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07100182 CITY OF CUPERTINO ' �- ° BUILDING DIV1SlON PERMIT ��'"�� * ' ,: ; ,;: ; <. ..... _ _ .. PERMIT NO. BUILDI G ADDRESS: �75 CALVERT DR FSR CON;3TRUCTION 07100182 • PERMIT ISSUE DATE �ER'S NAME: , PACIFIC PROPERTIES (BLDG. E) 3490 UN:CON ST SANITARY NO. CONTROL NO. PHONE: (510) 49�)-7911 BUtLDING PERMIT iNFO ARCHI'fECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 i p � LICENSED CONTRACTOR'S DECLARAT[ON JOb DESCTIptlOfl � V� I hercby af[irm that I am liccnscd unJcr provisions oC Chaptcr 9(rnmmcncine ;Z� w imScciion7ooU)o[Division3aftheBusinessandProCcssionsCodc.andmyliccRSeis REPLACE PLLTMBING, ELECTRICAL, SIDING, STUDS LIKE > j y in full Corce and cftect i� �� 8� � ,�i �;«„x �s: ►-�•�► rS FOR LIK:� WHERE EFFECTD BY FIRE p Datc �l? !./n'� Conaaaor UA ��'1,j�'ifr� Sc=Z1rCf+JV�� : � W ARCHITECTS DECLARATION i a a I undcrstand my plans shall bc uud as public rccords )qU ' u. � Licenud Prufcssional : � a OW NER-BUILDER DECLARATION j a� i hcrcby alTrm Ihat 1 am cxcmpt Crom thc Contractor's Liccnsc Law Cor Uc , p O following rcason. (SccGan 7031.5, Busincss and Profcssions Codc: Any city or rnunty �,°, Pi which rcquires a permit w cnnswct, altcr, impmvc. demoliah, or repair any suuctmc �� N prior w i�s issuancc, alsu rcquiccs U�c applicant Cor such permit to filc a signcd s�� t �, Valuation �?< that hc is liccnscd pursuant to thc p�ovisions of thc Contractur's Liccnsc Law (pupux 9 .� Ft. Floor Area t F� (commenring wiih Section 7000) of Division 3 aC �hc Busincss and Profcssinns Cadc) ar � 17 � Q �� that he is e�cempt ihcrctrom and ihe basis Cor the allegcd eumption. Any violation of Secdon 7031.5 by a�ry appiicant for a permit subjccu �he applicant to a civil pcnalty of Number Occupancy Type not morc �han fivc hundred dollars (5500). 3 7 5 1 9 � 2 �� ❑ I, as owner o[ Uu propccty. or my cmployca with wagu u the'v sole compentatioe. will do the work, and the swctum is not;r.mndcd or ofCeced farsalc (Sec.7044. Hnsin�ss Required Inspections and Professians Code: The Con�cacwr's Licence Law docs not apply in an ownec of propeny who builds or imQraves thereon, and who does such worlc himselCor rtuoaEh 6is own employces. providcd ihat such improvemen�s are not in�ended or otCeced Cor saie. It. however, the building or improvement is sold within one year oC completion. �6e oarnu- builder will have the burdee of proving �at he did not build ar improvc [ar pu�pose of . salc.). � I, as owner a( the property, am ezclusively contracting with licensed rnnuactas a constn�ct the project (See. 7044. Business and Profasions Cade:) The Contnetnls Li- cense Law docs aot apply to an owner of propeny w6o builds or improves tMe�eon. a� . who conuacts for sucA pmjec�s with a convactot{s) licensed pursuant to �he ContractafY License Law. ` �m uempt under Sec. , B& P C for ihis �escoa _ ..ner �a� - WORKERS COMPENSATION DECLARATION I herchy affimi under penalty of perjury onc of the follawing declaration� ❑ t hsve and will maintain a Certificate of Consent to self-insure for Worker's Campen- sation, as providcd for by Sation 3700 of the [abor Code, far Ne performanoe of t6e work for which ihis permit is issucd. ❑ I havc and will maintain Workct's Compensation Insurance, as required by Seaiao , 3700 0( the Labor Code, for ihe performance of �he work for which �his permit is issaed. My Worker's Compensatian Insunnce cartier and Policy number ue: Cartiu: ✓�rATt' Conll�i,`NJM'�e,e/ Policy No.: � �OG ��5--- CERTIFICATE OF EXEMP770N FROM WORKERS' COMPENSATlON 1NSURANCE ('ihis sectian nced not be complc�ed i( the permit is for onc hundred dollars (S I00) orlcssJ I cenify thas in thc perfoenance oC thc work for which Ihis pertnit is issucd, t shall ao[ employ any person in any manncr so u to becomc subject to the Warkcrs' Compensatiw Laws of Cali(omia. Datc Applicant NOTICE 7'O APPLICANT: If, aftcr making Uiis Ccnifica�c of Ezcmp6on, you slauld bccome subjcct to �hc Workcr's Compcnsation provisions o( thc Lalwr Cadc, you muu � O forthwith comply with such provisions or this pccmit shall bc dccmcd �cvolccd. z �"'' CONSfRUCTtON LENDING AGENCY H i-�. I hercby aliirm Ihat thcre is a conswction Iending agcncy Cor il�e performaMe o( - a, � lttc work for which ihis pertnit is issucd (Scc. 3097, Civ. CJ , (da Q L.endct's Namc � z Lender's Address U � ( ccrti(Y Wat 1 have rcad this application and sutc that thc abovc informatiun is w ►-� cortect. I agree to comply wiih all ci�y and county ordinances and sta�e laws relaang w rJ J building conswction, and hereby authori�e represeniatives of this ci�y to enter opon thc � W abovc-mcntioned properry for inspecuon purposes. a (Wc) agree to sare, indcmaify and kecp harmleu the Ci�y of Cupertino against �� liabiliuu, judgmcn�s, cos�s and expcnscs which may in any way accruc against said Gry () ,'� in conuqucnce of thc grantin this permi� Date ��2 ��- � APPLICANT UN S AND WILL C P Y WITH ALL NON-PO[NT Issued by: SOURCE S• lb/2G U� Re-roofs '� Signaturc of ApplicanUContractor �a� T e of R oof HAZARDOUS MATERIALS DISCLOSURE yp Wit( thc applicant or future building occupant storc or handlc harardous mate[ial efincd by the Cupenino Munici al Codc. Chap�cr 9.12. and thc Hcalth and SaCety _�� Section 25532(a)? All roofs �hall be inspected prior to any roofing material being installed. ❑ Ycs o . Will ihc applicant or futurc building occupant usc eyuipment or Jcviccs whK6 If a roof i� installed without first obtaining an inspection, I agree to remove emit harardous air contaminants u fined by Uu Bay Area Air Quality Managcmem all new m aterials for inspecrion. Dislrict? � � y� Nu I havc read ihe ha�ardrnu maicrials rcyuiremcn�s undcrChaptcr 6.95 of ihc Califor- nia Hcalih & Safcty Codc, Sections 25505, 25533 and 25534.1 undcrstand Uut iC�he huildin6 docs not curtcnQy havc �hat it u my rc ibility to nodfy ihc occupant of the � rcyuiremcn�s mctprior oCaCcnificatco(Oc �r. SignatureofApplicant Date �'''� � 2 �' G7 All roof coverings to be Class "B" or better Owncr or authorizcd agcm Da�c :. �j�t �c�� CITY OF C'UPERTINO � r��F PERMIT APPLTCATION FORM CUP�#�TINO APN # Date: �'�`� � �oZ�] � c�C� 2�� Building Address: Vlailing Address (if different from building address): I7 Cfk.UF�2 oe CuPEi�i'�Nn �v�` Owner's Name: Phone #: �AU F! C � M a� �{0$ - 2 - � Contractor: License #: �.oa�c�sr Nc 5�.=�-zrr a ic �zs �Nc • 8888 S� Contact: Phone: 510 � Cupertino Business License#: �- O � Fax:S/O-y - () G � �s � Building Permit Info: Bldg � Elect � F'lumb � Mech ❑ Job Description: RCP�Acc� 8�� , E�*�tcAC, S,aN:, srvr�S tir� o �kr �r� - tE n CT7 L",�1 Residential ❑ Commercial [y' Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: 1?OC�.�� _� Type of Construction: Please check this box if t� project is a �a„1 second-sto addition: Project Size: Standard I� Large ❑ Major ❑ Quanti Fee ID :Fee Descri tion Fee Grou BAPPLOTHER ()ther Ap liances MECHANICAL BBOILERl Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boile�� > 100K to SOOK Btu MECHANICAL BBOILER3 Boil�;r > SOOK to 1M Btu MECHANICAL BBOILER4 Boile r> 1 M to 1.75 M Btu MECHANICAL BBOILERS B�iler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX IncVOff/Comm/Quasi BUILDING BCONSTAXBQ Co�i. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Coiistax — Resi/Mobile BUILDING BELEC 1000 EIE;c 600V <= l 000A ELECTRICAL BELEC1001 E] ec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD F;nergy Add Multi BUILDING BINVESTIGA fnvestigation fee BUILDING 1 of 3 .:�. CITY OF C UPERTINO ��F pERMIT APPLI=CATION FORM cuP�� i�o Quanti Fee ID l�ee Descri tion Fee Grou BMISCELL 1V[iscellaneous Fee BUILDING BMITIGATC Comn. Housing Mit. Fee BUILDING BNUCOMME Ne w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNtJCOMMP N:w Comm Plumb PLLTMBING BOVERTIME In:;pection Overtime BUILDING BPBACKFLOW Atr�ospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLLTMBING BPERMFEE B Id Permit Fees BUILDING � BPFIXTURE Pbl Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK ]'lan Check Fee BUILDING BPLANCKADD Pla�l Check Add Multi BUILDING BPLANCKREP Plar� Check Repeat Fee BUILDING BPREPIPE Rf� i e Of Fixtures PLUMBING BPSEWAGE S ewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BpSPRINK Lawn SprinklerBackflo PLLTMBING BPSTORM Storm/Rain Water PLUMBING gpTRAp Kitchen Tra PLUMBING BPVENT Alt of Drain & Vent PLLJMBING BPWATER InstalVAlter Water Pi e PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT F;einspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C - :Jnits <= 10,000 cfin MECHANICAL BREMAPPLI ��ppliance Install MECHA1vICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT I,ighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relc� Furnace > l OK btu MECHANICAL BREMHEAT H eater Installation MECHANICAL BREMINHOOD In�;tallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL gREMNRAFP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pol e/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rc 11, Switch & Outlets ELECTRICAL BREMRELOCA R�,location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Rerr odel Res A pliance ELECTRICAL 2 of 3 ; � n CITY OF C'UPERTINO � ��TY F PERMIT APPL][CATION FORM CUPEI�TINO Quanti Fee ID :F'ee Descri tion Fee Grou BREMSIGNAD Rmcll Signs Add Branch ELECTRICAL BREMSIGNS Rem�del Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Sin le Duct MECHANICAL BREMVENSYS Ve ntilation S stems MECHANICAL BSCBLVD ��cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE .�eismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM 3wimming Pool BUILDING BTEMP T��m ora Power ELECTRICAL BTEMPPERM Tem ora Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC �tusiness License BUILDING ELECTRIC l;lectrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE M echanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Pluinbin Permit Issue PLUMBING PPLBG Phunbing Fee sq foot PLLTMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran e Residential PLANNING 3 of 3 CITY OF CUPERTINO 7 ITEMS OF 7 PERMI�' RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp:"Rng: Sub: Bl);: Lot: APN ......... 37�i19027.00 DATE ISSUED.......: 10,'26/2007 RECEIPT #.......... BS()00003084 REFERENCE ID # ...: 07:_00182 SITE ADDRESS .....: 17'.i CALVERT DR SUBDIVISION ....... CITY .............. CU]'ERTINO IMPACT AREA ....... OWNER ............: PA(;IFIC PROPERTIES (BLDG. E) ADDRESS ........... CITY/STATE/ZIP ...: , RECEIVED FROM ....: AN`�HONY QUALLS CONTRACTOR .......: PA1JL QUALLS LIC # 28012 COMPANY ..........: FSIZ CONSTRUCTION ADDRESS ..........: 34'�0 UNION ST CITY/STATE/ZIP ...: FR]�MONT, CA 94538 TELEPHONE ........: (5:L0)490 FEE ID UNIT QUANTITY ��'IOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 1,700.00 83.16 0.00 83.16 0.00 BPFIXTURE UNITS 1.00 9.00 0.00 9.00 0.00 BPVENT iJNIT5 1.00 10.79 0.00 10.79 0.00 BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0.00 BSEISMICRE VALUATION 1,700.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 186.23 0.00 186.23 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 186.23 VISP --------------- TOTAL RECEIPT : 186.23 Community Development '` ° � 10300 Torre Avenue �" �;s;° , Cupertino CA 95014 Telephone (408) ?77-3228 C1TY OF Fax (408) 777-3333 CUPEI�TINO Buildin De artment JOB ADDRESS: PERMIT # �T C.l� �►2 ► DR CU PC r �l � � RSO l c - � `� � � �— OWNER'S NAME: ACIFI(, P �� COin Atiti PHONE # yd8- 2� Z(22 GENERAL CONTRACTOR: CoQNN''R S�oN�� k�zT i�'ilc.�r�c1 F # y�8- Z-(? I am not using any subcontractors: — �(X 2 � ! �? Si 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 SepticTank Sheet Metal Sheet Rock Tile �a-ZC - o � Owner/ Contractor Signature Date