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07060177 CITY OF CUPERTINO BUILDING DI`,JSION PERMIT PERMIT NO. BUILDINGDDRESS: 07060177 1( 04 DEEP CLIFFE DR J P GORNAN INC PERMIT ISSUE DATE OWNER'S NAME: BIEGHLER MELVIN C AND HILMA 0 305 VINEYARD TOWN CENTER SANITARY06/21/2007 oCONTROL NO. 'NE: (408)77S -3296 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p LICENSED CONTRACTOR'S DECLARATION Job Description v1 hereby affirm that I am licensed under provisions of Chapter 9(commencing — U W with Section 7000)of Division 3 of the Business and Profcssinns Code,and my license is REPLACE FIRE PLACE REPLACE GAS FIRE PLACE >>y in full force and effect. INSERT. ? License Class_Lic.N p Dam Contractor f w ARCHITECTS DECLARATION U1 understand my plans shall be used as public records U.f- Licensed Professional O OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the p Oa 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 swctur Valuation Q^y prior est its issuance,also requires the applicant for such permit to file a signed statement r' .Ft.Floor Area $3500 -Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �'q YH (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3560400 3 A8bT Number not more than five hundred dollars(5500)• 0 1,as owner of the property,or my employees with wages as thew 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 conuactor(s)licensed pursuant to the Contractor's License Law. B&P C for this reason I am a rcpt under Sec. Owners '� Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty 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 are: Cartier: 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 of the work for which this permit is issued,I shall not employ any person in any maWer s to cpm t to the Workers'Compensation Laws of Calif is.Date— �A k Applicant C NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the 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 E.r I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(See.3097,Civ.C.) L4 A Lender's Name Lender's Address U C I certify that 1 have read this application and state that the above information is Lt+ correct.1 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. P1. (We)agree to save,indemnify and keep harmless the City of Cupertino against HrA 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): TIONSC� P" 2 LA� (o�l -U7 Re-roofs Signature of Applicant/Contractor Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupantstorc 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. 0Yes yNo 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 all new materials for inspection. emit hazardous air contaminants at defined by the Bay Arca Air QualityManagement District? Yes Wo 1 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 currently have a tenant,that it is my responsibility to notify the occupant of the Date rc iremcnts hi It must be met prior to issuance of a Certificate of Occupancy. S ignatur'of Applicant ieant All roof coverings to be Class"B"or better Owner or authorised agent Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMI`[' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN 35504003 . 00 DATE ISSUED. . . . . . . : 06/21/2007 RECEIPT #. . . . . . . . . : BS)00001728 REFERENCE ID # . . . : 07)60177 SITE ADDRESS 10304 DEEP CLIFFE DR SUBDIVISION CITY CUPERTINO IMPACT AREA . . . . . . OWNER BIEGHLER MELVIN C AND HILMA 0 ADDRESS CITY/STATE/ZIP CUPERTINO CA, 95014-3955 RECEIVED FROM CAROLINE E ANDERSON CONTRACTOR JCSEPH GORMAN LIC # 24918 COMPANY J P GORMAN INC ADDRESS . . . . . . . . . . : 305 VINEYARD TOWN CENTER CITY/STATE/ZIP MCRGAN HILL, CA 95037 TELEPHONE (408)779-3296 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 BSEISMICRE VALUATION 3, 500. 00 0.50 0. 00 0.50 0. 00 MPERMITFEE FLAT RATE 1.00 38 .37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 73 .73 0. 00 73 .73 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---------------- CREDIT CARD 73 .73 MC --------------- TOTAL RECEIPT 73 .73 010(o 11 -7 a CITY OF C'UPERTIN 1w or PERMIT APPLICATION FORM CUPEkTINO APN# Date: q - Dos - _o Building Addres• Mailing Address (if different from building address): bg - Owner' Name: Phone #: as- 7 -ssC-)Z Contractor: License #: 19 Contact: 1 _Ph one yZ �6i�� C no u �(8�ss License#: 0 11Y12 v�.��CSQh Fax:3yL- C��ci � c'1 l e I _-3 � l uilding Permit Info: �� CL Ce ��r�� 'C�,L,�-- � '� Q�Ce.S �s"� re-� QC-e- Bldg ❑ Elect ❑ Plumb ❑ Mech [r Job Description: Residential Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost ofot ct* Occupancy Group: Type of Construction: Please check this box if the project is a �- second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description_ Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bc,iler<= 100,000 Btu MECHANICAL BBOILER2 Boil(r> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boil,;r> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ir d/Off/Coimn/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 F,lec 600V> 1000A ELECTRICAL BELEC200 Ele c Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF C'UPERTINO �� of PERMIT APPL [CATION FORM CUPEI�TINO Quanti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Com in. Housing Mit. Fee BUILDING BNUCOMME N:w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP I`ew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW At nospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE ];Id Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Incl Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD PILn 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 Sprinkler/Backflo PLUMBING BPSTORM ;Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT ?It of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/ff 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 R,-,location of Furnace MECHANICAL BREMFURNOV Re to Furnace> 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rein Non-Res Appliance ELECTRICAL BREMPOLE P:)le/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc)tl, Switch & Outlets ELECTRICAL BREMRELOCA :Zelocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Rcmodel Res Appliance ELECTRICAL 2 of 3 CITY OF C'.UPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quanti Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Veit Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific PlanBUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP T em orary Power ELECTRICAL BTEMPPERM Teirporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC 3usiness License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE El,-c Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL j MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin ;LR Comme/Multi-Fam PLANNING PLLONGRNGR Plannin ;Long Range Residential I PLANNING 3 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 �CIT1f OF Fax(408)777-3333 7UPEkTINO Buildfn De artment JOB ADDRESS: PERMIT T# OWNER'S NAME:rY\eAu i PHONE # ` b -7 - ,5 GENERAL CONTRACTOR:_T.L_c>x- 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