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10050081 CITY OF CUPERTINO BUILDING D ERM NT CO INC PERMIT NO: 10050081 CONTRACTOR:LIN ANDY WAY DATE ISSUED:05/07/2010 IILDING ADDRESS: 7551 NORM 476 W TA%LOR ST NNER'S NAME: DONNELLY EDWARD S AND LORRAINE PHONE NO.(408)286-9990 SAN JOSE CA 95110 .ER'S PHONE: 4082522782PLUMB LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT IN BLDG� ELECT� � MECH l— RESIDENTIAL COMMERCIAL icense Class Lic.# Date JOB DEI.CRIPTION:REMOVING THE EXISTING COMPOSITION ROOF AND 'ontractor INSTALLI JG 30#FELT,AND 28 SQUARES OF NEW 40 Y hereby affirm that I am licensed under the provisions i Chapter 9 COMPOSI CION SHINGLES commencing with Section 7000)of Division 3 of the Business&Professions -ode and that my license is in full force and effect. [hereby affirm under penalty of perjury one of the following two declarations: l 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. rovided for by Valuation:$8000 1 have and will maintain Worker's Compensation Insurance,as p Ft FI mor Area:0 Section 3700 of the Labor Code,for the performance of the work for which this Sq. Occupancy Type: permit is issued. APPLICANT CERTIFICATION APN Number:36611153.00 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 IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter PF R1VIIT EXPIRES IF WORK upon the above mentioned property for inspection purposes. (We)agree to save id Ci in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE O indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the app with all non-point source regulations per the Cupertino Municipal Code,Section Date: 9.18. Issued by: Dates-- ---- Signature RE-.ROOFS. [� OWNER-BUILDER DECLARATION P P roofing material being installed.If a roof is f All roc fs shall be ins install,A 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 oinspected prior to any the following two reasons: my employees with wages as their sole compensation, inspec[ion. 1,as owner of the property,or Signal ure of Applicant: will do the work,and the structure is not intended or offered for sale(Sec.704 , Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to A"OR BETTER construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS" 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 ham a read the hazardous materials requirements under Chapter 6.91 will oft e Compensation,as provided for by Section 3700 of the Labor Code,for the Cali ornia Health&Safety Code,Sections 25505, and r 9 12 55 d4the Healh maintain& provided for by com 3liance with the Cupertinoshould Municipal Code,orhandlehazardous material. performance will the work for which this permit o issued. Safety Code,Section 25532(a) 1 have and will maintain Worker's Compensation Insurance,as P 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 Chapter 9.12 and the coni aminants as defined by the Bay Area Air Quality Management District I will permit is issued. subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,l shall maintain compliance with the Cupertino Municipal Code, not employ any person in any manner so as to become J Owner or authorized agent: Date:_ Compensation laws of inanCalifornia. If,after making this certificate of exemption, become subject to the Worker's Compensation provisions of the Labor Code,Imust — forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I h:reby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) and state laws rel correct.I agree to comply with all city and county ordinances relating Lender's Name to building construction,and hereby authorize representoatives of t agris ee to ty to eenter upon the above mentioned property for inspection pure Lf nder's Address unify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said understands ty in cons(and will of ARCHITECT'S DECLARATION granting of this permit.Additionally,the app fans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section I,rnderstand my p 9.18. Licensed Professional Date Licensed CITY OF CUPERTINO BU�[LDING PERMIT CONTRACTOR:SEARS HOME PERMIT NO: 10050185 BUILDING ADDRESS: 20236 NORTHBROOK SQ IMPROVEMENT 1024 FLORIDA CENTRAL PKWY DATE ISSUED:05/25/20 10 ''NER'S NAME: JERRY&SHARON COLE PHONE NO:(925)245-2000 LONGWOOD,FL 32750 tjvVNER'S PHONE: 4082533270 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB rr License Class Lic.# �2-�3� 1 MECH RESIDENTIAL COMMERCIAL Se0.�-s e�rrwm. -f Date s I a s I 1 0 ,NEW SINK& Contractor = JOB DESCRIPTION:INSTALL NEW KITCHEN COUNTERTOPS I hereby affirm that I am licensed under the provisions of Chapter 9 PTRAp (commencing with Section 7000)of Division 3 of the Business&Professions NO CALINETS,NO ELECTRICAL,NO MECHANICAL,NO ING 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 Section 3700 of the Labor Code,for the performance of the work for which this Valuation:$4625 Sq.Ft Floor Area: permit is issued. APPLICANT CERTIFICATIONOccupancy Type: I certify that I have read this application and state that the above information is APN P umber:31639023.00 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 STARTEWITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 180 DAYS FROM LAST CALLED INSPECTION. 9.18. ate fas 1 ICS Issued by: Date: aa2Lf ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All rc ofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, instal led without first obtaining an inspection,I agree to remove all new materials or will do the work,and the structure is not intended or offered for sale(Sec.7044, inspe-,tion. Date: Business&Professions Code) Sign Lture of Applicant: 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 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. Cali fornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by coirr pliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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 Ad(litionally,should I use equipment or devices which emit hazardous air permit is issued. agement 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,n tanants as defined by the Bay Area Air Quality 1Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,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 Per or authorized t: 5 forthwith comply with such provisions or this permit shall be deemed revoked. te: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I h xeb 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 the above mentioned property for inspection purposes.(We)agree to save .unify and keep harmless the City of Cupertino against liabilities,judgments, Lc nder's Address 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 9.18. I t.nderstand my plans shall be used as public records. �(as/lam Signature ate _ L censed Professional CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31639023 . 00 DATE ISSUED. . . . . . . : 05/25/2010 RECEIPT #. . . . . . . . . BS000010482 REFERENCE ID # . . . : 10050185 SITE ADDRESS . . . . . : 20236 NORTHBROOK SQ SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JERRY S SHARON COLE ADDRESS 20236 TORTHBROOKK SQ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . . RANDALI EARL BLACKM CONTRACTOR ALFRED W NYMAN JR - ASST SEC LIC # 23097 COMPANY SEARS FOME IMPROVEMENT ADDRESS 1024 FLORIDA CENTRAL PKWY CITY/STATE/ZIP . . . : LONGWOOD, FL 32750 TELEPHONE (925) 245-2000 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ------ ---- ---------- ---------- --- 1BCBSC VALUATION 4, 625. 00 1 .00 0 . 00 1. 00 0 .00 1BPFIXTURE NO OF FIXTURE 1 . 00 8 . 00 0 . 00 8 . 00 0 . 00 1BSEISMICR VALUATION 4, 625. 00 0 .50 0 . 00 0 .50 0 .00 1PPERMITFE FLAT RATE 1. 00 x:2 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 2:2 .00 0 .00 42 . 00 0 .00 - ---------- ---------- ---------- ---------- TOTAL PERMIT 93 .50 0 .00 93 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CHECK 93 .50 #5636 --------------- TOTAL RECEIPT 93 .50 i CITY OF CITY OF CUPERTINO LM GENERAL BUILDING CUPERTINO PENT APPLICAT-[ON FORM Date: Building Address:;xqv C LA S�t c- U Mailing Address(if different from building address Are Hazardous Materials being used as part of this project? Yes ❑ No .�. ❑ No If ,provide letter from HOA HOA: Exterior work only) Yes Phone#: Owner's Name: yob as3 3a� � Gc�l� Phone: -rAa- OV5 Contractor: Fax: ct aS a s -ac>>�i 7171 Contractor License#: '(a X3"-1C1 Cu ertino Business License#: phone: 1,40'1 Contact: Fax: ao a b 3 _ e\\Zcxbeth 1�.. 1 Residential Commercial ❑ Job Description: N)Q-� �}o Cab Building Permit Info: Plumb,� Mech ❑ Bld ❑ Elect ❑ J- 0ccupancy Type: Type of Construction(Usage Class): - T VCor� S F� II/III/V-A ❑ II/I11 B,IVH , 1-A, 1-B ❑ Square Footage: Valuation: � 1$ L4k.0-� Project Size: Express [ Standard ❑ Lar e❑ Major ❑ • Please complete relevant portion of th s Green Building�EEsD�he�ck & attach itGreen Buildmg' licable,include in plan set to the application or if app Points Achieved: For help,contact Build it Green at www.buil dit reen.c r Revised 07/14/09 5-1 1 °S D CITY OF CUPERTINO CITY E TGENERAL BUILDING APPLICATION Cu � ING FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ISTUCOAP Stucco Applicat.ons (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 wine ows) 1 WINMEWSTR New Window-s-ructural shear B wall/masonry (iacludes plan ck fee) IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Pernit Fee M 1 PPERMITFEE Plumbing Perm it Fee P 1ELCPLNCK Stand Alone Elixtric Pln Ck(hourly) E 1MECPLNCK Stand Alone M,.chanical 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 aline 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT / TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel &Doc-umentation B I 1BUSLIC Business Licer.se B 1' 5 of 5 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 CUPERTINO Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ap a 3 c4z, t�oc-_- \Oroclt Sq PERMIT# o l � OWNER'S NAME: -73; G,CZ\e. PHONE# 40-8 i3 -7 - GENERAL CONTRACTOR: _'27M9'tm&\+ BUSINESS LICENSE# -1 a t3-19 ADDRESS: ZS3 E A\ru_xc ,q M16f r_ CITY/ZIPCODE: CA ct SSCP "Our municipal code requires all businesses working in the,--ity 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 SUBCONTRAC70RS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ao t p Signature Date Please check applicable subcontractors and complete the following information: 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 5 j��jao� o Tj;�� Own�er/C�ontrac�torSi�gnatu�re Date