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07060188 CITY OF CUPERTINO BUILDING DIVISION PERMIT G.dINT] CTQR QR AT�f)1 * BUILDING ADDRESS: PERMIT NO. 21199 OROGRANDE PL TBD - TO BE DETERMINED 07060188 PERMrr ISSUE DATE OWNER'S NAME: CUNNINGHAM DANIEL AND 06/22/2007 SANITARY NO. CONTROL NO. f,M:T rTUL'D TTT BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH a 0 a a i p p LICENSED CONTRACTOR'S DECLARATION lob Description % )= 1 hereby aCfrm that!am licensed under provisions of Chapter 9(commencing CZ,)UW with section 7000)aI'Division3oflheBusiness and ProfessionsCode,and mylicense's KITCHEN REMODEL, RELOCATE REFRIGERATOR, >>y in full force and effect. j Z License Class Lic.# MI CROWN TE, o Date Contractor ARCHITECTS DECLARATION OVEN. I understand my plans shall be used as public records �uJU LL.F- Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Calc:Any city or county which requires a permit to construct,alter.improve,demolish,or repair any structure u Z} prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q.Ft.Floor Area 2 O 0 O H (commencing with Section 7000)of Division 3 of the Business and Professions Cade)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 Number Occupancy Type not more than five hundred dollars($500). 36217015 ❑1,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 for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does 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:)The 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 conu=or(s)licensed pursuant to the Contractor's License Law. ❑1 pt der c. B&P C for this reason Ow r Z 2 6 OR bffAITION DECLARATIO 1 hereby a rut under pen of perjury one of the following declarations: L]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. ❑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 Worker's Compensation Insurance carrier and Policy number am: Carrier. 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.) 1 cenifv that' r ormance of th work o which this permit is issued,1 shall not employ an rson any atmer tab to subject to the orkers' om ensadon Laws of ili( Applicant NOTICE TO APPLICA :If,after m 1,j this Certificate of Exemption,you should become subject to therker's Compensation provisions of the Labor Code,you mus ,J O forthwith comply with ch provisions or this permit shall be deemed revoked. z"" CONSTRUCTION LENDING AGENCY E^— 1 hereby affirm that there is a construction lending agency for the performance of p4 the work for which this permit is issued(See.3097.Civ.C.) QLender's Name a z Lender's Address U 0 1 certify that I have read this application and state that the above information is V.►+ correct.I agree to comply with all city and county ordinances and state laws relating to O V building construction,and hereby authorise representatives of this city to enter upon the U above-mentioned property for inspection purposes. Ctr (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 U Z inconsequence of the granting o(this per to �. AP NT UNDERSTAND AN ILL COMPLY WITH ALL NON-POINT Issued by Date ' UR R ON ,7-Z Re-roofs �/ ftnkt—urc of Appli t/Conuactor Date T e Of Roof HAZARDOU ATERIALS DISCLOSURE yP Will the applicant or future uilding occupant sore 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 Shall be inspected prior to any roofing material being installed. ❑Yes If a roof i 3 installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as def by the Bay Arca Air Quality Management all new rr;aterials for inspection. District? ❑Yes o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 undersand that if the building does not currently have a tenant,that it is my rc#onsibility to notify the occupant of the rcyui Its hich must be me r to issuan&of a Certificate cupancy. Slature of Applicant Date All roof coverings to be Class"B"or better caner t nt CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B11:: Lot: APN 36� 17016 .00 DATE ISSUED. . . . . . . : 06/ 22/2007 RECEIPT #. . . . . . . . . : BS(,00001743 REFERENCE ID # . . . : 07(160188 SITE ADDRESS 213.99 OROGRANDE PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CUNNINGHAM DANIEL AND CATHERIN ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4151 RECEIVED FROM . . . . : DAPIIEL CUNNINGHAM CONTRACTOR . . . . . . . : TBI) - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBI) - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY 2�MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- 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 BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 .00 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 190. 66 0. 00 190. 66 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 190. 66 #4175 --------------- TOTAL RECEIPT 190. 66 CITY OF CUPERTINO CITY OF PERMIT APPL[CATION FORM CUPEkTINO Date: _ LPN# �r 7 �1�' ©© / Build' Addres : Al,,Wailing Address (if different from building address): wner's Name: Pho e-#: Otis .t J-5-7- ontractLicense � L,�I�hri G #�2 Z�'Y-7 Contact: Phone: Cupertino Business License#: �—7— (/ 1�� Fax: Building Permit Info: Bldg CR" Elect ❑ Plumb ❑ 1,lech ❑ Job Descri tion: Residential �Kzc�� L dC% Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Projec I-0 Occupancy Group: 3 Type of Construction: Please check this box if the project is a CZW second-story addition: ❑ ?roject Size: Standard ❑ Large ❑ Ma or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER ether Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boil--r> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Inii/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co:Istax-Resi/Mobile BUILDING BELEC 1000 El-,c 600V <= l OOOA ELECTRICAL BELEC1001 E lec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 11w "Ra 1111 CITY OF CUPERTINO CITY OF PERMIT APPI,[CATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Corr in. Housing Mit. Fee BUILDING BNUCOMME N,-w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP 1`ew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE B1dg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Ga:; Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD PIE n Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE SewajZe Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lavin Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pipe PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Zeinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY F:emodel Busways ELECTRICAL BREMFIXT : ighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Reb Furnace> l OK btu MECHANICAL BREMHEAT Ileater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pc le/Platform Fixture ELECTRICAL BREMPOWER Pow�r Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R,-,pair/Alter Heating MECHANICAL BREMRESAPP Rerlodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUP TYOF O PERMIT APPLWATION FORM 'Zuantity Fee ID Fee Description Fee Group BREMSIGNAD Rin it Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Th(:atrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD ,')cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL .; pedal Inspection BUILDING BSWINI Swimming Pool BUILDING BTEMP T em orary Power ELECTRICAL BTEMPPERM Tetr porary Bldg Permit BUILDING BTEMPSVCS Temp 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 PI zmbing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING PLLONGRNGR Plannin Long Range Residential PLANNING 3 of 3 s Azy r qui a ,,„„ ,• 3��' ��' .e- M �`���- �' � `rT�'�.� i Mtr=' ,e��s� a'kw '�zF � � 41 jj Assessor's Parcel Number: Name of own Project address. L-�Contact perso ___phone. S Fax. Net square footage of lot. Eic.sting Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? �N required for the i-oj ect? Is privacy protection planting q P On what floor(s) is work being done? _ aril — Brief description of work. O �Jvrt`01(L Ls? Lim.(';2_G� `,1 •YL'f�� Code editions: 2001 CBC V,,-),N)2001 CFC' lam'-N)2001 CMC (Y-N) 2001 CPC (Y -1)2001 NEC N) e� liv LErORD.AfUPR1OEffective 1l/1/02 CE W �T�HEOPANS OCfry p,)ATE RDINANCE,6 ; , 'ICNE %hi s ser of p-a,�_� I�8 fkept oil the/J}b rid specificati T1 ul to ma':t at,?%times ons h9C� � 1J St9 a n NB i? m Wii/1( ally Cfi�nor s a d it is U, he bu6'diR trt Nvritf,, °r alterat., rhe sta IAE t., City of pE1 mission fro `HAL mp'ng of this Cupertino. on NOT p'an and 'ppro�al o f be heid to per sP8clficati0ns i rhe violation of mit 3o!r City Orgrnarrce of Stat ny Provor to iftrt, e W. Plan Review Process Work Book Page-8-Revis-,d 8/22/05 KITCHEN and BATHROOM CIRCUITS REQUIREMENTS* MINIMUM REQUIREMENTS FOR KITCHENS: CIRCUITS - (No lighting or other outlets may be on any ci-cuits listed below.) 2 or more 20 amp small appliance branch circuits. Serve kitchen, pantry, breakfast room, dining room and clock, electric ignition systems (gas cook top). 1 - 15 amp or 20 amp for built in microwave fix in 1 - 15 amp for each garbage disposal 1 - 15 amp for each dishwasher 1 - 15 amp for each compactor 1 - 15 amp or greater permitted for re-'rigeration equipment RECEPTACLE SPACING FOR KITCHEN COUNTER NEC Code requires a receptacle outlet at each counter spE ce wider than 12 inches, spaced so that no point along the wall line is more than 24"from a receptacle. Receptacles t:)serve island or peninsula counter tops shall be installed above, or within 12"below counter top. Receptacle outlets shall be installed so that no point along the center line of the long dimension is more than 24"measured horizontally from a receptacle in that space. The measurement of a peninsula type counter top is from the edge connecting to tie non-peninsula counter. Counter top spaces separated by range tops, refrigerators, or sinks shall be considered as separate counter top spaces. Receptacles rendered inaccessible by appliances fastened in place shall not be considered as these required outlets. Receptacles shall not be installed in a face-up position in ti-a work surfaces or counter tops in a kitchen of dining area. All 15 and 20 ampere receptacles that serve counter top surfaces shall have G.F.I.C. protection. Semon 210-521^1 Receptacle outlets that serve counter top surfaces Shim require GFCI protection &rierioW . I q ;=24' for personnel. 12'or Ps3nhwla CaNnEft VAX 24' long drwil'isim 24,cr more --- One receptacle outlet required for peninsular F and island counter spaces with long dimension of 24 inches Ref rig or greater and short ,� " _ I• ti dimension of 12 inches or greater. 24' 4W i e"WhAde ou"Ed 1€F No pokil on wail rrors tian wa space 12 in.at ?�, 24 IT1,fry a feCe IXIC W r Page 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 Building Department All Cupertino building permits must meet certain conditions related to maintaining environmental quality and public peace and safety. The two most common conditions are described below. STORMWATER POLLUTION CONTROL State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and the Santa Clara Valley Water District cont-ol stormwater pollution. Educating local residents and businesses and enforcing sturmwater pollution control laws are key parts of the City's compliance efforts. Stormwater pollution prevention: It's up to us In northern Santa Clara Valley, storm dra ns flow directly to local creeks and San Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife dependent on our waterways, for people living near streams and baylands, and for the local water supply. Common sources of s:ormwater pollution include: • Dripped oil, fuel, and antifreeze frc,m vehicles and heavy equipment; • Construction debris, including dirt, concrete and paint; • Landscaping runoff containing pesticides or weed killers; and • Any material dumped or spilled inti streets or storm drains The property owner and the contractor share ultimate responsibility for activities occurring at a construction site and will be held responsible for any environmental damage caused by subcontractors or employees. For more information on construction-related stormwater requirements, see the Stormwater Quality Regulations section o"the City of Cupertino web site at: http://www.cijlpertino.org/city government/departments and offices/ environmental services COMMUNITY NOISE CONTROL The basic noise control requirements for construction sites are as follows: • Typical construction work hours are: - Weekdays - 7 a.m. to 8 p.m. - Weekends - 9 a.m. to 6 p.m. • Construction other than street construction is prohibited on holidays. Residential daytime noise levels from complaint site - 60 dBA • Nonresidential daytime noise level 3 from complaint site - 65 dBA For more information on noise control, please see Chapter 10.48 of the Cupertino Municipal Code, which can be accessed at http://www.amlegal.com/cupertin,) ca -7777777777777= 7.77:77. .77777: CITE'OF CUPERTINO BUILDING DIVISION PERMIT ��.T 4F. PERMIT NO. BUILDING ADDRESS: 20284 PACIFICA DR EDWARD SNOUFFER 07060232 PERMIT ISSUE DATE OWNER'S NAME: EDWARD SNOUFFER 06/26/ SANITARY NO.. CONTROL NO. DNE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 i p p LICENSED CONTRACTOR'S DECLARATION Job Description V r- I hereby affirm that I am licensed under provisions of Chapter 9(commencing ,z M with Section 70()0)of Division 3 of the Business and Professions Code,and my license is REPLACE HOT WATER HEATER (ELECTRIC) . y in full force and effect. ? License Class Lm•8 F Dam Contractor .r ARCHITECTS DECLARATION 2 C 1 understand my plans shall be used as public records )WU u,y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county < rZ which requires a permit to construct,alter,improve,demolish,or repair any structure L1" H prior to its issuance.also requires the applicant for such permit to file a signed statement Valuation -?< that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 Sq.Ft. Floor Area $325 v (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y 5 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 t �l Number Occupancy Type not more than five hundred dollars(5500). 36944014 �`i 0 1,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 for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors License Law does 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 Mold or improve for purpose of as owner of the property,am exclusively corseting 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 property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. 0 1 am exempt nder Sec/ J B&P C for this reason Owner-i7_1 'S _ Date d WO COMPENSATION 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. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number arc: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Mis section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner 1 aso c b'cct to the Workers'Compensation Laws of Californi Date Applicant NOTICE TO CA :If,aftermaking u Certificate of Exemption,you should become subject to the ker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z r CONSTRUCTION LENDING AGENCY (moi rA I hereby affirm that there is a construction lending agency for the performance of (Yr> the work for which this permit is issued(Sec.3097,Civ.C.) wA Lender's Name 0r, z Lender's Address U 0 I certify that I have read this application and state that the above information is LL. correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. ✓'a (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b) SOUR REGULATIONS. th Re-roofs Sigifature of A icandContract Date Type Of Roof HAZ; US MATERIALS DISCLOSURE yP 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 shall be inspected prior to any roofing material being installed. 0 Yes Q(No If a roof is installed without first obtaining an inspection,I agree to remove 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 all new r Taterials for inspection. District? Cl Yes W�o I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not c r cntly have a tenant.that it is my responsibility to notify the occupant of the require ntswhichmustbemetpri rt issuannceo a orOccupanry. Signature;of Applicant Date o All roof coverings to be Class"B"or better Owner or au44ized agent DW CITY OF CUPERTINO 3 ITEMS OF 3 PERMI`[' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN 36 )44014 . 00 DATE ISSUED. . . . . . . : 06 /26/2007 RECEIPT #. . . . . . . . . : BS)00001799 REFERENCE ID # . . . : 07 )60232 SITE ADDRESS . . . . . : 20284 PACIFICA DR SUBDIVISION CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : EDWARD SNOUFFER ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3014 RECEIVED FROM . . . . : EDaARD S SNOUFFER CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : EDNARD SNOUFFER ADDRESS CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3014 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 38.37 34 .86 0. 00 34 .86 0. 00 BPWHEATER PER HEATER 1. 00 10.79 0. 00 10.79 0. 00 PPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 84 . 02 0. 00 84 . 02 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER CHECK 84 . 02 -#1009 --------------- TOTAL RECEIPT 84. 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING OWNER-BUILDEJR VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. All the work authorized by this permit B. — A portion of the work C. _ None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. — All of the work B. _ A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to be performed 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be performed ............................................................................ ................................... I declare under penalty of perjury that the a rove is true and correct. I have read and understand the Owner-Builder Information (reverse ide). ' �'"� ' Date: V e , -9 7 Property Owner's Signature: Job Address: `� QC CO- r Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Deyartment. CITY OF (CUPERTINO WATER HEATER CUPEI�TINO PERMIT APPLICATION FORM Date: APN# 305, q14 -- © 14. . o0 aneJC1 aoa7 Building 0 Address• QcC 5014- O er Name: - r PL Phone#: ✓►0 u S u z a K K e 'T is S o vi (4�0 Contractor: /Q Phone License#. l Contact: Phone: Cupertino Business License#: �o�o Building Permit Info: Bldg ❑ Elect Plumb Mech ©� Job Description: c uta ea�e�' 14Z e 4r r L r� �a � Residential [vY Commercial ❑ Cost of Project: �: 3"2_�_ Strapped P- On Platform ❑ Bonded New Location ❑ Replacement i Qty.. f A 1f Fee ID Fee Description Fee Group BPWBEATER . Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '"UPEkTIN0 Building Department JOB ADDRESte,.1��ea- PERMIT# OWNER'S NAME: 1`x4- u PHONE# 5,2 GENERAL CONTRACTOR: FAX# I am not using any subcontractors �L , U h S 2-007 Si;nature Date Please check applicable subcontractors and com»lete 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