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07110047 CTTY O UPFRTINO ���TTR�►.�:��T� ���R�k�;��� ` su�� DIVIyION PERMIT > ` PERMfT NO. BUILDING ADDRESS: TBD — TO BE DETERMINED 0 7110 0 4 7 • 10211 DANUBE DR pQtMTf ISSUE DATE JER xnME: � ' 11 / 0 9/ 2 0 0 7 PAULINE SITYU SANiTARY NO. CONTROL NO. PHONE: BUiLDING PERMIT INFO ARCHTIECI'/ENGINEER: gLDG ELECC PLUMB MECH �� 0 � � u O p LICENSED CON7'RAC1'�R'S DECLARATION IOb DeSCfIpLlOi1 v 1 dcrcby affirm that 1 am ��a�d undcr provisions of Chaptcr 9(commcncing � z � withSccGon7000)oCDivision3ofthcBusinestandProfcuiumCodc gATHROOM� REMODEL� KITCHEN REMODEL� NON-STRCT . �<a infullCorceande[tect �� x �!1v �� JYC GENER.AL BLD R S I N C . P D B S L 1 1 / 9/ 0 7 �� Z Licenx Clus �--- ConlracWr r r �„� p Datc A C CI'S DECLA � I undcrstanJ my plans shall bc uscd u public rccords m< ��U ; u. y Liccnscd Ptufessional � O ` OWNER-BUILDER DECLARATION ,'� <� � hercby a[firm �hat I am excmp� fn�m ihc Con�raanr's Liecnsc Law (a� thc O O lollowing m.ason. (Scction 7031.5, Busincu and Profcssions Ca1c: Any city or county �,°, Pi which rcquims a pcnnit �o conswc4 altcr. improvc, demolith. or rep�ir any swcwre V$�ll3LlOi1 y" y prior to ils issuance, also rcqa�res �hC applicant for such permit to file a signed sulemen� s Ft. Floor Area � 4 O O O -�<� hc is licenscd pucsuant to thc provisions of thc Conuacwr's Liccnsc Law (Chaptcr 9 q' Y t = - �(commencing wi�h Scction 7000) of Division 3 of thc Busincu and Profcssions Cadc) or i�� that he ia exempt theiefrom and the b�sis for the allcgcd eumpdon. Any violanon o[ Number Oeeupancy Type Sation 7031.5 by arry applicant [or a pe+mi� wbjecu the applicant to a civil penalty o( 3 6 9 4 9 0 0��(� not morc than fiw hundmd dollars (SS00� � I. u owner of U�e prope+ty. or my employces with wages az ihe'v solc compensation, wi11 do ihe work end ihe stcucw�e is not intendcd or of[eced for sale (Sa• 7�44. Bus'°ess Required Inspections snd Professians Code:'I1u Conuuar's License Law docs no�'PP�Y 1 O „' O of property who builds or improves thercan, and who das such work himael[ or through hia own employces. Provided that such improvemen�s ue not in�d or oReced Cor sale. U. �owever. the building or improvemeet is sold W ��h'n o"� Y�u oC completion, the owner- builder wiR have U�e b�rd�" o[ proving tiiat he did not build or improvc tar purpose of M � g �,. sak.). s� h'� ' y�, �, � . ❑ I. as owner of the property. sm exclusively conuacting wiih Iicensed rnnvactors to + .` wnsuuct the pcojea (Sec. 7044. Business and Prohssions Code:)'11x Contrx�nrs W- ccnse L�w docs not apply W an ownu of property who huilds or improves ihe�eon. and . �`' � p who convac�s for such projecu With a coniractor(s) licensed pursuant to �hc Conusctofs :�-; �,(� ;� ' License Law. � , `�" n3 � I am enempt under Sec. , B& P C for �his rcason �vner Date WORKER'S COMPENSATION DECLARA'1'ION 1 heceby afCitm under penalty of pery'ury one o[ the following declaratians: � l hsae and will mainWin a Certificate of Consent to ulf-inswe for Workcrs Compen- sauon, as provided for by Sation 3700 of �he Iabor Code, for the pedorma�c o� � work for which ihis permit is issued• ❑ I havc and will maintain Workcr's CompensaUon Insunnce. as mquircd by Scction . 3700 oC the Labor Code. Cor the peA'ormance of the worlc fw which this permh 9s issued My Worke�s Compensarion Insurrna articr and Poliry number are: Cartier: Policy No.: CERTIFICA7'E OF E7�EMPT[ON FROM WORKERS' COMPENSATION 1NSURANCE (f]his scctian need not be completcd i[ the permit �s far onc hundreA do�►acs (f 100) ' or Icss.) I cenify thm in thc perfortnance af lAc work fw which ihis permll is issu�d� � sha1� not employ any person in any manncr so u w becomc subject w the �'�lortcn' Compensadan Lsws of Califomia. Da�c i O Applicam NOTICE TO APPC.ICANi': �f• aftc maki^B U��s Ccm�ca�c of Excmpuon, you seowu become subjxt to �hc Worker's Compcnwtion provisions of the Lsl+or Codc. yau must �'� fonhwi�h comply wi�h such provisions or this permi� shall bc dccmcd icvokcd. z O CONSTRUCCION LENDING AGENCY . �r � I hcrcl+y a[Cirm Uut thcre is a consuuction lending agency Cor U�c perCurtna�c u( ' p�„� � �hc work for which �his pertnit is issued (Scc. 3097, Civ. CJ W A Lendc�s Namc p+ L.ender's Address I certify U�at I havc rcad ihis applicuion aed sutc thu thc ahove informadun is w� cortcct I agree �o comP�Y with �� �+�y Nd coun[y artlinances and su�e laws mlaang �o building consuuction, and hcreby �uthoria ceprescntadves of ihis ci�y a enter upon thc � V atwve-mcndoncd ptopcnY fm insP�cuon pmposes �"' a (Wc) agra to ssve. indcmnify and keep harmless the Ciiy o[ Cupertino agsinst liabililies, judgmcntt, cosLS and expenscs which may in any way accrue aga�nst said City / (� z in conuquence oC ihe granting oC this permiG Date �' �-� ►y APPLICANT UNDERSTANDS AND WILL COMPI,Y W1TF1 ALL NON-POINT Issued b� : "-' SOURCE REGULA170NS. ' ��i� - [OOPS Signuurc of ApplicantlCo w� ,� of l Loof H OUS MATERiALS DISCLOSURE YP Will Ihe applicant or future building occupant storc or handlc ha•rardous ma�crial ; defincd by 1he Cupertino Municipal Codc. Chap�cr 9.12. and the Hcal�h and Safety ,� Scction 25532(a)? � All roof: shall be inspected prior to any roofing material being installe . �Y� If a roof is installed without first obtaining an inspection, I agree to remove �11 the applicant or future building accupant use eyuipment o ydcvices which all new rnaterials for inspeccion. cmi� harardnus air comaminan�s az dcGncd dy the BaY Area Air Quslit Mana cmen� Disuict? ❑Ya O� 1 havc rcad the ha�ardWS ma�crials requiremcnu undcr Chaptcr 6.95 of ihc Cal'+Cor- nia Ficalih & Safcry Codc, Scctiont 75505.25533 anJ 25534.1 undcrs�and ihu iC ihe building dacs nol curtcnlly havc a Ienan4 �<i� u mY �P���h����y � notiCy thc occupant of ihc Signatur ° of Applicant Date rcyuircmcn�s whic bc mel�cio^ta issuancc oC a Ccnifica�c of �Y• ,. � All roof coverings to be Class "B" or better Owncr or au arizcd agcn� � .� � .:: �s -�,� . �- �" '� . � ° t "3. 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' CITY OF CUPERTINO 5 ITEM.S" OF 5 PERMI�.' REC'EIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN ......... 36�►49008.00 DATE ISSUED.......: 11,'09/2007 RECEIPT #.........: BS�)00003201 REFERENCE ID # ...: 07__10047 SITE ADDRESS .....: 10:?11 D�INUBE DR SUBDIVISION ....... CITY .............. CU:?ERTINO IMPACT AREA ....... OWNER ............: PAIJLINE SITYU ADDRESS ..........: 19'385 HALL COURT CITY/STATE/ZIP ...: CU?ERTINO CA, 95014-2141 RECEIVED FROM ....: PAiJLINE SITYU CONTR.ACTOR .......: TB:� - TO BE DETERMINED LIC # 00096 COMPANY ..........: TB:� - TO BE DETERMINED ADDRESS ........... CITY/STATE/ZIP ...: , TELEPHONE ......... FEE ID UNIT QUANTITY �MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 4,000.00 104.76 0.00 104.76 0.00 BPFIXTURE UNITS 6.00 54.00 0.00 54.00 0.00 BSEISMICRE VALUATION 4,000.00 0.50 0.00 0.50 0.00 MPERMITFEE FLAT RATE 11.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 11.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 240.84 0.00 240.84 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 240.84 VISA --------------- TOTAL RECEIPT : 240.84 �..:.�, cl�r� o� c u����1�� ��� �� U`� � .�`�.�_.. tiClTYt..-F �� I� ������.�1� 1 I�l� ���1�'1 �UPE�TfN� �DDI'�'I��/� I����� APN # f- � � � Qg ` (� � Date: � ����yd� � �P Building Address: ` � � � �Ct1?G{�j� ��" ��-�✓�'�� C � 7 �� � ' 1�'��B�p�� ���€��-��� ��� ����`����z�, b`u�a���7, t�r���€���u� a�k���-��3��.. ; � �7 �S� ��a- `( �D u r`t , � �-er �Y� c C'� �,�D 1 � Owner's Name: Phone #: ��u�.�.� ��.yu �d� 8��--�6zg Contractor: Phone: �D� z� 2_,��?�$ State License #: 8 ��D o 7 p �ac1� � i an Fax: Contact: � Phone: u Cupertino Business License#: Fax: b '�- Building Permit Info: `�,.��n r���s� / r� m° c�-=�� �'2--��`�`'"' r2"" �,`�.Q.l �`"'� J�'`YC,"t—�-� t Bldg �l Elect O l'lumb C� Mech 0 Job Description: ��Vhat is being added? ��� What is being remodeled? ��� �� �� � �c� ��i �-o-�^ �/,,e r.`.� � �? E � ` Residential � Commercial ❑ Re�nadel Includes Re-Roof: Yes ❑ No � Rernodel Includes Structural: Yes ❑ No � Square Footage: Additian: .N f� Remodel: Garage: N� Porch: �1//a Deck: Other: Cost of Project: ��,`�D�. Occupancy Gr�o�up3 � � �� Type of Construction: Please check this box if th project is a � second-story addition: Project Size: Standard � Large ❑ M� jor ❑ ��or office us� on1yY ❑ �v�r �he counter � of 3 ��-` _ C(JPER'I'Il\TO � �; CI'I'Y OF � ��n�F PEIZIVII'I' APPI�ICA�'IOl�T FOI�IVI �uP�� ��e� ��������, Quantity Fee ID �'ee Descri tion Fee Grou BAPPLOTHER C�ther A liances MECHANICAL BBOILERI Boi: er <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to SOOK Btu MECHANICAL BBOILER3 Boiler > SOOK to 1M Btu MECHANICAL B BOI L ER4 Boilei > 11V� to 1.75 h/� �tu ME CH A. I�ICAL _ � . _ __ - - - ---- -- - - -- _--- — — ---------- --- �--- -- B��ILEFZS �c �iler % 1. %�I� �tu 1'�✓`i�C���l�I�A � � BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Cor�. Tax for BQ Zone BUILDING BCONSTAXH l�otel and Motel BUILDING BCONSTAXR Cor. stax - Resi/Mobile BUILDING BELEC1000 ElEC 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Fnergy Add Multi BUILDING BINVESTIGA ] nvesti ation fee BUILDING BMISCELL I�iiscellaneous Fee BUILDING BMITIGATC Comm. Housin Mit. Fee BUILDING BNUCOMME N�,w Comm Electric ELECTRICAL BNLJCOMMM Nev�� Comm Mechanical MECHANICAL BNUCOMMP N ew Comm Plumb PLUMBING BOVERTIME Ins ection Overtime BUILDING BPBACKFLOW Atanos heric Vacuum PLUMBING BPCESSPOOL Cess ool PLUMBING BPERMFEE �:ld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS Ga.c Pi in S stem Fee PLUMBING BPINTERCEP Inci Waste Interce tor PLUMBING BPLANCHK Plan Check Fee � BUILDING BPLANCKADD Pl� n Check Add Multi BUILDING BPLANCKREP Plan Check Re eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE �iewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK La��n S rinkler/Backflo PLUMBING BPSTORM �>torn�/Rain Water PLUMBING gpT�,p Kitchen Tra PLUMBING BPVENT � A lt of Drain & Vent PLUMBING BPWATER InstalUAlter Water Pi e PLUMBING BPWHEATER V��ater Heater/Vent PLUMBING BPWSVCS 1�1ain Water Service PLUMBING � of 3 ��;� � CI'TY OF (:ITPEI2�I'I1�10 � ��n�F e PE�II'I' APl'�ICATION F�1Zl�i ��PEd�TIN� . � ADDI'�`I�I��/�1����� Quanti Fee ID Fee Descri tion Fee Grou BREINSPECT [�eins ection Fee BUILDING BREMACOVER A/(� Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI A liance Install MECHANICAL BREMBUSWA�' F :emodel Busways E LECTRICAL � — - --- i �3IZEIVi�'IYrT �ightir� � ix tut --- � -- E� L��"I'I�TC'/�.� — BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rel � Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc A aratus ELECTRICAL BREMNRAPP Ren� Non-Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Pow��r Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Rf; air/Alter Heatin MECHANICAL BREMRESAPP Reniodel Res A liance ELECTRICAL BREMSIGNAD Rm�il Si s Add Branch ELECTRICAL BREMSIGNS Rerr: odel Si s, Mar uee ELECTRICAL BREMTHEATR Thf;atrical Li htin Fix ELECTRICAL BREMVENFAN Ve:it Fan Sin e Duct MECI3ANICAL BREMVENSYS Vcntilation S stems MECHANICAL BSCBLVD :>cb S ecific Plan BUILDING BSEISMICOM Se ismic Commercial BUILDING BSEISMICRE �3eismic Fee Res BUILDING BSPECIAL � ecialIns ection BUILDING BSWIM Swimmin Pool BUILDING BTEMP Tem orar Power ELECTRICAL BTEMPPERM Tem orar Bld Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Isusiness License BUILDING ELECTRIC ]�lectrical s foot ELECTRICAL EPERMITFEE Elf�c Permit Issuance ELECTRICAL MPERMFEE N echanical s. foot MECHANICAL MPERMITFEE Me�.h Permit Issuance MECHANICAL PPERMITFEE Ptu�nbin Permit Issue PLUMBING PPLBG Phunbin Fee s foot PLUMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran e Residential PLANNING ZADDCHG Address Chan e BUILDING 3 of 3 Community Development � ` f„ `. 10300 Torre Avenue �;,` . ��:�, ; Cupertino CA 95014 Telephone (408) 777-3228 , � Fax (408) 777-3333 CITY OF ' CUPEf�TINO Buildi�n De artment JOB ADDRESS: . � n u � �,- - PERMIT # �o�zll `� �i�lf o��7 OWNER'S NAME: G{.�cl•�-P S PHONE # -'' GENERAL CONTRACTO : -�-- 1 FAX # , ~ ` �-v�t� o ,Z�o 7 I am not using any subcontractors. ' Sif;nature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTIZACTOR 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 Rooting Septic Tank Sheet Metal Sheet Rock Tile .,- ` �Zc91/ o ,7.�i er/Contractor Signature Date FROM :CUPERTINOSANITARYDISTRICT FAX N0. :�082535173 Feb. 21 20a8 09:44AM P1 i ` � o �a .M1ET�q t � DSS7RICT MANAG�R-�',N • tFy�E�R 1� r-, `� �� BOARD OF' CIR�CT032S s MARKTFiOMA9 & COM AMY, INC. � ' 4 � WI[.4pM A. BOSWdRTH RICHARD FG. 7ANAKA � � JOFiN M. 6A7T0 D167'RICT COUNSE,� Y'.E�1�S .tF CURT15 B. HARFt190N � .$F,:R.VIi;G ` WENDELt� N. KERR, JR. AYKINSQN +�ARASYN, I,LP. � ~�` CIiRlSTOPH�F� C. LE� FiAROLD S. 7bPPEL �OB33 S7 �V�NI9 CRE� < BOULEVARA, 3L11TE ! O�3 Cl1P�RT[NO, GAt FORNIA 9901 d•21'S4 (409) Z53-707 S PNOn E• 1448) �253�5173 FAX www. cuper[inos��►tlterydistrict. com F,��: cUsn _, MoP Building i�ept. — C.upertin� � r L . �G�� C;ity of Cupertino � Attn..: B�ailding T�ep• n�ent `� C 1 Q300 '1'orre Ave. C'u.pertino, C:A 9501 -3202 Subjcct: SFD B�th oom&Kitchen/Reinodel Name: Shyu Resid nee Address: 1021.1 Dn ube �rive APN : 3G9�49-008 Yermit Nc�. 071100 7 ■ VideotaPe nd ProPcrty Line G)canorat inspected. No addit vnal cnn�litioh,s/req,�irements by t e Dr'strict. � ��% Ingpectvr: ieorge Santos/ Rogcr Santos......�� . . ......... . ............ � DAte:...02 21-2008 ................... SRnitarv Sewer I�ocati{�n: cc: Yroperiy Uwner 21' l�►ng �' dcc� s:�wU�rns�ctrst� i.FTTFRS�BLTTT nEP'�' I..ETTER.�\C"uSD 2U08 TV lnpectic�n__U7110Q 7_1021 l. Danube Dr_02-21 � •200A.doc SUPPLYING SANITARY SEW RAG� SERVIC�S FOR: CITY OF CuPERTIN�, PORriar�s OF TH� CiTiES OF SARATO�A, SUNNYVA��, LOS ALTOS AN� SURROUNDING UNINCORPOfZATEP AREAS