08120015 CITY OF CUPERTINO - 2+ x.a3�trow *�"
BUILDING DIVISION PE MIT .,,G RAGT"ORVINVO� SRM ATION -
BUILDING ADDRESS: rmmi T NO.
10933 LEAVESLEY PL BROTHERS
OWNER'S NAME: PERMIT ISSUE DATE
ON SA Y CONTROL NO.
ARCHTIECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECN
REPLCE 14 WINDWS& 2 PATIO O O O D
upQ LICENSED CON TRACTOR'S DECLARATION DOORS, SIZE FOR Job Descri tion
I hemby,&farm that l em li¢vea under Provisions of Chapter 9(onmmcncing p
< with Section 7000)of Dneision 3 of the Business and Professions ad my amy lleemmis —T^^ —T^_ —— .-.
,„ in" fame aM a ID94pl
b69
Lic,•a•Clual.ic.•
1.1-?.—OP+ Cmmm,
ee gQ 7W ARCHITECTS DECLARATION
i 2 U I mnersund,ey plan shall be used u public meorda
Dj!
g a to Licemed Professional
5
OWNER.B UILDERDECLARATION
rye 1 hereby afrom that 1 em otempt from the Conuvctors Uccma Law for the
i
00 following mason.(Section 7051.5,Business and Profeuians Codc:Any city or county
�s which requires a Permit to construct,alias improve.demnllm,nr.pair my snet..
Z<
Prior 0 b,inumm.also requires We applicant for such Permit in file a signed statement
E C that a is licensed paroant to the Provisions or the contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation
s€g (commencing with Section 7000)of Division 3 of the Business and Profession Cods)of ,
r3—
that he is esunpt therefrom and the basis far the alleged eumpdon.Any violation of
Section 7031.5 by arty applicant for a permit subjects tate applicant to a civil penalty of APN Number Occupancy Type
onr mo.Nan ftm hundred dollar(5500).
1,u owtur of the property army employees with wages ar dxh sole eompersadon.
will a.rhework,andthe he ctumumriomnade awdu lout a(Sec. Bush of
and ertywh obu Cam Tax cs themen.I^"�law aces Out apply m an oweer fir Required Inspections
man am whobuild&i improm thereon,and wa arnsuchwoM1 bhrtselfor through his
how mr,the s,pmN or that imprsonhimprommmthin mymnot armn of
moffad for sslelL _
however,the building or improvement Is told within ant year o!mprove far
the ownerf
builder will love Ore burdrn of proving Wt he aitl not build or improve for Purpose of
roam.).
❑1.u owner of the propmy sm caelm mly eomacmg with Ire."..d avnactma m
connotes Ne project(Sec.7064,Business and Professions Cade:)The Conume mes Li.
cove law don not apply to an owner of property who builds or improm Mumon,and,
who contracts for such projects witha mmmcmr(s)licensed p umarl to the Convectors
Liznse law.
❑Iamuemptunm See .B&PCforthismuun
Owen Disc
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury aro of the following decimations:
1 am and will maintain a Certificate of Covent m self-insure for Worker's compere
'am u provided fns by Section 3700 of the labor Code.for Ne pe rfarmamx of me
wmk for which Nis permit is issued
❑1 pave and will maintain Workers Compensation hwunce,a required by Section
37W of the labor Code,far the performance of the work(.,which this permit is issued. .
My WorkeaaeL��Co��mpor�Jdon Insurance carrier and Policy number am:
Cartier. /Y'!'ASTI Policy No.:Lrm—C7000 M bZ as
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ITU section need not Mcanplemd if rhe p.I,u(mane hunameddellara(5100)
or ins)
I Terrify Met I.the performance of Me work fm which this Permit Is issued.I mall rot
employ my person In my mmRr sec at m became subject to the Wormrt Compensation
Laws of Celiforil.Dam
Applicant
NOTICE TO APPLICANT.If.after making this CcriEmic of Exemption.you should
become subject in the Workers Compensation provisions of Ne labor Code.you mum
.,O fanbwith comply with such provisimu or this permit shall a deemed mooted.
? CONSTRUCTION LENDING AGENCY
[—t I hereby aRmm than Nem uaco 9.lmtdingagency for rix Perlormarxe u(
the work fm which this permit is issued(sec.3097.Civ.C.)
Lenders Name
z LuMds�dd.
U O 1 certify Nat 1 M.mad this application and sum Nat the abom informed.Is
IL E-' card.l egret m comply with all city and county oaffi ¢s and sum laws Id.1 to
0U building eomormton,and hereby authorim representatives of this city to emu upon the
LL7 above-mentioned property for inspection puryexs
(WO)agree to save,indemnify and keep bombast the City of Cupertino against
(0.q liabilities,judgments.cow and eapensu which may in my way..,.agmnst said City zz
'
U z in consequence of the granting of Nu Permit.
APPLICA FASTANDS D WILL COMPLY WITH ALL NON-POINT Issued by: Date tw
Re-roofs
of ApplicanUCCOOLTIct—ter Dam
SC
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will tix applicator future Wilding occupant more orandle hazardous material
ss aemsd by the Cupertino Mmdcipal Cade,Chapter 9.11 and the Hale,and Safety
Cade.Section 255324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yn e}N.
Will the applicant or future building occupant use equipment fir dcvicn which If a roof is installed without first obtaining an inspection,I agree to remove
it hvardnu air contxminsnts as defined by the Bay Arca Air Quality Management all new materials for inspection.
suictT
❑Yn ON.
latero maJ the hu micur mae:rials requlmemcnts under Chapter 6.95.fthe Califon
me Health&Sdcty Code.Semtiav]5505.25533 and 25534.I anticnmd Nm if Ne vikmg
don tot cu ham a mnanl Nu it' my.spovihility m notify dx.,am of the
rcgat
hichmamhe r m,s afccmpcmuy. Signature of Applicant Date
�a a
rora.e,.rirza.sent D . All roof coverings to be Class'p."or better .
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35615028 . 00
DATE ISSUED. . . . . . . : 12/02/2008
RECEIPT # . . . . . . . . . : BS000006727
REFERENCE ID # . . . : 08120015
SITE ADDRESS . . . . . : 10933 LEAVESLEY PL
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KEITH &SUSAN MILLAR
ADDRESS . . . . . . . . . . : 10933 LEAVESLEY PL
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4747
RECEIVED FROM . . . . : RYAN BUCHANAN
CONTRACTOR . . . . . . . : GENE V. CAVANNA LIC # 27964
COMPANY . . . . . . . . . . : BROTHERS HOME IMPROVEMENT
ADDRESS . . . . . . . . . . : 2510 DOUGLAS BLVD
CITY/STATE/ZIP . . . : ROSEVILLE, CA 95661
TELEPHONE . . . . . . . . : (408) 295-0680
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 10, 200 . 00 1. 10 0 . 00 1 .10 0 . 00
1WINREP EACH 8 2 . 00 734 . 00 0 . 00 734 . 00 0 . 00
TOTAL PERMIT 735 . 10 0 . 00 735 .10 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
------------ -- -------
CREDIT CARD 735 . 10 MC
---------------
TOTAL RECEIPT 735 . 10
s
Community Development
10300 Torre Avenue
.+ Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
46UPERTINO
Building De artment
JOB ADDRESS: ICtta3 tem rcke / Place PERMIT#
Cuper-liwo CA 9561y rl-&9lS
OWNER'SNAME: Ire i+ti 5 un PHONE 408 a`►s-0t-6p
GENERAL CONTRACTOR: bmi"ers 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
Owner/Contractor Signature Date
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CITY OF CUPERTINO
CI OF
CUPEKTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # �5 I Date:
Building Address: 16933 te0.yeakeq Place
Gy�cr}i.�o CA 9501y
Mailing Address (if different from building address):
Owner's Name: Phone#:
kei}4� 5ksc pine Diller Nag 2- -7 3
Contractor: ,11 Phone:(ybbj xis-o 68 O
$r�crg RbML
Fax:t g06),AqY--37'7 2
Contractor License#: b 9 qoo
Cupertino Business License#:
Contact: (ZPhone:
.�an T g�hahan (yob)59X-313_
• Fax:
Residential oC Commercial
Job Description: lq virclaaS -P,,6o Door-S
S;Lc 4w- S' ze_,
S�caS9Mc-4 F¢}ro- Fc!- -=nS kJI
Building Permit Info:
Bldg L�' 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 E�-- �1-3
Valuation: a, Square Footage:
Project Size: Expresstandard ❑ 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 hel , contact Build it Green at www.builditgreen.org
Revised 7/01/08
in,o CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING i
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BBOILERI 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
1BBOILER3 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
1BBOILER4 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
I 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 •