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07110152 CITY nF CUPERTINO `' ' > BUILDING DIVISION pERNIIT G��R�.��}� ��'T�E�k� ' :. , ,a: ,.::...:z: BUILDING ADDRESS: � : PERMIT NO. 10108 CRESCENT CT (LOT 4) KELLY CORDON DEVELOPMENT 07110152 NER'S NAME: p� y�� D p�.�.� KELLY GORDEON DEVELOPMENT 1224 � ARATOGA—SUNNYVALE RD 11/27/2007 PHONE: ( 4 0 8) 8 i 3— 8 7 7 4 SANITARY NO. CONTROL NO. ARCHITECT/ENGiNEER: BU(LDING PERMIT INFO BLDG EI,EC[' pLUMB MECH � � 0 � � o p LICENSED CON'lRACTOR'S DECLARATION � � I hcrcby afficm that I am liccnsed undcr provisions of Chap�cr 9(commcncing Job Descripdon z� with Scction 7000) of Divisian 3 of thc eusiness and Profcssions Code, and my licensc is TEMPOR.P RY POWER L�T 4 "� y i n f u l t f o r c e an d c f fec � ,� ? Licensc Class Lic. it n f, � Da�c Conuactor ARCHITECI'S DECLARATION �� U I undcrstanJ my plans shall be uscd u public rccorda � � � y Licenscd Rufcssional ,� � OWNEA-BUILDER DECLARATION +� <� 1 hcrcby al7irm �ha� I am excmpt from thc Convactor's Liccnsc Law far thc L G O following rca400. (Scction 7U31.5, Busincss and Pmfessiona Cak: Any city or county •e ° m � which requires a pefmit to conswct, al�r, improve, demalish, or �epair any swctum � y� prior lo iLS issuancc, alw �cquims thc applicant for such permit W filc a signcd sta�cmen� �_ � that he is IiccnxJ pursuam to �hc provisions of thc Convactor's Liccnsc Caw (Chap�cr 9 Sq. Ft. Floor Area $ Valuation y F- $ (commcncing wi�h Secdon 7000) of Division 3 of ihc Busincss and Profcssions Codc) or 2 Q Q y �.-. that Ae ia exempt therefrom and the basis Cor �he aileged exempdon. Any violation o[ Section 7031.3 by any applicant for a pecmit subjecu the applicanl to a civil penalty of Number QCCll ai1C T e not more than five hundred dollars (5500�. 3 2 617 0 3 0�� P Y YP ❑[, u owner of tlx propcny, a my employcea wiN wages u the'u solc compewtion, will do the work, and �he strucwre is not intended or oRered for sale (Sec. 7044, Husinesa and Rofessians Cade: The Conuacwr's l.icense Law does not apply w m owner of Required Inspections property who builds or improves �hereon, and who das such work himsel[ or Uvough hia own emptoyces, provided �hat such improvemen�s are not imm�ded ar olYercd for sala If. however, the building or impmvement ia wld within one year of completion, the owner- builder v¢ill have the burden of proving �hat he did no� 6uild or improvc for purpoce of k. %� I, as awner oC the propeny, sm acclusively contracting wiW licenaed contncwrs w construM Uie projett (Sec. 7044, Business and Pro[essions Code:) The Contractnr's Li- cense Laa docs not apply �o an owner of propeny who builds or improves Ihemon, and , who conuac�a tor such ' cts with a eonuutor(s) licensed pursuant to �he Convactors Licenae Law. � I am exem nder a , B dc P C for �s n �ner p�k Y 6 RKIIt'S COMPENSATTON DECLARATION �rm under penalty of pery'ury rme o[ �!rc fallawing declaralions: ❑ I hsro and will mainain a Cenificate of Consent to xlf-insws for Workcrs Compen- sation, u pcovided for by Sectian 3700 of the Iabor Code, for ihe performance of the woric [or which Ihis pertnit is issued. , ❑ I have and will maimain Workers Compensation Insurance, az required by Scction 3700 of ihe labor Codc, Cor thc pcdormance of the w�k for which this permit is issued ' My Workers Compensation Insurance curicr and Poliry number ue: Grtiu: Paliry No.: CER'I'IFICATE OF EXEMPI70N FROM WORKERS' COMPENSATION INSURANCE (77iis section necd irot mplcted if the permit is far onc hundred dollus (S 100) nr Icss.) I cenify Uiat in t�c farm of the work for �s permu is iscued, 1 shall not employanypersan anymafj�r so e '' 7Yodrar�C6�ipcnsation Laws of Califomia Applicm� N077CE 7'O PP : If, aMr making �his Ccrtifica�c of F�ccmption, you shoulJ bccome subject to thc Worker'a Compensetion provisions of �hc LsAor Codc, you muu � O forthwith comply with such provisions or this pecmit shall be decmed awoked. � �"" CONSTRUCT(ON LENDING AGENCY .� � [—� � I heroby afLrtn Wat thcre is a co�wcGnn Icnding agcncy (ar thc perfurmance uf ai � ihe work fur which this pemiit is iuued (Scc. 3097, Civ. C.) W� A L.endcrs Namc � z C.ender's Address V 0 1 certilY Uut 1 havc read this application and sutc that thc above informauun is � ""' cortcc� 1 ssrce to comply wi�h a11 ci�y �nd county oreiinar�ces and sute laws relating w � U building conswction, and he�cby authorim eeprcscntauvcs of Uiis ciry w cmcr upnn Wc alwve-mcntioiced properry for inspenion purposes ( �,'�� a (Wc) ag�ce to save, indcmnify and kecp harmless ihe Ciry of Cupertino against �� liabiliues, judgmcn�s, cos�s and expenscs which may in any way acauc agains� said City („) z in consequence oC ung oC Ihis permiL �"� APPLICANT E ANDS AND WI�p WITH ALL NO -PO Issued by: Date /� ��'�'�� SOUR GULA � � Re-roofs 2/� ' nuurc of App pnUContractor Dalc HAZARDOUS MA7ERIALS D[SCLO � Type of Roof Ihc applicant or Cuturc building occupant sarc o handlc haiandous mamrial kfincd by Ihe Cupertino Municipal Codc. Chaplcr 9.1 and �he Hcal�h and Safety �. o uo�zssszca�� All roofs sliall be inspected prior to any roofing material being installed. Ycs If a roof is installed without first obtainin an ins ection, I a ree to remove wll the applicant or fuwre building accupant use equipment or Jevices which g P g emit harardous air conWninants cd by thc Bay Area Air Quality Managcmen� all new ma .erials for inspection. a�;�� ❑ Ycs 1 havc resd �he hvardcws matcrials requiremcnu undcr Chapmr 6.95 of ihc CaliCa- nia Hcalth y . Scctiatg 25505. 25533 and 25534. undcrstv�d that if i lu building does n urtcnuy havc a icnan4 ihs '' onv � �ry w nodfy thc occupani f ihe a rcyui �s which muu be met r w iuuarKC o( a Ccrtir�ca�c of oc �r. Signature o f Applicant Date -------- ` 26 0 All roof coverings to be Class "B" or better wncr or suthorixc gcnl Da ' CITY OF CUPERTINO � ¢ ? TEM�' POWER CUPEfZTINO PERMIT APPI:�ICATION FORM �° �� 11 �� t'�.� APN # Date: � �— � �►,, � fD , ��o � , � �� Building Address: . � -�— L " �,C ��.�'�i�C o c. � �2 l � � � �i C�' � �G Owner's Name: Phone #: � ��- �o �� .� �� o ,� � � a8 87� g �� T Contractor: Phone #: �Q �? � �7� �' J7 � r L� �+� ��- �[ �- � C_ � �7 8�� j Fax #. `� � � � Contact: / Phone #: � � � // - y j / C b � � �� (�? �/ �� Contractor License #: Cupertino Business License #: Job Description: l� Lr,�cr "�--�ic�t ��f/ D �� o � f1 � �� ✓c� �.� �- 4� Residential � Commercial ❑ Valuation: Qty. if Applicable Fee ID Fee Descriptior Fee Group Permit Type j ERT>1K Res. Temp Pov��er >1K Amps ELECTRIC REAP14 �f ERT<200 Res. Temp Pov�-er <200 ELECTRIC Amps ERT2001K Res. Temp Pov��er 200-1K ELECTRIC Amps EPERMITFEE Electric Permit Issuance ELECTRIC ELCPLNCK Electric Plan C �eck ELECTRIC / BSEISMICRE Seismic Residential BUILDING BSEISMICOM Seismic Commercial BUILDING CEAP14 CITY OF CUPERTINO � , ` � � TEMP l'OWER � . 1 OF CUPEi�TINO PERMIT APPLICATION FORM BPWSVCS Water Service PLUMBING CPWS or RPWS PPRSEWG Private Sewage Di;posal PLUMBING System PCESS Cesspool PLUMBING BPWATER InstalUalter Water :?ipe PLUMBING BPFIXTURE Plumbing Fixture PLIJMBING PGASRES Residential Gas Pi��ing PLITMBING System 1-4 Outlets BPGAS Gas Piping System 5+ PLUMBING Outlets PPERMITFEE Plumbing Permit F�:e PLUMBING Issuance PLMBLNCK Plumbing Plan Check PLUMBING PLMBINSP Other Plumbing/ga;> Insp. PLUMBING /� TRAVDOC Travel & Documen�atiori Fee BUILDING / BUSLIC Business License BUILDING CITY 0-? CUPERTINO 4 ITEMS OF 4 PERM:CT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B__k: Lot: APN ......... 3::617030.04 DATE ISSUED.......: 1:./27/2007 RECEIPT #.......... B:>000003342 REFERENCE ID # ...: 0"'110152 SITE ADDRESS .....: 1(�108 CRESCENT CT (LOT 4) SUBDIVISION ....... CITY .............. CL�PERTINO IMPACT AREA ....... . OWNER ............: KF',LLY GORDEON DEVELOPMENT ADDRESS ..........: SFR.ATOGA -SUNNYVALE RD CITY/STATE/ZIP ...: S�.RATOGA, CA 95080 RECEIVED FROM ....: BFIAN KELLY INC CONTRACTOR .......: BRIAN KELLY SR. LIC # 22726 COMPANY ..........: KELLY GORDON DEVELOPMENT CORP ADDRESS ..........: 12241 SARATOGA-SUNNYVALE RD CITY/STATE/ZIP ...: SARATOGA, CA 95070 TELEPHONE ........: (408)873-8774 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 200.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1ERT>1K t7NITS 1.00 71.39 0.00 71.39 0.00 1TRAVDOC FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 153.47 0.00 153.47 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 153.47 #5776 --------------- TOTAL RECEIPT : 153.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL �~^ •= Community Development ; � . 10300 Torre Avenue I � '� Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPE�TINO Buildin De artment JOB ADDRE�S: � PERMIT # / G D D �G�'� `�l' <`�-f' �� r '� � l � l .1" �. OWNER'S NAME: -� � a.- �� ,� �/ PHONE # p g) T GENERAL CONTRACTOR: ��-� � .� (( � gp,X # � l �ag� / I am not using any subcontractors: -�' '' - � l� zb o Si,;nature Date � Please check a licable subcontr com �lete the followin information: SUSCONTRACTOR BUSIrTESS 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile � � ' �--_ C< � f � wner ontractor Signature Date /