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09100144 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10196 VISTA DR CONTRACTOR:SOUTHWEST ELECTRIC PERMIT NO:09100144 OWNER'S NAME: VISTA DRIVE HOA 14510 BIG BASIN WAY DATE ISSUED: 10/22/2009 `ER'S PHONE: 4087189870 SARATOGA,CA 95070 PHONE NO:(408)999-8721 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class_ Lic.#� a r7 y J MECH f- RESIDENTIAL f- COMMERCIAL Contractor A Date • 1 hereby A7.that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE&INSTALL (commencing with Section 7000)of Division 3 of the Business&Professions DRIVEWAY(3)LIGHTS;SOUTHWEST Code and that my license is in full force and effect. ELECTRIC REWD BUS LIC 10/21/9 1 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.Ft Floor Area: Valuation:$1000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:31624044.00 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:,,,-� Z Signature Date C� 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 installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature 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 California Health&Safety Code,Sections 25505,25533,and 25534. 1 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 Additionally,should I use equipment or devices which emit hazardous air contaminants 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 Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's I Compensation laws of California. If,after making this certificate of exemption,I Owner r horized 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 hereby 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.) 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 upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address i nify and keep harmless the City of Cupertino against liabilities,judgments, o 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 understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31624044 .00 DATE ISSUED. . . . . . . : 10/22/2009 RECEIPT #. . . . . . . . . BS000009009 REFERENCE ID # . . . : 09100144 SITE ADDRESS . . . . . : 10196 VISTA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER VISTA DRIVE HOA ADDRESS 10196 VISTA DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2223 RECEIVED FROM . . . . : STEPHEN P WILKENS CONTRACTOR . . . . . . . : STEPHEN WILKENS LIC # 21488 COMPANY SOUTHWEST ELECTRIC ADDRESS 14510 BIG BASIN WAY CITY/STATE/ZIP . . . : SARATOGA, CA 95070 TELEPHONE (408) 999-8721 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 000 . 00 1 . 00 0. 00 1. 00 0 .00 1BREMFIXT NO. FIXTURES 1. 00 63 .00 0. 00 63 . 00 0 .00 1BSEISMICR VALUATION 1, 000. 00 0 .50 0 . 00 0 .50 0 . 00 1EPERMITFE 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 148 .50 0 . 00 148 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 148 .50 VISA --------------- TOTAL RECEIPT 148 .50 CITY OF CUPERTINO CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# Date: Building Address: 1 v (p Mailing Address (if di fer nt from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No [ HOA: Exterior work only) Yes No ❑ If yes, provide letter from HOA Owner's Name: Phone#: Contractor: Phone: 4,'vk- �;-O k_ 6.14 7- i, t,° Lt w e- ' LS 2 L Fax: Lf CO'1 Contractor License#: °7 1 b h I Cupertino Business License#: Contawt: Phone: bar k 0 S"- �� Fax: -7 7 --b q 63 Residential Commercial Jo Description: bk Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A5 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B Cq— V--7 Valuation: Square Footage: fl-D V Project Size: Express ERstandard ❑ 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.buildit reen.or Revised 07/14/09 CITY OF CUPERTINO cin OF GENERAL BUILDING APPLICATION CUPEt�TiNO FEE SCHEDULE Quantity/Sf Fee ID Fee Description 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) 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE 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 Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5 Vista Drive Home Owners Association 10198 Vista Drive, Cupertino, CA 95014 Wednesday, Ocboter 21 2009. To The City of Cupertino Building Department Cupertino, CA Dear Sir/Madam, We have contracted SouthWest Electric Company of Saratoga, CA to replace and install new lights in the common area of Vista Drive Townhome complex. Vista Drive HOA authorizes Southwest Electric to obtain all necessary building permits required for the project. The two buildings have five townhouses with addresses in the contact information below. Please contact HOA members for any additional inquiries. 10184 Vista Drive, Cupertino CA 95014 Owners: Mr and Mrs. Ching-Yuan Chen 20233 Joseph Circle, Cupertino, CA 95014 Ph: 408-252-3735 10190 Vista Drive, Cupertino, CA 95014 Manish Mehta Manish r mehta ahoo.com Cell: 408-892-9903 10196 Vista Drive, Cupertino, CA 95014 Joon -Seok Moon (Jay) smoon mail.com Cell: 408-718-9870 10202 Vista Drive, Cupertino, CA 95014 Syed Faridul Ha sfarid mail.co C: 408-391-4877 10208 Vista Drive, Cupertino, CA 95014 K.R.Bala'i Krbalami66 ahoo.com Cell: 408-218-0717 Thanking you, Sincerely, K.R.Balaji, President, Vista Drive HOA Manish Mehta, Treasurer,Vista Drive HOA Jay Moon, Secretary, Vista Drive HOA Wednesday October 21, 2009 Community Development 10300 Torre Avenue =A/ ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,UPEkTINO Building Department JOB ADDRESS: PERMIT# /' 0f -f f��r (? / 0� 1111 OWNER'S NAME: L,` -fA PHONE # !-o GENERAL CONTRACTOR: S s �- FAX # p 7 I am not using any subcontractors: ( v Lz Signature Date Please check applicable subcontractors and complete the following information: 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date