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07030052 CITY OF CUPERTINO I}�EQRM�4TI��1. BUli.DING DIVISION PERMIT ' PERMIT NO. BUILD,NG ADDRESS: 23625 OAK VALLEY DR TBD — TC BE DETERMINED 07030052 PERMIT ISSUE DATE OWNER'S NAAIE: CHRIS & HEIDI FINAN 03/08/2007 SANITARY NO. CONTROL NO. .)NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description VPI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is BUILT I I`I BBQ y in full force and effect. -1&4 40 W v�2 License ass Lic.ir Dam Contractor ARCHITECTS DECLARATION 12-4 < 1 understand my plans shall be used as public records )yU Cy Licensed Prufcssional H OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the ca following reason.(Section 7031.5,Business and Professions Code:Any city or county e 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 statementValuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;>q.Ft.Floor Area $1000 0 r (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 Number Occupancy Type not more than five hundred dollars($500). 34256004 . 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 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.). 0 1,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. 0 1 amexemp n ARKEWS B&P C for this reason Owner Date W NSA770N DECLARATION I hereby affirm under penalty of perjury one of the following declarations: - r;• ,-av :. - 0 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 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 Worker's Compensation Insurance carrier and Policy number are: Carrier.("V,f I�✓� Policy No.: CERTIFICrA OF EXEMPTION FRO WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss.) I certify that in the performance of the work for which this permit is issued,l 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY Fr rA 1 hereby affirm that there is a construction lending agency for the performance of CG> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name az Lender's Address U C-) I certify that I have read this application and state that the above information is L ►' correct.I agree to comply with all city and county ordinances and state laws relating to rJ- Ubuilding 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 APP�Gpl SLANDXWCOMPLY WITH ALL�NON-POI Issued by: SOU1 �-y r uo Re-roofs Signature of Appliean on for Date HAZARDOUS MATERIALS DISCLOSURE Type of Loof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Codc.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 204 Will the applicant or future building occupant use equipment or devices which If a roof s 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 materials for inspection. District? ZI I- 0 Yes ro 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcly Code,Sections 25505,25533 and 25534.I understand that if the building docs not cymnily h4ve,a n6 that it is my responsibility m notify the occupant of the require rets is uss et prior issu of a Certificate of Occupan Signature of Applicant Date nc out� All roof coverings to be Class'B or better orixcd agent � Date 8 7h Ti t 7, CITY OF CUPERTINO 10 ITEMS OF 10 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN . . . . . . . . : 34,'',56004 . 00 DATE ISSUED. . . . . . . : 03i'08/2007 RECEIPT #. . . . . . . . . : BS000000634 REFERENCE ID # . . . : 07030052 SITE ADDRESS . . . . . : 23E25 OAK VALLEY DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER CHRIS & HEIDI FINAN ADDRESS . . . . . . . . . . : 23625 OAK VALLEY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : TBI) - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBI) - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY jNOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BENERGY PERMIT FEE 169.56 81.39 0 .00 81.39 0.00 BPERMFEE VALUATION 10, 000 .00 169.56 0. 00 169.56 0. 00 BPFIXTURE UNITS 1 .00 9. 00 0.00 9. 00 0. 00 BPGAS OULETS 1 .00 5 .40 0 .00 5.40 0.00 BPLANCHK PERMIT FEE 169.56 226 .28 0 .00 226 .28 0. 00 BREMRECEPT NO. OUTLETS 2 .00 2 .40 0 .00 2 .40 0.00 BSEISMICRE VALUATION 10, 000.00 1. 00 0 .00 1. 00 0. 00 EPERMITFEE FLAT RATE 1 .00 38.37 0 .00 38.37 0 .00 MPERMITFEE FLAT RATE 1.00 38 .37 0 .00 38.37 0 .00 PPERMITFEE FLAT RATE 1.00 38 .37 0 . 00 38 .37 0 .00 - ------ ---------- ---------- ---------- TOTAL PERMIT 610.14 0 .00 610.14 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 610.14 7709 --------------- TOTAL RECEIPT 610.14 CITY OF CUPERTINO PE TING PERMIT APPLICATION FORM C U R APN# ,3V —y6 -06Y L� � -'y6 --0 Date: � r Building Address: Mailing Address (if different from building address): l Owner's Name: - Phone#:vSv ., c-,(.0--7 - Gfo-T-� 4UW L-u) r- 6 t Contractor: License#: S - . Contact: P one:L4G�j-�i1= Cupertino Business Licens #r/ C - G/G'DDDD.�� T *17 s� Fax: D - ,� 1 Building Permit Info: Bldg ❑ Elect Plumb Mech Job Description: . Residential IVI Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: 6 i0mo Type of Construction: Please check this box if the project is a second-story addition: El Project Size: Standard ❑ Large ❑ Major ❑ Qu-a—ntity Fee ID .Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bo-ler<= 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 Bailer> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Incl/Off/Comm/Quasi BUILDING BCONSTAXBQ Co-i. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co:istax–Resi/Mobile BUILDING BELEC 1000 El,-c 600V <= 1000A ELECTRICAL BELEC1001 E(ec 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 CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Corin. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N,-.w Comm Plumb PLUMBING BOVERTIMEInE pection Overtime BUILDING BPBACKFLOW Atriospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldjj Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK flan Check Fee BUILDING BPLANCKADD Pla:l Check Add Multi BUILDING BPLANCKREP Plait Check Repeat Fee BUILDING BPREPIPE Repipe Of Fixtures PLUMBING BPSEWAGE ',ewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK LaAn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT At of Drain &Vent PLUMBING BPWATER Inst.Ill/Alter Water Pie PLUMBING - - BPWHEATER A ater 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 F.emodel Busways ELECTRICAL BREMFIXT =-ighting Fixtures ELECTRICAL BF:EMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rel) Furnace> l OK btu MECHANICAL BREMHEAT Heater 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 2 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R,-pair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL of 3 CITY OF C'UPERTINO CUPE F PERMIT APPUICATION FORM Quantity 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 VE ntilation 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 Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC l-lectrical sq foot ELECTRICAL EPERMITFEE Elf c Permit Issuance ELECTRICAL MPERMFEE N/echanical sq. foot MECHANICAL MPERMITFEE Mel:h Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3