmM1 darter law San =t apply lf rt away of
and Pm Lacenc,
who Muipraorimgot woehimvlfedForage his
who
suNvmgandmessdorssuch
own em lot, ndedeloRrsed fel sale R,
awnemployes,provided Natsuchimp.
iartus
el impmversmt uold within one yea or mmPRe=. the ewar-
bowews, the building sold
builda will have the budm of porting Nat bo did rot ddM or improve fa PtnPos Of
the
tile.}
❑ 1, as; owner of the propeny, am exclusively contracting with licensed m mmnou an
mmust the, Project (Sec 7(14. Buinrsa and Pro(nsion Code:) The coammm rs W.
clrte law does not apply he an Owner of property who builds or improves themn, and.
who contracts for such projects with a contractor(s) licensed pursuant b the ConuabrS
Likens Law.
❑lOrn exempt der Sm . B At P C roc thio moon
Date
WORK 'S COMPENSATION DECLARATION
-
1 hereby anon order Penalty a perjury arc of Ne following decimations:
lf-inm fawmkeescomper,
1 Mw ass in will maintaa Cmefiom ofConcent b sti
now. as provided for by Section 3700 of the Label Code. fel tie performance of damwoe
for which this permit is issued.
C]I have and will maintain Workers Compcnaum Insu=re, u resulted by section
3700 of Ne Tatter Colt, for the pedomJamce of Ne work fore this permit is Issued.
which
My Workerpwation IrUn/Ice Paltry No.: nu / Ir3 OO�D( i
Cartlec ILs�•'— ``
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
fads scsi=must not 4 completed Etbo penis Is felo a huMrtd nations ($100)
Or less)
1 adfy Nit in the, perfmms se of the work for which this permit Is issued. I "I nm
employ any Peron in any manner an as to become subject to the Workers'Commnsumn
-
Laws of California Dau
Applicant
NOTICE TO APPLICANT. If, after making this Ccnificam of Exemption, you should
become subject in he Worker's Compensation previsions of the label Code, you most
' forthwith comply with such provision or this Permit shall bo domed rooked.
CONSMUCTION LENDING AGENCY
1 hereby aRm this them 'u a ConamNm lending agency for the, perfmmaae of
' de wort for which this permit Is issued (Sex. 3097, Civ. C.)
Undoes Name
'
,
Lenders Ade mss
1 cenify Na I have roti this application and suss this on, Wow infelmati= u
'
' colect. l at. to Comply with all city seat county ordinaav and suss laws relating in
Wilding sums c on. and hereby aallonm reprommadVC, of this city to Cow upon the
j anew-mendoned property forinpcction purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities.judgments, Cosa Out expenses which may in any my acme against mid City
in
APPL CAemac of the gr4fing of this N r UND ANDS AND Permit.
PLY WITH ALL NON -POINT
Issued by: Date 2
SOURCE REGU N5.
Z(9.0 8�
'
Re -roofs
Type of Roof
Sigwum of AppliDue
canUCon
US MATERIALS DISCLOSURE
Will de applicant Or factum building Ocmpmtstom Or handle hamdou ma=ul
laWdefined by the Cupertino Municipal Code. Chapter 9.11. and the Health and Safety
. S25532(a)?(.)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yo
[3y. �o
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use oquipmml or devices which
a haradnu it Conuminanta as defisd by Ne Bay Area Air Quality Managcmcout
all new materials for inspection.
rin7 /
C] Yet ONO
1 haw mad one haandous macrials requiremoms underchaper b.95 of the Csiifor.
da HealthBSafe Cade.Savelu75S(D.n533a Z534.1wdrntmd Nuifdc Willing
daea let Lmlell haw a ImNI. Na it Y my TSprllStEllily b IIa11fY de raaPalt Of dK
mquirtmcnu'hmuuEemeyPdp�ofaComecabofOccupancy.
Signature of Applicant Date
i4i Zb
All roof coverings to be Class'Wv or better
Doe'
Ow or aulnariscd age
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• 5 ITEMS OF 5
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN .......1: 36939036.00
DATE ISSUED.......: 11/26/2008
RECEIPT #..........: BS000006703
REFERENCE ID # ...: 08110100
SITE ADDRESS .....: 10591 FARALLONE DR
SUBDIVISION .......
CITY .............. CUPERTINO
IMPACT AREA .......
OPERATOR: SylviaM
COPY # : 1
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
311.96
---------------
311.96
REFERENCE NUMBER
----------
1415
' OWNER ............:
GABLER CARL W AND
VIRGINIA D
ADDRESS ..........:
10591 FARRALONE
DR
CITY/STATE/ZIP ...:
CUPERTINO CA,
95014-4406
RECEIVED FROM ....:
SJ RIOS ELECTRIC
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
1BELEC1001
-
METERS 1.00
---------- ------
119.88
0.00
-- --
119.88
-
0.00
1BSEISMICR
VALUATION 1,800.00
0.50
0.00
0.50
0.00
1BUSLIC
FLAT RATE 1.00
110.00
0.00
110.00
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
---------- ----------
311.96
0.00
-------
311.96
---
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
311.96
---------------
311.96
REFERENCE NUMBER
----------
1415
LU
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADD0
5/ 2 a ��
PERMIT#
OWNER'S NAME: 0-OKL GA4'31Gb2
PHONE# qLn
GENERAL CONTRACTOR: 7
FAX # 4oqO • Ss03 a
C
I am not using any subcontractors:r
Signa Date
Please check applicable subcontractors and complete the following information:
n
U
Owner/ Contractor Signature
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
Sheet Metal
Sheet Rock
Tile
n
U
Owner/ Contractor Signature
Date
Volt
CITY OF CUPERTINO
0 CUPEkTiNO GENERAL BUILDING
•
PERMIT APPLICATION FORM
U //0/00
APN # ; 3
Date: 0�3C?0
Building Address:
Mailing Address (if different from building address):
'5
Owner's Name: C (3 1943 /e &
Phone #:1{0 3 as3 34 S
Contractor: g ^� �� �S e
Phone:
Fax: tl l a5f4 $03o
Contractor License #: `t80 t -�R'2
Cupertino Business License #:
Contact:
Phone:
Fax:
ResidentialffF Commercial
Job Description: 5✓�� �P l,�c 2UU,o, Ip
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ IUIIUV-A ❑ II/III B, IV -HT, V -B ❑-�
V--�3
Valuation: .� Square Footage:
Project Size: Ex ress�andard ❑ Lar e ❑ 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.buildit reen.or
Revised 10/20/08
r.
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CI F
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1 GENCOM
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)
1BBOILER2
Installation /relocation of ea
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorDtion 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
Install ation/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)
IMEETINGIHR
Application Meeting
B
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