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07110041 CITY OF CUPERTINO ° BUILDING UIVISION , PERMIT ��« ;; ;.: ,. BU1LD NG D ESS: PERMIT NO. . _.:. . ,:__. �1�� VAI AVE BRYAN & SUSAN LANSER 07110041 . JER'S NAME: PERM�T �SUE DATE BRYAN & SUSAN LANSER 21333 �AI AVE � 11/08/2007 PHONE: SANITARY NO. CONTROL NO. ARCH17'ECT/ENGiNEER: BU[LDING PERMIT INFO BLDG ELECT PLUMB MECH � � � 0 � O p LICENSED CON'TRACfOR'S DECLARATION ;� V I hcrcby afGrm Nat I am liccnscd umlcr provisions of Chaptcr 9(commcncing Job Description Z � with SccGon 70(N)) of Division 3 of thc Busincsc and Profcssions Codc, and my licensc is ADD S KY L I GHT @ K I TC H EN °= y in full foree and effect. � Z Licensc Class L�. � �'-� F„ p Dam Con�racwr ' � ARCHITECI'S DECLARATION e 1 undcrstanJ my plans shall bc used u public rccorda ;qU L O y Lii:ensed Prufcssional n y � OWNER-BUILDER DECLARA'CION � < f I hcrcby alTirm ihat 1 am exempt fmm ihc Coniractor's l.iccnsc Law for �hc O O (ollowing rcaton. (SccGon 7031.5, Busincss and Profcssions Ca1c: My city or county e m Pi which rcquims a permit to cnnswct, aller, improve, demalish, or �epair any swaum '� Z y pnor ui its issuancc, also rcquires thc applicani for such permit to filc a signcd s�a�cmcnt �_ � that he is liccnsed pursuanl ta thc provisiona of the ConUactor's Liccnsc Law (Chapter 9 Sq. Ft. Floor Area Valuation y F- �(commcncing wi�h Sccdon 7000) M Division 3 0( tlic Busincsc and Profexsions Codc) or $ 1 8 � � y �.. that he ia exempt che�efrom and the buia for t6e allegcd exemption. Any violation o( Sation 7031.5 by a�ry appticant for a pecmit su6jecu the applicant to a civil penaRy of Number Oceupaney Type not mme man eve nanarea auuars cssoo>. 3 6 2 0 5 01 2`.�� ❑ I, u owner of the property, or my employcea with wages u the'v solc compensadon, will do 1hc work, and ihe atiucwce is not intendcd or oRered for salc (Sec. 7044. Busineu and Professions Code: The Conuactor's License Law does not apply m an owner of Required Inspections propeny who builda a imptovrs thercan, and who does sucA work himuif or through his own employces, provided ihat such improvemen�s arc nat in�ended or ofiered for sale. l[, Aawever, �he building or improvement is sold within one year oC complcuon, tlrc owner- builder wili hm the burden of penving IAat he did no� build or improve (or purpose of sakJ. u owner of the property, am exclusively conuacting wilh ticenud rnnuactors w nauuct ihe p�nject (Sec. 7044. Businas and Professions Code:)'ILe Conuxmr's Li- cense Law docs not spply to an owner of propeny who buitds or improves themon, and , who contrac�s for such projecLS with a conuactar(s) licensed pursuant to the Convactor's License Law. '"'� I am ezempi under Sec. , B dc P C fw ihis rciwn ner Date \ WOR C•'S CO! P NSATION DECLARA7TON I hercby atTirm un r penalty o[ pe�jury one of the following declarations: ❑ I hsve and will mainuin a Ccnifinm o( Consent to xlf-insum Cor Worker's Compen- ution, u provided for by Secdon 3700 0[ che Labor Code. far the performancc of �he work for which �his permit is issucd. ❑ I have and will mainuin Worker's Compensation Insunnce, u required 6y Scnion 3700 of ihe Labor Code. Cor the pedormance of �he work fw which Wis permit is issued. My Worke�s Compensa�ion insunnce carrier and Policy number a�c: Cartier. Policy No.: CERTIFICA7'E OF EXEMPI'!ON FROM WORKERS' COMPENSATIONINSURANCE • (This scctian necd not bc completeJ if the pc�cnit is fw anc hundred dallazs (5100) or Icss.) • 1 cutify ihn� in thc performance of thc work for which Ihis permil "u issucd, l shall not cmploy any pccson in any man ic�r o b�some subjec� w the Workcrs' Compensation Laws of Califomia. G ',' Applicam w � �� NOTICE 7'O APPI] AM: [, af�cr making �is Certi[ica�c of ExempGan, you should become subjcct w thc Worter'a Compcnsation provisions of Nc Labor Codc, you must � O forthwith comply with such provisions w this pecmi� shatl be dcemed n.woked. z '"'' CONSfRUCftON LENDING AGENCY [— ►�-� 1 hcccby aRrm Ihat thcre ia s conswction Icnding agcncy for thc perCwmar�cc uf p; ✓ ihc work for which �his pertnit is iuued (Sec. 3097, Civ. C.) � � A Lendcr's Namc � • � z L.cnder's Address V 0 I ccniCy ihal I havc resd ihis application and sntc ihu thc ahovc informatiun is w�"' co�cL I agra w comply mth all ciry and county ortiinances and sta�e Iaws relaang w � U building consuucUon, and hcreby authorix mprescntaGvcs of ihis city to cntcr upon tAc W atave-menuoned property for inspecUon purposes. (Wc) astee ta ssve, indcmnify and Icecp humless ihe Cily of Cupertino against i „� � lisbilitiu, judgmcnLS, costs and expcnses which may in any way acccue against said City V z in consequence oC U�e granting of ihis permiG �"� APPLICANT UNDERSTANDS AND W1LL COMPLY WITH ALL NON-POINT Issued by Date `�-�'"�� SOURC EGULATtONS. C Re-roofs � Signaw of App ' UCon r Dam � H OUS MATERIALS D[SCLOSURE Type of R oof f Will Ihe applieant or future buiiding acupant store or handlc ha•rardous ma�cri�l iefined by �he CuperQno Municipal Code. Chapter 9.12, and the Heal�h and Safcry .�. Scction 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. ❑ Ycs �to Will the a�licant or fu�ure building accupant use equipment or devices which If a roof i;� installed without first obtaining an inspection, I agree to remove cmi� harardous air conisminants u defincd by the Bay Area Air Quslity Managcmcnl all new m aterials for inspection. o�$�;�� ❑ Ycs �Nu 1 havc read die hvardous mamrials �equi�cmcn�s undcr Chapicr 6.95 0! U�e Califor- nia Hcalih & Safcry Code, Seciions 25505, 25533 and 25534.1 undctstand thaz if ihe 6uilding does no� curten0y havc a �cnan4 ihat il is my responsiAiliry io noufy Uu occupant of thc � n��e m� n� �� a� a�u�� or. c��r�a� ora�,�r. Signature of Applicant Date Ow�cr or aumori� agcnt ` p„� All roof coverings to be Class "B" or better � � `, ,.1 ' -✓ v��, c yi C 2 , , , -� T .,: � cn 2 rc'� -c� � 0 2� c° �,, = m v M c� �'�,,, tK Z� � o� -� ;o G' m � - � � � � � �� Cs' >! � • �. 'e t'' �-. `° ° �-' � ; ' Cp ... "►� ?:- 2 3 4 ' �' �n �. 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N N � n n � � o � �.� '"T7 � r' C .� �7 � N �' � 'C7 N CPJ � � � ? �� ? �e �' � F �. o � � � � o �� - ' �� n adN � � � s ~• �' � � � �c' � rn � � �• _, j, � -- S oa ►, :.,. a o .' ��` ' , Q. �'h .�.�. 1 � , ,_ �'' '-�� „ � — �i• � �` �� `� � � -.�C `�, �;�, ,�� '' ° c � �� _� � � � �. Cri � �� . �. � � • � �n (D ,.�.� OQ .�.. � (Tq r"'' � ^� � � 0 (� \ �' S / � C ��C � � �� v� � � � � ,� � � � � �. � � � �. .� _ � � �' � � � �, 3 � � � � � � ao' �: -� � / o�ro d � �. � � � � � � � � .d ^ N ` -� W � N � W � � � � �c w o � � W � � �1 � � �. � F� C --. "s p„ � �-�'s �' �- �' O � � N � � � b dq ..�i "+ �. r' ►'"�.. d� ►-t C � � � � x � � � � � z -- � o � � N o � ��c � � � N � � � � � � � � N �� 4 z c � '� � � m �� n � ^ N�'� n \, p�� n � �.� O J I - C � � N � � � �� . � � o � � � � o �� rn � n � �. �' ia �. N ara �� F� � m� � a � Uo � � �n S � �, � . �. cD � x � .'S. � � � � O �-.,:: .—. 7C � � � � � � , f � p � � � 4C D p� � � l ��._.'a , � � � �, � CITY OF CUPERTINO 3 ITEMS OF 3 PERMI'.' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: BlJ:: Lot: APN ......... 36:?05012.00 DATE ISSUED.......: 11,'08/2007 RECEIPT #.........: BS�)00003195 REFERENCE ID # ...: 07:_10041 SITE ADDRESS .....: 21:333 VAI AVE SUBDIVISION ....... CITY .............. CU:?ERTINO IMPACT AREA ....... OWNER ............: BR�tAN & SUSAN LANSER ADDRESS ..........: 21:333 VAI AVE CITY/STATE/ZIP ...: CU:?ERTINO, CA 95014 RECEIVED FROM ....: BR�tAN liANSER CONTRACTOR .......: LIC # *OWNER* COMPANY ..........: BR�tAN & SUSAN LANSER ADDRESS ..........: 21333 VAI AVE CITY/STATE/ZIP ...: CU?ERTINO, CA 95014 TELEPHONE ......... FEE ID UNIT QUANTITY .�MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 83.16 39.92 0.00 39 .92 0.00 BPERMFEE VALUATION 1,800.00 83.16 0.00 83.16 0.00 BSEISMICRE VALUATION 1,800.00 0.50 0.00 0.50 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 123.58 0.00 123.58 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 123.58 #6935 --------------- TOTAL RECEIPT : 123.58 o�l � I � ��k _ = CITY OF �CUPERTINO CUPE�TINO PERMIT APPI.ICATION FORM APN # � l.� � � � �� Date: t I r 6 j � � � � Build' A d ess• , Mailing Address (if different from building address): �� v'r�I l�"V� Owner's ame: Phone #: � ��w� L�r-� �f0� 2S 3 1� 3 Contractor�� License #: v � Cont t: Phone: �� Cupertino Business License#: � cc.� 1�a- `�� F�: 2� � ( �� Building Permit Info: _ _.('� �� ; �� j��"� � � ��t �h�n Bld � Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: tQ- /�/� ��/� Occupanc Gro �` b W V . Cit� r � Type of Construction: Please check this box if the project is a u�c.� �C�, � second-sto addition: � Project Size: Standard ❑ Large ❑ M,�'or ❑ Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER Other Ap liances MECHANICAL BBOILERI B��iler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to SOOK Btu MECHANICAL BBOILER3 Boi ler > SOOK to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILERS ]3oiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING � BCONSTAX bid/Off/Comm/Quasi BUILDING BCONSTAXBQ C��n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR C��nst� — Resi/Mobile BUILDING BELEC 1000 E lec 600V <= l 000A 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 1 of 3 CITY OF I�UPERTINO CuP��T�NO PE�IT APPL,ICATION FORM Quanti Fee ID Fee Descri tion Fee Grou BMISCELL Vliscellaneous Fee BUILDING BMITIGATC Cor�un. Housing Mit. Fee BUILDING BNUCOMNIE T(ew Comm Electric ELECTRICAL BNLJCOMMM Ne�,� Comm Mechanical MECHANICAL BNLJCOMMP 11ew Comm Plumb PLUMBING BOVERTIME vis ection Overtime BUILDING BPBACKFLOW A:mos heric Vacuum PLLTMBING BPCESSPOOL Cess ool PLUMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS G� s Pi ing System Fee PLUMBING BPINTERCEP Ind Waste Interce tor PLLTMBING BPLANCHK Plan Check Fee BUILDING ' BPLANCKADD Pl �n Check Add Multi BUILDING BPLANCKREP Pl�in Check R eat Fee BUILDING BPREPIPE F:e i e Of Fixtures PLUMBING BPSEWAGE Sewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK La�vn S rinklerBackflo PLLTMBING BPSTORM �torm/Rain Water PLUMBING BPTRAP Kitchen Tra PLUMBING BPVENT �.lt of Drain & Vent PLUMBING BPWATER Ins1 alUAlter Water Pi e PLUMBING BPWHEATER �Vater Heater/Vent PLUMBING BPWSVCS TZain Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/� Unit > 10,000 cfin MECHANICAL BREMAIRHAN A1C Units <= 10,000 cfin MECHArtICAL BREMAPPLI Appliance Install MECHAIVICAL BREMBUSWAY :Zemodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN R�;location of Furnace MECHANICAL BREMFURNOV Re: o Furnace > l OK btu MECHANICAL BREMHEAT 3eater Installation MECHANICAL BREMINHOOD Ii►stallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAFP Rer� Non-Res A pliance ELECTRICAL BREMPOLE Pc>le/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rc rtl, Switch & Outlets ELECTRICAL BREMRELOCA F:elocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Re�nodel Res Ap liance ELECTRICAL :: of 3 � CITY OF ��UPERTINO CUPE�TINO PE�IT APPL.ICATION FORM Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rrridl Signs Add Branch ELECTRICAL BREMSIGNS Rernodel Si s, 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 'Cem ora Power ELECTRICAL BTEMPPERM Tern orar Bld Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical s foot ELECTRICAL EPERMITFEE E:.ec Permit Issuance ELECTRICAL MPERMFEE l�Iechanical sq. foot MECHANICAL MPERMITFEE M��ch Permit Issuance MECHANICAL PPERMITFEE Ph�mbin Permit Issue PLUMBING PPLBG P lumbin Fee s foot PLUMBING PLLONGRNGC Plannin;J LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin;7 Lon Ran e Residential PLANNING 3 of 3 Community Development �` ''.,� ' 10300 Torre Avenue .:� � �;s; : Cuperti.no CA 95014 ��' ' Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEi�TINO Buildi:n De artment JOB ADDRESS: Z i3 � � �� PERMIT # � � � , OWNER'S NAME: `� �' rx.�� L�-,,��.-�— PHONE # 2S 3�� GENERAL CONTRACTOR: S'� c�.�- ��•., _. FAX # I am not using any subcontractors: l� Si�;nature I7ate Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIrtESS NAME BUSINESS 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 l� r/ o tractor Signature Date