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08120074 CITY OF CUPERTINOa^ s*+x+X4 axwaF.�e'kt ' BUILDING D,;WsION PERMIT COI TRACTOR II URMATION BUILDING ADDRESS: PERMIT NO. 10367 VISTA KNOLL BLVD TBD - TO BE DE EEXINED- 08120074 OWNER'S NAME: PERMIT ISSUE DATE A O. CONTROL NO. NE: ARCHthECTIENGINEER: BUILDING PERMIT INFO BLOC ELECT PLUMB MECH l� 0 um0Q LICENSED CONTRACTOR'S DECLARATION Job D05CrIpUOn U F 1 hucby arrimetrot 1 am il—. d under pmvic assar Csup.9(mmmenem, withSatwn TIXX)ofDivem 3ofdm Butivavana Pmrectians Caa9 mylicc=¢ .MP' inm seemeeffect G�(j�fj REPLC WATER MAIN BETWEEN WTR METER & HOUSE m z Llave Class Uc,a teacher e Oam I understand my plans Nall be�d u public records JyU k I Licensed Profeuiovl cI OWNER-BUILDER DECLARATION COGhereby Affirm that 1 1 ,Bump(Intent bo Contractor's ds L erose Law for 1W COG O following reason.(Section]0313,Business and Profession Calc:Any city or county $� which rcquirns a permit to comrucl,alar.Wpmve,sumo(W,Or rtpair any stroerum prior m its ance,alxa rtquims lie Applicant for soh pumm rile a signed summcm —xi thatWklicensoaedpursvnuathepmvisionsofthe Contrmmr'slJcevclaw(Chapter 9 Sq.Ft.Floor Area Valuation YDS (commenting with Section 7000)a Division 3ofthe Business And ProfessionsCode)of 1500 Nat W u exempt themrmm and the hssu for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit mbjccm lW applicant to A civil penalty Of APN Number Occupancy Type not mart dun five hundred dollar(5300). 32613117 . 00 0 1,As awoer of the property.or my employees with wages As their sale compensation, will do the,wart,and de sbumum is not intended or offered for sale(Sec.7014.Busiress ns Required Inspections And pretensions Code:The Coobacmrs License Uw does WE apply m an owner of q P property am bunds or improves thereon,and veno does sten work hivuelr ar through his own employees,provided dist such improvements are not inuMed oroQe ad f0esok.If. A...the building or improvement Is mid within one year of eempktion,the owner- builder will leave the burden of proving that he did ma Wile or improve for purpose of sakJ. 0 1,ex ownex of the property.Am extensively cnntanling wiilb licensed cormns mes m coutrocl the pmlecl(Sec 7014.Business and Profession Cade:)The Conbmmrs Li. cannot,few dues rot Apply in,an owner of property who Wilds or improm theman.and, who contracts for such projects with a eonuactor(s)licensed pursuant to the Contractor's Lkene Law. 0 lans...Ptunder See ,BkPCfor Nisreamn Owner Data WORKER'S COMPENSATION DECLARATION 1 Amoy aRum under Penalty of perjury one of to rafkwms hclmaderns, - - have AM will maintain A CartiOcauaf Cement self-inure far Wanden Wands Comp - don.ss provided fee by Section 3700 of due Mbar Code.far the performers of to work for which Nis permit is ismod. 0 I have and will mgmant Worteh Compensation Ivuranca,An required by Section 3700 of the Mbar Cade.for the performance of the wort for which this permit Is issued. My Warkefa Campmossm. carriar and Policy number am: Carrier, Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE CMinacerlmt rand notac,completed if 1W permit isrorobe hundred dollms(5100) ar leu) 1 ceni(y dant on than performence of de wart Ise wppm'h N''u�pumila iaucE.1 shell not employ any person in my manmrmaamhcmx ANienem the WWk,n'Compenadon Laws of Calirom`a DYe 66�lCCJJ''`��/iy rr2ii� — Applicant 701 NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should become suhkct to the Warkds Compensation provisions of than lJbor Code,you most �z fodAwith comply with such provision or this permit shall bo deemed revoked, OCONSTRUCTION LENDING AGENCY (-+ IWrtby damn than there is a mruuucdon lending agency for to performnce of C the wrk for which Nis permit is issued(Sec 3157,Civ.C.) W�Q LaMcYs Name D z Lender,Address U O 1 c rdfy that I have read Nis Application And suis that the above information is IT. ^. comm 1 agree to comply with All city and county mdivnet,s And sum laws misting to 5th Wilding convection,and hembg authorize repmmnutives of this city to cnmrupon the 0. ahove-mention properly for inspection purposes (Wan)agree to save,indemnify and keep harmless the City of Cupertino against nF.r to thbihsiiesjudgmcns.costs end expenses which may In my way accrue against mid City UZ in cmwgvnce.1'the granungof Nis penult. ^v APPLICANT tlj/NDERSTAND AND WILL CQQQQQQ LY WITH AIL NON-POINT Issued by: Date SOURCE OLATTO� �s� Re-roofs Signature of "liesnUCantracmr Dam IlnznR HDUS MA ALA DISCT.OSURE Type of Roof Will the appEantor fil.Wilding occupantstoro or haMk hazardous material As defined by the Cupertino More 1 Code.Chapter 9.12.And de Health and Safety Code,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. 0 Yes o Will the applicant or future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it luvardon air c.rome ants as defined by tho Bay Ma Air Quality Management all new materials for inspection. strict? GYu V. I have mad the tomand notherialamquimemasu"p=G95 oftie Glifor. NaFlvilh S.1etyCade,Savau25 SJJ and 2533d.1uMermarrd thcifNc Wilding don n ndy hate,umans that i u y resportsibility th redly the aceta of Use mqui fits matWmetva ancm0amar rapuuy. Signature of Applicant Date 12 O r O Own raraamarizeaasem am All roof coverings to be Class'%¢"or better CITY OF CUPERTINO • 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : TWp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32613117 . 00 DATE ISSUED. . . . . . . : 12/08/2008 RECEIPT # . . . . . . . . . : BS000006778 REFERENCE ID # . . . : 08120074 SITE ADDRESS . . . . . : 10367 VISTA KNOLL BLVD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FIRST STATEWIDE REALTY ADDRESS . . . . . . . . . . : 10367 VISTA KNOLL BLVD CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1035 RECEIVED FROM . . . . : VIP PLUMBING & DRAI 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 ---------- ------------- --------- ---------- ---- -------- 1BPWATER UNIT 1 . 00 40 .79 0 . 00 40 . 79 0 . 00 1BSEISMICR VALUATION 1, 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 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 --- ---------- ---------- TOTAL PERMIT 236 . 87 0 . 00 236 . 87 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER -- --------------- ----------- CHECK 236 . 87 #1382 --------------- TOTAL RECEIPT 236 . 87 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING • el Community Development \t 10300 Torre Avenue t:R1F^% • Cupertino CA 95014 '' Telephone(408)777-3228 CITY OF Fax(408)777-3333 OUPERTINO Building De artment JOB ADDRESS: _ PERMIT# p 10367 Vi31A (NOGG �LvO ��0 OWNER'S NAME: If/ 5T 6 2M C PHONE # 'fO 263 46-55 ET ( 7- GENERAL 7- GENERAL CONTRACTOR W P Pl_ � / (%J FAX # I am not using any subcontractors: )2 GS Signature Dat Please check applicable subcontractors / d complete th4lfollowing 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 ' CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEI.TINO PERMIT APPLICATION FORM APN# r / f� -7 O Date: X02 Vi fz G 8' ZO=O g Buildingg,Address: 1 D3 6 7 V 14- VD s Dame: ._ S Phone #: Contractor: P ne#: VIP R-ur-IgInJG A /V �l� � /<J C' 6tfr7 22 !S1&:' CiL C f� N i IV Cp- Fax #: / Contact: Phone#: bl©NRa=� 1r'44f> 64ti 2��� Fax #: Contractor License#: Cupertino Business License #: Job Description RcPJ/q:c R "A A.) at %k7cc AJ Wfl lc 2 4IResidential Commercial ❑ Valu n: i,5 o c9 Project Size: Express Standard Large Major❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BSEISMICOM Seismic Commercial P 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P IRPSS sewer/sanitary sewer CITY OF CUPERTINO GSE'` REPIPE/SEWER/MAIN SERVICE CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group IPRREPIPE Residential re-pipe per fixture P IR-PRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P IPCESS Cesspool P IBPWATER Install/alter Water Pipe P IBPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P IPPERMITFEE Plumbing Permit Fee Issuance P / 1PLMBLNCK Plumbing Plan Check P • IPLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B Revised 6-16-08 •