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07050112 CITY OF CUPERTINO BUILDING DIVISION PERMIT � . �R1ECIR'v�AT�(IN BUILD N8ESS: PERMIT NO. � �� RIVERCREST CT ARGONAUT WINDOW & DOOR 07050112 OWNER'S NAME: PERMIT ISSUE DATE VIEGAS JOHN R AND CELEST C 10624 S DE ANZA BLVD 05/14/2007 NfsrDTT SANITARY NO. CONTROL NO. (408) 378-4018 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 o z LICENSED CONTRACTOR'S DECLARATION Job Description 'V)= I hereby affirm that I am licensed under provisions of Chapter 9(commencing .zwith Section 7000)of Division 3 of the Business and Profcssiont Code,and my license is REMOVE•/RE PLAC E 11 WINDOWS & 3 DOORS. EGRESS/TEMP r Z y in full force and clfect Lic fn� LicenseC s WHERE REQDr STUCCO EXTERIOR F w Date ^ Contractor ARCHrMCTS DECLARATION 7 a< 1 understand my plans shall be used as public records >yU Licensed Professional y OWNER-BUILDER DECLARATION j> 1 hereby affirm that I am exempt from the Contractor's License Law for the p Oa following reason.(Section 7031.5,Business and Professions Code:Any city or county ti which requires a permit to construct,alter,improve,demolish,or repair any structure ?Z y prior to its issuance,also requires the applicant for such permit to rile a signed statement Y that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;;q.Ft.Floor Area Valuation e.t- (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or $15000 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(5500). 3263700 V V 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 fired Ins ectl o ns and Professions Code:The Contractor's License Law does not apply to an owner of q P 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 Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a comractor(s)licensed pursuant to the Contractor's License law. 0 I am exempt under Sec B&P C for this reason OwnerLADate WORKER'S COMPENSATION DECRATION I hereby affirm under penalty of perjury one of the following declarations: 0 1 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. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Work]�Vis cr ssaa�uoOn IInsuranc carrier and Policy number am: Carrier(a�ra Policy No.:?_fh 0//d/Gdj 4- rb V CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 1 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Fr`C-+ I hereby affirm that there is a construction lending agency for the performance of (Y,> the work for which this permit is issued(Sec.3097,Civ.C.) Wfs.A Lender's Name z Lcndees Address U 0 1 certify that I 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 rJ- U building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against F" cI) liabilities,judgments,costs and expenses which may in any way accrue against said City _ U z in consequence of a granting of this per it. APPLICANT U R ANDS AND ILL COMP Y WITH ALL ON-POINT Issued by: Date / SOUR EG TI S. P 4 Re-roofs tgna of App r on to tc AZ S MATERIALS DISCLOSURE Type of R)of Will the app cant or futum 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)? All roofs:hall be inspected prior to any roofing material being installed. 0 Yes /^ 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 m.lterials for inspection. District? 0 Yes 9i4r- 1 have read 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 docs not currently have tenant,that i 'tet y responsibility to notify the occ pant of the require mCots w' m be prio uanc o aC 'ficatcofOccup r. Signature AApplicant Date ownor amlhbriz agent 0 All roof coverings to be Class"B"or better CITY OF,CUPERTINO BUILDING DIVIS16N PERMIT BUILD N D,,ppgESS: PERMIT NO. � VH RIVERSIDE DR NORIK' S PLUMBING 07050111 PERMIT ISSUE DATE OWNER'S NAME: NAU VANCE J AND VALERIE E 911 FURLONG DR 05/14/2007 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: INSTALIr NEW GAS LINE FOR A BLDG ELECT PLUMB MECH 0 0 a a p LICENSED CONTRACTOR'S DECLARATION m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z m with Section 7000)of Division 3 of the Business and Professions Code.and my license is m y in full force and effect ._ 7 Z Z 2 b r Z License C1 s Lic•8 F mD Contractor Ns�. 3 �^ 'D ^1 W ARCHITECTS DECLARATION CI understand my plans shall be used as public records )WU U.in Licensed Professional OWNER-BUILDER DECLARATION j< 1 hereby affirm that 1 am exempt from the Contractor's License Law for the in 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 Z; prior w its issuance,also requires the applicant for such permit to Ole a signed statement rFt.Floor Area Valuation e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �q t F (commencing with Section 70D0)of Division 3 of the Business and Professions Code)or i 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 APN Number Occupancy Type not more than five hundred dollars($500). 0 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 affered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of q 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 I am exempt under Sec B tit P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: lI have and will maintain a Certificate of Consent to self-insure for Worker's Compen- on,as provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. 0 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 Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the perrimit is foronc hundred dollars(EI00) 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�asoome subject to the Workers'Compensation Laws of California.Date �/Y Applicant NOTICE TO APPLICANT:1, r making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z � CONSTRUCTION LENDING AGENCY Fr C/3 I hereby affirm that there is a construction lending agency for the performance of R!> the work for which this permit is issued(Sec.3097,Civ.C.) Gwr Q Lender's Name a z Lender's Address U 0 1 certify that 1 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 authorise representatives of this city to enter upon the Uabove-mentioned properly for inspection purposes. L4 (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 (.� 01 U ,'Z in consequence of the granting of this permit. Date l APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. � _( Re-roofs Signature of Applicant/Contractor DateType of Roof HAZARDOUS MATERIALS DISCLOSURE 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 Code,Section 25532(a)? All roofs:hall be inspected prior to any roofing material being installed. ❑Ya � 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 Area Air Quality Management all new materials for inspection. District? 0 Yes �No I have read 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 docs not currently have a tenant,that it is my responsibility to notify the occupant of the requiremen h moat be met prior to issuance of a Certificate of Occupancy1 Signature A Applicant Date SIS NI�� All roof coverings to be Class"B"or better Owner or authorized agent D� CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN . . . . . . . . : 35( 02007. 00 DATE ISSUED. . . . . . . : 05/14/2007 RECEIPT #. . . . . . . . . BSC00001305 REFERENCE ID # . . . : 07C50111 SITE ADDRESS . . . . . : 22404 RIVERSIDE DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : NAU VANCE J AND VALERIE E ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3959 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : NORIK OHANIANS LIC # 26270 COMPANY . . . . . . . . . . : NORIK'S PLUMBING ADDRESS . . . . . . . . . . : 911 FURLONG DR CITY/STATE/ZIP . . . : SAD JOSE, CA 95123 TELEPHONE . . . . . . . . : (4C8) 972-5965 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPGAS OULETS 1.00 5.40 0 .00 5 .40 0. 00 BSEISMICRE VALUATION 800 .00 0.50 0 .00 0 .50 0.00 PPERMITFEE FLAT RATE 1.00 38 .37 0 .00 38 .37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 44 .27 0 .00 44 .27 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 44 .27 4324 --------------- TOTAL RECEIPT 44 .27 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING s CITY OF C UPERTINO CUPS TINO PERMIT APPLICATION FORM '� 070501/ 1 ,PN # 35b Oa -v °7 Date: s-//1107 Building Address: P✓Iailing Address (if different from building address): fid ,�)e / 1 Owner's Name: Phone#: Na),z L 0 C'9 4 q Cotitrac.tor.: Lfcetise#: Contact:*,N ✓kµ µ Phone: (/O /3ezz Cupertino Business License#: Fax: �70 Building Permit Info: rK»5L tto w ate' 1 Bldg ❑ Elect ❑ P lumb Mech ❑ Job Description: Residential [2f Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: add Occupancy Gro : Type of Construction: Add 04s J,L -o neP)C,,*& -amv Please check this box if the project is a `-K-A-D�-L. second-story addition: El Project Size: Standard R Large ❑ Major ❑ Quantity Fee ID lee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boilei > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler-> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boller> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX InclOff/Comm/Quasi BUILDING BCONSTAXBQ Coit. Tax for BQ Zone BUILDING BCONSTAXH iotel and Motel BUILDING BCONSTAXR COTIstax-ResWobile BUILDING BELEC 1000 Elec 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA nvestigation fee BUILDING 1 of 3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID I`ee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP Nf;w Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBAC'KFLOW Attilospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK flan 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 S1 orm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT AL.of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Writer Heater/Vent PLUMBING BPWSVCS M<dn Water Service PLUMBING BR.EINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Romodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT H,-ater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pol:/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc t , Switch & Outlets ELECTRICAL BRENIRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance_ ELECTRICAL 2 cif 3