06100076 CITY OF CUPERTINO
'BUILDING;DIVISION PERMIT
+Cd� T C? IMIfJN
BUILDING ADDRESS: TAFOYA CONST CO PERMIT NO. 06100076
7984 FOLKESTONE
PERMIT ISSUE DATE
OWNER'S NAME:
BONNIE LIBBY 57 N SUN FT AVE 10111 .1200C,
SANITARY NO. CONTROL NO.
NE:
(408).251-1234
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
-BLDG ELECT PLUMB MECH
0
O p LICENSED CONTRACTOR'S DECLARATION Job Description
U C I hereby affirm that I am licensed under provisions of Chapter 9(commencing
;Z td with Section 7000)of Divi n 3 of the Business and Professions ode,and my license is
y in full force and effect ° E," "� BATHROOM REMODEL - NON STRUCTURAL
t ? License Class LM•
�t --
Date r tnt'_ Contractor
ARCH ]DECLARATION
DECLARA ON
a< I understand my plans shall be used as public records
,a
Gy Licensed Professional
N OWNER-BUILDER DECLARATION
t�^ 1 hereby affirm that I am exempt from the Contractor's License Law for the
:00 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 a prior to its issuance,also requires the applicant for such permit to file a signed statement Ft. Floor Area Valuation
_ that he is licensed pursuant to the provisions of the Contractor's Liccnsc Law(Chapter 9 Sq
t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
r3. 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 r• 0 0 Occupancy Type
not more than five hundred dollars(SSW).
❑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.7041,Business Required Inspections
and Professions Code:The Contractor's License Law docs 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.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7041.Business and Professions Code:)The Contractor's Li-
ccnse 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 Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑]have and will maintain a Certificate of Consent to self-insure for Workces 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 Wor is C m t�ensan (Insurance carrier and Polity
Carier.�j 1 1-1-A', Policy No.: o
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,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
`,L forthwith comply with such provisions or this permit shall be deemed revoked.
Z OCONSTRUCTION LENDING AGENCY
(-t rte.. I hereby affirm that there is a construction lending agency for the performance of
p;> the work for which this permit is issued(See.3097,Civ.C.)
W QLender's Name
0. Lender's Address
V 0 I certify that 1 have read this application and state that the above information is
ls,►� cored 1 agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorise representatives of this city to enter upon the
0 W above-mentioned property for inspection purposes.
C7~ (We)agree to save,indemnify and keep harmless the City of Cupertino against
CA liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of granting of tri rmit. Date
►�+ APPLICANT U RST N N WILL COMPLY WITH ALL NON- INT Issued by:
SOURCE REG N �1 r�t t
"� Re-roofs
Signature of Applicant/Contractor Date T of Roof
HAZARDOU A ALS DISCLOSURE Type
Will the applicant or futurei in occupant store or handle hazardous material
as defined by the Cupertino Munic a de.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes a,
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
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes ❑No
1 have the hazardou aterials requirements under Chapter 6.95 of the Califor-
nia Health&Saf y ads,Sccti 35505.25533 and 25534.I understand that if the building
docs not curpi ntl h a t that it is my responsibility w notify the occupant f the
requirement w t 'o suance of a Certificate of ogcu cr. Signature of Applicant r Date
t� All roof coverings to be Class B or better
Owner or authorized agent Dare
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
"WEkTINO
Building Department
JOB ADDRESS: PERMIT#
OWNER'S NAME: A PHONE #--2 S
GENERAL CONTRACTOR: P°.I-," FAX # 'j j ( ' . 3
I am not using any subcontractors:
Signature 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 S5
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
CITY OF CUPERTINO
:m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36211002 . 00
DATE ISSUED. . . . . . . : 10/11/2006
RECEIPT # . . . . . . . . . : 36392
REFERENCE ID $# . . . : 06100076
SITE ADDRESS . . . : 7984 FOLKESTONE DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : BONNIE LIBBY
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : MARK TAFOYA
CONTRACTOR . . . . . . . : MARK TAFOYA LIC # 22233
COMPANY . . . . . . . . . . : TAFOYA CONST CO
ADDRESS . . . . . . . . . . : 57 N SUNSET AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95116
TELEPHONE . . . . . . . . : (408) 251-1234
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- ----- --- ---- -------- - ---------- ---- ------ ---------- ---------- ----------
BPERMFEE VALUATION 25, 000 . 00 331 . 56 0 . 00 331 . 56 0 . 00
BPLANCHKI PERMIT FEE 331 . 56 83 . 16 0 . 00 83 . 16 0 . 00
BENERGY PERMIT FEE 331 . 56 159 . 15 0 . 00 159 . 15 0 . 00
BSEISMICRE VALUATION 25 , 000 . 00 2 . 50 0 . 00 2 . 50 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---- ------ ---------- ---------- ----------
TOTAL PERMIT 796 . 48 0 . 00 796 . 48 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- --- ---------- --- ------------ ------------------
OTHER 796 . 48 VISA
TOTAL RECEIPT 796 . 48
CITY OF CUPERTINO
oh I cnOqCO
CITY of PERMIT APPLICATION FORM
CUPEkTINO
APN# _MZ Date:
Building Address: Mailing Address (if different from building address):
D
Owner's N e: Phone#:
Contractor: License#:.
,- A � �� Ca ( (io
Contac f _ Phone:`f 0 2�= (2�`i' Cupertino Business License#:
` QCn 1 t/3 Fax: S
Building Permit Info: 1 6 k h n)ryA Y1f C
Bldg ❑ Elect LTJ-.. Plumb EAK., Mech
Job Descripti n:
Residential Commercial ❑
Sq.Ft. Floor Area: (eo Sq.Ft.:
Cost of Project: Z Occupancy Grotm
Type of Construction: Please check this box if the project is a
,a ,\Ak U �-- �'� l�zl�'� second-story addition: ❑
Project Size: Standard 15` 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
BELEC1000 Elec 600V <= 1000A 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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