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07100184 CITI' OF CUPERTINO ' BUILDI �1��S�oN PERMIT �����.��Q� i���T���* : ..: . , _ : PERMIT fJO. BU(LD y�p R£SS: ��bl PARK VILLA CL A PERF�CT CLIMATE 07100184 • PERMIT L55UE DATE .ER'S NAME: HISAKO PARLAGRECO 83 B �ENTWOOD BLVD STE B SANITARY NO. CONTROL NO. PHONE: BUILDING PERMIT INFO ARCHI'[ECC/ENGiNEER: ADD A/ � TO EXISTNG SYSTEM BLDG ELECT PLUMB MECH � 0 � 0 i p p LICENSED CONTRACTOR'S DECLARATION JOIJ DeSCTl�7tlOfl � V� I hcrcby afGrm Uiat I arn liccnscd undcr provisions of Chaptcr 9(commcncing ; z� wi� Sccdon 7000) of Division 3 of ihc Busincss and Profcssiuns Codc, and my liccnsc is �� y in full Coree and ellect Z'� E j� S 0 � v� Z Licensc Ciazs �' Lic. # ; �, p Datc - Con�racta � ARCHITECTS DEC A ON i a a I undcrstand my plans shall bc uscd az public recnrcis �qU ' u. y Liccnsed Prufcssionai : � < OWNER-BUILDER DECLARATION j Q� 1 hcrcby affirm �hut 1 am cxcmpt Gum ihc Contracto�s Liccnu Law for thc . p o following reason. (Scctian 7031.5, Busincss and Profcssions Codc: Any city or county <°„ � which requiics a pertnit w conswc4 ��r. impmvc. dcmolish, or repair any strucwre � Z} prior ui i�s iscuancc, also rcquires �hc applicant for such pertnit to filc a signcd suicment Valuation � S � tha� hc is IiccnscJ pursuant to thc provisions o[ thc Contractur's li��cnsc Law (Chaptcr 9 )C�. FC. FIOOT AI'2a u t- �(commencing wi�h Scction 7000) of Division 3 oC ihc Busincss and Profcssions Codc) or ,, �., �hat he is ezempt thcmfrom and tAe basis Cor the allegcd eumpuon. Any violarion oC Section 7031.5 by �ny applicant (or a permit subjecu the applicant to a civil penalty o( APN Number Occupaney Type not morc than five hundrcd dallars (5500). ❑ I, u owner o[ ttrc property. or my employces with wages az �he'v solc compensa6an, will do thc wark and �he suudum is not inter.dcd or offered forsalc (Sec.7044, Busineu Required Inspections and Professians Code: "fhe ConuacWr's License Law da:s not apply to ae owner of praperty who builds or improves thercon, and who daes such work himself or ttwugh his own employecs, providcd that such improvements are not imm�dW or oQeced for sale. If. � however, the building or impcovement is sold within one year oC complcuon. �he owner- builder will have ihe burdee of proving It�at he did not build or impmvc [or purpase of sale.). ❑ I, as owner of the propeny. am ezclusively convacting with littnsed rnnvactors a rnnswct the projett (Sec. 7044. Busincss and Protessions Cade:)'fie Contnetor's Li- cense Caw docs not apply to an owner of propeny who builds or impmves Uineon, and , who convacts for such projects with a contractor(s) licensed pursuant to the Convactof's . License Law. � am uempt undu Sec. . B& P C far this mason �xr Date _. . WORKER'S COMPENSAT[ON DECLARAT[ON 1 hereby afficm under penalty of perjury anc o( the folbwing declaralions: ❑ I hsve and will mainiain a Ceni6cate ot Consen� to self-insure (or Workcr's Compen- sation, as provided for by Secdon 3700 of the [abor Code, far �he pedarmancc of the worlc for which Ihis permit is issued. � havc and will maintain Workcr's Compensadon Insurancc, u mquired by Scction , 700 of U�c Labor Code, for thc perCormance of the work for which �his permic is issued. My Worker's o� Insurance cartier and Poliry number ace: Cartier: �-��v� ti.�Cd.NJJ/�/y"�'�Policy No.f✓�.��1"Z-G�S' CER7'IFICATE OF EXEMPI'ION FROM WORKERS' COMPENSATION INSURANCE (This scaian nccd not bc comple�cd if the pertnit is Cor anc hundred dollars (E 100) o� Icss.) I certiCy U�a� in thc perfortnancc af ihc work for which ihia permit is issucd, [ st�all not employ any person in any manncr so u w bccomc subject w the Workcrs' CompcnsaGon Laws oC Califomia. Date Applicanl NOTICE TO APPLICAM: If, af�cr making U�is Ccni[ica�c of Excmptian, you shoulJ bccome subjcct �o thc Workcr's Compcncatian pmvisions of thc Lalwr Cadc, yau must , O farthwith comply with sueh provisions or this permil shall bc decmed revoked. Z ""' CONSTRUCI'lON LENDING AGENCY (. � I hcreby a�rm that thcrc is a conswc�ion knding agcncy for thc perfurtnarMC uf . a� ihc xrc�rk fur which �his permit is issucd (Scc. 3097, Civ. C.) LIa A Lendcr's Namc � z C.ender's Address U � I certify �hat I havc rcad this application and s�a�c ihat �hc abovc informauun is w � cortcct. l agree to comply with all city and county ordinances and sute laws relating to � U building conswction, and hereby authori�e reprcsenutivcs of this city to cntcr upoa �Ac � W abovc-mcntioncd property for inspcction purposes. a (Wc) agrce lo sare, indcmnify and kecp harmless �he Ciiy of Cupcnino against H � liabiliuu, judgmenls, wsLS and eapenses which may in any way accrue againsl said Ciry U z in consequencc oC thc granting of �ltis permit. D$LC �Q '� 2�L��_ � APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOURCE REGULAT[ONS. Re-roofs Signaturc of Applican(/Conuxtor �e� T e of R oof HAZARDOUS MATERIALS DISCLOSURE }�p �11 ihc applicant w(uw�c building occupantstorc or handlc ha•rardous matcrtal cfincd by 1he Cupenino Municipal Code. Chaptcr 9.12, and thc Hcalth and Satety .1c. Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. � y� �No . Will ihc applicant or futurc building accupant usc cyuipmcnt ar deviccs which If a roof i� installed without first obtaining an inspection, I agree to remove emit harardous air contaminanls at dcfincd by Ihe Bay Arca Air QualilY Managcmcn� all new rr, aterials for inspec*ion. oisuict? �Ycs F�Wu 7 I havc rcacl the hvardous ma�crials requircmcn�s unAcr Chaptcr 6.95 0( ihc Califor- nia Hcalth & Safcry Codc, Sccdons 25505, 25533 and 25534. I uncfcrstv+d that iC ihc 6uilding �( f a G! '"' � l docs nai curtcntly have a tenan4 �at it is my responsibili�y m notify the occupant of �hc rc which usi bc P �a� W�u��� ar a c�,;r,�a� oro��P�. Signature of Applicant Date 1'�p. z ��, _�� �Q' a ry ,.�.T �—a�'�V� All roof coverings to be Class "B" or better Owner or authori2c gcnl � `��- ��� � �—� r o c�� �� . � `� CITY OF C'UPERTINO ����F' pERMIT APPL:[CATION FORM CUPEi�TINO APN # I � I 2 ���D F� �J���� Date:��,�b-c�7 Building Address: � / ��� 1 � � l /� /�`� Mailing Address (if different from building address): � l li Owner's Name: Phone #: f/,�� s4 �to �ar�� re�o Yaa�- z� �- Z3� y Contractor: /� License #: /� �er�'GV� G l, � a�e 7Z 3�s�' Contact� Phone: ��j� 1���- 9.�Y Cupertino Business License#: �� � G:�4 Fax: - 61 qS y�o Z!! i�f� Building Permit Info: Bldg ❑ Elect � F'lumb ❑ Mech� Job Description: �, Residential � c� � N , � C��x � S� �` � C s e� Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: �11v� s��? Type of Construction: Please check this box if the project is a � second-stor addition: � Project Size: Standard Large ❑ Maj �r ❑ Quanti Fee ID l�ee Descri tion Fee Grou BAPPLOTHER C>ther Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILERZ Boiler > 100K to SOOK Btu MECHANICAL BBOILER3 BoilEr> SOOK to 1M Btu MECHANICAL BBOILER4 Boile� > 1M to 1.75 M Btu MECHANICAL BBOILERS Bc►iler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Cor . Tax for BQ Zone BUILDING BCONSTAXH Iiotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 El �c 600V > 1000A ELECTRICAL BELEC200 Elec 5vcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD E zergy Add Multi BUILDING BINVESTIGA I�vestigation fee BUILDING 1 uf 3 � � � CITY OF CvUPERTINO CuPf�T��o PERMIT APPL [CATION FORM Quanti Fee ID Fee Descri tion Fee Grou BMISCELL TZiscellaneous Fee BUILDING BMITIGATC Corr m. Housing Mit. Fee BUILDING BNUCOMME N�w Comm Electric ELECTRICAL BNUCOMMM Nevr Comm Mechanical MECHANICAL BNUCOMMP r ew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atnospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLLTMBING BPERMFEE Iild Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS Ga:; Pi ing System Fee PLLJMBING BPINTERCEP Inci Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE :3ewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lav�m SprinklerBackflo PLUMBING BPSTORM ��tormlRain Water PLUMBING BPTRAP Kitchen Tra PLIJMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Inst,ilUAlter Water Pi e PLUMBING BPWHEATER V�'ater Heater/Vent PLUMBING BPWSVCS N_ain Water Service PLUMBING BREINSPECT Zeinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BREMAIIZHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY F:emodel Busways ELECTRICAL BREMFIXT :�ighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rel�� Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREM1�]RAPP Rerri Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Pow��r Device/A aratus ELECTRICAL � BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA R elocation of Hood MECHANICAL BREMREPALT R�;pair/Alter Heating MECHANICAL BREMRESAPP Rerlodel Res Appliance ELECTRICAL 2 of 3 � CITY OF C+UPERTINO � TM�F PERMIT APPL [CATION FORM_ CUPEI�TINO Quantit Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rm�il Signs Add Branch ELECTRICAL BREMSIGNS Rerr odel Signs, Marquee ELECTRICAL BREMTHEATR Thf:atrical Lighting Fix ELECTRICAL BREMVENFAN Ve nt Fan Sin le Duct MECHANICAL BREMVENSYS V��ntilation S stems MECHANICAL BSCBLVD ;icb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL ��pecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP T em orary Power ELECTRICAL BTEMPPERM Tem orar Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC ]3usiness License BUILDING ELECTRIC Electrical s foot ELECTRICAL EPERMITFEE El��c Permit Issuance ELECTRICAL MPERMFEE N[echanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plu mbin Permit Issue PLUMBING PPLBG Pl �mbing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran e Residential PLANNING = of 3 CITY OF LUPERTINO 3 ITEMS OF 9 PERMI'P RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl{: Lot: APN ........ 35�10038.00 DATE ISSUED.......: 10/26/2007 RECEIPT #... ......: BS)00003086 REFERENCE ID # ...: 07L00184 SITE ADDRESS .....: 81i1 PARK VILLA CL SUBDIVISION ....... CITY .............. CU?ERTINO IMPACT AREA ....... OWNER ............: HI;�AKO PARLAGRECO ADDRESS ..........: 81i1 PARK VILLA CIR CITY/STATE/ZIP ...: CU:?ERTINO CA, 95014-4001 RECEIVED FROM ....: EDiVARD A GREGORY CONTRACTOR .......: SM:CTH, BYRON E LIC # 21144 COMPANY ........:.: A :?ERFECT CLIMATE ADDRESS ..........: 83"75 BRENTWOOD BLVD STE B CITY/STATE/ZIP ...: BR:�NTWOOD, CA 94513 TELEPHONE ........: (4�)8)861 9545 FEE ID UNIT QUANTITY ��NIOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMACOVER NO i7NITS 1.00 17.82 0.00 17.82 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 -�--------- ---------- ---------- ---------- TOTAL PERMIT : 93.47 0.00 93.47 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL INVOICE INVOICE INVOICE INVOICE I[�TVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMII' INVOICE OPERATOR: patg Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 35610038.00 INVOICE DATE......: 10/26/2007 REFERENCE ID # ...: 07100184 SITE ADDRESS .....: 81�1 PARK VILLA CL SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............: HI�AKO PARLAGRECO ADDRESS ..........: 81�1 PARK VILLA CIR CITY/STATE/ZIP ...: CU?ERTINO CA, 95014-4001 CONTR.ACTOR .......: SMCTH, BYRON E LIC # 21144 COMPANY ..........: A ?ERFECT CLIMATE ADDRESS ..........: 83'75 BRENTWOOD BLVD STE B CITY/STATE/ZIP ...: BR:�NTWOOD, CA 94513 TELEPHONE ........: (4�)8)861 9545 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ---------------- ---------- ---------- ---------- ENERGY APPLICATIc)N 34.86 0.00 34.86 AC UNIT >10000CFM PRINTING :?ERMIT 17.82 0.00 17.82 MECH PERMIT ISSUANCE PRINTING ??ERMIT 40.79 0.00 40.79 ---------- ---------- ---------- 93.47 0.00 93.47 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) ?77-3228 C(TY OF Fax (408) 777-3333 CUPEi�TINO Buildin De artment JOB ADDRESS: ��6 l�Rr It �,` `l Q��`,r" PERMI b��l� 0 1 c�" `� OWNER'S NAME: �,'Scr�� ar�4 rec J PHONE # YO�- Zs7- z-3.� �f GENERAL CONTRACTOR: f'�> = � FAX # I am not using any subcontractors: -:��� fD -2G -�� Si gnature Date Please check a licable subcontractors and com�lete the followin information: SUBCONTRACTOR BUSIr1ESS 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 A�@ ��v � Ci �� �� a,lQ Z« y�l Roofing Septic Tank Sheet Metal Sheet Rock Tile ���,��, _ LO-2 6 -o� Owner/Contractor Signa e Date