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07050021?0O .may r viz iaa )yU W f' - cc cc L L] ° :Er �""pp LR^ CITY OF CUPEK11NO BUILDING DIVISION 13UILD148 15� JOHN DR OWNER'S NAME: DAVID MCLEOD ARCHITECT/ENGINEER: PERMIT I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License Class Lic. 8 Date Contractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the 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 prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 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 or offered for sale (Sec. 7044, Business 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.). 0 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 U. 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 Contractors License Law. Q lam exempt up ee B & P C for this reason Own. s Date WORKER' 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 Workers 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 Workers 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 pesson m app!!{{ manner Iq be bjaesto�bpr>)1 ccrs' Compensation Laws of California A[td �J--if1y/`�' Applicant /t� VV t NOTICE TOA UCANT: If, Wr makiniFthILCerlificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must ,J. O forthwith comply with such provisions or this permit shall be deemed revoked. Z " CONSTRUCTION LENDING AGENCY Er ►�-� I hereby affirm that there is a construction lending agency for the performance of pC the work for which this permit is issued (Sec. 3097, Civ. C.) W Q Lenders Name az Lender's Address U C) 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction, and hereby authorize representatives of this city to enter upon the Uabove-mentioned properly for inspection purposes. W (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. ►� APPLICANT UNDERSTAND#,NQ WILL COMPL�WITH ALL NON -POINT SOURCE REGULATIONS./ /) n/V /l /Nt- .2 -n - Signature of Applicant/Contractor - HAZARDOUS MATERIALS DISCLOSURE Will am 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 Code, Section 25532(a)? Q YesNo 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 District? C3 Yes sj�Nu 1 have toad 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 does not currently have a tenant, that at �'y�qy responsibility to notify the occupant of the reouimt nts ahich must be.met prior Ui*mivance of a Certirrlalspf Occupattcy_ _ „r. Owner or authorized PERMIT NO. TBD - TC BE DETERMINED 07050021 PERMIT ISSUE DATE 05/03/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ELECT PLUMB MECH PANEL U):GRADE 200 AMP Sq. Ft. Floor 3693303P Issued by: Re -roofs Type of Roof Job Description Valuation $2440 Occupancy "Type Required Inspections All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new m� terials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36S33038.00 DATE ISSUED.......: 05/03/2007 RECEIPT #.........: BSC00001191 REFERENCE ID # ...: 07C50021 SITE ADDRESS .....: 20153 JOHN DR SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER DAVID MCLEOD ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO, 95014 OPERATOR: suew COPY # : 1 RECEIVED FROM ....: REC'EIPT INTERFACE CONTRACTOR TBI) - TO BE DETERMINED LIC # 00096 COMPANY TBI) - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: , TELEPHONE ........: FEE ID UNIT QUANTITY IXOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- BELEC200 METERS ---------- 1.00 ----------- 29.43 ---------- 0.00 29.43 0.00 BSEISMICRE VALUATION 2,440.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 ---------- 0.00 ---------- TOTAL PERMIT ----------- 68.30 ---------- 0.00 68.30 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 68.30 --------------- 68.30 VOICE ID DESCRIPTION -------- ---------------------------- 103 UFER 505 FINAL ELECTRICAL REFERENCE NUMBER -------------------- VISA-DAVID MCLEOD VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL a11Y1F CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM CPN #3 693 9 Date: 6AAA BuildingAddress: ., Mailing Address (if di erent from building address): o Owner's Name: Phone #: Contractor: n - Ali, l; oaf : License Contact: Phone: 1�jO5 Cupertino Business License#: Fax: Boiler > 500K to 1M Btu Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential LCI S �` CIL Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group Type of Construction: r Please the k this box if the project is a second -story addition: El c.— c+�"A avA F-1 T.Prue. F- Ma or F1 BCONSTAX A l VI%, -.b vasa.• vow... Quantity Fee ID BAPPLOTHER Fee Description 1Xher Appliances Fee Group MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 E oiler > 1.75M Btu MECHANICAL BCONSTAX -onstruction Tax BUILDING BCONSTAX In3/Off/Comm/Quasi BUILDING BCONSTAXBQ Ccn. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax – Resi/Mobile BUILDING BELEC 1000 E] ec 600V <= l OOOA ELECTRICAL BELEC1001 E lec 600V > 1000A ELECTRICAL BELEC200 Elegy: Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING of 3 CITY OF CUPERTINO aCITYF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Con im. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM Ne -w Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Ir. spection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Incl Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM S torm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT A!.t of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER VV ater Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cf n MECHANICAL BR.EMAPPLI appliance Install MECHANICAL BREMBUSWAY R emodel Busways ELECTRICAL BREMFIXT bighting Fixtures ELECTRICAL BREMFURN Re; ocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > IOK btu MECHANICAL BREMHEAT F eater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc i1, Switch & Outlets ELECTRICAL BREMRELOCA Rolocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Ren: odel Res Appliance ELECTRICAL 24 3 ' CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Th ,atrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS V m ilation 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 T emporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS TempDist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elea Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Pliunbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 )f3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT #� OWNER'S NAME: ZAJJ It '( �i'i r3 , PHONE # - - GENERAL CONTRACTOR 0 FAX # I am not using any subcontractors: Si;;nature Date Please check applicable subcontractors and complete the following information: Lt A Owner/ Contractor Signature ate SUBCONTRACTOR BUSIrTESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical jj�J ric, 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 Lt A Owner/ Contractor Signature ate