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12050216CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10895 NORTHVIEW SQ OWNER'SNAME: PATIL DEEPAK S AND NETRALI OWNER'S PIIONE: 4086669431 ❑ LICENSED CONTRACTOR'S DECLARATION License Class C/O ak Lic. q F5�-46 9 AME CR f LirGG+—z. Contractor Z 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 hereby affirm under penally of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I 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 building construction, and hereby authorize representatives of this city to enter upon the above mentioned properly for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may acerae against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulatims per the Cupertino unicipal Code, Section 9.18. Signature Date .i 3o Z ❑ OWNER-BII , DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or lily employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penally of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this peril is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in my manner so as to become subject to the Worker's Compensation Imus of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is cored. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the grating of this peril. Additionally. the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. CONTRACTOR: . I PERMIT NO: 12050216 DATE ISSUED: 05/30/2012 J I PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: INSTALL (8)CAN LIGHTS IN KITCHEN, (6) IN LIVING ROOM, (6) IN MASTER BEDROOM, (4) IN BEDROOM: REMOVE AND REPLACE (2) WATER CLOSETS, (3) SINKS. Sq. FI Floor Area: I Valuation: $5000 APN Number: 31636005.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ✓OWP AZe_,' Date: ,- ,30 ' 1, RF. -ROOFS: All roofs shall be inspected prior to my rooting material berg installed. If a roof is installed without firs( obtaining an inspection, I agree to remove all new materials for inspection_ Signature of ALL ROOF COVERINGS TO BE CLASS'S(" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25S32(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the Ilealth & Safely Code. Sections 25505, 2!";, and 25534. Owner or e 1 oriz Q �nt: r S o Deter/ L C NSTRIICTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Dale I Licensed 9 ITEMS OF 9 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31636005.00 DATE ISSUED.......: 05/30/2012 RECEIPT #......... BS000016947 REFERENCE ID # ... 12050216 SITE ADDRESS .....: 10895 NORTHVIEW SQ SUBDIVISION ....... CITY ............. CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 647.50 --------------- 647.50 VOICE ID DESCRIPTION -------------------------- 304 ROUGH ELECTRICAL REFERENCE NUMBER -------------------- #1567 VOICE ID DESCRIPTION -------- ---------------------------- 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL 512 FINAL HANDI-CAP OWNER ............: PATIL DEEPAK S AND NETRALI ADDRESS ..........: 10895 NORTHVIEW SQ CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: AMERICA'S VINYL EXT CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096 COMPANY ...........: TBD - TO BE DETERMINED ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ........: FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- -ADMIN --------------------------------- HOURS 1.00 41.00. ---------- 0.00 ---------- 41.00 ---------- 0.00 1BCBSC VALUATION 5,000.00 1.00 0.00 1.00 0.00 1BREMFIXT NO. FIXTURES 24.00 81.00 0.00 81.00 0.00 1BSEISMICR VALUATION 5,000.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 44.00 0.00 44.00 0.00 1PPERMITFE FLAT RATE 1.00 44.00 0.00 44.00 0.00 1PRSEWER UNITS 6.00 132.00 0.00 132.00 0.00 1STINSP UNITS 2.00 260.00 0.00 260.00 0.00 1TRAVDOC FLAT RATE 1.00 44.00 0.00 44.00 0.00 ---------- TOTAL PERMIT 647.50 ---------- 0.00 ---------- 647.50 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 647.50 --------------- 647.50 VOICE ID DESCRIPTION -------------------------- 304 ROUGH ELECTRICAL REFERENCE NUMBER -------------------- #1567 VOICE ID DESCRIPTION -------- ---------------------------- 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL 512 FINAL HANDI-CAP ��CITY OF CUPERTINO rp`% � FEE ESTIMATOR - BUILDING DIVISION jA[7DZE7SS: 10895'Northview Square DATE: 05/30/2012 REVIEWED BY: Sean Mach. Permit Fre: APN: BP#: 'VALUATION: $5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: tiler. hisp. I"x.: PENTAMATION 1REAP11 PERMIT TYPE: WORK Install 8 can lights in kitchen 6 in living room 6 in master bedroom 4 in bedroom Remove and SCOPE replace (2) water closets,.(3) sinks, (1) bathtub, new shower enclosure. Convert office to bedroom. NOTE: This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, ela). These fees are based on the preliminary information available and are only an estimate Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E/f 7/1//1) ,Ifeeh. Mon Che(k Plumb. Plan Check 0.0 1 hrs $0.00 Elec. Plan Check 1 0.0 1 hrs $0.00 Mach. Permit Fre: Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT (hher,th•, h. Imp. Other Plumb Insp. 0.0 hrs $44.00 Other Elec. Insp. 0.0 hrs $44.00 .1/erh. Imp. F,: c: Plumb. ht..p. re": tiler. hisp. I"x.: NOTE: This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, ela). These fees are based on the preliminary information available and are only an estimate Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E/f 7/1//1) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 24 # Electrical $81.00 IBREMFIAT I Fixtures, Lighting Suppl. PC Fee: Q Reg. Q OT FO.0 hrs $0.00 PME Plan Check: $0.00 = # Plumbing $132.00 IPRSEIVER Sewer, Sanitary Permit Fee: Hourly Only? O Yes E) No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $88.00 C'un.snvrlion Tay. Administrative Fee: (ADMIN $41.00 Q E) Work Without Permit? O Yes 0 No $0.00 Advanced Planning Fee: $0.00 = hours Inspections $260.00 1 ISTINSP 7 Inspection, Hourly Tavel Documentation Fee: 1TRAVDOC $44.00 Strong Motion Fcc: IBSEISMICR $0.50 Select an Administrative Item 131dg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $174.50 $473.001 TOTAL FEE: $647.50 Revised: 05/01/2012 10VK s /lU�rl� Vim /3S S0q SLr�lihy ��aw - �6,efr'� oN�EjzT OG�j�G CUPERTINO MAY 30 2012 Building Department MAY 3 0 2012 REVIEWED FO OMPLIANCE I Reviewed By: ///�I�S S �OW14 3® - - �y�� - - - - - IC—IUPERTINO I I NFW rnNSTRT Ir TON .. C')J'00A-� V -'s - CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildino(1Dcuoertino.orG I Zoj 0 ZI (o F-1 AT)OTTTON ITN AT TFRATTON/TT F-1 RFViSI0N1AFFFRRFD oRIGNAI.PFRM7T9 PROTECT ADDRESS APNa 0e) UAQCQL OWNER NAME ) fl-� L- PHONE 6Ea6- ) E- a�ea ou.-� w•w�L• wvh STREE'ADDRESS SOAR CITY. STATE ZIP FAX _ CONTACT NAME� VLKCTlJf^NlobVo PHONE 2-Ll77-^Iq1Z6C V 0 LV0W-r. E-MAIL�JY TE /- STREET ADDRESS FAX, S ❑ OWNER ❑ OWNFA-BUTDER ❑ OWNER AGENT W CONTACTOR ❑CONTRACTORAGENT ❑ ARCTUTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CZFgTORNAM n"w `"M/, VtAWhG LICENSENUMBER O� 6jTLICENSETYPE - G US 30-2 N3�g COMPANY NAME -MAIL d��,e.o�,Y�. FAX ?4L 916- �_o "ikc. STREET ADDRESS � �/ YpW?.)t �(/I1^ /oa,�OtvarejQ-. CITY�ST�L _ • _ fiir 7•+ O Z 6 '" �; Y - f q i�l / `-0- - ARCHITECT/ENGINEER NAME LICENSE NUMBERL Bus. LTC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY. STATE, ZIP PHONE DESCRIPTION OF WORK Bed ov w 1 lnS Imo/w.To,r_: /s. -:fir , S�tyC�rr� .mow R-klti r�o�✓!/E�T o FFi aE i o fi %3• �i7 ao �✓l EXISTING USE /z --z7 PROPOSED USE .f 1= CONSTR.TYPE ./moi r '/ Ns USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG New FLOOR DEMO TOTAL AREA AREA AREA NETARFA . BATHROOM KrrCfIN RENIODELAREA REMODEL AREA PORCH AREA ECK AREA TOTALDECKTORCHARA GAAGEAREADETACH A ACH I 0 DWELLING UNITS: / TSA SECOND UNTT YES BEING ADDED? NO SECONDSTORY ❑YES ADDITION? ENO PRE-APPLICATIONJ❑YFS IF YES. PROVIDE COPY OF PLANNNGAPPLN NO PLANNING APPROVAL LEITER IS THE BLDG AN 11 YES I EICHLERHOMEr )]NO RECEIVEI B �Q�DOO TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act own th(eYprrperty owners behalf. 1 have read this application and the information I have provided is correct. 1 have read LheyDesTpAnof Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. 1 thonze fives of Cupertino to enter the above -identified pro erty for inspection purposes. Signature of ApplicantAgent: Daze: �S/�C7z0�� SUPPLEMENTAL INFORMATION REQ PLUN CHECKTYPE ROUTING SLIP OVER-THE-COUNTER BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PIAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E]STANDARD ❑ PUBLIC WORKS _ form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ ❑ submittal of Building Permit application. MAroR SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH B(dgApp_2011.doc revised 06121/11 111" rO IH CITY OF CUPERTINO BUILDING PF.RMI.1- BUILDINGADDRESS: 20395 SILVI:RADO AVI: CONI RAC 'I OR: VA 1.1.1;)' 11 EA'I'I NO & PER>II'I NO: 120N117 C OOIJNO O\\'.NER'S ,NAME: CRAM SODERQUIS'I' 1171 N 4'I'II SI DA IF ISSLE1): 05 /30/21112 PlIO\E: SANJOSE. CA 95112 PHONE SO: (411%)294-6290 OOWNER'S UC LICENSED CON "I'RA(TOR'S DECLARATION F— F—� F CJ BUILDING PERMIT INFO: BLDG PLUMB License L'Iass � <, Lic.Y L ieJ.sq r' F �— � Cunlrctur� Pa .• . r : 'Date 5�.30� = NIECII RESIDENTIAL COMMERCIAL 1 hereby affirm Ont 1 am licensed under the provisions of Chapter 9 JOB DLSCRIPTIONRIli\IOVE AND RITI.ACF AIK COND] Il(1NING UNI.)' (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. hereby affirm under penally at perjure' one of the following Ivo declarations: I hare and will Innintain it certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the I.abor Code. for the performance of lite work lilt which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Sy. FI Floor.Arca: \"a lu:uiun: S379I SCCEloll 3700 0l to I.abor Code. for the performance of the work Ibr which this APN Number: 36939012.00 Oecupallc 'I%pe: permit is issued, APPLICAN'"I' CF-RIIF'IC:\ IION 1 cerlif% that I ],;we read this application and state that the above information is correct Iagreetoconiplysvitli all citpand cmmtyordinances and State lm.srelating PERMITEXPIRES IF WORK IS NOTSTARTED In buil Jing construction. and hereby authorize representatives oI'tbis city to enter upon the above mentioned properly lox inspection purposes. (We.) agree to save WITHIN 180 DAYS OF PERMITISSUANCE OR inJcnwil'y and keep hanuless the Cite or Cupertino against liabilities. judgmcnt5, 180 DAY EOM LAST CALLED INSPECTION'. c... ls. and c\penses which mac accrue against said City in consequence 01 Elie 19a III in,, m oI IItis perit. Ad d I I unit al IN. the appl lean( enders Lands and N'III Corn pl\' ions 1 11 with all non-point source regu ha per (he. Cupertino Municipal Code, Section Issuer) bv- Dale.: 9.18 S lgnaturCaICS //2 L� RE ROOTS: ❑ OWNER- It t; 11.1) E11 1) ECI.A HA'17(LN All roofs shall he inspected prior to any fouling muteriul hcing installed Ifo ruol is installed without line obtaining an inspeclion. I agree to renuyc all new materials Ila hereby affirm that 1 am e\empt from (he Contractor's I-tcense I.aw for one of inspection. the fit Itow ing Ivo reasons: L as owner ul'Ilie prulie rlr. or ill cot pIoyces with wages as their sole compensation. Sign;uurc of Applicant: Unto: will do the work. and Ilse structure is it or intended or ollired for sale (Scc. 7044. Rusincss & Pruf'essions Cock) 1, as owner of the pruperl, am e\clusiVd)1 contracting with licensed contractors l0 AIA, ROOF COVERINGS IO Bl- CI.ASS "A" Oil lit:I1 construct the project (See 7041, nosiness & Professions Code). 1 hereby affirm under penally of perjury one of the following three IIAZARDODS MA I ERL\LS DISCLOSURE decla ra(inns: I have read the hazardous material., requirements under Chapter 0.95 of the I luwe anti will maintain it Ccr HICnIe 01 Consent to sell'-insure for Worker California Ilcallh S. Safety Code, Section\ 255115, 25533. ;,ad 25534. 1 will Maintain Compensation. as provided for hp Section 370001'Ehe I.abor Code, for the Compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilcallh & pert rniance ill the fork for which this permit is issued, Safety Code. Section 25532(:1) should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance, as provided for by AJdilionallc, should I rise equipment or devices which emit hazardous air Section 3700 olthe Labor C'odc, lit Elie performance of the work Ibr which this contaminants as defiled by the But :\rea Air Quality Management District 1 will permit is issued. maintain compliance with the (:uperlinu Municipal (:ode. Chapter 9.12 and the Ilcallh & Safer)' Code, Sections 25505, 25533, and 25534. 1 calif)' that in the performance ul'dte work for which this permit is issued, I shall not enghlen any person in any manner so as to become subjCCE to the Worker's Osv3er n�aulh z • eat:J Compensation laws of California. Ih aller making Ellis cenificate of exemption- I E !�fi£2�I =crL//��.r becolne subject to the Worker's Compensation provisions ofthe labor Code, I must �— hxthoall comply will such provisions or this permit shall be deemed revoked- CONS I RUCTION I.ENDING AG ENC)," I hereby Zillion that there is a conaructiun Ieuling agency for the performance of work'. APPI.ICANT CERTI FICA "HON Ort which this permit is issued (Sec 3097. Civ C.) I ccrti IN (hat I ha% e. read this application and state than the above in lbnnat ion is Lender's N:une correct, I agree to comply with all cif)' and county ordinances and state laws relating I(, building construction, and hereby mlthorizc represcnlmives of this cin' to enter Lender's Adds upon the above mentioned property for inspection purposes. (We) agree to save indenmily and keep harmless the Ci(p of Cupertino against liabilities, judgments, costs, and expenses which man accrue against said City in consequence 0f the ARCI I I'Ih:(.'I"S DIA I.ARA'IION r:suing ol'Ihis permit, AJJitionallr. the aPill iCall ( trade islands and will comply I underslunit my 1) MIS Sha11 be hied as puhI is rCeol dS. wish all nun-point source reguhaions per the Cupertino Municipal Code, Section U8 I.icensed Prndensional Sign:lure Date ��,�,,,��, CITY OF CUPERTINO IN'R'l/AI FEE'ESTIMATOR- BUILDING DIVISION LaADDRESS: 20385 Silverado Ave. DATE: 05/30/2012 REVIEWED BY: jsg UNITS i APN: BP#: v��2� `VALUATION: $3,784 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p $65 PENTAMATION *URN/AC PERMITTYPE: WORK Remove and replace AC only SCOPE APPLIANCE/ EQUIP TYPE FEE ID Plumb. Plon Cheek QTY UNITS BP FEES Eh I', r'nir Fee: A/C Units (<=10K cfm) 1BREMAIR Oihca tiler. Li u. 1 # $65 Permit Fee: .Supp/. h/cp Ft•e . PME Unit Fee: $65.00 PME Permit Fee: $44.00 Consiruclion due: Administrative Fee: IADMIN $41.00 Work Without Permit? O Yes (E) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC 1 $65.00 Strong. Motion Fee IBSEISMICR NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Di -rip, Pip i Thoce loot aro haeod an rhe nrelindnary information available and are oniv an estimate. Contact the Dept for addn'i info. FEE ITEMS (Fce Rcsohnion 11-053 E/f 7/1/11) Mech. Plan Check 0.0 hrs $0.00 Plumb. Plon Cheek lite,:. flat (:heck Mech. Permit Fee: I MPERM/T Plnmh. Permit Fre•: Eh I', r'nir Fee: Other Mech. Insp. 1 0.0 hrs $44.00 Oilier Plumb Insp. Oihca tiler. Li u. .1Ice h. la.p. Fre: !'lunch. hisp. Fed: Ekv. hiaP. Fro. NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Di -rip, Pip i Thoce loot aro haeod an rhe nrelindnary information available and are oniv an estimate. Contact the Dept for addn'i info. FEE ITEMS (Fce Rcsohnion 11-053 E/f 7/1/11) FEE QTY/FEE MISC ITEMS /'/un Check Fie: ,Cupp/. PC. Fee 177 PME Plan Check: $0.00 Permit Fee: .Supp/. h/cp Ft•e . PME Unit Fee: $65.00 PME Permit Fee: $44.00 Consiruclion due: Administrative Fee: IADMIN $41.00 Work Without Permit? O Yes (E) No $0.00 Adveniced l'l<uuiing Fres: Travel Documentation Fee: ITRAVDOC $44.00 Strong. Motion Fee IBSEISMICR $0.50 Select an Administrative Item Blde, Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $195.50 $0.00 TOTAL FEE: $195.50 Revised: 05/01/2012 6 ITEMS OF CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36939012.00 DATE ISSUED.......: 05/30/2012 RECEIPT 4.........: BS000016950 REFERENCE ID 4 ...: 12050217 SITE ADDRESS .....: 20385 SILVERADO AVE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: sue+ COPY ,' 1 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 195.50 --------------- 195.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- 23659 VO -ICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING OWNER ............: CRAIG SODERQUIST ADDRESS ..........: 20385 SILVERADO AVE CITY%STATE/ZIP ...: CUPERTINO, CA 95.014 RECEIVED FROM ....: VALLEY HEATING CONTRACTOR ..... JEFF AND CINDY FAULINER LIC 4 241 .COMPANY ..........: VALLEY HEATING & COOLING ADDRESS ..........: 1171 N 4TH ST CITY/STATE/ZIP ...: SAN JOSE, CA 95112 TELEPHONE ........: (408)294-6290 FEE ID UNIT QUANTITY AMOUNT PD -TO -.:)T ---------- THIS REC ---------- ---------- -ADMIN ------------- ---------- HOURS 1.00 -------------------- 41.00 0.00 41.00 0.00 1BCBSC VALUATION 3,784.00 1.00 0.00 1.00 0.00 1BREMAIRHA NO.UNITS 1.00 65.00 0.00 65.00 0.00 1BSEISMICR VALUATION 3,784.00 0.50 0.00 0.50 0.00 IMPERMITFE FLAT RATE 1.00 44.00 0.00 44.00 0.00 1TRAVDOC FLAT RATE 1.00 44.00 0-00 44.00 0.00 T TOTAL PERMIT 195.50 0.00 195.50 0 00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 195.50 --------------- 195.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- 23659 VO -ICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CUPERTINO GENERAL PERMIT'A'PPL•ICATION IMEP COMMUNITY' DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aacuoertino.oro F-1 PLUMBING kMECHANICAL ALECTRICAL ❑MISCELLANEOUS M ISC PROJECT ADDRESS S,.1L)fq J6 263Y5( / J ... f1 APNd 6 / (� OWTER NAME Cf�; PHONE ;406-121-6; Too E-MAIL/ STREET ADDRESS U.S�S �UPr± 0' d A c. CITY, TATE, LIP �.. q�xt FAX CON "FACT NAME PHONE E-MAIL STREETADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR _KCINTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVEI.OPF,R ❑ TENANT CONTRACrO 111E V I LICENSE NUMBER 585 G LICENSE TYPE C -ZO BUS. LICd / COMPANY NAME va i E-MAIL FAN S 1"REET ADDRESS ll' N'4t�iSt CITY. STAT' C4 r5/l2 PI IONS �IOfi 97f (2�D ARCHITECTIENGIN'EER NAME LICENSENUMBER BUS, LIC d COMPANY NAME E-MAIL FAX STRI[ET ADDRESS CITY, STATE, ZIP PHONE USE OF FDar DUPLE.% ❑ MULTI-FAMILYPROTECT BUILDING. COMMERCIAL IN W ILDLAND ❑ YES URBANINTERFACF, AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO ISTIIEBLDGAN ❑ YES EICHLER HOMEI ❑ NO DESCRIPTION OF WORE: � (. � / I/r. 'TOTAL VALUATION: 3�OT— RECEIVEDBY: By my signature below. I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and slate laws relating to building cons met ion. I au ize representatives ofCuperlino to enter the above -identified property for inspection purposes. Signature of ApplicandAgenl: ea Date: SUPPLEMENTAL INFORMATI N REQUIRED .: o6FtceusEorvuY,'- . �.. ^ 1;❑ OVER-THE-COUNTER _ '❑ EXPRESS 't• _.; •11 -'STANDARD .I - ❑ LARGE _ 6 ❑ MAJOR M6PAfiscApp_2011.doe revised 0621111