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07100024 _ _ __ _ _ __. __. . CIT'�' OF CUPERTINO ' � " ` ` BUIIDING DIV'rSION �� •lt ��' : .,: _ ::<. PERMIT NO. BU1LD �� r � Anl �� ss RODRIGUES AV JOHNSTCN ELECTRICAL 07100024 . b t� OW NER'S NAME: PERMIT ISSUE DATE TH RESIDENCE 130 LI NCOLN AVE 1 2 7 HE SANITARY NO. COM'ROL NO. (408)266-0236 ARCHITECTBNGINEER: BUILDING PERMIT INFO BLDG ELECT pLUMB MECH L� � 0 0 i O p LICENSED CONTRACfOR'S DECLARATION IOI� DeSCTlpt10❑ % W I hcrcby afficm �hat I am liccnscd undcr provisions of Chapicr 9(commencing ; Z� wim Scction 7�) orDi�isian 3 of thc Busincss uid Profcssiuns C�ode, and my �iccnx is E LECTR I CAL PANEL UPGRADE � 2 O O AMP S. ?�� in futl Co¢e and � � � ? Licensc CI Lic. # : E, � Datc Contractor ARCHITECI'S DECLARATION �x( i a a 1 undcrswnJ my plans shall bc uscd as public reconis )yU ' a y Liccnscd Pmfcssional � y � OWNER-BUILDER DECLARATION t hcrcby atYrm tha� I am cxcmpt Crom ihc Contractors Liccnsc Law far thc � p O follawing rcason. (Sccrion 7Q31.5, Busincss and Pro(cssions Codc: Any ci�y ar county �,°, � which requims a permit to cnnswc4 altcr, improvc, dcmolish, or repair any urucwre ° Z} prior to i�s issuancc, also rcquires thc applicant for such pertnit to filc a signeJ sta�emcn� �, < tha� he is licensed pursuan� to the provisions of the Convactur's Licenx Law (Chapter 9 .� Ft. Floor Area Valuation u �2p $170� E- �(commencing with Sccdon 7000) of Division 3 oC Uic Busincss and Profcssians Codc) ur y �.. that he is ezempt thcmfrom and the buis Cor ihe alleged eumption. Any violadon o( Section 703I.5 by arry applicant Cor a pertnit subjccu ihe applicant �o a civil penalty of q Number Oceupaney Type not more than fivc hundrcd dallars (5500). 3 r j 9 1 � 0 r j 6.� ❑[, as owner oC ttie property, or my cmpioyca with wages u their solc compensation, will do the work, and �he suuctum is not intendcd or oftered for salc (Sec. 7044, Business Re uired Ins ections and Professions Code: The Contcactor's License Law does not apply to an owner of Q p pcopeny wha builds or improves ihercon, and wha daes such wwk himself or tlwugh his own emplayces, providcd �hat such improvements are not in�ended or oQered (or saie.lC, however, the building or improvement is sold within one yesr oC completio�, the owner- builder will have the burden of proving tha� he did not huild or improvc for purpox o( salc.). ❑ l, as awner of the property, am exclusively contracting wi�h licensed rnnuactors to consuuct ehe projett (Sec. 7044. flusinus and ProCessions Cade:) The Convactor's Li- cense Law docs no� apply �o an owner of property who builds or improves ihe�eon, and , who contractc for such projects with a contractor(s) licensed pursuant to We Contnctors License Law. �[ am ezempt under Sec. , B& P C for this rcason Ownu Date WQRKER'S COMPENSA'I70N DECLARATION " ' ' I hcceby �rm under penalty of perjury one of the tollowing declarations: 0] hsve and wilt maintain a CectiGcate of Consem to xl(-insure for Workc�s Compen- sation, u provided for by Section 3700 oC che Cabor Cade, for �he performance oC the work for which lhis permit is issucd. ❑ I have and will maintain Worker's Compensation Insunnce, as rtx�uired by Scction 3700 oC ihe Labor Codc. Cor Nc per[ormancc of the work for w6ich ihis permit is issued. ' My Worker's C�rnpensadon [nsurance carticr and Policy number are: Cartier. ��'11J1Ll�'�s Poliry No.: � Z � ERTIFICA OF EXEMP!'[ON FROM WO CERS' COMPENSATlON INSURANCE ('ihis section necd not be complcted if drc permit is for anc hundred dotlars (S 100) or Icss.) • I cenify ihm in thc perfortnance of ihe work fw which this pertnit is issucd. I shall not employ any person in any manncr so as m bccomc wbjcct �o the Workcrs' Compcnsation Laws of Califomia. Datc Applicant NOTICE TO APPLICAM: If, aftcr making ihis Ccrti�catc of Ezcmption, you should become subject to �he Worker's Compensation provisions oC the Labor Code, you muu . O forchwi�h comply wi�h such provisians or tliis pccmi� shall be dccmcd �cvokcd. Z"" CONSCKUCTION LEND WG AGENCY E-+ � I hcs6y afGrtn �hat thcre is a construcdaa Icnding agency for thc performance of R; � thc wurk for which this permit is issucd (Scc. 3097, Civ. C.) W� Q Lendcr's Namc • a z Lcnder's Address U � t cenify �hat 1 havc rcad �his applieation and statc ihai thc abovc infortnatiun is w � corrcct. 1 agrtx �o comply wi�h all ciry and county orJinances and siak laws relating �o Q U building conswction, and hemby authori�e representatives of this ci�y to emer u�n �he � W abovc-mcntioncd properly (or iaspccuon purposes. + a (Wc) agree to save, indcmni(y and kecp harmlcss thc Ci�y of Cupcnino against �� Iiabilitiu, judgmcn�s, costs and expcnscs which may in any way accruc agains� said City U,'� io consequcncc oC thc granting of this pctmil. • Date � —�� APPLICAM UNDERS7A DS N S�/1 COMPLY WITH ALL ON OINT Issued by: �� SOURCE REGULATIO . / � �� Re-roofs /� Signazu of A on r tc HAZARDOUS MATERIALS DISCLOSURE Type of Rc of Will the applicant or future building occupanc storc or handlc ha•rardous ma�crial az dc6ned by lhe Cupenino Municipal Cadc. Chaptcr 9.12, and �he Hca1W and SaCMy Codc.Section 25532(a)? All roofs s�all be inspected prior to any roofing material being installed. ❑ Ycs WiII thc applicant or uwrc building occupant usc cyuipmcnt or dcvices which If a roof is installed without first obtaining an inspection, I agree to remove • cmit harardous air conuminants u dcfincd by the Bay Area Air Quality Managcment all new ma terials for inspecrion. ��sU�� o Y� � 1 havc rcad the hvard ros matcrials requircmen�s unckr Chap�cr 6.95 of �hc Califor- niaHcalth&Sa(ctyCodc.Sections2550 ,25533 534.lundcrscan thazif building dces not curtcntly avc a tcnan s responsi iliry w notiCy c upant nf thc rcyuircmen�s w be l p o o issuancc oC crtificatc of cu �r. S ignature c f Applicant Date oW�� a ma��a �n� o„� All roof coverings to be Class ��8�� or better . CITY OF C UPERTINO �� (� c � �� a � r�n�� pERMIT APPLICATION FORM CUPER�,TINO _ �PN # � s � � � . O � Date: /� . � `� Building Address: P✓Iailing Address (if different from building address): 20� 85 Ro1�,e �� s Nu - Owner's Name: Phone #: K� y Tifom on� tiv �. g3c.Q • 33 I Contractor: License #: `To °l 5 R b g Contact: Phone:N48.2fo(p•02310 Cupertino Business License#: �� c/ Fax: yv . b.�� 3 23 �l I I Building Permit Info: Bldg ❑ Elect �) P �umb ❑ Mech ❑ Job Description: Residential �d Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: a p Occupancy Group: � � 700 �- —3 Type of Construction: Please check this box if th project is a � p �� --► second-stor addition: � Project Size: Standard � Large ❑ Majc�r ❑ Quanti Fee ID F'ee Descri tion Fee Grou BAPPLOTHER C ther Appliances MECHANICAL BBOILERl Boil er <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to SOOK Btu MECHANICAL BBOILER3 Boiler > SOOK to 1M Btu MECHANICAL BBOILER4 Boiler > 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 Con. Tax for BQ Zone BUILDING BCONSTAXH F�otel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Ele� 600V <= 1000A ELECTRICAL BELEC1001 El��c 600V > 1000A ELECTRICAL BELEC200 Elec ;3vcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD E:iergy Add Multi BUILDING BINVESTIGA Ilvestigation fee BUILDING 1 c�f3 ,, _° � ` CITY OF CrUPERTINO CUPEt�TINO PERMIT APPL=[CATION FORM Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rmcll Si s Add Branch ELECTRICAL BREMSIGNS Remodel 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 �wimming Pool BUILDING BTEMP T�:m orar Power ELECTRICAL BTEMPPERM Tem �orar Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC E�usiness License BUILDING ELECTRIC Flectrical s foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mec h Permit Issuance MECHANICAL PPERMITFEE Plur.ibin Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLLTMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran e Residential PLANNING ZADDCHG l�ddress Change BUILDING 3cf3 CITY OF CUPERTINO 3 ITEMS OF 3 PERMI�' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bllc: Lot: APN ......... 35!>10056.00 DATE ISSUED.......: 10,'02/2007 RECEIPT #.........: BSl)00002865 REFERENCE ID # ...: 07:_00024 SITE ADDRESS .....: 20Ei85 RODRIGUES AV SUBDIVISION ....... CITY .............. CUI�ERTINO IMPACT AREA ....... OWNER ............: THC)MSON RESIDENCE ADDRESS ..........: 20fi85 RODRIGUES AVE CITY/STATE/ZIP ...: CU]'ERTINO, CA 95014 RECEIVED FROM ....: JOFINSTON ELECTRICAL CONTRACTOR .......: BR==AN JOHNSTON LIC # 23411 COMPANY ..........: JOfiNSTON ELECTRICAL CONTRACTOR ADDRESS ..........: 13(12 LINCOLN AVE CITY/STATE/ZIP ...: SAPI JOSE, CA 95125 TELEPHONE ........ (4(►8)266-0236 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 1,700.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT RATE 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 #1132 --------------- TOTAL RECEIPT : 70.72 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL �;:�° ,. Communiry Development � �� ' , 10300 Torre Avenue '� � �` � 's' Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 �UPE(�TINO Buildin De artment JOB ADDRESS: PERMIT # � �� '�/ ��-`� OWNER'S NAME: bV�t.�►v PHONE # �3 _�� GENERAL CONTRACT R: N�,� FAX # , I am not using any subcontractors: � (1 � Si�,nature ate Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIl`TESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing 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 �heet Rock Tile ' �a � � e /Con actor Signature Date