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07110106 CITY OF CUPERTINO � ' ' BUILDING DIV1510N PE�IT �*������� ��������' ' , ,- . :. : , . :.:. .: . _ : .: :.. _ _: BUILDING ADDRESS: PERMIT NO. 10684 STEVENS CANYON RD LOT ROCKWEL]� HOMES INC 07110106 . � ' NAME: PERMI'f LSSUEDATE ROCKWELL HOMES LLC 1202 ME]ZIDIAN AVE � 11/19/2007 PHONE: SANITARY NO. CONTROL NO. (408)26'7-9400 ARCHI7ECI7ENGINEER: BUILDING PERMIT INFO HLDG ELECT PLUMB MECH � � � � u O p LICENSED CONTRACTOR'S DECLARATION JOU D05Ci1pU0I1 � 1 hcrcby affirm Uut I am liccnacd undcr provisions of Chaptcr 9(commcncing � z � wi�h Scction 70(M)) of Division 3 of �hc Business and Pro[cssions Codc s n d my licensc is C �jv]�Z�N .�REA E L E C T R I C MET ER �� y in full fom and e(fec� ;� � � j v� Z Licensc CI ��• x y E„ p Da�c � Con � AR HITECI'S DECLARATION �� t t undcrsund my plans shall be wcd as public rccords 7yU � � y Liccnsed Pcufcstional n y � OWNER-BUILDER DECLARA'I70N I hcrcby affirm �ha1 1 am ucmpt Crom ihc Can�ractor's Liccnsc Law far thc � t � r � L p o following rcason. (Sxtion 7031.5, Business and Professiona Cadc: Any city or county K°, �i which ccquires a pemiit to conswct, altcr. improvc. dcmoli�h. or mpoir any suucturc � Z � prior w ils issuancc, alsu tcquires ihc applicant for such pertnit to filc a signed sla�mcnt < that Ne is liccnscd pursuant to thc pmvisions o[ ihc Conuxtor's liccnsc Law (Chapicr 9 Sq. Ft. Floor Area � 5 O O Valuation Y t = - �(commencing wiih Secdon 7000) of Division 3 of �hc Busincss and Profcscians Cade) ar i�� that he is exempt themtrom snd the basis for the alugcd eumption. My violation of Section 7031.5 by siry applicant for a pem�it subjecu ihe applicant to a civil penalty of A� Number Occupancy Type not more �han five Aund�ed dollars (5500). 3 5 6 � 3 � Q L. Li 1 O ❑ I, u owner of Uie property. a my employcea with wages u the'v solc compensatioa, willdothework.andihesuuaumisnotinten�doroffecedforsale(Sec.7044,Businesa Re uired Ins ections and Rofessions Code: The Conuxwr's License Law dacs not apply m an ownec of 9 p propeny who Iwilds or improves �hercon, and who daes such work himaelf or through his own employces, provided tha� such improvemrnls are not intended or oRered for sala 1[, however, the building or imp�ovement ia sold within om year of completion, ihe owner- builder will haw Uu burden oC proving �Aa� he did not build or improve tor purpose of saleJ. ❑ I, u awna of We property, am acdusively contncting wi�h littnaed rnntractors w consuuct �he project (Sec. 7044. Business and Professions Code:) 72�e Contrxtor's Li- cense Law docs no� apply �o an ownu of property who builds or improves Weieon, and , who conuacts Cor such p�ojects wiih a convacwr(s) licensed pursuant a We Contrutor's Licenae Lsw. ' I am aempt undu Sec. , B& P C for this reuon iner �a� WORKER'S COMPENSATION DECLARATION 1 dercby affitm under penalty of pery'ury ane of the following declaradans: ❑! hs.�e and will mainuin a CeniGcate o( Consent lo ulf-insure Cor Workcr's Compen- sation, at provided for by Section 3700 0[ �he [abor Code, far �he perfortnance o[ thc worlc for which Ihis permit is issued. ❑ I havc and will maintain Workcrs Compensaaon Insurana, as �equired by Scction 3700 oC thc Labar Code. Cor thc performance of �he work for w6ich this pertnit is issued. My Workers + C�o . m�pensatian Insurana cartier and Policy numbcr a�e: Cartier. •-t � � t7!'� �li No � � 'fE O O M ER COMPENSATiONINSU ' (This sccUon necd not bc complctcd if the permit is foronc hundrcA dollus (S 100) or Icss.) ' I cenify that in thc performance of thc work fw which ihis permii is issucd, 1 shall not rmploy any person in any mamur so u W bcrnmc subject to the Workcrs' Compensauon Laws of Cali(omia Dale Applicam N017CE T'O APPLICAM: If, a(icr making �his CcrtiGca�e of Excmption, you should become subject W ihc Worker's CompcnsaGon ptovisions af ihc (.alwr CodG yau must � O forthwith camply with such provisions or �his pecmil shall be deemed eevoked. z "" CONSTRUCf10N LENDING AGENCY [. �-�. I herchy sflirm �hat thcre is a consuuction Icnding agcncy for thc perfartnance of , �Y., � ihe work [o� which this permit is issucd (Scc. 3097, Civ. CJ W� Q Lendcr's Namc ' � z (,cnder's Addmss V � � cecti(Y �hst I have read �his apphtwon and siatc that thc above informauun is w � cortccL I agrce w comply wi�h sll city and counry ortfinanccs and au�e laws relating W 0 U buildin6 conswctlon, and hereby authorin repmsentativcs of ihis city to cntcr �pon Uu � W atave-menGoned pmpcny far inspec�ion purposes a (Wc) agree to save, indcmnity and kecp hazmless ihe City of Cupertino against �,F„� � liabilitiu, judgmcn�s, cos�s and expenses which may in any way accruc againsl said City V� in consequence of ihe granting of this permit. Date ►'" APPLICANI' UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by �7 rJ� SOURCE REGULATIONS. / � - � Re-roofs � Signature of A icant/Conuactor Da�c HAZARDOUS MA'fERIA1S D[SCLOSURE Type of R oof j� � Will Ihe appliant or future building occupant storc or handlc ha•rallous malcrial G efincd by thc Cupenino Municipal Code. Chaplcr 9.12, md thc Hcal�h and Safcty k. Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed. �y� ❑No Will the a�licant or futurc building accupant use cyuipmcnt w dcvices which If a roof i� installed without first obtaining an inspeetion, I agree to remove emit hai.ardous air contaminanls az dcfncd by the Bay Arca Air Qualily Managemen� all new m aterials for inspection. Districc? QYes u 1 havc rcad the hvaMm�s ma�crials requircmcn�5 umlcr Chap�cr 6.95 of Uu CaliCor- nia Hcalth & SatcryCodc, Seciions 25505, 25533 aru125534. f wukts�and thu iCthc building docs no� curtcntly ha an4 iha� it is my responsibiliry m notify thc occupant nf �hc rcyu�rcmcn�s w� bc t pri uancc o[a Ccnit;�c oroc • --�rj gnature of Applicant Date /� All roof coverings to be Class "B" or better Owner or au orized agen� 0�� ��1/�C�� . ; � CITY OF ��UPERTINO . ' PERMIT APPI,ICATION FORM CUPEI�TINO APN# �S� o� �(1�, �/ Date: 1/� � � , � � Buildi�g Ad ress: Mailing Address (if different from buil ing address): �� � � La7' � , Owner's Name: Q C � t � � � � � C Phone # � g n � �'� � � G C o�'Y� oc Contractor: License # ��3 � �a� c� ct C t;,) ��\ �� S Contact: � Phone: Cupertino Business License#: ' � — � � � � °) �f 07 Fax: � � " Building Permit Info: C�r�j'(G.�'j ,(� � �'�l �C� / �,c�t-3� � ��1�/ � , Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: „ Residential �'�'� � `� � �� � � Commercial ❑ Sq.Ft. Floor Area: ,.�� i� C� � C�-� Q ��� Sq.Ft.: Cost of Project: r� � Occupancy Group: / Type of Construction: � Please check this box if the project is a second-sto addition: � Project Size: Standard ❑ Lar e❑ M;i�or ❑ Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER Other A liances MECHANICAL BBOILERl B��iler <= 100,000 Btu MECHANICAL BBOILER2 Boil�r > 100K to SOOK Btu MECHANICAL BBOILER3 Boiler > SOOK to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHAIVICAL BBOILERS l3oiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX I�id/Off/Comm/Quasi BUILDING BCONSTAXBQ C��n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Cc>nstax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 l�,lec 600V > 1000A ELECTRICAL BELEC200 ' Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING l of 3 � (j�/- C.'_� � .��7'`�e l�Gt�� S � CITY OF ��UPERTINO �( � p p �a�� ��� �F pERMIT APPI,ICATION FORM CUPEl�TINO Quanti Fee ID Fee Descri tion Fee Grou BMISCELL Miscellaneous Fee BUILDING BMITIGATC Coinm. Housing Mit. Fee BUILDING BNUCOMME rdew Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP :�ew Comm Plumb PLLJMBING BOVERTIME I:�s ection Overtime BUILDING BPBACKFLOW Atmos heric Vacuum PLUMBING BPCESSPOOL Cess ool PLLTMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS G�is Pi in System Fee PLUMBING BPINTERCEP Ir.d Waste Interce tor PLLTMBING BPLANCHK Plan Check Fee BUILDING � BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Pl �n Check Re eat Fee BUILDING BPREPIPE ��e i e Of Fixtures PLUMBING BPSEWAGE Sewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK La�vn S rinklerBackflo PLLJMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tra PLUMBING BPVENT ��lt of Drain & Vent PLUMBING BPWATER Ins�talVAlter Water Pi e PLUMBING BPWHEATER `Vater Heater/Vent PLUMBING BPWSVCS rdain Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A�C Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHAlvICAL BREMBUSWAY fZemodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN R�location of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHA1vICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD I»stallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREI�INRAPP Re�n Non-Res Ap liance ELECTRICAL BREMPOLE P �le/Platform Fixture ELECTRICAL BREMPOWER Pov��er Device/A aratus ELECTRICAL BREMRECEPT Rc �tl, Switch & Outlets ELECTRICAL BREMRELOCA ]Zelocation of Hood MECHANICAL BREMREPALT T.epair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL ? of 3 CITY OF ��UPERTINO CUPEI�TINO PE�IT APPI,ICATION FORM Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rnidl Signs Add Branch ELECTRICAL BREMSIGNS Retnodel Signs, Mar uee ELECTRICAL BREMTHEATR Tr eatrical Lightin Fix ELECTRICAL BREMVENFAN V��nt Fan Sin le Duct MECHANICAL BREMVENSYS � entilation S stems MECHANICAL BSCBLVD Scb S ecific Plan BUILDING BSEISMICOM S��ismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL S ecialIns ection BUILDING BSWIM Swimmin Pool BUILDING BTEMP 7'em ora Power ELECTRICAL BTEMPPERM Teni ora Bld Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical s foot ELECTRICAL ( EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE TZechanical sq. foot MECHANICAL MPERMITFEE Mf�ch Permit Issuance MECHANICAL PPERMITFEE Plumbin Permit Issue PLUMBING PPLBG Plumbing Fee s foot PLUMBING PLLONGRNGC Plannin ; LR Comme/ Multi-Fam PLANNING � PLLONGRNGR Plannin ; Lon Ran e Residential PLANNING 3 of 3 INVOICE INVOICE INVOICE INVOICE INTOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: patg Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 356)3001.L16 INVOICE DATE......: 11/L9/2007 REFERENCE ID # ...: 07110106 SITE ADDRESS .....: 10634 STEVENS CANYON RD LOT 16 SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............: ROCKWELL HOMES LLC ADDRESS ..........: 1202 MERRIDIAN AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95125 CONTR.ACTOR .......: MACK MOHSEN LIC # 27921 COMPANY ..........: ROCKWELL HOMES INC ADDRESS ..........: 1202 MERIDIAN AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95125 TELEPHONE ........: (408)267 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ---------------- ---------- ---------- ---------- ELECT SVCS 600V <=200A PRINTING PERMIT 29.43 0.00 9.43�, BLDG PERMIT FEES PRINTING PERMIT 83.16 0.00 83.16 �� SEISMIC RESIDENTIAL PRINTING FERMIT 0.50 0.00 0.50 `' ELEC PERMIT ISSUANCE PRINTING FERMIT 40.79 0.00 40.79 t ---------- ---------- --------- � 153.88 0.00 153.88 � � VOICE ID DESCRIPTION VOICE ID DESCRIPT ON 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FR.AME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FR.AME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY CITY OF CUPERTINO 4 ITEMS OF 4 PERMIZ RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 35603001.L16 DATE ISSUED.......: 11/19/2007 RECEIPT #.........: BS000003280 REFERENCE ID # ...: 07110106 SITE ADDRESS .....: 10684 STEVENS CANYON RD LOT 16 SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... OWNER ............: ROCKWELL HOMES LLC ADDRESS ........... CITY/STATE/ZIP ...: , RECEIVED FROM ....: FRFNK YAVARI CONTRACTOR .......: MACK MOHSEN LIC # 27921 COMPANY ..........: ROCKWELL HOMES INC ADDRESS ..........: 12C2 MERIDIAN AVE CITY/STATE/ZIP ...: SAI�� JOSE, CA 95125 TELEPHONE ........: (4C8)267 FEE ID UNIT QUANTITY �.MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BELEC200 METERS 1.00 29.43 0.00 29.43 0.00 BPERMFEE VALUATION 500.00 83.16 0.00 83.16 0.00 BSEISMICRE VALUATION 500.00 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 � .'�` ' Community Development 10300 Torre Avenue �' '��� -' Cupertino CA 95014 Telephone (408) 777-3228 C(TY OF Fax (408) 777-3333 CUPEi�TINO Buildin De artment JOB ADDRESS: ��, /P � S , �� PERMIT # /O C�3 v ��'�� ' � � �a,�a� OWNER'S NAME: iC � Q l� l� ��-m� s PHONE #./{� - ��/ v� GENERAL CONTRACTOR: FAX # I am not using any subcontractors: � - � - �-- � - � T ' ,�nature Date Please check a licable subcontractors and com �lete the followin information SUBCONTRACTOR BUSIl`JESS NAME SUSINESS LICENSE # Cabinets & Millwork Cement Finishing IIectrical 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 _� y _ _ ( — � � Own / Contractor Signature Date