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07100019 CIT�' OF CUPERTIlYO ' ` ' BUILDII:G DIVISIt�N PERMIT �� Z��Q`�"�'TI�� : ' ; . ::: ,. _. :.. <; ., _ , PERMIT NO. BUILD N �c ADDRESS: �U230 JOHN DR TBD — TC BE DETERMINED 07100019 • PERMTT LSSUE DATE OWNER'S NAME: WITT DAVID R ET AL 1 � SANITARY NO. CONTROL NO. NE: BUILDING PERMITINFO ARCHIIECTlENGiNEER: BLDG ELEGT PLUMB MECH � � � � � p a LICENSED CONTRACI'OR'S DECLARATION JOI7 DESCi1pL10❑ � v� I hcrcby afGrm that I am licenscd umlcr provisions of Chaptcr 9(commcncing ; Z� wi�h Scciion 7000) of Division 3 of �hc Busincss and Profcssions Codc, and my liccnse is ADD A� C � I Z' °� y in full Corce and c ecc j v� Z Licensc Clats �— Z U Lic. # : F w Datc � t? • Z- 0 1 Contrac�or � ARCHI'I'ECI"S DECLARA770 i� 6 1 undcrstand my plans shall bc uscJ as public rccorcis >aU ' a y Licensed Pmtcuional : � a OWNER-BU(LDER DECLARATION �NJ I hcreby at7rm �hat I am cxempt Crom ihc Contractors Liccnsc Law Car �hc � p O following rcazon. (Scction 7(131.5, Business and PmCcssions Codc: Any city ar county <°„ �i which ccquiccs a permit to cnnsuuct. altcr. impmvc. dcmalish. or rep�ir any swaure rior u� i�s issuancc, alsu rcquires thc applican� far such permit �o filc a signcd sta�emcnt ° Z; r � q. Ft. Floor Area Valuation �= Q lhat hc is liccnscJ pucsuanc to t hc pmvisions o f U u C o n t r x t u r' s L i c c n s c L aw (Cha ptcr 9 � 5 O O O r t- (commencing with Scction 70�0) of Division 3 aC ihc Busincss and Profcssions Codc) or L�� thal he is ezempt thcretram and the bazis (or We allegcd ezempdon. Any violauan of Section 7031.5 by any applicant for a permit subjccts thc applicant to a civil pcnalry af Number Occupancy Type not more ihan five hundrcd dollars (SS00). 3 6 9 3 5 � ��: �� ❑ 1, as owncr oC ttie property, or my cmployces with wagas u their solc compensatlon, willdothcwork.andshesuuctuceisnotinuendedoroHeredforsatc(Sec. Required Inspections and Prolessions Codc: The Conuactor's C.icense Law docs not apply to an owner of propeny who builds or improves thercon, and who daes such work himself ar thcough his own employccs, providcd that such improvements are not in�ended or af(ereA Cor sale. ([, however, the building or impmvement is sold within one yesr oC rnmpletion, the ownu- builder will have the burden of proving that he did not huild or improvc [or pu�pose o( sa1eJ. ❑ I, as awner o[ tLe property, am exclusivcly conuuting wiW licensed rnnuactas m const�uct the projett (Sec. 7044. Businas and Professians Cade:) T6e Conuacwrs Li• ccnse Law docs not apply w an ownv of propeny who builds or improvcs Ihe¢on, and . who convacu Cor s�h projects with a contractor{s) liansed pursuant to �he Contru[ors License Law. ❑ I am ezempt under Sec , B& P C for �his rcawn Owner Date _ .. _,- WORKER'S COMPENSATION DECLARATION I hereby aHirm under penalty o( perjury onc af �he falbwing declaruiun� � I have and will main�ain a Cutificate of Consent to ulf-insure [or Worire�s Compen- sation, as providcd for by Sec[ion 3700 oC che Labor Code, for the petfarmanoc o[ ihe work for which this pem�it is issucd. ❑ 1 have and will maintain Workcr's Compensadon [nsurana, u rcquired by Scction , 3700 oC �he Labor Code, fa �he performance of the woric [or which this permi� is issued. My Worfcer's m nsation Insunnce carrier and Poliry nu G aic��, � j a Cartier. S Policy No.: �� C RTIf1CATE OF EXEMPI70N FROM ORKERS' COMPENSATIONiNSURANCE (f2iis scction necd not be completcd if thc permit is for onc hundred dallus (5100) ar Icss.) I certi[y thxt in thc performancc of thc work for which �his permii is issucd, 1 shall not employ any person in any manner w as to became subject a ihe Workers' Compensazion Laws of Cali(omia. Datc Applicant NOTICE TO APPC.ICAM: lf, aft�r making this Ccrtiticate of Excmption, you shauld bccome subjcct to thc Workcr's Compcnsation provisions aC Wc L.abor Codc, you muu � Q forthwith comply with such provisions or this pecmi� shall hc dccmcd revokcd. Z '"" CONSTRUC['ION LENDING AGENCY F r�-. I hcccby alfirm Ihat thcre is a consuucGon knding agcnry Cor thc performance of - �(. .� thc work Cur which this permit is issucd (Scc. 309'1, Civ. CJ , W Q Lendcr's Narnc a z Lender's Address V � [ certify �hat I have rcad ihis application and s�atc iha� thc abovc intormatiun is �� cortect. 1 agrce �o comply wiih all city and county orefinances and sute laws celating w � U building conswction, and hereby authori�e represen�atives of ihis city to enter upon �Ae � W above-mentioncd property for inspection pur�wses. a (Wc) agree to save, indcm�i(y and kecp harmless thc Ciry of Cupertino against '„�,+ � liabilities, judgments, costs and expensa which may in any way accruc againsl said City /� ' U z in consequcnce oC the granting of Ihis {xrmiL Date // �2 ►-� APPLiC UNDERSiANDS AND WILL COMPLY WITH ALL NON-POIM Issued by: �� SOU EGU�.ATI �w ' ^ �D Re-roofs Si natutc of Applipn r � T Of, R �Of ��- HAZARDOUS M D[SCLOSURE YP Will ihc applicant or futwc building occupant storc or handlc ha•rardous mauxiat az dcfincd by �he Cupertino Municipal Cadc. Chap�cr 9.12. and �he Hcalth and SaCetr co� Scction 25532(a)? All roofs ;;hall be inspected prior to any roofing material being installed. � y� Cxl'No , i' If a roof i:; installed without first obtaining an inspection, I agree to remove Will thc applicant or Culurc 6uitding occupan� usc equipmcnt or dcriccs which cmit harardaus air contaminana u ekfincd Ay the Bay Area Air Qualiry Managcment all new aterials for inspeciion. Distcict? ❑Ycs �No A I havc rcad the hvarGous maicrials requircmcnts undcr Chap�cr 6.95 0( �hc Califor- � nia Hcalth & cty Codc, Sections 25505, 25533 and 25534.1 undcrs�v+d ihat iCthc huildinB L � � I . � a' /� [ s"� � Jocs no� �ly havc a Icnant, that it is my rcsponsibiliry to nodfy thc occupam o� Ihe rcyuirc c which mu met,prior �o issuancc of a Ccrtificate o� cu lgnature of A cant Date ti� C '� A coverings to be Class "B" or better Owncr or authorizcd agcnl �� . `: CI'TY O� ��7PEIZ�IN� a 1 t c�o�? �`� �.� . � �.; � ��1�..�� /�� CUPE�T1�10 PE�II�' APPI.I��ATION �O � N # �� ,� � .� Date: Z �. ��J � �� U Building Address: � - Z3 � Owner's N e: Phone #: � _ �,� S.',�. y � _ _ Q�' Z,� �� C�c�a�t�-a�or: P1�or�e: Lic�nse #: � � �-7�� a �= .��-� / �"�l`i Z � .� Contac : Phone: Cupertino Business L�cense #: �/V �- �, ' Building Permit Info: �()� j`V� �� . Bldg ❑ Elect �' Pl�zmb C� Mech Job Description: Residential -� Commercial ❑ For Residential Installations: Attic � l floor � 2 floor � Adhere to min set back requirement For Commercial Installations: °placement same weight 0 Additional weight (stn.ctural calcs) � �tructural Calculations required for new installation C� New installation Planning Approval R uired ❑ Cost of Project:� �-�-�� Type of Construction: Occup�y�group: � J Strapped ❑ On Platform • Bonded Sq.Ft. Floor Area: New Location � Re lacement � Qty. if Applicable Fee ID Fee Description Fee Group BENERGY EnE;rgy BUILDING gg��U� Futnace MECHANICAL BREMACOVER A/(; Unit > 10,000 cfin MECHANICAL BREMp�IRHAN A/C Units <= 10, 000 cfin MECHANICAL / BREMRECEPT Re ,ptl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL ( MPERMITFEE Mech Permit Issuance MECHANICAL / PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Blc.g Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Ga� Piping System Fee PLUMBING BUSLIC Bu�iness License BUILDING CITY OF �UPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ... ...... 36935004.00 DATE ISSUED.......: 10/02/2007 RECEIPT #.........: BS000002858 REFERENCE ID # ...: 07100019 SITE ADDRESS .....: 20230 JOHN DR SUBDIVISION ......: CITY .............. CUFERTINO IMPACT AREA ....... OWNER ............: WIZT DAVID R ET AL ADDRESS ........... 20230 JOHN DR CITY/STATE/ZIP ...: CUFERTINO, CA 95014 RECEIVED FROM ....: R.ANIRO BEJINEZ CONTRACTOR .......: TBL - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBL - TO BE DETERMINED ADDRESS ........... CITY/STATE/ZIP ...: , TELEPHONE ......... FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00 BREMRECEPT N0. OUTLETS 1.00 1.20 0.00 1.20 0.00 BSEISMICRE VALUATION 5,000.00 0.50 0.00 0.50 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 276.19 0.00 276.19 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 276.19 VISA --------------- TOTAL RECEIPT : 276.19 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL � ;' Community Development �� 10300 Torre Avenue ��` � � �° � Cupertino CA 95014 �,. Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEi�,TINO Buildin De artment JOB ADDRESS: PERMIT # 2(0 l � �, I � v� '� .-- D � C OWNER'S NAME: , ` S PHONE # o� � o/ GENERAL CONTRACTOR: � ,q. , FAX # I am not using any subcontractors: �v�lZ �� o Si,;nature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIrTESS NAME SUSINESS LICENSE # Cabinets & Mill�vork Cement Fini.shing IIectrical 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 L+ _ � er/Con actor Signature Date