07030131 CITY OF CUPERTINO
BUILDING DIvISION PERMIT '� T� 'Z MAI �
PERMIT NO.
BUILDING ADDRESS: _ 0 7030131
10919 NORTHSHORE SQ " � �c
(""yER'S NAME: PERMIT ISSUE DATE
'7 11ARRON HONIGMAN ��/ C, � 03/19/2007
SANITARY NO. CONTROL NO.
;,,;ONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BE PLUMB ME�CH
� r
i p a LICENSED CONTRACTOR'S DECLARATION Job Description
UIP I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of thc Business and Professions Codc,and my license is MOVE/RE]LOCATE ELECTRI CAL BOXES/GARAGE ROBBINS
t<a in full force and effect.
i z License Class Lic.x CONSTRUCTION PAID FOR BL 3/19/07, RECEIPT
F w Date Contractor
ARCHITECT'S DECLARATION #B S O O O O t)0 7 17
i sa
a 1 understand my plans shall he used as public records
>yU
U.ti Licensed Professional
: a OWNER-BUILDER DECLARATION
1 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
:00 following reason.(Section 7031.5,Business and Profession Code:Any city or county
<-0 9 which requires a permit to construct,alter,improve,demolish,or repair any structure
12- prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
so that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft. Floor Area $2000
2 t- (commencing with Section 7000)of Division 3 of thc Business and Professions Code)or
L 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(1500). 316 3 8 0 3
❑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 Conuactor's License Law does not apply to an owner of
properly 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 In-
cense Law docs 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.
❑1 am ex C. B&P C for this re n
�— .Z�
rr ` Date
ORKEt'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.
❑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 ate:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S 100)
or less.)
I certify that in the performance of the work Cor hi this pe it' tied.1 shall not
employ any person in any manner to bee or s Compensation
Laws oC California.Da
Applicant
NOTICE TO APPLICANT 1, making this Certificate of Exemption,you should
become subject to the Worker's Com nation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
z OCONSTRUCTION LENDING AGENCY
(~,rte-. I hereby affirm that there is a construction lending agency for the performance of
p� > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
a,z Lender's Address
U 0 I certify that 1 have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relating to -
Ubuilding construction,and hereby authorise representatives of this city to enter upon the
a about-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 consequence of the granting of this permit. Date ✓"
►- APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATi
6e-roofs
Signature of Applicant/Condractof Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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
Le.
Section 25532(a)? � All roofs shall be inspected prior to any roofing material being installed.
es
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 Arca Air Quality Management all new n.aterials for inspection.
District? ,�
❑Yes , Nu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Co, coons 25505,25533 and 25534.1 understand that if the building
does n nano that it is my responsibility to notify the upan t f the
rcquirc nts is ust be met prior to issuance of a Certificate of e v Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorized agent' Date
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31638030. 00
DATE ISSUED. . . . . . . : 03/19/2007
RECEIPT #. . . . . . . . . : BS000000717
REFERENCE ID # . . . 07030131
SITE ADDRESS . . . . . : 10919 NORTHSHORE SQ
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MARRON HONIGMAN
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0533
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : ED ROBBINS LIC # 00065
COMPANY . . . . . . . . . . : ROBBINS S CONSTRUCTION
ADDRESS . . . . . . . . . . : 6090 MONTEREY RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95138
TELEPHONE . . . . . . . . : (408) 348-1960
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 2, 000.00 83 .16 0.00 83 .16 0. 00
BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0. 00
BUSLIC FLAT RATE 1 .00 107.00 0. 00 107. 00 0. 00
EPERMITFEE FLAT RATE 1.00 38.37 0 .00 38 .37 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 229.73 0 .00 229.73 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 229.73
CHANGE -10.27
---------------
TOTAL RECEIPT 229.73
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
I
CITY OF C'UPERTINO
CITY OF PERMIT APPLICATION FORM
CUPS TINO V
CPN 11 ✓LF03<�) Date: v-5 1�10
Build�e 7 �1 VIaiJi�pg Address (if different fr bu' ding a dress):
�LJJ / j
Ow r' N Phone#:
Con Mtor A' /� �-- License#:
Co Phone: Cupertino Business License#:
V C3 V-3 Fax:
Building Permit Info:
Bldg ❑ Elect F lumb ❑ Mech ❑
Job Description: r G 6 � .
Residential '� -e( ' &X'F501;�Ommercial ❑
01
Sq.Ft. Floor Area: W Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction: Please check this box if the project is,a
second-story addition: ❑
ro ect-Size-- dard Large ❑
quilitity Fee ID lee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boilei > I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 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 Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Cori. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Cor.stax-Resi/Mobile BUILDING
BELEC 1000 Elc e 600V<= I OOOA ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF C'UPERTINO
CM OF
CUPE6�TINO PERMIT APPLICATION FORINT
antiFee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME Ni;w Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME In 3pection Overtime BUILDING
BPBACKFLOW Atniospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING _
BPERMFEE Elft Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Inc Waste Interceptor PLUMBING
BPLANCHK flan Check Fee BUILDING
BPLANCKADD Plal Check Add Multi BUILDING
BPLANCKREP Plait Check Repeat Fee BUILDING
BPREPIPE Rf i e Of Fixtures PLUMBING
BPSEWAGE c ewa a Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM S torm/Rain Water ' PLUMBING
BPTRAP Kitcl Trap--_-.-__ — PLUMBING
BPVF,NT Alt of Drain &.Vent _ PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATFR W iter Heate�-/Vent _ PLUMBING
BPWSVCS Main-wit-&F ice PLUMBING
BREINSPECT F-einspection--Re(F ' -} BUILDING
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY R:model Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Rel kation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT H_-ater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pol-,/Platform Fixture ELECTRICAL
BREMPOWER Power Device/A paratus ELECTRICAL
BREMRECEPT Rcpt,, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Rem)del Res Appliance ELECTRICAL
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CITY OF C UPERTINO
CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID lee Description Fee Group
BREMSIGNAD Rmc l Signs Add Branch ELECTRICAL
BREMSIGNS Rem,)del Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOIl4 Seismic CommercialBUILDING
- -- - - - BSEISMICRE--- - — 'Seismic Fee Res — BtALDING
BSPECIAL S Decial Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Eusiness License BUILDING
ELECTRIC F"Iectnical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Me(h Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG - Plumbing Fee sq foot PLUMBING
PLLONGRNGC_ Planning LR Comme/Multi-Fam PLANNING
" PLLONGRN_GR P�annin _Long Ran a Residential PLANNING
ZADDCHG address Change BUILDING
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