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10100039 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7695 ORANGE BLOSSOM DR CONTRACTOR:SGK HOME SOLUTIONS, PERMIT NO: 10100039 INC. ( 'NER'S NAME: PORTOCARRERO JAMES AND MARTHA 3801 CHARTER PARK CT STE B DATE ISSUED: 10/04/2010 ..'IER'S PHONE: 4089961076 SAN JOSE,CA 95136 PHONE NO:(408)264-6964 0 LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class X-C. / Lic.# Ci 2.0 2 �s �� MECH RESIDENTIAL COMMERCIAL "6/122,7�� Contractor t Date /�`/ I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE&REPLACE WINDOWS&PATIO DOOR LIKE (commencing with Section 7000)of Division 3 of the Business&Professions FOR Code and that my license is in full force and effect. LIKE(8) I hereby affirm under penalty 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,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$5800 permit is issued. APPLICANT CERTIFICATION APN Number:36611085.00 Occupancy Type: 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 property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of is permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-po o egulations per the Cupertino Municipal Code,Section IVO 9.18. dige" Issued by: Date: Sion Date /c/c/A) 0 OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safe i de,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,1 /��'� become subject to the Worker's Compensation provisions of the Labor Code,I must Ow root, " agent: forthwith comply with such provisions or this permit shall be deemed revoked. �1�, ' Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name u•. the above mentioned property for inspection purposes.(We)agree to save iffy and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address cc. �,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 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMITRECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk : Lot : APN • 36E11085 . 00 DATE ISSUED • 10/04/2010 RECEIPT # • BSC00011643 REFERENCE ID # . . . : 10100039 SITE ADDRESS • 76S5 ORANGE BLOSSOM DR SUBDIVISION CITY • CUF ERTINO IMPACT AREA OWNER • POF.TOCARRERO JAMES AND MARTHA ADDRESS • 76E5 ORANGE BLOSSOM DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5250 RECEIVED FROM • SGP: HOME SOLUTIONS, CONTRACTOR • VL7DIMIR MERABIAN LIC # 30341 COMPANY • SGF: HOME SOLUTIONS, INC. ADDRESS • 38C1 CHARTER PARK CT STE B CITY/STATE/ZIP . . . : SAD' JOSE, CA 95136 TELEPHONE • (4C8) 264-6964 FEE ID UNIT QUANTITY 7.MOUNT PD-TO-DT THIS REC NEW BAL 1BCBSC VALUATION 5, 800. 00 1 . 00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 5, 800. 00 0 . 60 0 . 00 0.60 0 . 00 1WINREP EACH 8 8. 00 380 . 00 0 . 00 380. 00 0 . 00 TOTAL PERMIT : 381 . 60 0 . 00 381. 60 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER CHECK 381 .60 #4043 TOTAL RECEIPT : 381 . 60 t 7)z) 2 rn C.4-7204-72cs io t 9- o 3 L 3 s y = r ..)C 3 -77 1 s- o R P.-ilki 6 C. guise, 2,4 . 4 6,, pe-a_770,-• 0 a qr_o ,4 • ii-•40-r-t-t-7t. Ong -- 9 q4 - L0� q pi i"rC".7- 4 I e 1 7- 41110101) • • • • APPRCIVEL IN ACC ORDANCL v`JI T H THE CITY O: I CUPERTINO CODES . 0 ORP ANCE'. /a Y /� . DATE /lop__- . .-41 • SIGNE' _ 44P SIGNED set of • . ind s.:, ications MUS' I. . ...r.1-- be kept m the lob at all times and it is ,nlawt it to make any changes or alterations- ' �+— ^ permission from 'I. - cm same without written pe - the Building Department,City of Cupertino The stamping of this plan and specifications f • SHALL NOT be held to permit or to be an• ' approval of the violation of any Provisions . . -,t.1ny C!ty 07 i.,,,p,,r ,L, :-.t ,,,,, , I". g 1 1 V M AR Code editions: 2007 CBC (Y-N)2007 CFC (Y -N)2007 CMC (Y-N) %..56 -.1-1t-'-'4;1124-4/1--i 2007 CPC (Y -N)2007 NEC (Y - N) Effective 1/1/08 ' ? E 1� W c,��o�.rS �-'t�4 . S'V o cwt . CITY OF CUPERTINO 4. # FEE ESTIMATOR-BUILDING DIVISION tom' ADDRESS: 7695 ORANGE BLOSSOM DRIVE DATE: 10/04/2010 REVIEWED BY: LARRY S APN: BP#: *VALUATION: $5,800 *PERMIT TYPE: Building Permit PLAN CF ECK TYPE: Addition PRIMARY OVER THE PENTAMATION 1 R3SFDADD USE: SFD or Duplex COUNTER? 0 Yes • No PERMIT TYPE: � WORK REMOVE AND REPLACE EXISTING WINDOW:;, LIKE FOR LIKE. ALL WINDOWS REQUIRED TO SCOPE MEET EGRESS DO SO PER 2007 CBC OCCUPANCY TYPE: TYPE OF FLR ARES, PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. (s.f.) R-3 (Custom) II-B,III-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY 0 Yes Q No I It r Pt rnrrt /,,. ? r ,t 1:°e I;t'1 NOTE: These fees are based on the preliminary information availai rle and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 09-051 Eff 7 1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 8 # Window/Sliding Glass Door Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $380.00 1 WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fees Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 "onyfI z4 non 1(i: a Acoustical Fee: 0 Yes ® No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 Planning Fee: $0.00 Select a Non-Residential Trtri>�f Ut)�`tr1)1c'iitatioli Building or Structure 0 Strong Motion Fee: 1BSEISMICR $0.58 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $1.58 $380.00 TOTAL FEE: $381.58 Revised: 9/29/2010 STORMWATER POLLUTION CONTROL AND NOISE CONTROL COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildirq@a,cupertino.orq GENERAL INFORMATION All construction work must meet certain conditions related to maintaining environmental quality and public health and safety. This policy described the two most common inquiries regarding construction: Stormwater Pollution Control and Noise Control. STORMWATER POLLUTION CONTROL State law requires that the City of Cupertino, along with 1E. other Silicon Valley cities, Santa Clara County and the Santa Clara Valley Water District control stormwater pollution. Educating local residents and businesses and enforcing stormwater pollution control laws are key pz.rts of the City's compliance efforts. Stormwater pollution prevention: It's up to us! In northern Santa Clara Valley, storm drains flow directly :o local creeks and into the San Francisco Bay without going through a water filtering/treatment process. Stormwater pollution is a serious problem for wildlife dependent on our waterways, for people living nezx streams and baylands, and for the local water supply. Common sources of stormwater pollution include: • Dripped oil, fuel, and antifreeze from vehicles and heavy equipment; • Construction debris, including dirt, concrete and paint; • Landscaping runoff containing pesticides or weed l:fillers; and • Any material dumped or spilled into streets or storm drains. The property owner and the contractor share ultimate responsibility for activities occurring at a construction site and will be held responsible for any environmental damagt: caused by subcontractors or employees. For more information on construction-related stormwater requirements, see the Stormwater Quality Regulations secti,t ' of the City of Cupertino website at: http://www.cupertino.org/indcx.aspx?page=487 COMMUNITY NOISE CONTROL Construction noise is limited to: • Residential daytime noise levels from complaint sig e—60 dBA • Non-residential daytime noise levels from complaint site—65 dBA Daytime hours are defined as being between the following hours: • Weekdays—7:00am to 8:00pm • Weekends—9:00am to 6:00pm Construction, other than street construction greater than 750 feet of a residential area, is prohibited on holidays, except that construction conducted by a homeowner or resident of a single family dwelling using domestic construction tools is allowed on holidays betwee:i the hours of 9:00am to 6:00pm. For more information on noise control, please refer to Cha)ter 10.48 of the Cupertino Municipal code, which can be accessed at http://www.amlegal.com/cupertiiio ca. Stormwater/Noise Control 2010.doc revised 09/22/10 IC \ vt' , 3-c: , ,„,, a. .„:„.„, CITY OF CUPERTINO CITYO'F cuPERJINO GENERAL BUILDING PERMIT APPLICIATION FORM APN # �� j I II ci , 6 0 Date: /!J/ t o Building Address: —1 c 5,f C c-,-- BC.,z,e cv1--‘, p Q: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this pro ect? Yes ❑ No ❑ HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Owner's Name: Phone #: #,,..,e_ --?o it,r-Vb C4A-aft,e`a-0 i9 (. -- 16 -) 4 Cor} aok. Phone: 2 4, u (p 4 q J � Fax: 2CK fa1t ( Contractor License#: q,-)._v -2 k Cupertino Business License#: C tact: _ Phone: 6,0_,, A.,, A-2N4-c,-i-t - Fax: t C-C --2-1—f-P Residential ' Commercial ❑ ._r Job Description: W i 47Dw5' ,i -p Qm—r •1,ov2 CALL (-'--0A - Luce- . Building Permit Info: Bldg ❑ Elect ❑ Plum') ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A E II/III B, IV-HT, V-B Valuation: ��6 Square Footage: /ef UO Project Size: Express E Standard ❑ Large ❑ Major E Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set & the sheet index. oints Achieved: 1 for help, contact Build it Green at www.builditgreen.or; Revised 07/14/09 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7771 ORION PL CONTRACTOR:KNIGHT ROOFING PERMIT NO: 10100093 SEI:VICES 'NER'S NAME: WU FREDERICK C AND SARAH S 42035 OSGOOD RD DATE ISSUED: 10/13/2010 OWNER'S PHONE: 4088738790 FR 3MONT,CA 94539 PHONE NO:(510)438-9077 ❑ LICENSED CONTRACTOR'S DECLARATION BU ILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: TEAR OFF SHAKE ROOFING.INSTALL DURALITE (commencing with Section 7000)of Division 3 of the Business&Professions LIGYTWEIGHT TILE ER 1647 Code and that my license is in full force and effect. I hereby affirm under penalty 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 Sq.lit Floor Area:0 Valuation:$12870 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION API' Number:36218045.00 Occupancy Type: 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 DAYS 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 9.18. Issued by: Date: ". qture Date - 0 OWNER-BUILDER DECLARATION RE-ROOFS: All rc ofs 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 the following two reasons: instal ed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the roe inspe�:tion. p p rty,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) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I havi read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the Calif(rnia Health&Safety Code,Sections 25505,25533,and 25534. I 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 Addit orally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maint sin compliance with the Cupertino Municipal Code,Chapter 9.12 and the 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 Owne•or authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I heret y 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 wh ch this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lende•'s Name to building construction,and hereby authorize representatives of this city to enter r he above mentioned property for inspection purposes.(We)agree to save Lende•'s Address aify 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 ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I under stand my plans shall be used as public records. 9.18. Signature Licensed Professional Date CITY OF CUPERTINO E',UILDING PERMIT BUILDING ADDRESS: 10740 ORLINE CT CONTRACTOR:AMERICAN BRANDS PERMIT NO: 10100042 CON:;TRUCTION OWNER'S NAME: PENNY PENG 1029 BLOSSOM HILL RD STE 3 DATE ISSUED: 10/05/2010 0....e:R'S PHONE: 4088886495 SAN LOSE,CA 95123 PHONE NO:(408)265-8000 LICENSED CONTRACT9R'.S DECLARATION r r r // BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 3107 (`" r MECH RESIDENTIAL COMMERCIAL Contractor4ne/i Yee! be., 4: Date CJ'S 0(.6 2d/ 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADD 204 SQFT ENCLOSED PATIO COVER ON NEW (commencing with Section 7000)of Division 3 of the Business&Professions CON('RETE Code and that my license is in full force and effect. SLAB @REAR OF HOME I hereby affirm under penalty 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. 1 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 Sq.F:Floor Area: Valuation:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:35922056.001 Occupancy Type: 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 property for inspection purposes. (We)agree to save FERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 1VITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM L T CALLED INSPECTION. with all non-point ource re lations per the Cupertino Municipal Code,Section 9.18. 1 "� Signature Date Issuf d by / 10 [J Date: 0 OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: instal ed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, insper:tion. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I hay:read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safer; Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall main,air compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health& afety Cole,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Ownm r 'rauthor •d agent' forthwith comply with such provisions or this permit shall be deemed revoked. Date: C.75- CZ-6, Zu(V APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is 1 here)),affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lend:r's Name upon the above mentioned property for inspection purposes.(We)agree to save nnify and keep harmless the City of Cupertino against liabilities,judgments, Lend m's Address and expenses which may accrue against said City in consequence of the g:a.iting 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 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10434 PARADISE DR CC NTRACTOR:ALLSTAR PLUMBING PERMIT NO: 10100027 OWNER'S NAME: PICCONE EDWARD C AND SYDELL K 32( PHELAN AVE DATE ISSUED: 10/04/2010 -.IER'S PHONE: 4082572904 SA SI JOSE,CA 95122 PHONE NO:(408)230-5569 ❑ LICENSED CONTRACTOR'S DECLARATION 5.3 / d3 BL ILDING PERMIT INFO: BLDG ELECT PLUMB r License Class 3 Lic.# // MECH r RESIDENTIAL COMMERCIAL r Contractor l- 9 a, Rce/'/�p Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL 2 WAY HOUSE CLEAN OUT ON MAIN SEWER (commencing with Section 7000)of Division 3 of the Business&Professions LIN E Code and that my license is in full force and effect. WITHIN 24INCHES OF HOUSE FOUNDATION I hereby affirm under penalty 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,for the performance of the work for which this Sq. Ft Floor Area: t .ation:$4425 permit is issued. '' APPLICANT CERTIFICATION APPI Number:359102 00 k� I certify that I have read this application and state that the above information is Occupancy Type: 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 property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT-EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signator@ �1i Date f�j,/-/� Issued by: Date: Li OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: insta led without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, ins/3(ction. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Sign:ture of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I hav e read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. Calif rrnia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safet Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Addi Tonally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will main.ain compliance with the Cupertino not employ any person in any manner so as to become subject to the Worker's Healt h&Safety Code,Sections 25505,25533 ,rand 25534.icipal eChapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must ( aut rze< e . forthwith comply with such provisions or this permit shall be deemed revoked. ,-- Date:JO-Y-/C) APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I here ry affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for wt ich this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lend(r's Name upon the above mentioned property for inspection purposes.(We)agree to save 'Indy and keep harmless the City of Cupertino against liabilities,judgments, Lend(r's Address ,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 ARCHITECT'S DECLARATION 9.18. I uncle-stand my plans shall be used as public records. Signature Date Licena ed Professional CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: ]got: APN • 35916026 . 00 DATE ISSUED • 10/04/2010 RECEIPT # • BS000011634 REFERENCE ID # . . . : 10100027 SITE ADDRESS • 10434 PARADISE DR SUBDIVISION CITY • CUPERYINO IMPACT AREA OWNER • PICCONE EDWARD C AND SYDELL K ADDRESS • 10434 PARADISE DR CITY/STATE/ZIP . . . : CUPERYINO, CA 95014-2914 RECEIVED FROM • MICHAEL RODRIGUEZ CONTRACTOR • DUARTE TADEV LIC # 22189 COMPANY • ALLSTJ,R PLUMBING ADDRESS • 326 PEELAN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95122 TELEPHONE • (408) 230-5569 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL 1BCBSC VALUATION 4, 425. 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 4,425. 00 0 .50 0.00 0.50 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 .00 1PRSEWER UNITS 1 . 00 21 .00 0 . 00 21. 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 TOTAL PERMIT : 106 .50 0.00 106. 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER CREDIT CARD 106 .50 VISA TOTAL RECEIPT : 106 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CL PERTINO FEE ESTIMATOR- B-UILDING DIVISION L./ ' ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $4,425 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARYSFD or Duplex �`�'�`�� PENTAMATION 1RPSS USE: ('t't� .t ik i-_: PERMIT TYPE: 4 WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $21 TOTALS: $21.00 ` Ir, hi:. r I I Plumb.Plan Check Li hrs $0.00 f:;<< 1'„ln t ri.,°k I Plumb.Permit Fee: 1PPERMIT Z:I<x 1' or;i1 t;,'c: Other Plumb Insp. [).0 hrs $42.00 NOTE: These fees are based on the preliminary information available and are onl an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 Eff. 7/1/10) FEE QTY/FEE MISC ITEMS P/0/7 (l1ccA /`cc .1 i ppl. 1?(' PME Plan Check: $0.00 Pc•r'rrtit F<'c: city,,,! his/) PME Unit Fee: $21.00 PME Permit Fee: $42.00 C.'orztttrction TcrA it:otdstic rt!1t'c l icy t, Fec: Work Without Permit? 0 Yes 0 No $0.00 Nuriiing 1:cVo: Travel Documentation Fee: 1TRAVDOC $42.00 i Strong Motion Fee: $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $106.50 $0.00 TOTAL FEE: $106.50 Revised: 9/29/2010 cvv .-7 CITY OF CUPERTINO REPIPE/SEWERMAIN SERVICE CUPET 1NO PERMIT APPLICATION FORM APN# ` Q 2aP Date: ! I /0 - `7 - 0-0/0 Building Address: 10 -/3 `/ ?',ipap Pk' C4'/ > 5 CA ''S,'/ Y Owner's Name: Phone#:1/061-1- 1 2 QO q Six p� cco,v� - — Contractor: Phone#: C/0 g-2- -2-_70 2 GG 6-0 Qal-e-R 4t(' 7' ( u rv\-64-9 Fax #: Contact: -.;, 5-eti,9/ Phone#: y0 b-2.g2 - 7 0 2. Fax #: Contractor License #: '- q a 3 e Cupertino Business License/7#: Job Description: 1;v tA j _9.- ''"+y f- U>�' c kw/ oaf c7,&'Al / 5 LtiUP w,tHIA 9- Y pvc,14,j Pl fjo t'je Residential ( Ci)mmercial Valuation: , ( , n Project Size: 'Express ❑ Standard ❑ Large E Major 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. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial buildir g P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piing System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission. B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10282 PARLETT PL CON TRACTOR:ALLIED AIRE SERVICE INC PERMIT NO: 10100187 OWNER'S NAME: CHAN KWAN H AND ESTELLA C TRUS 470 S HILLVIEW DR DATE ISSUED: 10/26/2010. VER'S PHONE: 4088882038 MIL'ITAS,CA 95035 PHONE NO:(408)934-8844 LICENSED CONTRACTOR'S DECLARATIONr r ��D �. _ BUI DING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# .q7‘�r//W as MECH r RESIDENTIAL r r COMMERCIAL Contractorr#-- �:�srIae. Date 19/...:300 I hereby a rum that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE FURNACE,SAME LOCATION (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 penalty 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. Sq.I t Floor Area: Valuation:$1250 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. ' APN Number:31646040.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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,SectionIssued ;=�� Date: ,2--Z- ---/--6 9.18. 1�� Signature � �4 Date RE-ROOFS: Li OWNER-BUILDER DECLARATION All r)ofs shall be inspected prior to any roofing material being installed.If a roof is insta[led without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of insp action. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Sign iture of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). — I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I ha,e read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's Cali Fornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this coni aminants as defined by the Bay Area Air Quality Management District I will is issued. maii►tain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permitHeath&Safety Code,Sections 25505,25533,and 25534. 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 O a�►th E ent Compensation laws of California. If,after making this certificate of exemption,I _2.i�e�.c�'"�(�,®��1' Date: ff:-Z/io 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. CONSTRUCTION LENDING AGENCY I hei eby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for)rhich this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Len der's Name 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 Len der's Address upon the above mentioned property for inspection purposes.(We)agree to save unify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I un lerstand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Lia used Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 10 PERMIT LECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN • 3164E040 . 00 DATE ISSUED • 10/2E /2010 RECEIPT # • BS000011847 REFERENCE ID # . . . : 1010C187 SITE ADDRESS • 10282 PARLETT PL SUBDIVISION CITY • CUPEFTINO IMPACT AREA OWNER • CHAN KWAN H AND ESTELLA C TRUS ADDRESS • 10282 PARLETT PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM • ALLIED AIRE SERVICE CONTRACTOR • STEINER, ARNOLD R LIC # 19207 COMPANY • ALLIED AIRE SERVICE INC ADDRESS • 470 S HILLVIEW DR CITY/STATE/ZIP . . . : MILPITAS, CA 95035 TELEPHONE • (408) 934-8844 FEE ID UNIT QUANTITY AMOJNT PD-TO-DT THIS REC NEW BAL 1BCBSC VALUATION 1, 250. 00 1 . 00 0. 00 1. 00 0.00 1BSEISMICR VALUATION 1, 250 . 00 0 .50 0 . 00 0. 50 0 . 00 1MFR=<100 UNITS 1. 00 L26 . 00 0. 00 126. 00 0 . 00 1MPERMITFE 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 : 211. 50 0 . 00 211. 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER CHECK 360 . 00 #21866 TOTAL RECEIPT : 360 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Building Department City Of Cupertino 10300 Torre Avenue <941.19s.9 Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUB CONTRACTOR LIST JOB ADDRESS: /292g2- %CeL/.77//7":ete--,r PERMIT# OWNER'S NAME: ,f4, GzPHONE # GENERAL CO TRACTOR: � A�w_ J - BUSINESS LICENSE# ADDRESS: ?�s; i`Xjt0sc> ,rL_ CITY/ZIPCODE: *Our municipal code requires all businesses working in tht'city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring /Carpeting Linoleum / Wood Glass / Glazing Heating / l ,%re Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile . : /z24//e7 �i Owner/Contractor Signature • 1111111111111101111111111.11111111M__ !. n•oor rQua ityan• n s es _.. 1 AQ/Health pts y=yes 0 • 2.Use Low VOC,Water-Based Wood Finishes 2 I AO/Health pts y=yes. 4149 _• P y=yes 0 "�� • _ -- 3 IAQ/Health is es • 4.Use Salvaged Materials for Interior Finishes 3 lesource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6I Q/Health is es 6.Use Exterior Grade Plywood for Interior Uses p y� 0 11 IAO/Health pts y=yes 0 4 I.kO/Health.pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 I lesource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 I lesource pts y=yes • 0 10.Install Whole House Vacuum System 31AQ/Healthy is =Yes P 0 N.Flooring _ 0 0 0 1.Select FSC Certified Wood flooring _ B RE source pts y=yes 04,910 *IOW _. 4 Re source pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Re source pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl .5 IA /Healthtoy=yes 5.Use Exposed Concrete as Finished Floor t • D 4 Re source pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 0 0 0 • • Total Points Available:I J -1401. 1301 57 . Total Points Project Received:I - - 01 01 01 • G data/progs/gr eenbulldu pidePnes/mmodelerslgreenpointsfinala1204protecredxls /0/ (.--)/i CITY OF C-UPERTINO FURNACE/AC CUE RJINO PERMIT APPLICATION FORM APN# Date: t v Building Address: • /19,782 Owner's Na // C 16/9- j�/f/ , / A Ph ne#: c/,�` Contractor: Phone#: 93%88 ' /,/iee eir-e-9/e-co Fax#: elDt 93Vex6WD Contractor License#: Cupertino Business License#: Contact: Phone#:4/7f' 6 O /63/7 c5z Ze.2e/s74- Fax #: SDP BEV-'1 Building Permit Info: Elect EV-- Plumb Mech Residential Commercial ❑ Job Description: For Residentia stallations: Attic ❑ 1 floor1 2nd floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Ac.ditional weight(structural calcs) ❑ Structural Calculations required for new installation [] New installation Planning Approval Required ❑ Cost of Project: Type of Construction(Usage Class): ea Strapped ❑ On Platform ❑ Bonded C New Location❑ Replacement,, Project Size: Express [Standard ❑ Large ❑ Major❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include :n plan set & the sheet index. Revised 01/07/09 CITY OF CUPERTINO E,UILDING PERMIT DATE I v v BUILDING ADDRESS: 19973 PEAR TREE CT CONTRACTOR: FAIRBURN INDUSTRIES PERMIT NO: 10070122 OWNER'S NAME: RISHI BHARGAVA 20061 WRIGHT DR DATE ISSUED:08/13/2010 0' t'S PHONE: 4089058344 LOS ,;ATOS,CA 95033 PHONE NO:(408)353-4285 ❑ LICENSED CONTRACTOR'S DECLARATION� r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# V.72-3 8 ,/b � t !O / `! MECH RESIDENTIAL COMMERCIAL Contract Date ( ( l I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADD A BAY WINDOW,REMODEL LIVING RM.FAMILY (commencing with Section 7000)of Division 3 of the Business&Professions RM,b Code and that my license is in full force and effect. KITCI lEN-670SQ A d tw Ity,+• 1 hereby affirm under penalty of perjury one of the following two declarations: 1., ,,1 S ' �' 1 have and will maintain a certificate of consent to self-insure for Worker's „At �- C Y C� ,,yvs—(.4-1/i a Rte-' 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,for the performance of the work for which this permit is issued. Sq.F Floor Area: Valuation:$60000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31630087.00 Occupancy Type: 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 property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. o , ,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-points • r a'ins per the Cupertino Municipal Code,Section 9.18. �f 180 D YS FROM L CALLED INSPECTION. Signature Date /bi-/ (/Q Issued by: ��7 2 /0 )° Date: C OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All ro>fs shall be inspected prior to any roofing material being installed. If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspec tion. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signal ure of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I Iravi read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by Calif(rnia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Addit onally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,1 shall conta ninants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliant• , the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Healt r&Safety +•e,Sections 25505,25533,and 25534. 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. Owner • to _ent: / Date: !D/ `// (� APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating 1 here)ry affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for wt ich this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lendi r's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, c, and expenses which may accrue against said City in consequence of the Lend(r's Address ,g of this permit.Additionally,the applicant understands and will comply wnn all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licen,.ed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10224 PENINSULA AVE COP TRACTOR:JUST WATER HEATERS PERMIT NO: 10100096 INC BIER'S NAME: SHUHUA YU 3400 INVESTMENT BLVD DATE ISSUED: 10/13/2010 OWNER'S PHONE: 4083169713 HM WARD,CA 94545 PHONE NO:(510)293-9901 ❑ LICENSED CONTRACTOR'S DECLARATION r r- r- BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL r COMMERCIAL Contractor Date • I hereby affirm that I am licensed under the provisions of Chapter 9 JOU DESCRIPTION:REPLACE EXISTING 75 GALLON GAS WATER HEATER (commencing with Section 7000)of Division 3 of the Business&Professions LOC 4 TED IN THE GARAGE Code and that my license is in full force and effect. I hereby affirm under penalty 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 Sq.14 Floor Area:0 Valuation:$1363 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APP Number:32622020.00 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 DAYS 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 9.18. Issued by: Date: • 'tture Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All i oofs 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 inst:lied without first obtaining an inspection,I agree to remove all new materials for the following two reasons: insp:ction. 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, Sigr attire of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I 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 Cal:fornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. coir pliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safi ty 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 Adc itionally,should I use equipment or devices which emit hazardous air con aminants as defined by the Bay Area Air Quality Management District I will permit is issued. mai ritain 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,I shall Hea Ith&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 Ow ier or authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must — Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I he-eby 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 vhich this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Len der's Name to building construction,and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes.(We)agree to save Len der's Address .mify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I ur derstand my plans shall be used as public records. 9.18. Lic!nsed Professional Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10201 PHAR LAP DR CO,ITRACTOR:LOS GATOS ROOFING PERMIT NO: 10100121 OWNER'S NAME: MA ROBERT K AND TINA M P 0 BOX 1726 DATE ISSUED: 10/15/2010 ,ER'S PHONE: 4088392990 La;GATOS,CA 95031 PHONE NO:(408)298-9399 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r License Class Lic.# MECH r RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9(commencing 1013 DESCRIPTION:REMOVE EXISTING SHAKE ROOFING. INSTALL 7/16 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 penalty 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. Sq. t Floor Area:0 Valuation:$7691 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. APT Number:32639052.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: Date: 9.18. Signature Date — RE-ROOFS: Li OWNER-BUILDER DECLARATION All i aofs shall be inspected prior to any roofing material being installed.If a roof is insta lied without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of the insp,ction. following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Sign iture of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I haN e read the hazardous materials requirements under Chapter 6.95 of the California Compensation,as provided for by Section 3700 of the Labor Code,for the Heal.h&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance performance of the work for which this permit is issued. with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section I have and will maintain Worker's Compensation Insurance,as provided for by 2553 2(a)should I store or handle hazardous material. Additionally,should I use Section 3700 of the Labor Code,for the performance of the work for which this equij'ment or devices which emit hazardous air contaminants as defined by the Bay Area permit is issued. Air(►uality Management District I will maintain compliance with the Cupertino Mun cipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25505,25533,and I certify that in the performance of the work for which this permit is issued,I shall 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 or authorized agent: Date: 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for w hich this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lend..r's Name 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 Lend,r's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ing of this permit.Additionally,the applicant understands and will comply I and rstand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licer sed Professional Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 604 PHIL CT CONTRACTOR:AMERICAN RESIDENTIAL PERMIT NO: 10100098 SERVICES OF CA OWNER'S NAME: NIKLAS&CARA HALLIN 96:4 RIDGE LAKE BLVD STE 201 DATE ISSUED: 10/13/2010 NEWS PHONE: 4082536744 MEMPHIS,TN 38120 PHONE NO:(408)982-0405 LICENSED CONTRACTOR'S DECLARATION ��{ BIJILDING PERMIT INFO: BLDG r ELECT r PLUMB License Class Lic.#_ 7... MECH n RESIDENTIAL r COMMERCIAL r Contractor A / ' 7 t,,ed Q-_;Date l "'-J3/ I hereby affirm that I am licensed under the provisions of Chapter 9 JC B DESCRIPTION: INSTALL A HOUSE CLEAN-OUT (commencing with Section 7000)of Division 3 of the Business&Professions ** EE NOTES** Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: -- �, '4, 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 i ^� performance of the work for which this permit is issued. _ x `b , I have and will maintain Worker's Compensation Insurance,asprovided for b ‘1/4,41::4\ssa, k p y Sq,Ft Floor Area: f ° 'Val ation:$1800 Section 3700 of the Labor Code,for the performance of the work for which this > ' permit is issued. /1///t4 / — ' ��G l APN Number:3 ed+r 0 1; 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 DAYS 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 9.18. �+ / _./yki Iss ied by. _ �� Date/_/ Signature /'7 0/ IW"Uat /D r I ( 6 — 0 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 inst ailed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inI ection. 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, Sig nature of Applicant: Date: Business&Professions Code) _ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I h:ve 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. I will maintain performance of the work for which this permit is issued. con ipliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Saf qty 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 con taminants 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,I shall Hes 1th&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Q/� Compensation laws of California. If,after making this certificate of exemption,I Owi or au 1�y t. `"C ��/L become subject to the Worker's Compensation provisions of the Labor Code,I must /f t mate: f forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I he•eby 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'vhich 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 v--,the above mentioned property for inspection purposes.(We)agree to save Lender's Address mify and keep harmless the City of Cupertino against liabilities,judgments, t,.,.�.,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I un lerstand my plans shall be used as public records. 9.18. Licnsed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT F.ECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot : APN • 3754024 . 00 DATE ISSUED • 10/12/2010 RECEIPT # • BS000011729 REFERENCE ID # . . . : 10100098 SITE ADDRESS • 604 FHIL CT SUBDIVISION CITY • CUPEFTINO IMPACT AREA OWNER • NIKLF.S & CARA HALLIN ADDRESS • 604 FHIL CT CITY/STATE/ZIP . . . : CUPEFTINO, CA 95014 RECEIVED FROM • AMERICAN RESIDENTIA CONTRACTOR • DONALD KARNES LIC # 21504 COMPANY • AMERICAN RESIDENTIAL SERVICES ADDRESS • 965 FIDGE LAKE BLVD STE 201 CITY/STATE/ZIP . . . : MEMPFIS, TN 38120 TELEPHONE • (408) 982-0405 FEE ID UNIT QUANTITY AMCUNT PD-TO-DT THIS REC NEW BAL 1BCBSC VALUATION 1, 800 . 00 1 .00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 1, 800 . 00 0 .50 0 . 00 0. 50 0 .00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1PRSEWER UNITS 1. 00 21 . 00 0 . 00 21. 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 TOTAL PERMIT : 106 .50 0 . 00 106 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER CHECK 106 .50 # 8128005384 TOTAL RECEIPT : 106 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CIJPERTINO FEE ESTIMATOR- BUILDING DIVISION WI ADDRESS: DATE: REVIEWED BY: jAla '. APN: BP#: *VALUATION: $1,800 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY ,= PENTAMATION 1 RPSS SFD or Duplex z' ., PERMIT TYPE: USE: t11rtr :, WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $21 TOTALS: $21.00 ,.ctrn Plumb.Plan Check 1. 0.0 I hrs $0.00 Pr < 11,>E-'r Pc>r,,I r Plumb.Permit Fee: 1PPERMIT [/ f',°;i I,.. hlc 1h1Ire°,r>. Other Plumb Insp. [E—h–r-s— $42.00 o h,, tIc h°ti,' 1`�'<': 1 z�ri=.f� t�.r� L�E I;1(( 1,1v, 1` NOTE: These fees are based on the preliminary information avah able and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 Elf 711:'10) FEE QTY/FEE MISC ITEMS f'lust C't c=c A FI :. SHIT' I'C' 4 PME Plan Check: $0.0C t'c>'hut I'cc /Cupp!.. Inv, PME Unit Fee: $21.0C PME Permit Fee: $42.00 //([toil Tux I, mho, lt'S Work Without Permit? 0 Yes 0 No $0.00 Maiming l c c i Travel Documentation Fee: ITRAVDOC $42.0C Strong Motion Fee: $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: I $106.50 $0.00 TOTAL FEE: I $106.50 Revised: 9/29/2010 CITY OF CUPERTINO REPIPE/SEWER/YIAIN SERVICE CUPEONO PERMIT APPLICATION FORM APN # ,2�� 0 - Date: (. /Z1 /3 -/0 Building Address: , - Owner's Name:,, 1 K�� C4Rp / �1 V Pone _ " Contractor:A RS P J S 1L /0 6 /74: 4 Phone �' Fax # !q)9 - '-LX-,G"'� Contact: Phone#: Li Fax #: Contractor License #: Cupertino Business License#: Job Description: � 11 ,f 7 c:„.€44„),T Residential ,J Commercial E Valuation: 4 c306, c'Z Project Size: Express Standard ❑ Large ❑ Major❑ 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. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sev,er 1BPREPIPE Commercial re-piT e per fixture P 1CPRP 1PGASCOM Commercial Gas Fiping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission, B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09