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File Edit Actions Details Links Favorites Help rti -ia • Perrnit Inforriiation Permit Number 07030236 Status ` C - Closed �+ Master Number (q7 Notes 0 Project [q Apply Date % 03/26/2007 Operator bethe Permit Issue Date 06/07/2007 Operator suew Certificate Issued 11/28/2007 Operator PALM Certificate Type Certificate Number Permit ` Property Zoning Applicant ContractorDefined Fields Location Inforrnation Address x 1 10737 BROOKWELL DR City/State/Zip CUPERTINO APN 36921005.00 Unit j Oa-mer Entity Information Owner Name " TRACEY PHILIP W ET AL Use Default 11 Address Home - ® 95014 City/State/Zip CUPERTINO C4 95Q14.4608 Permit Details Permit Type' SFDWLADOI �QI DO NOT USE Usage Class x JDWL--WNEW lgl' DDWELLING TYPE 5 WOODNEW J Applied Value x 150000 SQUARE FT. i 497 Calculated Value 244554 raw US C-404 Type ' 4L 34 ADD: RESIDENTIAL Permit Form ` iAUTOPERM - PERMIT Ownership 1 - Prig gate r+� Project Size w' Permit issued 0610712007 Enter the purpose or anv special conditions for this permit Purpose/Special Conditions ADDITION OF A DINING ROOM, BEDROOM REMODEL OF KITCHEN, BATHROOM LIVING ROOM AND BEDROOMS_ -SANITARY IS SUNNYVALE'S JURISDICTION_ ;PORCH 6 DECK = 96+160*38.51=9859 REMODEL = 1272*100.75=128154 FILMED- 20111 [Add Default T v 1%/OK Back F Contractors l-W Fees lj Plan Reviews la Inspections Print Permit (Adjustments Ifli Holds KCopy Permit Close Permit Overrides l Supplemental Fields I'lNotes I1nAttachments Y 0C m <a �v E� a� F U. N — <C °e m z; FC r3' CITY OF CUPERTINO BUILDING DIVISION PERNUT PERMIT NO. BUILDINQ ADDRESS: 10737 BROOKWELL DR TBD - TO BE DETERMINED 07030236 OWNER'S NAME: PERMIT ISSUE DATE TRACEY PHILIP W ET AL 0 7 2 7 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is �% ADDITION OF A DINING ROOM, BEDROOM in full force and effect y�a License Class Lieu REMODEL OF KITCHEN, BATHROOM LIVING ROOM AND Date tractor R HITECTS Du+ jao BEDROOMS . - SANITARY IS SUNNYVALE ' S JURISDICTION. I understand my plans shall be used as public t1ccords Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the rollowing reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a 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 Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation i that he is licensed pursuant to the provisions of the (commencing with Section 7000) of Division 3 of the Business and Professions Codc) or $ 2 4 4 5 5 4 . that he is exempt therefrom and The basis for the alleged exemption. My violaton of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type not more than five hundred dollars (SS00} 3 6 9 210 0 5"'�'t�� ❑ 1, as owner of the property, or my employes with wages as their sole compensation, will do the work, and the structure isnot intended or offered for sale (Sec.7044,Business Required Inspections 01 p and Professions Code: The Contractor's License Law does 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.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractor's U- ccnse 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 Contractoes License Law. C:]1 am exempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, 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 Codc• for the performance of the work for which this permit is Issued. ' My Worke(r�"fo�mpen�s}a�don In ants carrjer and Polity num�cr/^am% ? •� 64 OV (v Carrier: J" t:r_ � Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE " (This swdon need notbe complemd if the permit is for one hundred dollars (S100) or less.) 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Sec. 3097, Civ. C.) ' Lender's Name Lender's Address I certify that I have read this application and state that the above information is -' correct. I agree to comply with all city and county ordinances and state laws relating to " building concoction, and hereby authorira representatives of this city to enter upon the above -mentioned properly for inspection purposes. L (We) agree to save, indemnify and keep harmless the City of Cupertino against n liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit -' APPLICANT UNDERSTANDS AND WILL C PLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. �' Re -roofs "2— Signature of Applicant/Contractor Date HAZARDO MATERIALS DISCLOSURE Type of Roof Will the applicant or fu building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. [:]yesj%No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emir hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes No I have mad the hazardous materials requirements under Chapter6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not curtendy have a tenan that it is my responsibility to notify the occupant of the requiremeurs which mast Ix o issuance of a certificate or occupancy. Signature of Applicant Date ' " All roof coverings to be Class "B" or better Owner or auth • od agent Datc adu CITY OF CUPERTINO SCITY OF CUPERTINOO PERMIT APPLICATION FORM ADDITION/REMODEL APN # 3 q -,� 1 r 006 Date: Building Address: ©� -3- RybVkVwt Dr. QP/n 0 Cd7f,r77(CZ Mailing Address (if different from building address): Owner's Name: I C j „� mcey Phone #: C�W&) Contractor: C �s�ucf� Phone: C '%I r-_11,44 State License #- Fax: Ci Contact:��� �� Phone: CM) $� i - 37� pertino Business License#;• Fax: Building Permit Info: A A J- IN ZY, / rL e- Bldg Elect Plumb Mech Job Description: What is being added? t ti A.c . c What is being remodeled? e%AyvoyvS . Residential 4 Commercial ❑ Remodel Includes Re -Roof: Yes No ❑ Remodel Includes Structural: Yes No ❑ Square Footage: Addition: l.fq -, Remodel: j Z Garage: 4M Porch: Qz Deck: y b Other: Cost of Project: a, Occupancy Group: Type of Construction: Please check this box if the project is a second -story addition: ❑ Project Size: Standard C3 Large ❑ Major ❑ *For office use only* ❑ Over the counter 1 of 3 cof CUPEkTINO ,*CITY OF CUPERTINd* PERMIT APPLICATION FORM ADDITION/REMODEL Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2. Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housin Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING �`. BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING 2 of 3 CITY OF CUPERTINO* CITY OF CUPEkTINO PERMIT APPLICATION FORM ADDITION/REMODEL Quantity Fee ID Fee Description Fee Group BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL 7 MPERMFEE Mechanical s . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING 7 PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3 Community Development s 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPERTINO Building Department JOB ADDRESS: PERMIT # d (moo L �`7�'�u�-3� OWNER'S NAME: - �- ; 0 PHONE # GENERAL CONTRACTOR: - FAX # I am not using any subcontractors: �� / ✓� �(� - �� r � � Signature Date Please check avvlicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS 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 Owner/ Contractor Signature Date