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07030127 CITY OF CUPERTINO BUILDING DIVISION PERMIT o T R I FC} M�4T Q1� PERMIT NO. BUILD�Nd�aDpRPENNINGTON LA K DESIGNERS 07030127 l U (b� - PERMIT ISSUE DATE OWNER'S NAME: GOTTWALD RUDY 3480 INVESTMENT BLVD 03/16/2007 SANITARY NO. CONTROL NO. .JNE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: INSTALL VINYL SIDING OVER BLDG ELECT PLUMB MECH 0 a o 0 i p p LICENSED CONTRACTOR'S DECLARATION AJA Job Description m F 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Diviston 3 f the Business and fessio o�c, my license is r a a in full force and eff i fV� nz Lie enac CI L�Llc.# 11 F o pflOC ContractorAA L4A CHmc-rS DECL RA 10 i z e 1 understand my plans shall he used as public records >yU n.y Licensed Professional : a OWNER-BUILDER DECLARATION aI hereby affirm that I am exempt from the Contractors License Law for the p o 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 structure a" y prior w its issuance,also requires the applicant for such permit to rile a signed statement Sq.Ft.Floor Area Valuation -?< that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 F$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number not more than five hundred dollars($500). ❑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.). ❑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. ❑I am exempt under Sec. B&P C for this reason Owner Dale 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 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 WorkSs�anper�tapon I rartx carrier and Policy num :r Gorier. TolcwO Polity No.: 1 CERTIFICATE OF vnoN FROM WORKERS' COMPENSATION INSURANCE (chis 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 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 CONSTRUCTION LENDING AGENCY TVI- I hereby affirm that there is a construction lending agency for the performance of f~> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name z Lender's Address U C) 1 certify that 1 have read this application and state that the above information is U. correct.I agree to comply with all city and county ordinances and state laws relating to .J U building construction,and hereby authorize representatives of this city to enter upon the above-menuuned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against f�,y rA liabilities,judgments,costs and expenses which may in any way accrue against said City / ^� U z in conseq cc of the granting of this permit. Date ` elle APPLIC UNDERSTANDS COMPLY WITH ALL NON-POINT Issued by: soo I -I Re-roofs Signature of Applicant/Con for Dam Type of Roof HAZARDOUS 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 Cotte,Section 25532(a)? � All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes No If a roof i;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 materials for inspection. District? ❑Yes I havc read the hazardous materi s requirements under Chapter 6.95 of the Califor- nia Heal SafctyCalc,Sections 255 ,25533 and 25534.1 undcrstand thatif the building docs no rrently have a tenant, it is my responsibility to notify the occupant of the rc ui w ch the 'or to issuance of a Cc ate pancy. Signature of Applicant Date All roof coverings to be Class"B" or better Owner or authorircd agent Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: bethe COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 362 )3031. 00 DATE ISSUED. . . . . . . : 03/ L6/2007 RECEIPT #. . . . . . . . . BS0)0000711 REFERENCE ID # 07030127 SITE ADDRESS 1026 PENNINGTON LA SUBDIVISION CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GOTTWALD RUDY ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : RECEIVED FROM RECEIPT INTERFACE CONTRACTOR LARRY JUDSON LIC # 23172 COMPANY K DESIGNERS ADDRESS 34EO INVESTMENT BLVD CITY/STATE/ZIP . . . : HAYWARD, CA 94545 TELEPHONE (53.0) 786-0455 FEE ID UNIT QUANTITY JjMOUNT PD-TO-DT THIS REC NEW BAL ___ ------------- ---------- ----------- ---------- - BENERGY PERMIT FEE 1.00 34 .86 0.00 34 .86 0.00 BPERMFEE VALUATION 25, 987.00 332 .64 0.00 332 .64 0. 00 BSEISMICRE VALUATION 25, 987.00 2 .60 0 .00 ----_-2_60 ------0- TOTAL PERMIT 370 .10 0 .00 370 .10 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- --------------- - ----- CREDIT CARD 370.10 AMEX --------------- TOTAL RECEIPT 370.10 CITY OF C UPERTINO A OF PERMIT APPLICATION FORM cuPF�TIN® PN# Date: Building Ad ess: L Mailing Address (if di�ffer�e�nt fr�� in�il� address): rwner's Name: Phone#: ��F �5- -5-2 2 9 Contrctor: fG, a r — License #: - --- - ontact: _ Phone: {�1 Cupertino Business License#: L Fax: Buildi g Permit Info: Jh5.+6`L VY hT-L 53" �,X h "i%-,`c(-& 'O h - 1-t C, 5 Bldg Elect ❑ P:umb ❑ Mech ❑ cription: � G OJob Desv0vyi � L Residential � Commercial ❑ Sq.Ft. Floor Area: _ Sq.Ft.: ` Cost of Project: V q �' 1Occupancy Group- Type of Construcc,un: _ Please check this.box if the project is a Vyy��L 5J 1 V� second-story addition: _E - ra�ect Arte:=Standard Large--❑-__.- llgajc,r❑ quantity Fee ID Fee Description _ Fee -Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boile-> 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 Indy Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Con>tax-ResWobile BUILDING BELEC 1000 Eley, 600V<= l 000A ELECTRICAL BELEC1001 Elcc 600V > 1000A ELECTRICAL BELEC200 Elec LSvcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 cf3 CITY OF C UPERTINO cUP TYOF�rvO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL M-scellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Ins7)ection Overtime BUILDING BPBACKFLOW Atrr ospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUIViBING _ - BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas .3iping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Rei a Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawr- Sprinkler/Backflo PLUMBING BPSTORM St)rm%Rain Water PLUMBING BPTRAP Kitchen Trap - PLUMBING BPVENT Alt of-Drain,&,Vent --. PLUMBING BPWATER InstalVAlter Water Pie PLUMBING _BPWHEATER Water Heater/Ve�nt PLUMBING -BPWSVCS -Mam Wafer_S6r��ce r- PLUMBING BREINSPECT R-ins—ectioriFe_e BUILDING BREMACOVER A/C Unit>10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT L-ghting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem:,,ton-Res Appliance ELECTRICAL BREMPOLE Pole,/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Re-ocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF C-UPERTINO C,. OF PERMIT APPLICATION FORM CUPEkTINO quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmd: Signs Add Branch ELECTRICAL BREMSIGNS Remc del Signs, Marquee ELECTRICAL BREMTHEATR Thez.trical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S,-,b Specific Plan BUILDING BSEISMICOM. Seip mic Commercial -- BIJII I�IlITC -- --- — - BSEISMICRE -- — --Seismic Fee Ides _ BUILDING BSPEClAL Special Inspection BUILDING BSWIM �;wimming Pool BUILDING BTEMP Tcmporary TemporaryPower ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS ",emp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Eleo,Permit Issuance ELECTRICAL MPERMFEE M:chanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFE_E Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC---= ` Planning LR Comme/Multi-Fam PLANNING PLLONGRhIGR Panin -Low_Ran a Residential �- PLANNING - - BUILDING ZADDCHG ,address Change 3 of 3 _ Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ;UPERTINO Building Department JOB ADDR Vis. -- PERMIT# OWNER'S NAME: L- ''� �l PHONE# q 09 1 Z . .5 Z GENERAL CONTRACTOR: A FAX# I am not using any subcontractors: ;nature 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