10100100 CITY OF CUPERTINO LUILDING PERMIT
BUILDING ADDRESS: 7535 WATERFORD DR CON TRACTOR:JAMES P LOWEELEY PERMIT NO: 10100100
OWNER'S NAME: JOHN&KATHI LUCAS 1689 MERRILL DR DATE ISSUED: 10/13/2010
NER'S PHONE: 6507042116 SAN JOSE,CA 95124 PHONE NO:(408)828-7700
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB F
License Class W� Lic.# �P'191 3
MECH F RESIDENTIAL F COMMERCIAL r
�
Contracto13 M E J� Or- e �C=, (3 ( C,
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:MOVE FURNACE INTO ATTIC REPLACE WATERHEATER
(commencing with Section 7000)of Division 3 of the Business&Professions TANI:LESS IN ATTIC
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.I t Floor Area: Valuation:$100
Section 3700 of the Labor Code,for the performance of the workhis
permit is issued.
APPLICANT CERTIFICATION for which
APN Number:36617023.00 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 regulatio s per the Cupertino Municipal Code,Section / �Q�
9.18. Issu-d �- Date:/G`�!/%' v"
Signatur ate ® 3(�
L_ OWNER-BUILDER DECLARATION RE-ROOFS:
All r)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 insta.led without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspf ction.
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the stricture is not intended or offered for sale(Sec.7044, Sign iture 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 ha✓e read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the Cali Fornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. com 3liance 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
cont aminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maiirtain 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 th&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 41ier or au to 9Q 3 tb
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 hei 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 i✓hich this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Len Jer'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 Len Jer's Address
i- -nnify 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
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.
Lia used Professional
Signature Date
CITY OF CL PERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: $100 -�
FPERMIT TYPE: Building Permit PLAN C HECK TYPE: Alteration/ Repair
PRIMARY r, �,� PENTAMATION FURN/AC
USE: SFD or Duplex r=,� t>s � !"' l PERMIT TYPE:
WORK
SCOPE
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check D.0 hrs $0.00
Mech.Permit Fee: IMPERMIT [Plumb.P,-rmit Fee: IPPERMIT
Other Mech.Insp. 0.0 hrs $42.00 Other Plumb Insp. [3D.Ohrs $42.00 C1rIr>t,.I'l-It .It-,rp, Li
NOTE. Thesefees are based on the preliminary information avaih We and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (ree Resolution 09-05I LtL 7%1iQi FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Mechanical
Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $126.00 IMFR=<l00 Furnace,Forced-Air
PME Plan Check: $0.00 = # Plumbing
Permit Fee: $0.00 $25.00 1PRWHEATR Water Heater
Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $84.00
1
C r3,Fi57""II;'.b7 1 fA
Acoustical Fee: 0 Yes (F) No $0.00 0
Work Without Permit? 0 Yes (F) No $0.00 E)
Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $42.00 Building or Structure 0
i
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $127.50 $151.00 TOTAL FEE: $278.50
Revised: 9/29/2010
CITY OF CI PERTINO
7 ITEMS OF 7 PERMIT FECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36617023 . 00
DATE ISSUED. . . . . . . : 10/13/2010
RECEIPT #. . . . . . . . . : BSO00011730
REFERENCE ID # . . . : 1O1OC100
SITE ADDRESS . . . . . : 7535 WATERFORD DR
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JOHN & KATHI LUCAS
ADDRESS 7535 WATERFORD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JAMES P LOWEECEY
CONTRACTOR . . . . . . . : JAMES P LOWEELEY LIC # 32028
COMPANY JAMES P LOWEELEY
ADDRESS 1689 MERRILL DR
CITY/STATE/ZIP . . . : SAN JDSE, CA 95124
TELEPHONE (408) 828-7700
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 100. 00 1 . 00 0.00 1. 00 0 . 00
1BSEISMICR VALUATION 100 . 00 0 .50 0 . 00 0 . 50 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
1PPERMITFE FLAT RATE 1. 00 42 . 00 0.00 42 . 00 0 . 00
1PRWHEATR UNITS 1 . 00 25 . 00 0 . 00 25. 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 2-78 .50 0. 00 278. 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- - -------------------
CREDIT CARD 278 .50 M,
---------------
TOTAL RECEIPT 278 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Engineering PROJECT JL 10 , 10
CES Residential&Commercial DATE - f 0 -7.-10 BY __ LAS
SHEET NO. I OF 2
Carollyn E. Scott, P.E.
Owner
859 University#29,Los Gatos,CA 95032
(408)354-4537
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUB(-"ONTRACTOR LIST
JOB ADDRESS: PERMIT# IN00 100
OWNER'S NAME: Loi, PHONE# C,c--CD -7Q Y -�-( (
GENERAL CONTRACTOR: LD C.,'0C-!- BUSINESS LICENSE # (,P 3 f &T
ADDRESS: $ eyl 4EX41 LLL ()2 CITY/ZIPCODE: SA-r-ZtS t: CP, q.5-(2 7'
*Our municipal code requires all businesses working in the 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:
VSignat.ire Date
Please check applicable subcontractors and complete 1 he following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum/Wood
Glass /Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
h CITY OF CUPERTINO 01 0
FURNA(�E/AC
CUPEI�TINO PERNUT APPLICATION FORM
APN# 4� Date:
Building Addre
s-
Owner's Name: Phone#:
Contractor: Phone#:yo� 2 g 7 7LO LJG2�Cle� U�
Fax#:
Contractor License#: Cupertino Business License#:
(�3
Contact: Phone#:
Fax #:
Building Permit Info:
Elect [_" Plumb Mech
Residential Commercial ❑
Job Description:
M(oV-e -(':Or - �n cc. �eP Gc� "OkTA-f �eellt_*r esS G
For Residential Installations:
Attic � l'floor ❑ 2nd floor E]
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 Constraction-fiJsage Class):
V V
r
Strapped El On Platform 0 Bonded .-�—' New Location Replacement
Project Size: Express Standard ❑ Large ❑ Major❑
Valuation:
Green Building: Please complete relevant portion of t:le Green Building Checklist & attach it to the
application or if applicable, include ii plan set & the sheet index.
Revised 01/07109