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07110045 CITY OF CUPERTINO ' f ` BUiLDI�'G DIViSI�e1N PERMIT .�a�����������T��� -s: ;:: ,, ., ,.. ,, ,:.:. , ,.. . _ BUILDING ADDRESS: PERMfT NO. 10670 CORDOVA ROAD JOHNSTCN ELECTRICAL 07110045 . PII2MTf ISSUE DATE YER'S NAME: WEST, DENNIS AND BARBARA 1302 LINCOLN AVE #204 � 11/08/2007 SANITARY NO. CONTROL NO. PHONE: (408)2E6-0236 BUfLDING PERMIT 1NF0 ARCHTTECI'/ENGINEER: BLDG ELECT PLUMB MECH � 0 � � u o p LICENSED CONTRACfOR'S DECLARATION JOU DeSCilIJt10I1 i� v C 1 dcrcby affirm that I am liccnscd undcr provisions of Chaptcr 9(commencing 2 O O �F' UPGRADE _��� wiih SccGon'7000) of Division 3 of ihc Busincss and Profcssiuns C o d c,and my licensc is �� y in full fo an e� ��'1 � O � v� z Licen V �. � ,'-, E„ O Datc Contrac�or � ARCHITECI'S DECLAR ON 1 undetstand my plans shall 6c uwd u public rcrnrds aa �yv ; �+. y Liccnsed Ptufcuional = y � OWNER-BUILDER DEC(ARATION I hcrcby ntTirm tha� 1 am excmp� (rom ihc Convactors Licensc Law for thc � p O following rcuon. (Scction 7031.5, Busincss and Profcssions Catc: Any city or county K,°, Pi which �cquims a pe�mit to consuuc4 al�r. impmve, demolixh. or repair any swcturc y Z y prior to i�s issuancc, also rcquires thc applicant for such permit to filc a signcd s�a�cment F[. Floor Area Valuation � x � that he is liccnsc d pursuant to t h c pmvisio n s o f i h c C o n t r a c t o r' s L i c e n s c L a w ( C h a p t e r 9 S 9 • $ 1 7 0 0 y F- �(commcncing with Scction 7000) of Division 3 of �hc Business and Profcssions Cadc) ur y �., that he ia exempt the�efrom and ihe buis for the allcgcd exempdon. Any violation of Section 703L5 by arry aQplicant for a pe�mit subjecu the applicant to a civil penatty of 3 4 217 0� 3`.�� Number Occupancy Type not more than five hundied dollars (5500). 0 1. u owner o[ tlie property. or my wptoycea with wages aa the'v solc compeesation, wiII do �hc work and the sauctuce is not intendcd or af[eced tor salc (sec. 7oa4. Bus��ness Required Inspections and Pro[essions Code: The Canuscwfs License Uw does not spply w an owner of property who builds a improves �hercon, and who does such work himself or through Ais own employccs. Prmidcd ihat such improvemen�s are not intended or olfeced [or sale. If, however, ehe building or impmvement is soid wi�hin ane year of completion, the owner- builda will have tlie burden of proving that he did mt build or improvc for puryose of sa1cJ. ❑ I, aa owner of �he propeny, am enclusively conuuting wi�h lianxd rnnusctors a wnstnut We projea (Sec. 7044. Business and Pro[essions Code:) The Coauacwr's Li- ccnx Caw does oo� appiy w an owner of propeny who builds or improves theeeon, md , who wnuac�s for such projecis with a conuactor(s) licensed pursuant w �he Convactors License Law. � 1 am uempt under Sec. , B R P C for this reston nu Date WORKER'S COMPENSAT[ON DECLARATION I hereby aftirm under penalty oCpe�jury one of ttx foilawing deciarations: ❑ I hsve and will mainuin a Cenificate of Consent to xlf-insure [or Workcr's Compen- sation, u provided for by Secdon 3700 ot �he Labor Code. for U�e performanx of the work for which ihis permit is isaued. ❑ I have and will maintain Worker's Compensation lnsunnce, u requircd by Section . 3700 of the I abor Code, Cw the pedormanee of �he wortc for w6ich this permit is issued My Worka's C pensaGon Insurancc r+rtia snd Policy n�b;r C� Poliry No.: � CER FICA'fE OF EXEMP'I'[ON FROM WORKERS' . COMPENSATION INSURANCE (This section necd not bc complc�cd if tAe permit is �or anc hundred daltus (5100) orlcss.) 1 cenify thu� in the performance of thc work (or which lhis permit is issucd. l shall not employ any person in any maancr so u to becomc subjeci w the Workcrs' Compcnsatlon Laws oC Cslifornia Dstc Applicant NOTICE TO APPLICANT: If, aftcr makingi ihis Ccnifica�e of ExcmpGon, you should become subjxt w �hc Workcr's Compcnsatian provisions of �Ac Lslwr Codc, you must � O forthwith comply with such pravisions or this peanit shall be dccmcd revokcd. z "" CONSTRUCTION LENDING AGENCY �- � 1 he�chy affirm ihat there is a conswcuon Icnding agcncy for thc perfwmance uf . p�., �� work for which this permii is iuucd (Scc. 3097, Civ. C.) . W A Lendcr's Namc a Z Lender's Address V � 1 certifY ihat 1 havc rcad this applicuion and statc ihat �he ahove infom�adun ia w� corrca I ag�ce w comply with all ciry and county oNinsnces and sute Iaws relaung w 0 U building conswction, and hereby authorin ecpresentativcs of ihis cily to cnicr upon ihc � W ahove-mcnuoired propcny for inspection purposes a (Wc) agree to save. 9ndcmnify and kecp hacmless �he Ci�y of Cupertino against �� liabilitiu, judgmcnls, costs and expenses which may in any way accrue agajnst said City �] V z in consequence aC the g ung of ihis 'G Date l� •�� �/ � APPLICANT U DE NDS ILL COMPLY WITH AL NO -POINT Issued b� ': SOURCE REG , �/�� / Re-roofs Sig uro o anUC r °"� T of]Zoof HAZARDOUS MATERIALS D[SCLOSURE YP ill Ihc applicant ar futurc building occupant storc or handlc hmardous ma�crial deRned by the C�pertino Munici al Codc, Chaptcr 9.12. and chc Healih and Safety �. Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed. pvcs o Will �hc applicant or wrc building accupant usc cyuipmcnt or dcvices which If a roof is installed without first obtaining an inspection, I agree to remove emit haiardous nir con�aminanls defincd by the Bay Area Air Quslity Managcmen� all new r iaterials for inspection. o�s�;��� ❑ Ycs 1 havic ecad �he ha�ard mucrials rcquircmcnu under p�cr6.95 f ihaCali(or- niaHcalth&Sa(cryC ScctionsL5505.25533anJ7S534.1 dcrs�and�h if 6uilding efoes not curtcn0y a �cnan4 my ponsiAili w notify ihe u t of U�e reyui�cmcn wh' me� r iss oc 'rua�co�Oc Signatur�;ofApplicant Date All roof coverings to be Class "B" or better wnc a oriud agcnl - a� CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 39217023.00 DATE ISSUED.......: 11/08/2007 RECEIPT #.......... B�000003198 REFERENCE ID # ...: Oi110045 SITE ADDRESS .....: 10670 CORDOVA ROAD SUBDIVISION ....... CITY .............. CL�PERTINO IMPACT AREA ....... OWNER ............: WF;ST, DENNIS AND BARBARA ADDRESS ..........: 10670 CORDOVA RD CITY/STATE/ZIP ...: CL�PERTINO, CA 95014 RECEIVED FROM ....: JC�HNSTON ELECTRCL CONTR.ACTOR .......: BF_IAN JOHNSTON LIC # 23411 COMPANY ..........: JC�HNSTON ELECTRICAL CONTR.ACTOR ADDRESS ..........: 1�02 LINCOLN AVE #204 CITY/STATE/ZIP ...: S�N JOSE, CA 95125 TELEPHONE ........: (408)266 FEE ID UNIT QUANTITY AMOUNT 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 #1191 --------------- TOTAL RECEIPT : 70.72 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL Q�t ��V�� :� � _ ; CITY OF t�UPERTINO � C�TM�F pERMIT APPL,ICATION FORM CUPER APN # ,., � .� � ,.� � r �� Date: � a� Building Address: Mailing Address (if different from building address): � � 0� Owner's Name: Phone #: ���v� r �a 8 - a3s� ao� � Contractor: License #: J c 9 q lv Contact: Phone: �laB.Z��• 0231P Cupertino Business License#: C�7/� Fax: .2 . � 02 Building Permit Info: �DU �{-' f/�Gi�'i?��� ,. Bld ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: �'/ � -3 Type of Construction: Please check this box if t� project is a �1-- second-stor addition: Project Size: Standard .� Large ❑ M� jor ❑ Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER Other A liances MECHAI�ICAL BBOILERl Bc�iler <= 100,000 Btu MECHANICAL BBOILER2 BoilE;r > 100K to SOOK Btu MECHANICAL BBOILER3 Boiler > SOOK to 1M Btu MECHANICAL BBOILER4 Boil�;r > 1M to 1.75 M Btu MECHANICAL BBOILERS F�oiler > 1.75M Btu MECHANICAL BCONSTAX Construction Ta�c BUILDING BCONSTAX Ir. d/Off/Comm/Quasi BUILDING BCONSTAXBQ Cun. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Cc nstax — Resi/Mobile BUILDING BELEC 1000 E.ec 600V <= l 000A ELECTRICAL BELEC1001 F;lec 600V > 1000A ELECTRICAL BELEC200 Eler. Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING of 3 � � CITY OF C UPERTINO � �� , ��� F pERMIT APPLICATION FORM CUPER�TINO Quanti Fee ID l?ee Descri tion Fee Grou BREMSIGNAD Rmc.l Signs Add Branch ELECTRICAL BREMSIGNS Rem�del Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Ve��t Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation S stems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Sei Commercial BUILDING BSEISMICRE :�eismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP T em ora Power ELECTRICAL BTEMPPERM Tem orar Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC �iusiness License BUILDING ELECTRIC ]�lectrical s foot ELECTRICAL % EPERMITFEE Elf�c Permit Issuance ELECTRICAL MPERMFEE N:echanical sq. foot MECHANICAL MPERMITFEE Me��h Permit Issuance MECHANICAL PPERMITFEE Plu�n6in Permit Issue PLUMBING PPLBG Phimbing Fee s foot PLLTMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran e Residential PLANNING ZADDCHG Address Change BUILDING = of 3 Community Development 10300 Torre Avenue i' : � Cupertino CA 95014 Telephone (408) 777-3228 -- � Fax (408} 777-3333 t,UPEl�,TIN� Buildi:n De artment JOB ADDRESS: PERMIT # Q � l / Q C � �.� o �5U1 � OVYNER'S NAME: ,J� �,� : PHONE # • 5• 20 GENERAL CONTRACTOR Jp ' FAX # I am not using any subcontractors: � � Si; ture a Please check a licable subcontractors and com �lete the followin information SUBCONTRACTOR BUSII��ESS NAME BUSINESS LICENSE # Cabinets & Millwork � Cement Finishing IIectrical Fxcavation Fencing Fiooring. CarPeting Linolevm / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal � Sheet Rock Tile O�wz.ler/ Contractor Signature Date