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07100094 CITY OF CUPERTINO (''� ` �� f` BUIL'DINC DIVtS10N PERMIT C��T� ��'T�� �' '^ �������• _,. ..:.:: _ _ ; >..:: _ _ .. .. BUILD �rr�qq��essN BLANEY AVE COOL' S USTOM P 07100094 • OW NER'S NAME: PERM�T LSSUE DATE PATEL, G ITA 4718 ME?1DIAN A`JE 10 11 2007 NE: SANITARY NO. CONTROL NO. (408)353-9692 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH � � � 0 � O p LICENSED CONTRACTOR'S DECLARAT[ON JOb DOSCTIptlOil ; V� ! hcrcby aCfirm that I am ticensed unAc� provisions oC Chap�cr 9(commencing ; z� wim Sccuon 7000) otDivision 3 of thc Busincss and Pro(cssions Code, and my liccnsc is ELEC T P. �IVEL S ERV I C E UPGRADE ;� y in full forec and eCtect ��! )�� ��? Licensc C1ass L'u. M o i ; F � Da�c �Q � Conua� DUL C' cl CTO j�_ � - AkCHITECi'S DECLARATION 7� a I undcrstand my plans shall bc uscd as public rccords )yU ' w y Licenud Pn>fcssional � y � OWNER-BUILDER DECLARATION [ hcrcAy a1Trm that 1 am cxcmpt Crom ttic Contractor's Liccnsc Law for thc 3 p O follnwing reuon. (Sccuon 7031.5, Busincss and Profcuians Codc: Any ci�y or rnunty �,°, � which rcquires a pcmiit to conswct, altcr, impmvc, demolish, or �cpnir any structurc `? Z y prior ui iLS issuancc, also mquires thc applicant for such permit io filc a signcd statemcnt �_< that he is liccnscd pucsuant to thc provisions o[ thc Contracu�r's Liccnsc Caw (Chaptcr 9 ; iq. Ft. Floor Area Valuation r F� (commencing wiih Section 7000) of Division 3 0( Ihe Business and Professians Code) ur � 1 � � � y�� that he is exempt therefrom md ihe basis [or We allegcd exempuon. Any violation of Section 7031.5 by arry applicant Cor a pertnit subjects ihe applicant to a civil penalty of Number Oecupancy Type nat more chan five hundrcd dollars (5500� 316 2 3 0 3 3�� ❑ I, as owncr of tt�e property. or my employces with wages as their solc compensadon, will do thc wark, and the swauce is not intendcd or oftend for salc (Sec. 7044. Business Re uired Ins ectio ns and ProFessions Code: The Conuacwrs License Gw does not apply W an owner of Q � propeny who builds ot improves thercon, and who does such wark himself or tlwugh Ais own employccs, providcd ihat such improvemenLS are not imended or otiered Cor sak. I[, however, the building or improvement is sold within one year of complction, the owner- builder wil! have the burden o[ proving that he did not build ar improvc tor pu�pose of salcJ. ❑ I, as owner o[ the property, am eaeclusively convacting wilh licenud rnnvactars lo construct the projett (Sec. 7044. Business and ProCessions Code:) The Convactor's Li- ccaae Law dacs not apply to an owner of property who builds or improves Ihaeon, and . , who conuacts [or such projects with a conuactor(s) licensed pursuant w Uie Canvactor's License Law. Q 1 am ezempt undu Sec , B& P C for this mawn Owner Date WORKER'S COMPENSATION DECLARA170N I lureby affirm under penalty of pujury ane of the fotlowing declarations: ❑ I hsve and will mainwin a Certif ca�e o( Conscnt lo xlf-insure for Workcfs Compen- satian, as provided for by Section 3700 af �e Cabor Code. (ar �he perfortnancc o( thc wark (or which U�is pertnit is issued. ❑ I havc and will maintain Worker's Compensation Insurance, u �cquired by Scction 3700 0( the Labar Code, for Ne performance of the work for which this pertnit is iuued. My Warker's Compensa[ion Insucancc carricr and Policy numbcr are: Carrier. - S� �6M"1� Poliry No.: �� Z 7� ��/�! I CERTIFICATE OF EXEMP170N FROM WORKERS' COMPENSA7'ION iNSURANCE � (This secdon necd not bc completed i! the pecmit is for onc hundred dollazs (5100) or Icss.} ' 1 cenify thxt in thc performancc of �hc work for which �his permii is issucd. I shatl not cmploy any person in any manncr m bs w bccomc mbjcct to the Workcrs' Compcnsation L,aws ot Califomia. Datc Applicant NOTICE TO APPLICANT: If, after making ttiis Ceniticatc of Ezcmption, you should bccome subject a �hc Workcr's Compcnsation provisions of thc LaAor Codc, you muu � O fonhwith comply with such provisions or this pccmi� shall bc dccmcd revakcd. Z '"'' CONSTRUCTION LENDING AGENCY Er ►�-� 1 hemby affirm that there is a constcuction Iending agency Car the performance of �, � thc work Cur which �his permit is issucd (Scc. 3097, Civ. CJ a A Lendct'S Namc . ' � z L.cnder's Address V � 1 certiCy ihat 1 havc rcad ihis application and siatc �ha� thc abovc infortnaliun is �� co�rcct. 1 agree �o comply with all city and county ordinances and sute laws reladng to 0 U building conswction, and hcrcby authori�e represcnutivcs of �his city to cmcr upon �hc W above-mentioned properry (or inspecuon purposes. '' a (Wc) agree �o save, indcmnify and kecp harmless ihe City o! Cupertino against �.F, � liabiliuu, judgmcnts, costs and ezpcnscs which may in any way accruc against said City ' V z in consequencc oC ihc granting of Ihis pertnit. �'? � APPLICANT U ERSTANDS AND WIL COMP Y WITH ALL NON-POINT Issued by: Date �� SOURCE . - o � Re-roofs �1/ Signature pplicanl/Con r 1c H US MATERIALS D[SCLOSURE Type of R � )Of Will ihc applicant ar futurc building acupant s[ore or handlc harardous matcrial az dcfincd by Ihc Cupertino Municipal Codc. Chap�cr 9.12, and thc Hcal�h and Safcty co��. Section 25532(a)? / All roofs : hall be inspected prior to any roofing material being installed. ❑Ycs �No Will �hc applicant or futurc building occupant use cyuipmcnt or Jcvices which If a roof i: installed without first obtaining an inspection, I agree to remove • cmi� harardnus air contaminanls az cfincd by the Bay Arca Air Quality Managcment all new m; iterials for inspecrion. o�su;��� ❑ Ycs o 1 havc rcaJ the hvardcws matcrials requircmcnts undcrChap�cr6.95 ot ihc Califor- nia Hcalth & Safcry Codc, Sections 25505, 25533 and 25534. ! undcrstv�d that iC �he 6uilding docs no� curtcntly havc a tcnan� fhat it is my responsibility to noufy thc occupant nf ihc rcyuircmcn�s which must � prior issuan a c�r�a� ara��a��r. Signature �f Applicant Date � r � ° All roof coverings to be Class "B" or better Owncr or authori•r. d agcnt �� , �� � �o Q � �. . :� � _ � � � � � CITY OF C UPERTINU ����F PERMIT APPLJ[CATION FORM CUPEI�TlNO �PN # 3 � � � 3 GS � � • � U Date: � � `l/ d � � i Building Address: Mailing Address (if different from building address): �a � �7 9 /1/ G,�-iv�y ,g � � Owner's Name: , Phone #: . � A E o� Z.��-- v��S Contractor: License #: L'va L' S C° �S To v"t ��/ Ub 3 Contact: �., Phone: � �� Cupertino Business License#: ,� � `� �D� � Fax: � 6 I -• 3 `1 � o� o� Building Permit Info: Bldg ❑ Elect C� F'lumb ❑ Mech ❑ Job Description: - Residential ❑ � V C �� U P��2 /� i�'t � Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: ����� Occupancy Group: � � Type of Construction: , �` f' Please check this box if t� project is a l,r� second-stor addition: � roject Size: Standard L� Large ❑ Major ❑ Quanti Fee ID liee Descri tion Fee Grou BAPPLOTHER Other Ap liances MECHANICAL BBOILERl Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boile�� > 100K to SOOK Btu MECHANICAL BBOILER3 Boilf:r > SOOK to 1M Btu MECHANICAL BBOILER4 Boile -> 1 M to 1.75 M Btu MECHANICAL BBOILERS B��iler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX IncVOff/Comin/Quasi BUILDING BCONSTAXBQ Co�i. Tax for BQ Zone BUILDING BCONSTAXH :3ote1 and Motel BUILDING BCONSTAXR Cor�st� — Resi/Mobile BUILDING BELEC1000 Elf;c 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL � BENERGY Energy BUILDING BENERGYADD F nergy Add Multi BUILDING BINVESTIGA =nvestigation fee BUILDING 1 of 3 � z CITY OF C'UPERTINO �� �uP��T��o PERMIT APPL�[CATION FORM Quanti Fee ID :Fee Descri tion Fee Grou BMISCELL 1�liscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME N�;w Comm Electric ELECTRICAL BNUCOMMM Nev�� Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLLTMBING BOVERTIME In �pection Overtime BUILDING BPBACKFLOW At� nospheric Vacuum PLL JMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE E.ld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Inc Waste Interceptor PLUMBING BPLANCHK :Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Pla�i Check Repeat Fee BUILDING BPREPIPE Ri� i e Of Fixtures PLUMBING BPSEWAGE '�ewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT A] t of Drain & Vent PLUMBING BPWATER Inst<<lUAlter Water Pi e PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT I:einspection Fee BUILDING BREMACOVER A/C' Unit > 10,000 cfin MECHAIVICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI ��ppliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT I,ighting Fixtures ELECTRICAL BREMFURN Re] ocation of Furnace MECHAI�TICAL BREMFURNOV Relu Furnace > l OK btu MECHANICAL BREMHEAT F, eater Installation MECHANICAL BREMINHOOD In:ctallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAFP Rem Non-Res Appliance ELECTRICAL BREMPOLE Po e/Platform Fixture ELECTRICAL BREMPOWER PowE r Device/A aratus ELECTRICAL BREMRECEPT Rc t l, Switch & Outlets ELECTRICAL BREMRELOCA R.location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Rerr�odel Res Appliance ELECTRICAL 2 of 3 � { = CITY OF C'UPERTINO ` ��� � PERMIT APPL=[CATION FORM cuP����vo '�uanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rmcil Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR The.atrical Lighting Fix ELECTRICAL BREMVENFAN Ve�it Fan Sin le Duct MECHANICAL BREMVENSYS VE�ntilation S stems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Se ismic Commercial BUILDING BSEISMICRE �3eismic Fee Res BUILDING BSPECIAL � pecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Tem orar Power ELECTRICAL BTEMPPERM Tem ora Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC liusiness License BUILDING ELECTRIC �lectrical s foot ELECTRICAL EPERMITFEE Eli�c Permit Issuance ELECTRICAL MPERMFEE 1V[echanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plu:nbin Permit Issue PLUMBING PPLBG Pl�unbing Fee sq foot PLLJMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran e Residential PLANNING 3 of 3 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIZ RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 31623039.00 DATE ISSUED.......: 10/11/2007 RECEIPT #.........: BSC00002967 REFERENCE ID # ...: 07100094 SITE ADDRESS .....: 10179 N BLANEY AVE SUBDIVISION ....... CITY .............. CUF'ERTINO IMPACT AREA ....... OWNER ............. PAZ'EL, GITA ADDRESS ......... 10179 N BLANEY AVE CITY/STATE/ZIP ...: CUF'ERTINO, CA 95014 RECEIVED FROM ....: PHILIP J COOL CONTRACTOR .......: PHILLIP COOL LIC # 22976 COMPANY ..........: COC�L'S CUSTnM ADDRESS ..........: 47i8 MERTDIAN AVE CITY/STATE/ZIP ...: SAI�f JOSE, CA 95118 TELEPHONE ........:� (4C8)353-9692 FEE ID UNIT QUANTITY �,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BELEC200 METERS 1.00 29.43 0.00 29.43 0.00 BSEISMICRE VALUATION 1,000.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 70.72 0.00 70.72 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 70.72 #2330 --------------- TOTAL RECEIPT : 70.72 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL �: ' � Community Development ' 10300 Torre Avenue •� �;t� - Cupertino CA 95014 Telephone (408) 777-3228 ClTY OF Fax (408) 777-3333 �UPEf�TINO Buildin De artment JOB ADDRESS: _ PERMIT # � o t�� ��-��� C��-7r�o �,� v'1 ��oo� � OWNER'S NAME: � r T� r} T'��— PHONE # 2 S�� 0 7 7 S GENERAL CONTRACTOR: � dU ^ c;�� FAX # I am not using any subcontractors: Si;;nature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIrTESS 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 �' a � � Owner/ ontract ignature Date