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07110036CITY OF CUPEKITNU BUILDING DIVISION PERMIT ADD ESS: 013 SWEET OAK ST cER'S NAME: KAY TOLOMEO PHONE: yOz <W �i ii ?C6U U. Aye �p0 KmEn FFC iERs 00 z� r -r L1, A �z UO LT. Fm OU a rA U ARCHITEC (ENGINEER: LICENSED CONTRACIUtcs UMLAKAI tun I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade. and my license is in full force an feet. O Z License Class Lm• N Dam Contractorl !A/ ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires it permit to construct. alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollar ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work. and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conuactoes License Law docs not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. I am exempt under Sec. B tit P C for this reason aer Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self -insure for Workers Compen- ss as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section neM not be com d if the pc ' is for one hundred dollars ($100) or less.) 1 certify that in thrm e e w r ich this permit is' ucd, l shall not employ any persoy m subject to the W Compensation Laws of Cslifo 'in Applicant ` NOTICE It AbOLICANT: It. r in this Cc ific of Exemp n, you should become subj Lo the Worker's Compc tion provist of the Labor otic, you must forthwith co ply with such provisions this permit shall be deemed ked. CONSTRU ON LENDING AGENCY Iby affirm tint there is construction lending agency for performance of the. work f r which this permit is i ued (Sec. 3097. Civ. C.) Lender's Namc L endees Address I certify that 1 have read this application and stare that the above information is cortecL I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representativeyof this city to enter upon the above-mentioned proy for inspection poses (Wc) agnx ve, indcmn' an/U�rm the City of Cupertino against liabilities, judgmen ,oats and y y way accrue against said City in consequence of granting peAPPLICANT U ERSTAN S AND PLY WITH ALL -POINT SOURCE R,I«G TIONS. , Signature of fpplica'nt/Contractor are HAZARDOU ALS DISCLOSURE Will/the applicant or future buildi g occupant store or handle h • ous material eftned,�y the Cupertino Municipal ode. Chapter 9.12, and the alth and Safety Jc,Section 25532(a)? ❑Yes ❑No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area r Quality Management District? ❑ Yes ❑ No 1 have mad hazardous arc s requ' cnts r Chapter 6.95 of the Califor- nia Health S, Safct ode, Sectio .255 .1 understand that if the building does not Curentl avc a ten it is 'lity to notify p t of the requirements w h must be m or a rtifcac copancy. or PERMIT NO. TBD - TD BE DETERMINED 07110036 PERMIT ISSUE DATE 11/07/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description BATHROOK REMODEL NEW STRUCTURAL. MAG CONSTRUCTION PD BSL 11/7/07 3q. Ft. Floor Area I $7000 3265100V Issued by: Re -roofs Type of R Required Inspections 9 e n All roofs ;hall be inspected prior to any roofing material being installed. If a roof i; installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPERTINO 9 ITEMS OF 9 PERMI`[' RECEIPT Sec: Twp: Rng: Sub: Bl -r,: Lot: APN ......... 32,351008.00 DATE ISSUED.......: 11/07/2007 RECEIPT #.........: BSI)00003184 REFERENCE ID # ...: 07/10036 SITE ADDRESS .....: 11)13 SWEET OAK ST SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER KK( TOLOMEO ADDRESS ..........: 11)13 SWEET OAKS ST CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: MAG CONSTRUCTION CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096 COMPANY ..........: TB -D - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: TELEPHONE ........ FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- BENERGY ------------- PERMIT FEE ---------- 137.16 ---------- 65.84 ---------- 0.00 ---------- 65.84 ---------- 0.00 BPERMFEE VALUATION 7,000.00 137.16 0.00 137.16 0.00 BPFIXTURE UNITS 2.00 18.00 0.00 18.00 0.00 BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0.00 BREMVENFAN NO UNITS 1.00 45.39 0.00 45.39 0.00 BSEISMICRE VALUATION 7,000.00 0.70 0.00 0.70 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- TOTAL PERMIT ---------- 390.66 ---------- 0.00 ---------- 390.66 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 390.66 --------------- 390.66 REFERENCE NUMBER -------------------- #3427 O O J E O L m a L L A LJ 9 ASSESSOR COPY O O C M O .� �C) 00 ~— vl- 10 N �♦— M Lo O C (Y) O 0 .� U U) w 0 z N 1 r rn 0 U O �- O M I— vii O, O co 04 CY) U) w 0 z N 1 . OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM FEE SCHEDULE Quantity Fee ID Fee Ilescription Fee Group ( EPERMITFEE Eectrical Permit Fee MPERMFEE Mechanical Permit Fee PPERMITFEE Plumbing Permit Fee 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) 1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) TRAVDOC Travel & Documentation BUSLIC Business License 5 of 3 CITY OF CUPERTINO 3 ITEMS OF 3 PERMI`C' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN ......... 35308022.01 DATE ISSUED.......: 11/29/2007 RECEIPT #.........: BS)00003360 REFERENCE ID # ...: 07L10165 SITE ADDRESS .....: 20520 STEVENS CREEK BLVD BLDG SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER S TARBUCKS ADDRESS .......... CITY/STATE/ZIP ...: SAJ FRANCISCO CA, CA 94103 RECEIVED FROM ....: R :C ELECTRIC INC CONTRACTOR .......: RO3INSON, GARY LIC # 10239 COMPANY R { ELECTRIC INC ADDRESS 42:`21 OSGOOD RD CITY/STATE/ZIP ...: FREMONT, CA 94539 TELEPHONE ........: (510)770-5660 FEE ID UNIT QUANTITY LiMOUNT PD -TO -DT THIS REC NEW BAL ---------- ----------------------- 1ELECINSP HOUR ---------- 1.00 ---------- 122.38 ---------- 0.00 ---------- 122.38 0.00 1EPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- TOTAL PERMIT ---------- 203.96 ---------- 0.00 ---------- 203.96 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 203.96 --------------- 203.96 REFERENCE NUMBER -------------------- #16515 CITY OF 7UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS:PERMIT acs C�pe'� 11 0) # --� OWNER'S NAME: 3J 1 PHONE # IS F� G GENERAL CONTRACTOR: '77 FAX # I am not using any subcontractors: Si;nature Please check applicable subcontractors and comi:)lete the following information: Date - 17 1 ` Owner/Contractor Signature l I v -.l N -. Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing x 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 1 ` Owner/Contractor Signature l I v -.l N -. Date