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07060234BUILDING DIVISION PERMIT BUILQIi226 EsCARTA BLANCA ST OWNER'S NAME: LINDA & JEROME MARTINO ONE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is n full force and effect. .icensc Class Lic. # )ate Contractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 703 1.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages az thea sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Cork: The Contractor's License Law dotes not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner builder will have the burden of proving that he did not build or improve for purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) Tote Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ i am exempt der Sec. B & P C for this reason Owner t Date �% f ORKER'S OMP NSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: O zC/I W; aA az UO OU Uz :arrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance f the work for which this permit is issued, 1 shall not employ any person in an r so az to become subject to a kcr ' m sation Laws of California. Date Applicant NOTICE TO APPLICA : If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Set:. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building conswction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT CRW INDUSTRIES 1157 DELL AVE (408) 37E;-2477 PERMIT NO. 07060234 PERMIT ISSUE DATE 06/26/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description REPLACE TWO WINDOWS WITH SAME SIZE DOUBLE PAYNE; ONE IN LAUNDRY ROOM & OTHER IN 1/2 BATH. HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safely Code, Section 25532(a)? ❑ Yes 4�ryu Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑Yes �No 1 have read the hazardous materials requirements under Chapter 6.95 of thc Califor- nia Health & Safety Codc, Sections 25505, 25533 and 25534.1 understand that ifft building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which in met nor to r cc of a Cc 'focate of Occupancy. Owner or authoaYcd agent I Date' Area 3 2 613 04' a Number Issued b) Re -roofs $740 occupancy Type Required Inspections Type of Roof All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature, of Applicant All roof coverings to be Class "B" or better Date 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN 32613049.00 DATE ISSUED.......: 06/26/2007 RECEIPT #.........: BSC00001804 REFERENCE ID # ...: 07C60234 SITE ADDRESS .....: 22265 CARTA BLANCA ST SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER LINDA & JEROME MARTINO ADDRESS CITY/STATE/ZIP CUPERTINO CA, 95014-1008 RECEIVED FROM ....: LINDA A MARTINO CONTRACTOR .......: BILL BURR LIC # 23525 COMPANY ..........: CRI INDUSTRIES ADDRESS ..........: 1157 DELL AVE CITY/STATE/ZIP CATIPBELL, CA 95008 TELEPHONE ........: (408)378-2477 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BENERGY ------ PERMIT FEE ---------- 83.16 ----------- 39.92 -------- 0.00 39.92 0.00 BPERMFEE VALUATION 740.00 83.16 0.00 83.16 0.00 BPLANCHK PERMIT FEE 83.16 110.98 0.00 110.98 0.00 BSEISMICRE VALUATION 740.00 0.50 0.00 0_50 ----- ------0_00 TOTAL PERMIT 234.56 0.00 234.56 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 234.56 --------------- 234.56 REFERENCE NUMBER -------------------- VISA CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM APN # Date: /.3041 9. o Building Address: 7 ]Mailing Address (if different from building address): Owner's Name: Phone #: 7,7 Z Contractor: License #: BBOILER2 Contact: Phone: 4 0, -3 -7 1 Cupertino Business License#: Fax: 46%- 31� - z, 0*20- 2 1 S Z Building Permit Info: Bldg E4-- Elect ❑ F lumb ❑ Mech ❑ Job Description: f4 �P � tc`' �" �"`` F`cl� ` `%-' `� �a� S ` �e "` t� Pn,°I``�z- Residential (' 1 is i'/, Ll,",utck v✓Ccwn 64L� , i 'lz bcV, Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a Construction Tax second -story addition: Ll_- 0+--A -A r11/ T arae f-1 Mai or F1 In,J/Off/Comm/Quasi i 1 V IG%.t LJMI-o U Quantity Fee ID BAPPLOTHER Fee Description ether Appliances Fee Group MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boil --r > 500K to 1M Btu MECHANICAL BBOILER4 Boilcr> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX In,J/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec: Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD :energy Add Multi --r_— BUILDING BINVESTIGA Investigation fee BUILDING of 3 100F ,11 CUPERTINO CITY OF C UPERTINO PERMIT APPLICATION FORM Quantity Fee ID BMISCELL fee Description Miscellaneous Fee Fee Group BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldjl Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK flan Check Fee BUILDING BPLANCKADD Plaii Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Rf pipe Of Fixtures PLUMBING BPSEWAGE Sewage Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Insta.lUAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Re _ocation of Furnace MECHANICAL BREMFURNOV Rel) Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD In itallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL gREMNRAPP Rerr. Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rept], Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL u'D1WK4VP0App Rer,edel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPEk INO CITY OF C UPERTINO PERMIT APPLICATION FORM Qua nti Fee ID lee Description Fee Group BREMSIGNAD Rmc 1 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD c cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Ti -,m orary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS remp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PT.I.ONGRNGR Planning Long Range Residential PLANNING 3 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: L. E� 4 3 -C--ems U�,i'�i� � OWNER'S PHONE # �I o � - 3 7 F - 2y 77 K-7--z- CONTRACTOR: be o c rz-t.:) FAX # 'to? - > -IS- -n07 I am not using any subcontractors: Signature 1p10,noo ar,r,l;rahlP a„hrnnirarfnr-, and comr-lete the following information: Date 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 Owner/ Contractor Signature Date