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07110031 CITY OF CUPERTINO BUILDING DIVMOON PERMIT _ . BUILDING ADDRESS: PERArr NO. 10085 ADRIANA AVE ( DANIEL MACKEY CONSTRUCTION 07110031 ,IER'S NAME: f l IN 1. PERMIT ISSUE DATE FAULHABER FAYE L 112593 HEBRON AVE 11/06/2007 PHONE: I(408) 2711-6799 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH UO LICENSED CONTRACTOR'S DECLARATION Job Description !hereby affirm that I am licensed under provisions of Chapter 9(commencing -Z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is MOVE OVj tHD WIRES UNDRGRUND 2�y in full force and e t 2 D 12 Z License Cl Lic.g 51*6 3 F p Date Contractor 4 ARCHITECr'S DFCLAIWICIN a U I understand my plans shall be used as public records I.C H Licensed Professional lira�� OWNER-BUILDER DECLARATION t X I hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county e m°Pi which requires a permit to construct,alter,improve,demolish,or repair any structure n prior trt its issuance,also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 i Ft.Floor Area i=c P P ( P q• $1000 Valuation Y t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)w ERE that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Nllmber not more than five hundred dollars($500). 3 2 6 2 0 0 2 a '( I Occupancy Type ❑I,as owner or the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.if. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- tense Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's 'icense Law. I am exempt under Sec. B&P C for this reason nvner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of Are Labour Code,for the performance of tie work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued My Worker's Compensation Insurance carrier and Policy number are: Carrier ST > 6 d Policy No.:���SZM:d EMFTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars(;100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Dat- Applicam NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z� CONSTRUCTION LENDING AGENCY f-i P" I hereby affirm that Mere is a construction lending agency for the performance of fyi> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lendees Nam- Z Lender's Address U I certify that I have read this application and state that the above information is (y correct.I agree to comply with all city and county ordinances and sure laws relating to 0 U building construction.and hereby authorize representatives of this city to enter upon the above-mcntioted property for inspection purposes. Ear a (We)agree to save,indemnify and keep harmless the City of Cupertino against i.y Go� liabilities,judgments,costs and expenses which may in any way accrue against said City V Z inconsequence of the granting this IL APPLICANT UNDERSTANDS S AND D WILL COMPLY WITH ALL NON-POINT Issued by: SOUR _ Date ,q /U . 1%1Z 1,6 7 Re-roofs Q Signuurc of ApplipHAZA rector / / Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle ba•/Ardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(')? _ All roofs.,hall be inspected prior to any roofing material being installed. ❑Yes o If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant trio equipment or devices which g p g emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes �No 1 have read the haz9rdous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of Are reequuir�LNraI s whicP0 be met prior to issuance of a certificate or 0 ytupnicy. Signature A Applicant Date Owner or authorized agent F tj Date All roof coverings to be Class"B"or better CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN . . . . . . . . . 32620029 . 00 DATE ISSUED. . . . . . . : 11/ 06/2007 RECEIPT #. . . . . . . . . : BS(100003179 REFERENCE ID # . . . : 07110031 SITE ADDRESS . . . . . : 10085 ADRIANA AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FAULHABER FAYE L ADDRESS . . . . . . . . . . . 10085 ADRIANA DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1125 RECEIVED FROM . . . . : BILL PIEPER CONTRACTOR . . . . . . . : DANIEL MACKEY LIC # 22597 COMPANY . . . . . . . . . . : DA [IEL MACKEY CONSTRUCTION INC ADDRESS . . . . . . . . . . : 251-'3 HEBRON AVE CITY/STATE/ZIP . . . : SAr[ JOSE, CA 95121 TELEPHONE . . . . . . . . : (408) 274-6799 FEE ID UNIT QUANTITY ILMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- --------=- -- -------- ---------- ---------- ---------- BELEC200 METERS 1. 00 29 .43 0. 00 29 .43 0. 00 BPERMFEE VALUATION 1, 000. 00 83 .16 0. 00 83 .16 0. 00 BSEISMICRE VALUATION 11000. 00 0.50 0. 00 0 .50 0. 00 EPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 153 .88 0. 00 153 .88 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 153 . 88 VISA --------------- TOTAL RECEIPT 153 . 88 Garage Asphalt driveway Sub Panel I"Schedule a0 PvC Conduit above rade 4" MIN. COMPAC"-ED GRAVEL g -GRAVEL MUST pp 5E CLEAN 1" Schedule 40 PVC conduit below grade AN TEEEMFjj p ER IS"mfn. Illl new underground electrical service to garage 4 s N A-X NOT TO SCALE T 4 3 � \ 1 Q 10085 Adrian Drive (E)100 Amp Service Panel Adr iana Drive Daniel Mackey Construction, Inc. SCOPE OF WORK: C4 L i c. 5140°►3 408-214-6 06OPr 408-214-6199 Fx • ELECTRICAL Remove existing c—°wrhead wir- '-providing power to garage Trench driveway ar,., >natall uiri►:.:�,-underground in PYC conduit Install small sub panel in ganige as ground as required O V L Building 1 Building 2 r eutral Electrode and Fig. 49 equipment �L Se p crate grounds Electrode Buildings Electrode L APPQUEST �` " 06 01 zoom `` ff�r 600}t 9rta Blanca St - htfiford Dr .- ' Gt ' t� 4g� o Dexter Dr 3 y Creekslde Ct - f� 85 0 Yarten � �� Park ( - O1 NarrroNaJ D E Clearcredc Ct CstP' Aug `� Park ClearwoW Ct 3 Cupertim Rd t7--.- � - ;. Mesta Vi�d►� '- - a= � _Stevens ire � > t66 9 RJackberrV Lomita Ave can uce Ave- Farm yoff Homeowner: �o Course Dose Ave 'b na An:a Faye Faulhaber 10085 Adrlana Dr ertlno, CA ,y u p Atazar Ave OG � > 95014 '"� O @2087A4apOuesttrEa .. fap:Qala @2aww NA.YZ.EQ Or 4* �..J51-26_16 �S Drawn By: 0, D. Mackey 408-214-6060 �O �� BCALE. NTS Garage Aephalt driveway Sub Panel 1"Schedule 80 PVC Conduit above grade _ 4" MIN. COMPACTED GRAVEL - -GRAVEL MUST BE LEAN I" Schedule 40 PVC conduit below grade AND F C MATTt 2 18"min. - new underground electrical service y to garage 4 ' y A-X NOT TO SCALE 3 tl 0 10085 Adriana Drive (E)100 Amp Service Panel Adrf ana Drive - J Daniel Mackag Construction, Inc. SCOPE OF WORK: CA Lic. 514053 408-214-60roOPn 408-214-6199 Fx • ELECTRICAL Remove existing overhead wires providing power to garage Trench driveway and install wiring underground in PVC conduit install small sub panel in garage ais ground as required ©-4 bl- ���� �pcc��icat�o a it�S ua 1 �k 1� "A0 �rnQS c !`�W�� v�c;fltin gKt1l1°• S Akan 4 Nbl ae ��°\a�oo°{ t�LOS. � -'AA 01 S-- - Sz Building 1 Building 2 Isal neutral (� Fig. 49 Electrode and equipment Separate rounds Buildings Electrod g e Electrode L 120.9 m s - �n MKM Dr r !q { AC'Jf U CIV — i I i �N`l�py p _,`\ mmLL Clear Ct i ti E+ J MAP Rd� Al +,\` `N i Lg�Va A" .fi r ye ... �,� Nomeown.r: �. ui t` r �� �4,�� �.. Faye Faulhaber ��^ 10085 Adriana Dr $ kn = Cupertino CA Ave `� 95014 J 1 �� au y o�� M� a,est' u►c ti `1 ,' I Rw . 408-251-261(0 i J i `M!KSpO�02M N TEQ"or;TeleAtlas. Drawn By: D. Mackey 408-214-6060 SCALE: NTS 0-71100aI CITY OF C'UPERTINO cuPF� kT tNo PERMIT APPLICATION FORM APN# Date: Building Address: Mailing Address 6f different from building address): 100 85 A DKIAKIA -Ug, Owner's Name: Phone#: VP �E I=AULH Ale>C�?-, A66 - 25T Z�7 Contractor: License #: b-AW-f_L MAr_Y_E Y C oNS1 fzV C.T WJ 114 "_ - S i o6�S Contact: Phone: 4� T1.. -S2,-3o Cupertino Business License#: l "EiLL i_'+ � Fax: Ao8 22- 51 -1 Building Permit Info: Bldg ❑ Elect I Plumb ❑ Mech ❑ Job Description: (nave avc-(Z he n w I S I Residential 9 UN-oca- C•1P-0U Nt� Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: ` O 0 cab Occupancy Group;. Type.of Construction: Please check this_box if the project is a 1Z-3 second-story addition: Project Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER I Other Appliances MECHANICAL 1 � 1 BBOILERI i Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boll er> 100K to 500K Btu ) MECHANICAL 1 BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu i MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING ' BCONSTAXH Hotel and Motel BUILDING 1 BCONSTAXR C onstax—Resi/Mobile BUILDING BELEC1000 )Jlec 600V <= 1000A ) ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL / BELEC200 El cc Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING l 1 of 3 , �,I , CITY OF C UPERTINO CU~PE�r PERMIT APPLI=CATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME Now Comm Electric ELECTRICAL ' BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL _ Cesspool I PLUMBING (� BPERMFEE I:ldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor � PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Ph n Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING - -BPSTORM ;itorm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Inslall/Alter Water Pipe PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER i A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C' Units<= 10,000 cfm MECHANICAL + BREMAPPLI J Appliance Install I MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Re lo Furnace> l OK btu MECHANICAL BREMHEAT + Heater Installation MECHANICAL BREMINHOOD I astallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Re n Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rcptl, Switch & Outlets ELECTRICAL ' BREMRELOCA Relocation of Hood MECHANICAL i BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 Community Development x 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEKTINO Building Department JOB ADDRESS: PERMIT # . OWNER'S NAME: �4� t,L 1-��� 8� : .� PHONE # GENERAL CONTRACTOR: , l'o j. FAX # 2 -74 -(9 7 Tq I am not using any subcontractors: 16 le-7 If_ Si gnature Daate Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating j ( Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock I Tile 1 7 Owner/Contractor Signature Date