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10060140rnr rryNC ADDRESS: 10390 MANN DR WNER'S NAME: DUNDEE MAPLES ER'S PHONE: 4084801104 CITY OF CUPERTINO BUILDING PERMIT PERMIT NO' 10060140 CONTRACTOR: -TBD --TO B �' DATE ISSUED: 06/22/2010 L PHONE NO: 11G PERMIT INFO: BLDG ELECT PLUMB LICENSED CONTRACTORS DECLARATIONBUILDING Lic. # S2c �� MECH I- RESIDENTIAL COMMERCIAL .icense Class � Dater JOB DESCRIPTION: REPLACE SERVICE PANEL 200AMP contractor LG�� =ensed =tunder�� **SEEN(,TES** l hereby affirm that I am 1provisions of Chapter 9 (commencing with lSection s On full force a and of the Business & Professions Code and that my 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 Valuation: $975 performance of the work for which this permit is issued. y Sq, Ft F toor Area: I have and will maintain Worker's Compensation Insurance, as provided for b Section 3700 of the Labor Code, for the performance of the work for which this Occupancy Type: APN Number: 32645009.00 Hermit is issued. APPLICANT CERTIFICATION ation is -rtify that I have read this application and state tordinaneat the s and stave te laws relating ,-rect. I agree to comply with all city and county building construction, and hereby authorize representatives of this enter ree to save on the above mentioned property for inspection purposes. (We) ag 3emnify and keep harmless the City of Cupertino against liabd City in equence of he ts, sts, and expenses which may accrue agains sai understands and will comply anting of this permit. Additionally, the app ith all non -point source reg tions per the CupertinoMunicipal Code, Section Date ignature� J OWNER -BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for one of he following two reasons: t, 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 contractors to rofessions Code). construct the project (Sec.7044, Business &P I hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to self -insure for Worker's 0 of the Labor Code, for the Compensation, as provided for by Section 370 performance of the work for which this permit is issued. rker's Compensation Insurance, as I ion 3700for by p ve and will the Labor Code, for the performance of the wok for which this Section PERMIT EXPIRES IF WORKRI T ISSUANCE STARTED OR WITHIN 180 DAYS OF PEM 180 DAYS FROM LAST CALLED INSPECTION. �-- Date: [ssuei l RE -ROOFS: All ro As shall be inspected prior to any roofing material being installed. If a roof is instal ed without first obtaining an inspection, I agree to remove all new materials for inspe :tion. Date: permit is issued. rmance of the work for which this permit is issued, I shall I certify that in the perfo 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 become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith comply with such provisions or this permit shall be deemed revoked. Sign: ture of Applicant: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the Cal forma Health &Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertinoshould Ipal Code,tore orhandleChapter 9.12ou smatethe ria►�th & Saf qty Code, Section 25532(a) t or devices which emit hazardous air Ad litionally, should I use equipmenArea Air Quality Management District I will coy taniinants as defined by the Bay maintain complianceSections Cupertino Municipal d 25534e' Chapter 9.12 and the Code Health & Safety , 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 f uthorize tionrpurposese(s of We this to saveer upon the above mentioned property rP nnify and keep harmless the City of Cupertino against liabilities, judgments, , and expenses which may accrue again tsaid City in understands nd will comply of the granting of this permit. Additionally, the app licantwith all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date�— c;n gtfiirP. 0'% r o t rized ge '. Date �-`� CONSTRUCTION LENDING AGENCY I 1 ,ereby affirm that there is a construction lending agency for the performance of work's fe r which this permit is issued (Sec. 3097, Civ C.) L -nder's Name L ender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32645009.00 DATE ISSUED ....... : 06000010609 RECEIPT #......... REFERENCE ID # 1006014C SITE ADDRESS .....: 10390 M.7NN DR SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ...... OWNER DUNDEE 14APLES ADDRESS . 10390 nkNN DR CITY/STATE/ZIP CUPERTI:JO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM MIKE SK%J CONTRACTOR TBD - TD BE DETERMINED LIC # 00096 COMPANY TBD - TD BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: TELEPHONE ........ UNIT QUANTITY AMOa T PD -TO -DT THIS REC -- NEW -BAL- FEE ID ----- --- -------------------- 1BCBSC VALUATION -------------------- 975.00 1.00 0.00 0.00 1.00 42.00 0. 00 0.00 1EPERMITFE FLAT RATE 1.00 42.00 �_2 00 0.00 42.00 0.00 1ERT<200 UNITS 1.00 1.00 '.2.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE ----127.00 -- ------- � 0.00 0..00 TOTAL PERMIT TOTAL METHOD OF PAYMENT AMOUNT ZEFERENCE -------------- NUMBER ----- ------------ --------------- CREDIT CARD --------------- 127.00 VI 3A TOTAL RECEIPT 127.00 RECEIVED BY: PATRICIAG TODAY'S DATE: 06/22/10 TIME: 10:51 1 BUSINESS LICENSE TAX CREDIT CARD CITY OF CUPERTINO RECEIPT NUMBER: BS000010680 PAYOR: MIKE SKAJ REGISTER DATE: 06/22/10 BLUE SKY CONSTRUCTION TOTAL DUE: $114.00 REIN NUM: VISA TEIIDERED $114.00 $114.00 ---------------- $114.00 CHANGE $.00 C', ► 14- Q` CITY OF CUP11"i O CUPERTINO GENERAL BUILDING PERMIT APPLICA'CION FORM APN # -3 _ al Date: Building Address: fQS7,V /11AItit Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No If es, provide letter from HOA Owner's Name: � � Phone #: If Contractor: R � k e 5 j,_ 00115 �CXC -1,0 /I �j Phone: Fax: Contractor License #: s 5(-:)` `7 Cupertino Business License #: Contact:11\ � � > %cam S Phone: l c c Fax: J Residential] Commercial Job Description: Building Permit Info: Bldg 0' Elect LAY Plumb Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B g-- �L Valuation: �, Square Footage: Project Size: Express tandard ❑ 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.org Revised 07/14/09 CITY OF CUPI�RTINO �n of GENERAL BUILDING APPLICATION CUPEITINO FEE SCHEDULE ISTPLNCK-(3 Hr Min Standard PlaEalne ck:(wh:e:n:no EM/p) B when not over counter) hourl stand 1BCBSC Cal Bldg St�uzdards Commission Fee B I SEISMICR Seismic Re, idential B 1BSEISMICO Seismic Commercial B 1TRp,VDOC Travel & p,ocumentation B 1BUSLIC Business License B I of2T� 2oQ 5 of 5 ALL PERMIT TYPES Fee Permit Type Quantity/Sf Fee ID Fee Description Group 1GENRES or 1GENCOM 1STUCOAP Stucco App licat.ons (up to 400 sf) B additional stucc,) application B Replacement windows/sliding glass 1 WINREP door (ea 8 windows) B 1WINMEWSTR New Window -structural shear wall/masonry (includes Ian ck fee) IEPERMITFEE E Electrical permit Fee / 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Perrait Fee P -----E Stand Alone Electric Pln Ck (hourly) IELCPLNCK 1 MECPLNCK Stand Alone 1 Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone �?lumbing Pln Ck (hrly) P ISTPLNCK-(3 Hr Min Standard PlaEalne ck:(wh:e:n:no EM/p) B when not over counter) hourl stand 1BCBSC Cal Bldg St�uzdards Commission Fee B I SEISMICR Seismic Re, idential B 1BSEISMICO Seismic Commercial B 1TRp,VDOC Travel & p,ocumentation B 1BUSLIC Business License B I of2T� 2oQ 5 of 5 ALL PERMIT TYPES Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 2 Fax: 408-777-3333 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST PERMIT # C/ uf JOB ADDRESS: �G/L� �� L PHONE #� OWNER'S NAME: BUSINESS LICENSE GENERAL CONTRACTOR: 8 e %� �. CITY/ZIP ADDRESS Gc9 14fSk%�� have a Cit of Cupertino business license. *Our municipal code requires all businesses working m the any WILL BE SCHEDULED UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. Date I am not using any subcontractors: Signature h� f^��^� nu information: Please check applicable subcontractors and complete t1 SUBCONTRACTOR 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 BUSINESS Ni hC--t--/44cL 1 Tile Owner / Contractor Si ature Date