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06040081CITY OF CUPERTINO n�,tim BUILDING DIVISION PElVvlil Bu1LDINC AODREss: OLGA VASILIEV "E"h'rf N006040081 18730BARNHART AVE OWNER'S NAME: PEAMrr ISSUE DATE OLGA VASILIEV E: SANITARY NO. CONTROL NO. ARCH=fENGINEER: BUILDING PERMfr INFO BLDG EIECr PLUMB MECH 0 0 LICENSED CONMAC1IMS DECLARATION Job Description I) booby .f Me Wal 1 un lilzn 1 under prwirion. or CLper 9 (mmnsMn{ with Secdm 70011) NDir 3ofde Bovr w PM(nsou CD&, and mylianau mf.nfD "c ffa THREE SLIDING GLASS.DOORS, INSTALL SMOKE Do a°m Lcmu�ne DETECTORS WHERE NEEDED SDECLARATION ARCHr7Eall bo I unmkrsund my pWuad u publicrmM FI � �® �O LkmaJ PmfcW p.l - OWNER-BUILDER DECLARATION 1 heaby .ITu Wu I .m eaempl fmm We Cmmmar. LJ=w L.w for the folmwirmp. (Scrum 7W1.5, Boa^^.. and Pmfnuwe Code Aq c Y m mumr AtOK 291. 2006 bxb agulres • pnmh w cmCrcL ilex, mpr demaheo. m wpm say .uumWc UW(CYaplv9 Sq. Ft. Floor Area Valuatio 500 WUW nlecvad pu.Iatb,pon.malof We C000:ua'slkcna j(commcrdnlwi Seer 70DD)a Di im3NWCBuarem and Rof®.Code). ibac bo h camp, Woe mr and Oe h fa We L td n Vbm MY NWM6 Of SuLon 7031.5 by A"g ppbrsn(m.p it lbjem de 4PBnnt N a mN Pm Y APN Number panty Type not mmcm f m baNraO dollen(>;7DD>. 37527001. 00 D L u owoc of 0i PIWa•r. m o0' erplorea wirb n�u u Ib['v mk mmpemam. Required Inspections w dolbewool, r.nucoucmmtNmmOcdmaRrml(acuk(See 7( .Boris uN Prf>slau Cod - The Caouuvh Lw"e law don m •Wb W .n owom W pr,,M who W Uds m mproae.Ihmmlm, uN wbodmanehworkhimmJfm W Ibh bu owe employe ,Ird wr Mh Impro. nlsm oo, unto w0flcnd fora If. bmw . the bo"A{ m ompoos Y•Wdmom me yea ofmmplmita4 coo owten bullda wW Use We b udee of pm.iot War W did Ivt WIN or impowe for Por of saN.l O.L, u a..w Df the popny..m -du y ovnRacsinQ W W f....-a amucrar. W concent de pojea (Sec. 7010. Buil. wad P.11 .dam Cod') The CoouacWh LL reue Law dam ml apply N m. of popery wW Wi1Qr m'unporn Ihremi. and wh emlrYWfor mei pojem wW a emtnmv(s) Ocaund ptmul n the Comc.n Llame Law. ❑ I m e.voplvoc See .B hPC fordd. ooy - WORK COMPENSATION DECLARAi - -. - 1bbl aM. ender P.Iy of P.Ju'y mo W We rbl m{dmlunkns 1 bl. o,J w10 comwo a fko.e of Corey n of-hive ra Wwtcls C—Pc sdm, u pr i fa by Savm 370D of Ile Labor Code. fm IW pnfom.am of de wort (m wkkh tb . p.mlt is Lmucd. ❑ I base a will m U i, WDrtcrs Cwpem.Om 1p u . u rtgW d by Stmlm , 3700 of Wa labor Coo. far We poofomuma cfh wvk fa whkh IbV P k u luurd My Wmtd. Comp oo hmu.naa and Policy nmoer m: Curler. Pdk' Na.: CEIMFICATE OF EKFMPnON FROM WORKERS COMPENSATION INSURANCE r ' (Th4 realm nttd nm W campleed If We prmh N farms haord doom (SIOD) or Ira.) 1 mafy, dux In the p.fam.n¢ orf�We work lotwhich hia p h u ivs0.1 YW I oa .vabrn b We Wartem.'Caopermdoo [.Piqyp'.io.nym -: lawn W 011fomla. Due' /A �bttme App nm NOTICE TO APPLICAM. u..rer mwiciAj dd. CcmG= of Eacmpion, you il W bee N de Wo of tW labs Cede, yen muu Compeaulou h pm itA foMwith comply wIW such prnviaom or Wu permit still W dttmed Ie.atca Isamop 5 CO?4MUCItON LENDING AGENCY I hereby M. duet Were u. cnm'Wli. k-&t.Ceter ra the Perfa —of > the work (m which tN. permit is isued (Sec 7097. Cir. C.) :l, L<dcl. Nax ' L<nde>'c Addw Z I comfy Wal I ha� r ad..ppliadm and slue Wu We Ubw inrmry b mmrm 1 aprre W comply with all dty .od commy wdi. W vuc man -W-S W Wddmg cant ion, ad hereby auW mrtymcnu a du. 6'ymmrn open the abort-mnmdund Inapny fa i Xaioe purpoa. (WC) C. W arc. u*mrdfy .d lam lb m the C"y of CPferaru .µml nIlaboL14=Jad{monu.emms.d e.prmu which mty Nanr wy.nrue 1. yid Gly Z ioaonr�mena Wde {nmiafawls PnmiL Date APPIJCAtff,❑ STANDS AND WILL COMPLYNON-POINT SOUR /N`r,gU ONS. O// Issued Rf:400b5 �- Slgmturc o(Appl' HAZARDOUS MATERIALS DISCLOSURE D=Type of Roof W'i0 mW.ppllam af.bWldi.1 aocupmlvae ar loo b.vrdau oo- ri u &fled by the Cupm Mums W Codc. Chip= 9.12 a de Hallh ud S.fmy ma CD 'Sam..15532(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yen ,, ON. J If a roof is installed without first obtaining an inspection, I agree to remove WOI Wc.pplk.nl or future w1cling ozupnt ua wiper, m &N= w b :mit huu w conummseu a &a d by tho My Ar Air Qmllty Mm.Pmmnt all new materials for inspection. DmurkK❑Yn ON. Ihoelead thed+ mumhlsrequclrrnu von@.peW6 DrOe Cildin . WaH.1 dt Safcty41* vau2 and undvaand Wa Nll`1 oto aft don mql mmYlY. dot b u my mspmahOhr N mafy tic vpmt of We 11 my aq.lmmma, ° pdmbisaunmd.cWO .fcc Signature of Applicant Date ' ^ � ��a All roof coverings to be Class "B" or better Owner tt.uthanrad.ec �T a 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37527001.00 DATE ISSUED.......: 04/14/2006 RECEIPT 4.........: 34005 REFERENCE ID # ...: 06040081 SITE ADDRESS ..... : 18730 BARNHART AVE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: OLGA VASILIEV ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: OLGA VASILIEV CONTRACTOR .......: LIC # *OWNER' COMPANY ..........: OLGA VASILIEV ADDRESS ........... 39.92 CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE ........: BPERMFEE VALUATION OPERATOR: kieisew COPY # : 3 SEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BENERGY PERMIT FEE 83.16 39.92 0.00 39.92 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 TOTAL PERMIT 123.58 0.00 123.58 0.00 METHOD OF PAYMENT ----------------- OTHER TOTAL RECEIPT : 9 AMOUNT NUMBER 123.58 VISA 123.58 - CITY OF CUPERTINO 0(00+ 1 CITY OF PERMIT APPLICATION FORM CUPERTINO rj N# 3;19-,9q - Date: 0y. /Y 0 Building Address:M�ailQing Address (if different from building address): (' u!6IC w0 CA yS 0 18 0 ti �Q � VZ ` Owner's Name: 0ti/asialiev Phone #: X08 e6s—/7Zv ;C, Boiler <= 100,000 Btu Contractor: D� License #: Contact:08 Phone: f S- / 12 40 Cupertino Business License#: Fax: Boiler> 500K to 1M Btu / Building Permit Info: Q2 S //',y ut7 q /aSs d 0ORS ib c BBOILER4 Bldg L1 Elect ❑ Plumb ❑ Mech ❑ t- lax neadaal Job Description: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: O Occupancy Group: Type of Construction: Please check this box if the project is a Ind/Off/Comm/Quasi second -story addition: ❑ ro'ect Size: Standard ❑ Large ❑ Major ❑ Con. Tax for BQ Zone 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 r LJ 1 of 3 .-1 CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing 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 riFMerBackflo 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 BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIREAN A/C Units <= 10,000 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l 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 2of3 d�. CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 3 of 3 uantity Fee ID Fee Description Fee Group 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 S ecific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem ora Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3