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07040170 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 20314 NORTHGLEN SQ VALLEY SKYLITES 07040170 OWNER'S NAME: PERMIT ISSUE DATE RICHARD ALFRED A AND ALFRED A 21530 ,'_LDERr R0FT HTS RD. 04/23/2007 iNE: SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO INSTAL: TWO SKYLIGHTS BLDG ELECT PLUMB MECH JO OC(5fqTftt(!T0R NEEDS TO o LICENSED CONTRACTOR'S DECLARATION u affirm p I hereby arm that I am licensed under provisions of Chapter 9(commencing O eserlption 2 Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect j ? License Class Lic.# o Date Contractor ARCHITECTS DECLARATION C J I understand my plans shall be used as public records )yU u y Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct.alter,improve,demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to file a signed statement =0 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y 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 APN Number Occupancy Type not more than five hundred dollars($500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered forsale(Sec.7044,Business -Required Inspections and Professions Code:The Contractor's License Law docs 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.It, 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.). owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li. cense Law does not apply to an owner of proper if builds or improves thereon,and. who contracts for such projects with a contracw )licensed pursuant to the Contractors License Law. ❑1 am exempt under Sa& B&P C for this aeon Owner Dale44 KERS MPENSA ON DECLARATION I hereby under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Workces Compcn- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I 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: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars($100) or less.) I certify that in the performance of the work for w ' this permit is issued.I shall not employ any person in any aancr so bc sub' Workers'Compensation Laws of Calif Applicant NOTICE TO APP A :If,Ifter making this Certificate of Exemption,you should become subject to.Ac Worker's Compensation provisions of the Labor Code,you must ,Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY vim+ I hereby affirm that there is a construction lending agency for the performance of Ix > the work for which this permit is issued(Sec.3097,Civ.C.) WC4 A Lender's Name a z Lenders Address U 0 1 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 Ubuilding construction,and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against V] liabilities,judgments,costs and expenses which may in any way accrue against said City U'Z in consequence of the granting of this permit. / t APPLICANT UNDERSTANDS LY WITH ALL NON-POINT Issued by: Date SOURCEREGU ON.V a-1 Re-roofs sipaiturepikliplicantlConuactor Daw HAZARDOUS MATERIALS DISCLOSURE Type of R)of 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 Safety Code,Section 25532(a)? ® All roofs:,hall be inspected prior to any roofing material being installed. C]Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m Iterials for inspection. District? �✓/ ❑Yes M�'u 1 havc read the hazardous materials requirements undcrChaptcr 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant,that it is—my responsibility to notify the occupant of the rcquircm nts whit must x e- rio e i d erufrcatc of Oce Signature A Applicant Date Owner or orizedagcnt Date All roof coverings to be Class"B"or better CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: B1:c: Lot: APN . . . . . . . . : 31641044 .00 DATE ISSUED. . . . . . . : 04,'23/2007 RECEIPT #. . . . . . . . . : BS0)00001064 REFERENCE ID # . . . : 07040170 SITE ADDRESS 20314 NORTHGLEN SQ SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER RICHARD ALFRED A AND ALFRED A ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0520 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR MICHAEL HULETT LIC # 23794 COMPANY VALLEY SKYLITES ADDRESS 21E30 ALDERCROFT HTS RD. CITY/STATE/ZIP . . . : LOE� GATOS, CA 95031 TELEPHONE (4C8) 399-0444 FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 .00 34 . 86 0 . 00 34 . 86 0. 00 BPERMFEE VALUATION 2, 000. 00 83 .16 0 .00 83 .16 0. 00 BSEISMICRE VALUATION 2, 000 .00 0 .50 0 . 00 0 .50 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 118 .52 0 .00 118 .52 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 118 .52 visa --------------- TOTAL RECEIPT 118.52 CITY OF C'UPERTINO -,d CITY OF' PERMIT APPLICATION FORM CUPEkTINO APN# // �f.• Date: f �AP — 4r—�� ` ` a7 0 Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: (i1o�s� Contractor: License #: Contact: Phone:jq3 f, ?161 Cupertino Business License#: ,t f` Fax: vZ 3 `N Building Permit Info: Bldg R Elect ❑ Plumb ❑ Mech ❑ Job Description: bra _ /,- ," Residential M S A vS Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: -)D- 0 Type of Construction: Please check this box if the project is a second-story addition: ❑ i Project Size: Standard ❑ Large ❑ Maior ❑ Qu_a_ntity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler>500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 E oiler> 1.75M Btu MECHANICAL BCONSTAX construction Tax BUILDING BCONSTAX In JJOff/Comm/Quasi BUILDING BCONSTAXBQ Cc n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax —Resi/Mobile BUILDING BELEC 1000 El ec 600V<= 1 OOOA ELECTRICAL BELEC1001 E lee 600V> 1000A ELECTRICAL BELEC200 Elegy: Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING of 3 s, n CITY OF CUPERTINO CITY of PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Conan. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Ir.spection Overtime BUILDING _ BPBACKFLOW At ospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Ga,;Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD PIE Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM 'Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS 1V ain Water Service PLUMBING BREINSPECT :Zeinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI .appliance Install MECHANICAL BREMBUSWAY F_emodel Busways ELECTRICAL BREMFIXT lighting Fixtures ELECTRICAL BREMFURN Re location of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT 1-[eater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rerr Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rcp J, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO ally, F PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rnidl 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 Scb Specific Plan BUILDING _ BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM TenTorary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE EI�c Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plu mbin2 Permit Issue PLUMBING PPLBG PLimbing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 rUPEkTINO Building Department JOB ADDRESS: PERMIT # do Ile-19 OWNER'S NAME: -e a 1 Z Z,� Y PHONE # V6 9' J� x6 � GENERAL CONTRACTOR let FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and cornlete the following information: SUBCONTRAC'T'OR 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 B Owner/Contractor Signature Date