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12060095CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 795 ALDERBROOK LN CONTRACTOR: EMPIRE FLOORING & PERMIT NO: 12060095 DESIGN CENTER OWNF,R'S NASIE: PAUL & GRACE ROBINSON 495 E BROKAW RD DATE. ISSUED: 06/1512012 OWNER'S PHONE: 4083919169 SAN JOSE, CA 95112 PHONE NO: (408) 213 -0996 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class I _ ? V Lie.9 X93? /� K L/yr Contractor— r Dale 1 hereby affirm that 1 am licensed under the provisions of Chapler 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I 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 Code, f'or the performance of the work for which this permit is issued, APPLICANT CERTIFICATION I cenily that I have read this application and stale that the above information is coffee(. I agree to comply w ith all city and county ordinances and stale laws relating to budding 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 accrue against said City in consequence of the granting of this permit. Additionally..the applicant understands and will comply with all non -point source 7vgulatiwns per the Cupertino Municipal Code. Section 9.18. Signature Date s / ❑ OW'NE:R- BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Low for one of the following Iwo reasons: L 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 & Professions Code) h as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty 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 perlbnnance 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 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 any manner so as to become subject to the Worker's Compensation laws ofCalitihmia If. after making this certificate ofexcmption, 1 become subject to the Worker's Compensation provisions oflhe Labor Code, I must forthwith comply with such provisions or this permit shall he deemed revoked. 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 stale 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 granting of this permit Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: INSTALLATION OP GAS LINE, 6 GFCI OU 11,17 I'S Sq. Ft Floor Area: I Valuation: 15000 APN Number: 36916013.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: . �� r��TG Date: RE- ROOFS: All roofs shall be inspected prior tow), roofing material beug installed. Ira roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALI, ROOF COVERINGS TO BE CLASS "A" OR BETTER ILAZARDOUS MATERIALS DISCLOSURE: 1 have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth & Safely Code. Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emir hazardous air contaminants as defined by the Bay Area Air Quality Management District l will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth & Safety f:odc. Sections 25505, 25533, and 25534. or a na egg 0 Date: — CONSTRUCTION [.ENDING AGE:NCV 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 ARCIIITF.C7 "5 DECLARATION I understand my plans shall be used as public records. Licensed 9 ITEMS OF 9 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp;: Rng: Sub: Blk: Lot: APN ......... 36916013.00 DATE ISSUED.......: 06/15/2012 RECEIPT #.........: BS00001708S REFERENCE ID # ...: 12060095 SITE ADDRESS .: 795 ALDERBROOK LN SUBDIVISION ....... CITY ..:..r........: CUPERTINO IMPACT AREA -.. .. OPERATOR: patg COPY # : 1 METHOD OF PAYMENT --------------- -- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 292.50 VOICE ID DESCRIPTION, -- ------ --------------- -- ----- -- -- -- 202 UNDERFLOOR PLUMBING 506 GAS TEST REFERENCE NUMBER -------------------- MC VOICE ID DESCRIPTION - - -- ---- --------------- --- ------ -- -- 301 ROUGH PLUMBING 507 FINAL PLUMBING OWNER ............: PAUL & GRACE ROBINSON ADDRESS ..........: 795 ALDERBROOK LN CITY /STATE /ZIP ...: CUPERTINO, CA 95014 RECEIVED.FROM;....: CYRUS S FAKHARI CONTRACTOR ...: EMPIRE FLOORING & DESIGN CENTE LIC # 32920 COMPANY ....... ..: EMPIRE FLOORING & DESIGN CENTE ADDRESS ..... : .... : 495 E BROKAW RD CITY /STATE /ZIP .: SAN JOSE, CA 95112 TELEPHONE ........: (408) 213 -0996 FEE ID UNIT- QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- lADMIN ------------- - --- HOURS - -- 1.00 41.00 --- 0.00 ---------- 41.00 --- 0.00 1BCBSC VALUATION 5,000.00 1.00 0.00 1.00 0.00 1BPFIXTURE NO OF FIXTURE 1.00 9.00 0.00 9.00 0.00 1BREMRECEP NO. OUTLETS .6.00 44.00 0.00 44.00 0.00 1BSEISMICR VALUATION 5,000.00 0.50 0.00 0.50 0.00 IEPERMITFE FLAT RATE' - 1.00 44.00 0.00 44.00 0.00 1PGASRES OUTLETS 1.00 65.00 0.00 65.00 0.00 1PPERMITFE 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 TOTAL PERMIT 292.50 --- 0.00 -- -- - -- 292.50 --- - --- - -- 0.00 - -- METHOD OF PAYMENT --------------- -- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 292.50 VOICE ID DESCRIPTION, -- ------ --------------- -- ----- -- -- -- 202 UNDERFLOOR PLUMBING 506 GAS TEST REFERENCE NUMBER -------------------- MC VOICE ID DESCRIPTION - - -- ---- --------------- --- ------ -- -- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dkirim etr•_ ) . These fees are based nn the nreliminary information available and are on/v an estimate. Contact the Dent for atldn7 info. FEE ITEMS (Fir Resohuirm 11 -053 EO' 7/1111) ADDRESS: 795 Alderbrook Lane DATE: 0 611 512 01 2 REVIEWED BY: Sean jai APN: BP #: I 'VALUATION: $5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex Other Elec. Insp. 0.0 hrs $44.00 PENTAMATION 1RPGAS USE: 0' ' . I„y, a, PERMIT TYPE: WORK Installation of gas line 6 GFCI outlets and run a waste line to sewer for sink. SCOPE PME Plan Check: NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dkirim etr•_ ) . These fees are based nn the nreliminary information available and are on/v an estimate. Contact the Dent for atldn7 info. FEE ITEMS (Fir Resohuirm 11 -053 EO' 7/1111) ,A Plumb. Plan Check 0.0 1 hrs $0.00 Elec. Plan Check 1 0.0 1 hrs $0.00 1;.,, 1" !•mail Fer.- Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT ur6, -, .v,•, r:. hiy,. Other Plumb Insp. 0.0 hrs $44.00 Other Elec. Insp. 0.0 hrs $44.00 ,.,. o.u,l,. n, y,. r,•, : 0' ' . I„y, a, NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dkirim etr•_ ) . These fees are based nn the nreliminary information available and are on/v an estimate. Contact the Dent for atldn7 info. FEE ITEMS (Fir Resohuirm 11 -053 EO' 7/1111) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 = # $65.00 Plumbing IPGtSRFS Piping, Gas < =4 Outlets Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 = # $9.00 Plumbing W FIATURE Fixture set on One Trap Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. 0 OT 0,0 hrs $0.00 = Electrical $44.00 IBREhIRECEP Recep /Switch/Outlets PME Unit Fee: $0.00 PME Permit Fee: $88.00 f ,M.VI) it, '11UR l,l.c: Administrative Fee: IADMIN $41.00 O E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure (D 0 A Travel Documentation Fee: 17WAVDOC $44.00 Suong Motion Fee: IBSF-ISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fec: IBCBSC $1.00 SUBTOTALS: $174.50 $118.001 TOTAL FEE: $292.50 Revised: 06/05/2012 sm OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 --.-? Fax(408)777 -3333 Building Department JOB ADDRESS: / 74S filW�lbokndk L,d• QtijQsr�ilZd PERMIT # OWNER'S NAME: Paaz PWi 11,6 s yr PHONE Ja .n q GENERAL CONTRACTOR ®/'nt FAX # ( s d l In I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner /Co r i tore; Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical 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 Owner /Co r i tore; Date 3 fl IV)ED _ a �U a j _ \ JUN 15 2012 BY: COMM— IZyLMC.pVELOPMENTDEPARTMENT UIL i GDIVS, TINO APPROVED This set of p ans and specifications MUST be kept atiHB Job site du ing construction. It Is unlawful to make any., `- chant as or alterations on same, or to deviate % tlterefro , without approval from the Building.Ofilclal. C.,,_ 1 The slam ing of d specifications NOT M c z berlyeId appQ00 }3V \ d of anj 0n�/' Vl v C •` I I F -i0 1. i' s � � Q J � Air* brook Lh , JQ' -4 i7_7I/ f: ELDORADO ° OUTDOOR' THE BUILDING BLOCKS FOR LUXURY OUTDOOR SPACES "Robinson": 3D VIEW Page 2 of 6 "Robinson" : 2D TOP VIEW WWW.ELDORAD0STONE.00W0UTD00R 1 800.925.1481 ELDORADO A MUMAMS COMPANY 4— ;r l--TJ ;:i1li�vl�l1 r lrJ - - I ..i -..... - WWW.ELDORAD0STONE.00W0UTD00R 1 800.925.1481 ELDORADO A MUMAMS COMPANY ELDORADO 0 OUTDOOR' Page 3 of 6 THE BUILDING BLOCKS FOR LUXURY OUTDOOR SPACES "Robinson": ELDORADO PRODUCTS' SELECTED Before starting any installation of Eldorado Outdoor or Eldorado Stone, check with your local building code requirements and read all manufacturers installation instructions. You can download installation instructions at outdoor.eldoradostone.com/outdoor. The final printed color of this PDF is subject to the quality of the original photography and printer from which this PDF is generated. You should not assume this printed sample is a true representation of the actual product. For an exact representation, please contact your local Eldorado Outdoor or Eldorado Stone distributor. r, z4• 24• Qwemz ____________________ WWW.ELDORADOSTONE.COWOUTDOOR 1 800.925.1491' (3) Oty. 36' Cabinet 30'D 36'H OLPLS0036 (1) Cry. 48' Cabinet 30'D 36'H OLPLS0048 (2) Oty. Cabinet End Caps 24'W 24'H End caps complete the installation by closing off openings on either and of assembled island. OLPLSECAP (3) City. Fastener Sets Each set includes 4 nuts. 4 bolts 8 8 washers. One fastener set is required to secure two cabinets. OLPLSF004 ELDORADO A HEADWATERS COMPANY ELDORADO 4 OUTDOOR' THE BUILDING BLOCKS FOR LUXURY OUTDOOR SPACES "Robinson": OTHER PRODUCTS SELECTED Page 5 of 6 PtifJ'I:OO.ONAI p.a1.16 This layout was created with the following brand partner Lynx Professional Grills. Follow manufacturers instructions for proper installation. t WWW.ELDORADOSTONE.COM/OUTDOOR I 600.925.10.91 (1) Oty. SideBumer Double Side By Side SideBurner Double Side By Side Lynx Prod. No. LSB2PC -1 (1) Oty. Refrigerator Convertable 24 Refrigerator Convertable 24 Lynx Prod. No. L24CF (1) Oty. Sink Fits Most Straight Cabinets Lynx Prod. No. (1) Oty. Lynx 36" Grill 36' Built in Grill Lynx Prod. No. L36PSR -1 (1) Oty. 39' Access Door 39' Access Door Lynx Prod. No. LDR36 -2 ELDORADO s RL10WAt[RS WMPAW ELDORADO 0 OUTDOOR' THE BUILDING BLOCKS FOR LUXURY OUTDOOR SPACES "Robinson" : Lynx Professional Grills Appliances DealerDistributor(s) Page 6 of 6 .�xr�rooconn.n� r..:m.i_G Eldorado Outdoor has been designed to accept a wide variety of appliance manufacturers. This layout was created with the following brand partner Lynx Professional Grills. Please see the following section for contact info of a local Lynx dealer(s) near you. Please follow manufacturers instructions for proper installation. Visit us at http: /Aynxgrills.com Lynx Dealer and Distributor near.you. Outdoor Living Patio and Grills 1180 Kern Ave Sunnyvale CA 94085 408 - 245 -2900 The Complete Backyard 1600 Duane Ave Santa Clara CA 95054 (408) 748 -8100 WWW.ELDORADOSTONE.CONVOUTDOOR I 800.925.1481 Barbeques Galore 1875 South Bascom Ave #280 Campbell CA 95008 (408) 559 -7092 ELDORADO A HUMATERS WMPAW GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 MIS C CUPERTINO f0 • PLUMBENG MECHANICAL ELECTRICAL MISCELLANEOUS (408) 777 -3228 •'FAX (408)777 -3333 • buildinG(a)cuDertino.o PROJECTADDRMS a S A4 :ems Look h. .AINI -) 1 — — V I OWNERNAME PcjuL '-1O. /kiS I D 3 I JI�A G/-- R` e�h rCook L ^TT r �l 1IO S O / FAX CONTACT NAME PHONE E-MAIL STREETADDRESS CITY. STATE. ZIP FAX ❑ OWNER ❑ OWNER- BUDDER ❑ OWNER AGENT ID CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrELT ❑ F ozr R ❑ DEVELOPER 13 TENANT CONTRACTOR NAME % LICFNSENUMBER LICENSE TYPE BUS. LICK COMPANY NAME 6 �,�.�f // � / /, STREET ADDRESS • D a� CTiY. STATF� .. / PHONE O ARCHITECUENOINEER NAME LICENSE NUMBER BUS. LIC p COMPANY NAME E -MAIL. FAX STREET ADDRESS CITY. STATE. ZIP PHONE USE OF ❑SFD.DUPLEX ❑MULTI.FAMMY'. BUILONG: ❑COM RCW. PROJECTINWD,DLNO ❑YES URBAN DTTTRFACE AREA ❑NO PROIECT04 ❑YES FLOOD ZONE 0 N IS THE BLDG AN ❑YES EICHLER HOMES' NO DESCRIPTION OF WORK + h 4 l /... New . / �1 U l d 13 O Q / 4e e / [/ *' C, L• r- /VV C v 1.ie r d- fill TOTAL VALUATION: �oV K RECEIVED BY: ^ / By my signature below, i certify m each of the all application and the information I have pro ' is w ordinances and smte laws relating m buil ' g c 'mu Signature of Applicant/Agent — I am the property owuer or authorized agent m act on the property awoerr'svbehalf. I have read this L I have read the Description of Work and verity it is accurate. I agree m comply with ail applicable local I authorize representatives of Cuperticc to enter the above- ideuti6ed pmpc. —f ;or inspection pu�oses. �- Dare:. eS7PPLEMENTAL INFORMATION REQUIRED - OFFICE USE ONLY y OVER- THE-COUNTER Y ❑ EXPRESS U U ❑ STANDARD L ❑ LARGE ❑ MWOR MEPMcscApp_201 I. dot revised 06/21/11