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06100115 CITY OF CUPERTINO PERMIT BJILDING liIVIS10N PF,RMl l BUILDING ADDRESS: SAN JOSE PLUMBING PERMIT NO. 06100115 10326 BYRNE AVE PERMTT ISSUE DATE OWNER'S NAME: BARBARA KELLOG 1732 NE: SANITARY NO. CONTROL NO. 408296-182 ABUILDING PERMIT INFO RCHITECT/ENGiNEER: BLDG ELECT PLUMB MECH 0 p C LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Z with Section 70(X)) Division 3 of the Business and Professions Code,and my license is !"Cy in full force andt n REPLACE RESIDENTIAL. WATER HEATER License Class ILic.8 t Date Contras r 'i ARCHITECTS DEC ATION a< I understand my plans shall be used as public records >yU U.F' Licensed Professional �0� OWNER-BUILDER DECLARATION Gn Law for the k 1 hereby affirm that 1 am exempt from the Contractor's License O following reason.(Section 703 1.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure Z In 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 Sq.Ft. Floor Area Valuation FZ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1500 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(5500). ❑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 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.). ❑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 conu-actor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION T 1 hereby affirm under penalty of perjury one of the following declarations: L]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 Worker's mpens ion Insurance carrier and Policy number are: r Cartier. ,1- 6 licy No.• RTIF� ATE OF EXE ON FROM ERS' 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 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z 2 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of tx the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name aLender's Address U 0 I certify that I have read this application and state that the above information is ii correct.I agree to comply with all city and county ordinances and state laws relating to C V building construction,and hereby authorise representatives of this city to enter upon the above-mcncioncd property for inspection purposes. 0W4 (We)agree to save,indemnify and keep harmless the City of Cupertino against tF-r 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 APPLIC ERSTANDS AN WILL COMPLY WITH ALL ON-P NT Issued by: (/� ( V� S RE ATION Q Re-roofs Si erre of Appli tlContractor Date HAZARDOUS MATERIALS DISCLOSU E 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 Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. [3 Yes __JgNo If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which :mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. 3istrict? ❑Yes ---no I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Code,Sections 25505,25533 and 25534.1 understand that if the building docs not curren ha a ten hayt is my responsibility to notify the occupant of the require ntss tch ust w issuance oCa Certificate of Occupanc Si nature of Applicant Date at t All roof coverings to be Class"B"or better rtes or authorized agent CITY OF CUPERTINO CX-0 I c)o WATER HEATER CUPEt�TINO PERMIT APPLICATION FORM APN# Date: f, 3 Building Address: Owner's Names'" � � fji Phone#: _ _( r G _Sfs Contractor �-� Ph e: / License# r7 (r Contact:-- hone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb Mech LT Job Description• i� Residential--3 Commercial ❑ Cost of Project: , Strapped ❑ On Platform Bonded LJ New Location ❑ Replacement / Qty. if Applicable Fee ID Fee Descri tion Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING / BENERGY Energy BUILDING BUSLIC Business License BUILDING WU o O z UO O > � ° zIO a Q Ln a� O z r 3 a' �+ O OU 7 '' P� O E•'' y' O~ r-I NIL O O '4 O M O O S c�i W io G OC W Q O O a LCd 1 0 O r I z Q as O - z Y �. 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V �� u a o� tE�'aE ...•O �',eu;a" ggou., a o•0 8T E Y uc•� °G.�uSL uee to a °a0 �O E•- i0 °' 1; '9�-• u� u s°.vow" ^v �" 2su 3 0 .p uE o $s'A s�Qrn in �U V m N Q < 3x::10 3 at Al,9 ❑3 .9 no3ca S ❑eg u 3D O ❑`.�; ❑.r�+� V `c .. u GZ�'�. �.°�� NOLLOUSNI U311YO ISV'I WOM SAYO 081 NOISIAIQ NOI.LOddSNI a0 HJNY(1SSI11WTI3d d0 SAVU 081 NIHILM ONI L2Igdf1O 30 ALIO ....................w..0.n ccrvuv°c.wvva CITY OF CUPERTINO 3m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN 35719027 . 00 DATE ISSUED. . . . . . . : 10/03/2006 RECEIPT # . . . . . . . . . : 36287 REFERENCE ID # . . . : 06100014 SITE ADDRESS . . . . . : 202 CALVERT DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : SEQUOIA EQUITIES ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : TRAVIS HARTMARK CONTRACTOR . . . . . . . : SNYDER, PEPPER LIC # 21974 COMPANY . . . . . . . . . . : SPRIG ELECTRIC ADDRESS . . . . . . . . . . : 1303 LICK AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE . . . . . . . . : (408) 298-3134 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - ---- - -- - - - ----- - ----- ------- --- ---------- ---------- ---------- --- ------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 150 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ------- --- TOTAL PERMIT 73 . 73 0 . 00 73 . 73 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - ------ -- -------- --------- --- ------------------ OTHER 73 . 73 MASTERCARD TOTAL RECEIPT 73 . 73 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL CITY OF CUPERTINOI c)Q04 OW OF PERMIT APPLICATION FORM CUPEkTINO iPN# �--��r- � C� Date: r G •� p� Building Address: G 2 C LL_eT� ailing Address (if different from building address): 07e Is Name: Pho e#: ) 2,��- Z � 3 C10 Contra or: (�1 1 " Li ense �G _ c,7 Contac t�i Phone: L12 K, Cupertino Business License#: I GAJ t5 Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Descriptio _: A,;e-7v,,e r l�c e ex�`s vc-rz l kk X Z J c ez Residential Commercial; Sq.Ft. Floor Area: , ( 414 Sq.Ft.: Cost of Project: (S� ��, Occupancy Group: -$� Type of Construction: / J Please check this box if the project is a V V�,� second-story addition: ❑ ?roject Size: Standard ❑ Large ❑ Major ❑ 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 Boiler> 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 Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile 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 Investigation fee BUILDING 1 of 3