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10060059 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18880 BARNHART AVE CC,NTRACTOR:LAWRENCE LOPEZ PERMIT NO: 10060059 VNER'S NAME: LAWRENCE LOPEZ I&80 BARNHART AVE DATE ISSUED:06/10/2010 OWNER'S PHONE: 4086288425 CLPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class Lic.# REMOVE CIRCUIT BREAKER FROM EXISTING SERVICE PE►NEL Contractor Date THAT SERVED AS A GENERATOR I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 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 Ft Floor Area: Valuation:$100 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 AF N Number:37533012.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the /�lD granting of this permit. Additionally,the applicant understands and will comply Issued b Date: with all non-point source regulations per the Cupertino Municipal Code,Section _ 9.18. RE-ROOFS: mature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for ins lection. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Sid nature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed o actors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's ma terial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. wil I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by tht Health&Safety Code,Sections 25fj05,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Oiner or authorized agent: Date permit is issued. I certify that in the performance of the work for which this permit is issued,I shall C� 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I h.reby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revokwork's for which this permit is issued(Sec.3097,Civ C.) W__� Lender's Name APPLICANT CERTIFICATION Lender's Address 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 m the above mentioned property for inspection purposes.(We)agree to save ,emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the I u iderstand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. / Signature Date CITY OF CUE ERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY $# 1 Sec : Twp: Rng: Sub: Blk: Iot: APN . . . . . . . . : 37533C12 . 00 DATE ISSUED. . . . . . . : 06/•10/ 2010 RECEIPT #. . . . . . . . . BSOOOC10599 REFERENCE ID # . . . : 10060059 SITE ADDRESS . . . . . : 18880 BARNHART AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LAWRENCE LOPEZ ADDRESS . . . . . . . . . . : 18880 BARNHART AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : LAWRENCE LOPEZ CONTRACTOR . . . . . . . : LIC' # *OWNER* COMPANY . . . . . . . . . . : LAWRENCE LOPEZ ADDRESS . . . . . . . . . . : 18880 BARNHART AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- 1BCBSC VALUATION 100 . 00 2 . 00 0 . 00 2 . 00 0 . 00 1BSEISMICR VALUATION 100 . 00 1. 00 0 . 00 1 . 00 0 . 00 1EPERMITFE FLAT RATE 1 . 00 84 . 00 0 . 00 84 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 84 . 00 0 . 00 84 . 00 0 . 00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT =.71 . 00 0 . 00 171 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CREDIT CARD 171. 00 VISA --------------- TOTAL RECEIPT 171 . 00 CITY OF CUPERTINO CITY OF CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM Qbude -�-e IWOOQS:�J- APN # Date: 12v- Buil mg Address: M eU 66.r n kov t- Qvp Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes El No HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Owner's Name: � Phone#: �c,�.w,rte►,.�� - Contractor: Phone: Fax: Contractor License#: Cupertino Business License#: Contact: Phone: Fax: Residential Commercial ❑ Job Description: /� V� t U Y�c-K C �,Cci rte, c.Py Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-BEIF-'--' Valuation: Square Footage: hioo Project Size: Express andard ❑ Large ❑ Major ❑ 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. Points Achieved: For help, contact Build it Green at www.builditgreen.or Revised 07/14/09 S"iM CITY OF CUPERTINO CUPcinE(�F GENERAL BUILDING APPLICATION FEE SCH]_?,DULE Quantity/Sf Fee ID Fee Descriplion Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window.-structural shear B wall/masonry (includes plan ck fee) l EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical PE;rmit Fee M 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1BCBSC Cal Bldg Stan iards Commission Fee B ALL PERMIT TYPES / 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B J 1 TRAVDOC Travel &Doc imentation B r 1 BUSLIC Business Lice lse B 5 of 5