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07030302 CITY OF CUPERTINO BUILDING DIVISION PERMIT c��tTR��GTOR Ik' RMATIE�1� PERMIT NO. BUIL 41NG 4DRESS: 1049 NATHANSON AV JOHNSTON ELECTRICAL 07030302 PERMIT ISSUE DATE OWNER'S NAME: UPTON, ALEX 1302 LINCOLN AVE, STE 204 03/27/2007 SANITARY NO. CONTROL NO. ONE: (408) 26 -0236 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUM MEECCHH 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description W I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions GCode,and my license is SERVICE UPGRADE TO 200 AMP t y in full force d f �ry 60 License C "10 Le p Date Contracto F m ARCHITECTS DECLARATION 7 C a a 1 understand my plans shall he used as public records >aU ay Licensed Professional G a OWNER-BUILDER DECLARATION 1 herehy affirm that 1 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 $(Yi 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 statementS Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q• $1700 t= (commencing with Section 7000)of Division 3 of the Business and Professions Any vi Code)or L 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 32643074 . Number 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 oroffered for sale(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.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 contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under See. B&P C for this reason Owner Date WORKER'S 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 Workees 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 WorkelfASompensation n�Insurance carrier and Policy number arc: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM W RKERS' 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,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant 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 ,J ,Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY [�.t I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) GL)Q Lenders Name az Lenders Address I certify that I have read this application and state that the above information is LUL O correct.1 agree to comply with all city and county ordinances and state laws relating to V building construction,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 U Z in consequcncc oC the g ting of this mi Date �+ APPLICANT UNDE ANDS L COMPLY WITH ALL ON-P INT Issued b SOURCERE e Re-roof! Signori Applicant/Co ctor 1C T of Roof / HAZARDOUS MATERIALS DISCLOSURE Type L/ Will the applicant or future building occupant store or handle hayardous material as defined by the Cupertino Muni' 1 Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof;shall be inspected prior to any roofing material being installed. ❑yes No Will the applicant o future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, agree to remove emit hazardous air/� nanl defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have read terials requirements under Chapter 6.95 of the Califor- ria Health&Safet 505.AYofaCcr-fi"' 25534. nderstand that if the buildidocs not current t' o notify the occ pant of c Date rcyuircmcntswisr t cart of Occu y S ignatui a of Applicant All roof coverings to be Class"B" or better O r t ached agem Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMI" RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Bl:c: Lot: APN . . . . . . . . : 32343074 .00 DATE ISSUED. . . . . . . : 03 /27/2007 RECEIPT #. . . . . . • • . : BS)00000808 REFERENCE ID # . . . : 07 )30302 SITE ADDRESS . . . . . : 10549 NATHANSON AV SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : UPI'ON, ALEX ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1330 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR BRIAN JOHNSTON LIC # 23411 COMPANY JOHNSTON ELECTRICAL CONTRACTOR ADDRESS 1302 LINCOLN AVE, STE 204 CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE (408) 266-0236 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- - BELEC200 METERS 1 .00 29 .43 0 .00 29 .43 0 .00 BPERMFEE VALUATION 1, 700 .00 83 .16 0 .00 83 . 16 0. 00 BSEISMICRE VALUATION 1, 700 . 00 0.50 0.00 0 .50 0. 00 EPERMITFEE FLAT RATE 1 .00 38 .37 0 .00 38 .37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 151 .46 0 .00 151 .46 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 151.46 885-JOHNSTON ELECT --------------- TOTAL RECEIPT 151.46 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL A CITE' OF C UPERTINO COPE F PERMIT APPLI=CATION FORM APN# Date: 0-1 Buildi g Tess: Mailing Address (if ifferen from building address): Owner's Name: Ph #: o Co Tactor: Lie se#: Co tact: Phone 0W o23w Cupertino Busines License#: Fax. +�c -63 Building P rmit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Descriptio Residential 5t � JCommercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a _C//�_ second-story addition: El Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bailer<= 100,000 Btu MECHANICAL BBOILER2 Boili,r> 100K to SOOK 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 h td/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC 1000 F lec 600V <= l OOOA ELECTRICAL BELEC1001 14'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 CITY OF C'UPERTINO i noF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Descri tion Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME N,-w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Ir spection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum_ PLUMBING ___ BPCESSPOOL Cesspool PLUMBING BPERMFEE J31djj Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Ga3 Piping System Fee PLUMBING BPINTERCEP In Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plzn Check Repeat Fee BUILDING BPREPIPE R e i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM 3torm/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 1 lain Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C. Unit> 10,000 cfin MECHANICAL BREMARMAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Zemodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN R,-location of Furnace MECHANICAL BREMFURNOV Re to Furnace> l 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)t1, Switch & Outlets ELECTRICAL BREMRELOCA :Zelocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Rcmodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO "0 a�- CUPEk INO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rm31 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Th,;atrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS V!ntilation Systems MECHANICAL BSCBLVD 3cb 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 Temporary_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 Mf ch Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Plannin ; Long Range Residential PLANNING ZADDCHG Address Change BUILDING of 3 Community Development 10300 Torre Avenue �.. Cupertino CA 95014 M.. Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Buildin De artment JOB ADDRESS: PERMIT# OWNER'S NAME: 14 L : PHONE 2� GENERAL CONTRACTOR- Q FAX# I am not using any subcontractor Si ature Date Please check applicable subcontractors and complete the followinginformation SUBCONTRACTOR BUSI14ESS 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 /"ov/ 7� 971 Owner/Contractor Signature Date