09100020 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10330 MANN DR CONTRACTOR:SANDIUM PERMIT NO:09100020
OWNER'S NAME: GARRITY TERRENCE J ET AL 4223 VERDIGRIS CIR DATE ISSUED: 10/05/2009
IER'S PHONE: 4088949072 SAN JOSE,CA 95134 PHONE NO:(408)894-9072
❑ LICENSED CONTRACTOR'S DECLARATIONf—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#_nRik9 MECH r RESIDENTIAL r COMMERCIAL F
Contractor 4.1. �C `'�`" Date__
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DES
(commencing with Section 7000)of Division 3 of the Business&Professions CRAWLSPACE REPLACEMENT&RELOCATION TO
ACE AD
DESCRIPTION:A
Code and that my license is in full force and effect. ADD ON
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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 Sq.Ft Floor Area: Valuation:$12000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:32645003.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DA S FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section y Q
9.18. / Issued by: ,y" ` •� �// Date:
Signature —��
Date `�l 5[o ,
L� OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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 offered for sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
constrict the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,1 shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Own r uthorized ager
become subject to the Worker's Compensation provisions of the Labor Code,I must �P � `,'l,t -Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
it" *uify and keep harmless the City of Cupertino against liabilities,judgments,
c and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32645003 . 00
DATE ISSUED. . . . . . . : 10/05/2009
RECEIPT #. . . . . . . . . : BS000008827
REFERENCE ID # . . . 09100020
SITE ADDRESS . . . . . : 10330 MANN DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER GARRITY TERRENCE J ET AL
ADDRESS 10330 MANN DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1141
RECEIVED FROM . . . . : YIU-HANG LEE
CONTRACTOR . . . . . . . : MICHAEL LEE LIC # 28867
COMPANY SANDIUM
ADDRESS 4223 VERDIGRIS CIR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95134
TELEPHONE . . . . . . . . : (408) 894-9072
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 12, 000. 00 1 . 00 0. 00 1. 00 0 . 00
1BSEISMICR VALUATION 12, 000. 00 1 .20 0 . 00 1.20 0 . 00
1EPERMITFE FLAT RATE 1 . 00 42 .00 0 . 00 42 . 00 0 . 00
1MFR=<100 UNITS 1. 00 126 . 00 0 .00 126. 00 0 . 00
1MPERMITFE FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 . 00
1MRRAA UNITS 1. 00 63 . 00 0. 00 63 . 00 0 . 00
1PPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 359 .20 0 . 00 359.20 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 359 .20 VISA
---------------
TOTAL RECEIPT 359 .20
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
O
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # _ Date:
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Building Address:
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Owner's Name: Phone#:40 1�91� %-77—
Contractor:
-7ZContractor: Phone#:4� 6% 021
Fax#:
Contractor License#: Cupertino Business License#:
SSE �19
Contact: ` Phone#: 4,!� $14 �.-2 i
ee-
Fax #:
Building Permit Info:
Elect IT" Plumb [ Mech ❑
Residential �? Commercial
Job Description: - � � � a o t ,� cm--As. tce.,
For Residential Installations:
Attic ❑ 1 st floor ❑ 2nd floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
4r, ,200 o
Strapped ❑ On Platform El Bonded New Location . Replacement
Project Size: Express ❑ Standard ❑ Large ❑ Major❑
Valuation: . 12s-o a
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 01/07/09
CITY OF CUPERTINO
`k FURNACEAC
CUPER�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Grou
IMRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install ¬ incl in an ap 1 permit.
FURNACE FURN/AC
1 PGASRES Residential for ea gas piping system of P
1-4 Outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
r 1BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst<=100k BTU install or M
/ relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1 MFRN>100 Furnace Syst> l 00k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
IEPERMITFEE Electric Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B