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07100174 CIT�' OF CUPERTINO ' ' ` su�,.. DIYISION PERMIT C��'�G��� I��'���'TIQ1�': ' ,:. : . , _ : ,< ,:; _ BUILDING ADDRESS: PERMiT NO. �0 � 4 4 nFrTT �nnT AU� D�'�n .. P A �ER'S NAME: PHON . � S CONTROL NO. BU�LDING PERMfC INFO ARCHI'I'EC'C/ENGiNEER: BLDG ELECT PLUMB MECH � 0 0 0 ' Z LICENSED CON'['RACTOR'S DECLARATION - o Job Description �� 1 hcrcby afGrm Iha� I am liccnscd unJcr provisions oC Chaptcr 9(commcncine ��`-',, with Scction 7000) o( Division 3 of ihe Busincss and Pro[cssions Codc, and my liccnsc is '0. infullforccandc(f 4 � REPIPE/DIATER MAIN/WATLy'R HEATER � z Liccnu Class � Lic. � 5 r �' C� Con�raclor �V k '" : � Datc . � AR ITECI'S DECLAR O %-� 1 undcrstanJ my plans shall bc uscd as public rccords _ � f' Liccnud Profcssional � � OW NER-BUILDER DECLARATION I hcrcby affirm �ha� 1 am cxcmpt Crom thc Contractor's Liccnsc Law for thc j o following rcazon. (Scctiun 7031.5, Business and Profcssinns Ca1c: Any city or county ;�i which rcquirrs a permit to conswc� altcr, improve, dcmolish, or rcpair any structure , y '�, pnor ui ilt issuancc, also rcquires thc applican� for such permi� to filc a signed sta�cmcm Ft. Floor Area Valuati on �< �hat hc is liccnscd pursuant lo thc pmvisions of thc Contractor's Liccnsc Law (Chap�cr 9 S a• -� (commencing with Section 7000) of Division 3 of ihe Business and Profccsions Code) or �.. that he is exemp� tAerefrom and the bazu for the alleged ezemption. Any violation oC Section 7031.5 by any applicant (or a pamit subjccts the applicant to a civil penalty of APN Number Oeeupaney Type not more than five hundred dollars (5500). ❑ I, as owncr oC the propcny, or my employces with wages az �heir solc compensation, 316 2 9 0 6 E �. � � will do t6e work, and �he suucwre is not intendcd or oftered for salc (Sec.7044, Business Required Inspections and Professions Code: The Conuactor's License Law does not apply io an owner of propeny who builds a improves �hercon, and who does such work himselt or �hrough his own employccs, providcd that such improvements are not in�ended or offered for sala IC, however, the building or improvement ia sold wi�hin one year oC complction, ihe owncr- builder will have the burden oC pmving �hat hc did not build or improvc for puryose of saleJ. ❑ I, as awnor of the properiy, am czdusivdy conuacting wiih licensed rnmractors w � cons[ruct the projett (Sec. 7044. Business and ProCcssions Code:) 7trc ConUacwr's Li- cense Law does not apply w an owncr of propcny who builds or improves Wneon, and , who convac�s for such projec�t with a conlractor(s) licensed pursuanl to �hc Contractor's License I.aw. ❑ 1 am uempt under Sec. , B& P C for this rcason � Dau WORKER'S COMPENSATION DECLARATION I hercby aFfi�m under penalty of perjury onc of �he following declarations: ❑ I hsve and will maintain a Certi6cate o( Conscnt to ul6insum for Workcr's Compen- sation, as providcd for by Sec[ion 3700 oC �he Labor Code, (or the performance o[ thc work [or which this pertnit is issucd. ❑ I Aavc and will maintain Workcr's Compensation Insuranu, as �cquircd by Scction 3700 oC the Labor Codc, Car thc performana of the worlc for which �his permit is issued. My Worker� I�ns ca and Poliry number arc: Camer. T"��'L TL� � Pollry No.: d'J��� �" 2Z CERTIFICATE OF EXEMPI70N FROM WORKERS' COMPENSATION INSURANCE ('I'his section nccd not Ac complc�ed if the permit is for onc hundred dollars (5100) or Icss) 1 certify thas in thc perfortna�c of Ihc work fw which this permit is issucd. I shall not employ any person in any manncr so as ta becomc subjcct io the Workcrs' Compensation Laws of California. Datc Applicant NOTICE 7'O APPC]CANT: If, aftcr making this CeniGca�c of Ezcmption, you should bccome subjcct to Ihc Workcr's Compcnsation provisions of t6c Labor Cndc, you must � z (orthwi�h comply with such provisions or this pccmit shall bc dccmcd revokcd. � i ""' CONSTRUCTION LENDING AGENCY �►�-� 1 hcreby aCfirtn U�at thcre is a conswctinn Icnding agcncy for thc performancc of i� �hc wurk fur which this permit is issucd (Scc. 3097, Civ. C.) 7 A L.cndcr's Namc � � L.endersAddress ) 0 I ceni(y ihat 1 havc rcad this applicaeion and state iha� the above informadon is "" cmrcc7. 1 agrce w comply with all city and county onlinances and state laws relating to � U building consuuction, and hcreby authori�e representativcs o! ihis ciiy to cntcr u�mn thc � � w abovc-menuoncd properry for inspecuon purfwses. � a (Wc) agrce to save, indcmnity and keep harmless the Ciry of Cupcnino against �� liabiliuu, judgmcn�s, costs and ezpcnscs which may i� y way accruc against said City ) z in consaquencc oC Urc granting If(s �ICf ""' AePLICANT UNDERS L PLY WITH ALL NON-POINT Issued by: Date �' Z'�� SOURCEREG `� � � Re-roofs •�� Signa�um of canU ntra � Dalc ARD US MATERIALS DISCLOSURE Type of Raof ill �hc applicant or futurc building occupani storc or handlc harardous matcrial icfincd by thc Cupenino Municipal aptcr 9.12, and the Hcal�h and Safcty . Scction 25532(a)? All roofs sl�all be inspected prior to any roofing material being installed. � y� No Will the applicant or (uturc building occupant usc cyuipmcn� or dcviccs which If a roof is installed without first obtaining an inspection, I agree to remove I emit hazazdous air contaminants as dcfined by the Bay Arca Air Qualiry Managemeni all new ma:erials for inspee .IOR. District? � Ycs �� 1 havc rcad the ha�ardcws ma�crials re'rcmcnts undcr Chap�er 6.95 of ihc Cali Cor- nia Hcalih & SafctyCodc, Sccqotu 2550 33 anJ 25534. I undcrstand thaz if ihc building a's not currcnUy-have a ic� t is m nsibiliry tn notify thc occupant of thc � rt���Wn;�n ��� �r���r��a�x Signature cf Applicant Date -�`� G � ' ' All roof coverings to be Class "B" or better Own orizc gcn Datc �� � c�o i � .� j �� CITY OF CUPERTINO � �� �F pERMIT APPLI CATION FORM CUPEt�Tl�lO APN# � � � � �� � � Date: f L � � �� - C„�'7 Building Address: ]VIailing Address (if different from building address): � � � wner's Name: � Phone #: - ,' � ,'c a e E � 5 � -� .SC��� ractor: License #: �� � � C � � .�-: � � �l �� b� �� Contact: Ph e: Cupertino Business License#: Fax: � � � Building Permit Info: Bldg ❑ Elect ❑ Plumb � Mech ❑ Job Description: / / Residential I�' �� ' l �" �`�` ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: �`�� Occupancy Group: � � 1 ) Type of Construction: Please check this box if ta project is a � second-stor addition: Project Size: Standard ❑ Large ❑ Maj �r ❑ Quanti Fee ID ]�ee Descri tion Fee Grou BAPPLOTHER C>ther Ap liances MECHANICAL BBOILERl Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boilei > 100K to SOOK Btu MECHANICAL BBOILER3 Boilf;r > SOOK to 1M Btu MECHANICAL BBOILER4 Boile�• > 1M to 1.75 M Btu MECHANICAL BBOILERS B��iler > 1.75M Btu MECHANICAL BCONSTAX (;onstruction Tax BUILDING BCONSTAX InclOff/Comm/Quasi BUILDING BCONSTAXBQ Coi►. Tax for BQ Zone BUILDING BCONSTAXH :-iotel and Motel BUILDING BCONSTAXR Cor�stax — Resi/Mobile BUILDING BELEC1000 Elf-c 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Fnergy Add Multi BUILDING BINVESTIGA � nvestigation fee BUILDING 1 of 3 � CITY OF CUPERTINO - C� �� pERMIT APPLI CATION FORM CUPEI�TINO Quanti Fee ID l� ee Descri tion Fee Grou BMISCELL N:iscellaneous Fee BUILDING BMITIGATC Corrlln. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N:w Comm Plumb PLUMBING BOVERTIME In:;pection Overtime BUILDING BPBACKFLOW Atr�ospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK l'lan Check Fee BUILDING BPLANCKADD Pla:i Check Add Multi BUILDING BPLANCKREP Plasi Check Repeat Fee BUILDING BPREPIPE Rf� i e Of Fixtures PLUMBING BPSEWAGE � ewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLLTMBING BPSTORM Stonn/Rain Water PLUMBING gpTg�p Kitchen Trap PLUMBING BPVENT Al t of Drain & Vent PLUMBING BPWATER Inst<<lUAlter Water Pi e PLUMBING / BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT IZeinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHAIVICAL gREMAIRHAN A/C Units <= 10,000 cfin MECHAlVICAL BREMAPPLI ,�ppliance Install MECHANICAL BREMBUSWAY R.emodel Busways ELECTRICAL BREMFIXT ],ighting Fixtures ELECTRICAL BREMFURN Re .ocation of Furnace MECHANICAL BREMFURNOV Relc> Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD In �tallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL B��,��pp Rerr Non-Res Appliance ELECTRICAL BREMPOLE PolelPlatform Fixture ELECTRICAL BREMPOWER Pow��r Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Rf;pair/Alter Heating MECHANICAL BREMRESAPP Renlodel Res Appliance ELECTRICAL i � �. � ` Q�„� "`�` 2 of 3 � ° CITY OF C'UPERTINO . CUPE�TINO PERMIT APPLJ�CATION FORM Quantit Fee ID ]?ee Descri tion Fee Grou BREMSIGNAD Rmc l Signs Add Branch ELECTRICAL BREMSIGNS Rem��del Signs, Marquee ELECTRICAL BREMTHEATR The�trical Lighting Fix ELECTRICAL BREMVENFAN Ver�t Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation S stems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Sei�mic Commercial BUILDING i BSEISMICRE '�eismic Fee Res BUILDING BSPECIAL S �ecial Inspection BUILDING BSWIM ;>wimming Pool BUILDING BTEMP TE�m orary Power ELECTRICAL BTEMPPERM Tem �orar Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC F-lectrical sq foot ELECTRICAL EPERMITFEE Ele�� Permit Issuance ELECTRICAL MPERMFEE M�,chanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plunibin Permit Issue PLUMBING PPLBG Plumbing Fee s foot PLiJMBING PLLONGRNGC Plannin :LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin :Lon Ran e Residential PLANNING 3 of3 CITY OF CUPERTINO 4 ITEMS OF 4 PERMI�' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl};: Lot: APN ......... 31E;29066.00 DATE ISSUED.......: 10,'24/2007 RECEIPT #.........: BS()00003071 REFERENCE ID # ...: 07:_00174 SITE ADDRESS .....: 10:�44 DENISON AVE SUBDIVISION ....... CITY .............. CU]?ERTINO IMPACT AREA ....... OWNER ............: GA:�L & MICHAEL PYLE ADDRESS ..........: 10:344 DENISON AVE CITY/STATE/ZIP ...: CU:?ERTINO, CA 95014-2429 RECEIVED FROM ....: F1Z�NK CARDIA CONTRACTOR .......: CA]tDIA, FRANK L LIC # 612 COMPANY ..........: CU:?ERTINO PLiTMBING ADDRESS ..........: 13�)0 DELL AVE #C CITY/STATE/ZIP ...: CA]QPBELL, CA 95008 TELEPHONE ........: (4)8)253 FEE ID UNIT QUANTITY .�MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00 BSEISMICRE VALUATION 5,000.00 0.50 0.00 0.50 0.00 PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 92.87 0.00 92.87 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 92.87 VISA --------------- TOTAL RECEIPT : 92.87 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING Community Development ��"�"`�. � � 10300 Torre Avenue �� ��;�, , Cupertino CA 95014 Telephone (408) '177-3228 , J` CITY OF Fax (408) 777-3333 CUPEI�,TINO Buildi�l De artment JOB ADDRESS; , v � ' PERMI � � � . � �„� ��� �l�'� � OWNER'S NAME: �; f�/�L; cl��..� I L�� PHONE #�> - SC�� GENERAL CONTRACTOR: � �-j � �f..-.. b� FAX # e ._..____- .._---- , ' I am not usin an subcontractors: -' �� ' � —� l� � � � � g Y — �" / •€na e Date Please check a licable subcontractors and com lete the followin information SUBCONTRACTOR BUSIr�ESS 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