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07110092 CITY OF CUPERTINO �� ,��"' ; s�ncniN� e,iv�sioN PERMIT ; ,: ,: . :::. ::� ,... ,.: . ... PERMIT NO. aui�r�ir�c1n�4RESAPPLE TREE LN JSD ELE�TRIC 07110092 . 11 pEItM1T L�UE DATE ,�vVNER'S NAME: . 1 1� 15 � 2 � � 7 KURTZ FRED N AND DONNA L 151 W BEAMER ST SANITARY NO. CONTROL NO. P"o"E: (530) 668-9775 BUiLDING PERMIT INFO ARCHiTECT/ENGiNEER: B� E� PLU � u p p LICENSED CON'!'RACCOR'S DECLARATION JOU DeSCT1pLlOI1 � v � ��by ��n thet I am Gconacd undcr Qrovisions af Chapur 9(commencing KTCHN i; PGRD � 2 CNTR CRCTS � sc DED L INE S 4 z� wi�h Sccrion 7000) o[ Division 3 of thc Busincss and Pro[cssions Codc, aod my license is ��y infullfoeceandeff � �� * $�2631 � MICRO� LISPSL &DSHWASHR v� Z Licensc CI�sa � �� L n t- � Daic 1 1� 1^� 6�'1 Contractot � ARCHITECI'S DECLARATION -� 1 undcrstanJ my plans shall bc used u puhlic records m< � 4 O y Licensed Prufcssional OWNER-BUILDER DECLARATION � <� 1 hcrcby aRrm t6al I am raccmpl Gum 1hc Conuactor's Licenu Law for ttic o O follawing rcason. (Scction 7031.5, Busincss and Profcssians CoSc: Any city ar county K,° Fi which ccquires a pcmut w conswc4 aiur. �mlxovc. dcmnlish, or repnir any stcucwm '�' y prior to i�s issuancc, also rcquires thc applicani for such permit io Gle a signcd sta�cmcnt g Ft. Floor Area Valuation —�< that hc is IicenscJ pursuant to thc p�ov�sions of ihc CantractoY's Li��ensc Caw (Chaptcr 9 $ 2 Q Q Q Y F� (commcncing wi�h Scction 7000) of Division 3 of Ihc Busincss and Profcssions Codc) or i�� mp� �e(rom and the basis (or t6e allcged eumption. Any violaUon af QCCU N1C T e Section 703L5 by a�ry applicant for a permit sabjecu ihe applicant w a civil penaity ot 316 3 3 0 r' 8.� Number P Y yp not mae � han f ive 6undred dollars (5500)• ❑ I. u owner oC ttie properry. ar my employces with wages u the'v solc comprnssdon, x do the work, and U�e suuauce is not intended or offered for salc (See. 7044 s�� Required Inspections and Professiorm Code: 'lt�e Comractors Licen4e Law docs not apply in an owner of property v+ho builds or improves Nur�on, and who doos such vrork himulf or �luough his own employxs. provided that such improvements are not intended or olfeeed for sale. If, however. We building or improvement is sold within one yeer oC completion, the owner- pu7der w9p have the burden o[ proving Wat he did not build ar improve for purpose af saleJ. Q 1. ��,� of �he propeny. am aeclusively conuacting wi�h limnsed rnnuactors w constnut the projm (Sec. 7044. Business and Professions Code:) The Contruwr's Li- cense Iaw doca not apply w an owner of PropenY who huilds or improves Uie�eon, md , who convacts for such projeas wilh a conuactor(s) licensed pursuant to ihe Convactars " � e "� � , B& P C for �his rcuon I am eacempt under See. Ownv Date WORKER'S COMPENSATION DECLARATION 1 heccby affirm under penalty of perjury one of �he followinp declaruions: ❑ I Iw+e and will maintain a CeniGcate oC Consent lo ulf-insure for Workc�s Compen- suion, u provided (a by Section 3700 of the Iabor Cade, for the pedormance of U�e worlc for which Ihis permit is issued. ❑ I have and will maintain Workefs Compensadon Insunna. u required by Scction . 3700 oC the Labor Code. for the pcA'ormsnce ot the work !or which �his pe�mit is issued. My Work C�ompena on I tancc cartier and Poliry number�y� � j� Z� 4" � Cartier. �T �Jn� PolicyNo.: � � V " � 7 CERTIFICA7'B OF EXEMP770N FROM WORKERS' . COMPENSATION 1NSURANCE (I'hit section necd not bc completed'J the permit is for onc hundred dollua (S 100) , nr less) I ceni(y �hat in thc perfwmancc o[ thc work (w which ihis rertnit is issued. 1 shal� not employ any person in any manncr so as w become subject to �he Workcn' ComP�nsatlon Laws of Califomia. Da�c Applicant N077CE T'O APPLICANT: If, aftcr making ihis CcrtiGcatc of F�cemp6on, yau should becane subjcet a thc Workcr's Compcnsatian provisio�s of thc Lalar Codc, you muu , z forthwilh comply with such provisions w this pecmit shall be deemed mroted. � � CONSI'RUC170N LENDING AGENCY E„� .. � hereby a(tirm ihat there is a consuuction Icnding agcncy for thc performance uf p; � ihe work for which this permit is issued (Sa. 3097. Civ. CJ • W Q Lendcr's Namc �+ Lcnde�s Address (� 0 I certify tha� I haw read this application and statc Uut the abovc info�mation is w � cortcct I a6ree w comply with alt city md county oMinances and sute Iaws relating w 0 U buildins consuuction, and hereby authorin represen�ativcs of Uiu city w cntcr upon thc � W aAme-mcntioned propcny for inspectian purposes a (Wc) agree to save, indcmnify and keep harmless Ihe Ci�y af Cupertino against �„H„� y liabiliva, judgmcnts, coats and expenses which may in any way ucn�e against said City V z in con e gronting of this perm DatC APP ANT U ERSTANDS [�FD"WILL CO PLY WITH ALL NON-POINT Issued lry SOU LATIONS. � - � �'� � Re-roof s a.I� Signu af Applican uxtor Da� T oi Roof US MATERIALS DISCLOSURE YP applicant or futurc building occupant storc or hanNc ha•rardous matcrial s dcfined by �he Cupenino Municipal Code. Chap�cr 9.12. snd �he Heal�h and Safety c«� ,Scction25532(a)? All roo;s shall be inspected prior to any roofing material being installed. � y� No �11 thc applicant or fuwre ilding occupant usc eyuipmcnt or devices which If a roof is installed without first obtaining an inspection, I agree to remove cmi� harardous air conuminants u dcfincd by the BaY Area ti� Q�al�ry Managemcm all new materials for inspection as�;�� y� No 1 havc rcaJ �he ha�ardous ma�crials �cquiremcn�s unJer Chap�cr 6.95 of U�c Califor- nia Flcalth k Safcty Codc, Sections 15505, 25533 arul 25534. I undixsiand U�at if ihc building does no� curtenUy have a tenan4 ihat il is my rcspons96ility to nodfy the occupant of the „ 11 Date � m ��,��„ � ,�,� �; SignatLre ofApplicant � ��"� J °� All roof coverings to be Class B or better Ownc[_u aut �b`�nt � D,� �`�.��.� �IT� o� ��P�r��T�o ��+�� noF �'E�21VIIrT APPI.�� CATIOl�T �O�1VI �uP�� NO ADI)I'I`ION/� 1l��L � APN # � � o � �PPI� ��.G�G 1...►..� Date: j J y �� "�j� �l Building Address: '? p 1 � � � � �' t �Q, f✓�� i`�� cE�� `��`�e��r��t i�€r��,�� I��iE€�kF2� �d:��-�s�):: � Owner's Name: { � f Q �' � U r -�Z Phone #: � � �-- �I �`� "�� ._ 5 S � Phone: � 3 � G� 3�� 5 State License #: S, f� 2�� l�� Contractor. � � � � � � � f , L � Fax: . �,� �,�;,� _ �3�5 Contact: Phone: Cupertino Business License#: �� / n Fax: �� Building Permit Info: Bldg O Elect ?lumb � Mech ❑ Job Description: `That is being added? 1 � ,� C� �� c �S "C � 7 � ,, � � � w " S �' �✓` � Ev� � �, ( �, + � �� , Y � What is being remodeled? � , �1 Z,i1 �� Re sidential Ud Commercial ❑ �temodel Includes Re-Roof: Yes ❑ No ❑ Remadel Ii�cludes Structural: Yes ❑ No ❑ Square Footage: Addition: Reinodel: Garage: Porch: Deck: Other: Cost of Project:_�� t�� Occupancy Group: l �� v�� Please check this box if the project is a Type of Construction: j �, �-� �,, � �� ❑ second-story addition: Project Size: Standard I1�' Large ❑ Major ❑ ��or office use c�nlyY � Over �he cou�ter 1 of 3 x-- �`�,�;:a CITY OF CUPE1ZTIl�TO ��ry PE121VII'T APPI��=CATIOI�T FO�I �u�� o AD��'�Q�f�l�� Fee ID �� ee Descri tion Fee Grou Quanti Other A liances MECHANICAL BAPPLOTHER BBOILERI Bo�ler <= 100,000 Btu MECHANICAL BBOILER2 Boile:- > 100K to SOOK Btu MECHANICAL BBOILER3 Boil�:r > SOOK to 1M Btu MECHANICAL �B�ILER4 B oiler >� P� ta 1.75 h�I B tu MECHA�NIC _ — ----- — — — ------ ------ � --- ------ ---- --_ � -� -- BBC3IL,ERS ��i1e� > 1."%51� �t� I�E�T�I�I�I�I-�L _ BCONSTAX ��onstruction Tax BUILDING BCONSTAX In�i/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co lstax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD ]?nergy Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING BMISCELL 1�Iiscellaneous Fee BUILDING BMITIGATC Conun. Housin Mit. Fee BUILDING BNUCOMME r ew Comm Electric ELECTRICAL BNLJCOMMM Ne��v Comm Mechanical MECHANICAL � BNLJCOMMP 1'1ew Comm Plumb PLUMBING BOVERTIME I�is ection Overtime BUILDING BPBACKFLOW Atmos heric Vacuum PLUMBING BPCESSPOOL Cess ool PLUMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS G�is Pi in S stem Fee PLUMBING BPINTERCEP Ir�d Waste Interce tor PLUMBING BPLANCHK Plan Check Fee � BUILDING BPLANCKADD Pl an Check Add Multi BUILDING BPLANCKREP Plan Check Re eat Fee BUILDING BPREPIPE ltepi e Of Fixtures PLUMBING BPSEWAGE Sewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING gpT�p Kitchen Tra PLUMBING BPVENT � 41t of Drain & Vent PLUMBING BPWATER In� talUAlter Water Pi e PLUMBING BPWHEATER �Water I3eater/Vent PLUMBING BPWSVCS Main Water Service PLLJMBING 2 of 3 .��;-��.� CI'I'Y O� C'TJPElZ'I'II`TO . ��n �F PE�2IVII�' APl'L�[CA'TION �OR1VI �UPE4�TIN� �� Quanti Fee ID Eee Descri tion Fee Grou BREINSPECT lZeins ection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI ,� liance Install MECHANICAL BREMBUSWAY I� emodel Busways ELEC TRICAL _ __ � - - �- �I�El��I�T ! l ,ighti�g �� xtu� - es � ��,ECT�I�l�,.1, _ _ � I BREMFURN Re �ocation of Furnace MECHANICAL BREMFURNOV Rel�� Furnace > l OK btu MECHANICAL BREMHEAT F[eater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc A aratus ELECTRICAL BREMNRAPP Rerr� Non-Res A liance 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�; air/Alter Heating MECHANICAL BRE�VIRESAPP Rerlodel Res A liance ELECTRICAL BREMSIGNAD Rm31 Si s Add Branch ELECTRICAL BREMSIGNS Rex��odel Si s, Mar uee ELECTRICAL BREMTHEATR Th�;atrical Li htin Fix ELECTRICAL BREMVENFAN Vent Fan Sin e Duct MECHANICAL BREMVENSYS V entilation S stems MECHANICAL BSCBLVD 3cb S ecific Plan BUILDING BSEISMICOM Se ismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL ;i ecialIns ection BUILDING BSWIM Swimmin Pool BUILDING BTEMP 7'em orar Power ELECTRICAL BTEMPPERM Ten� orary Bld Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE T�echanical s. foot MECHANICAL MPERMITFEE M��ch Permit Issuance MECHANICAL PPERMITFEE Plu_mbin Permit Issue PLUMBING PPLBG P:.umbin Fee s foot PLUMBING PLLONGRNGC Plannin;s LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin;s Lon Ran e Residential PLANNING ZADDCHG Address Chan e BUILDING 3 of 3 CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 31633078.00 DATE ISSUED.......: 11/15/2007 RECEIPT #.......... B�000003254 REFERENCE ID # ...: Oi110092 SITE ADDRESS .....: 2C150 APPLE TREE LN SUBDIVISION ....... CITY .............. CL�PERTINO IMPACT AREA ....... OWNER ............: KL�RTZ FRED N AND DONNA L ADDRESS ..........: 2(�150 APPLE TREE LN CITY/STATE/ZIP ...: Ci1PERTINO CA 95014 RECEIVED FROM ....: ICJNACIO ARTEAGA CONTR.ACTOR .......: JC)RGE ARIAS LIC # 25769 COMPANY ..........: J:�D ELECTRIC ADDRESS ..........: 1`i1 W BEAMER ST CITY/STATE/ZIP ...: W()ODLAND, CA 95695 TELEPHONE ......... ('.i30)668 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------ ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BSEISMICRE VALUATION 2,000.00 0.50 0.00 0.50 0.00 ELECTRIC SQUARE FEET 90.00 7.20 0.00 7.20 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 _____40_79 ______0_00 ---------- ---------- TOTAL PERMIT : 83.35 0.00 83.35 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------- CREDIT CARD 83.35 AMEX --------------- TOTAL RECEIPT : 83.35