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06030077�s z C V G C C E LI Q 2 CITY OF CUPERTINO arxs^ �.ee✓a„i?i^ ar,,,F �i +fi o �'^u.. ' BUILDING DIVISION PERMIT VC -0', RAOTORUNF �ATIo .^l, BUILDING ADDRESS: PERMIT N0. COOL'S CUSTOM 06030077 ogj,at4 IFN BLANEY AV PERMT77 LSUE DATE NE:AVE, STE 131 SANITARY Na LNO. ARCHr1ECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 LICENSED COK7RACIORS DECLARATION Job Description P I bcrtby .10mn 1111L 1 mo BamN under pmvisiom of Clupur 9 (mo mswinj _ vith Secdoo 700() ofl)Ms ,3aft Buith . W Podmino, Code, W my lift is '�..0..ndel7ea t-1-9\ 003 Lm�..- Caotranw b _ .INSTALL GAS LINE. FOR FIREPLACE - U ARCH 1k DECLARATION ��pp 1 un&rsund my pl.m x601 he wed u pabllc Tern& p � � B [Y � �� . eF r/Np\`Ne■r(y�� Liocnrtd Rvfcui...l OWNERt BUILDERDECLtRA Ltt law for 0y I nercny .fErm But 11. oemp from Ne m.nv'.: M. Code: Any my m rnuuy lnp rum.. (Ssdo1 ](131.5, Bvsiwu and R f Any A '1J . da n .hilt . permit m coouruct, umr, hnpcoK. dvwlish, rc whkh 1•!✓111 n 9tir od FlXlo Prior m ILL ii[u.rRe..Iso rtquirts dc.pplimu for such pvmit m f k a sipncd jU iJ."u Sq. R. Area Valuail ChitpW l.h msdpsom.ot70th)aDblms of the Cantr.nvil:¢we law,codu9 (cmmmewlop wilt Scnlon 7000) of DMaim J of We Bwhcvmd Profusiom Code) or ri nit dm k u cusp thrtfmm W dm bnu for the Mk{ed ,..mN. MY doled- 01 Secdm 7031.5 by .try .pplk.m for s pemdl mbJew N .pplkml m . dQ pemhy of Occupancy Type tmt rture Inm EK bmdrtd don. (MS ❑ L u awoc of th pmpvsy, v my vopbyca vW v^F+u theh mk mropcmubn, Required Inspections dothen. andthe Vnwluendcd v fors.k(Su.7M.,B of fs I M^e Law dor oot .ppy m m o.mer or m,d h.0 UW pm emfws Code: propenY vbo bWlOsvimproKU Nvmn,.M Wrodaesstdtsmrk himselfv OuvoF6 h4 bL mp thir rotint ledvd(ced fv s>1c If. ave cmpbyvu,providedthu, imp." wiu.rt Wilrt ,tlm bulldinpwimgoKmenl4sold arc yer of coprowfm lbepm9 W Odv will NK tk dv&n of pmdng dor he did rot ddb v Impm.e fm purpose or did Ok.). ❑ Luowm of dm MWMY..m C ,olKy co inl vial bvwd[Onb.mwsm i,im p We p,.J=(Sec. 7044. Bnl;, W Pralui m Code)The Ctmr.-Wes LI. Rnm lav dot rat tt Ay m m owns of property Mtn bads or iot m Wertwt, W , .bo cmrr.ns fv such po)i m vlN. emuuwr(.) Iianad pzw.0 m do Conu.no(s ay. 1 w temp under Sa. . B ! PC for dds won 71 1 = ❑ (hvou D.se WORKERS COMPENSATION DECLARATION 1 hemby M. under peultyof pedtory. of the foU of deelunlmr b iK W will m0nin. CW fore of Comet to self-iuu.e for Worta'sCmnpcn. udan, u prvvt&d (v by Sc6oe 3700 of dm labor Code, for Ih perform.we of the , vmt for vbxh tints pernit LL issvd. ❑ 1 Nor W will m int io Worbi es Compmot”. I.. n quired by Stolon 3700 of the labor Code, fm the paform.nu of Ibe vort fo which Nu pnmit LL iuued. My Workeit CCkwnn mwlw lommta anio W Policy nomtrr.rt: Cartier: kgLt. (ZOIY Policy No.`>_` (Try �� _ CERIIFICAM OF EXEMPTION EROMWORKER5 - COMPENSATIONINSURANCE llbis.Wimr notb canpkcd If Ne famk LL for vm t000Ndo0.n(5100) or 4a) 1 c fy Nat in We pvfrcm.we of de wvk for vhicb Ws iermit u iiv I "i not empto, myRio^ In my mmwrmu to M.o sdb}eet to tk Watch* C.N.tiw law MC.hfomi.. Due Applk NOTICE To APPLICANT: It..fkr m.hinF 1445 Cenlllam M E.empion, you snopkl become sUb)=m do Wortee's Comp,,= o provisiom of tk Labor Code. you mvu ry hwith comply with such FM islom or dds Fermis slug be damcd Thorel. COAGENCY ft.is..,uimaino fa Nc perrrcm.ncxM 1 htmr"ic Erm Nu trcrt u.cd(St .ion .CmCpcwy dt<wort(v which thle permit4iavd(Sa. 3091. Civ. C.) Ruler's Name Rider's A/dus 1 I Ce y Nu I h. read thk grplk.don W nam mt the . Infonmti o u . ' cormn. I .{Tee m ).Ply viN JI dry W county ordi. W sum I.vs rt Wing m boom, canm 't WMMby mdorin: rtprtmmWse of Nu city m over upn. tK I .hove-memio popcny for imisnion popme. (We).Frte to UK. W=,dfy W kap h.nn)us the City of Cupwino.pnnn i Il.bilidu,jodbmcnLL.cou. W c.pcnso vhlcb my In my wy. Mitinst slid City In comequeaes of the jnntint of d'u pnmlt. ' APPLICANT UNDERSTANDS AND WILL COMPLY Wflli All NON -POINT —7` i �O Issued by: Date i S CE REGULATI S. Re -roofs �-- 71, �1\S10C� SipnuumofApp UConvrw--- -'^' Tim Type Roof HAZARDOUS MATERIALS DISCLOSURE of Will the.ppiow or forum bonding oceupmt tort or hitA n.wdau rrhe .l u cWiir by 1M CupeNeo Mro MI Coo, CWpv 9. 12. W Nc Hohh W S.fety Code. Soodon 25532(07 All roofs shall be inspected prior to any roofing material being installed. ❑Y2( / No YHl/. � - If a roof is installed without first obtaining an inspection, I agree to remove Win ft'Vlkuu or fuvoc bulldnp oa 2(t u¢ cyuipmmt w hrka vTkb nmudou.ir rnnumimnu n &fwd by the Bay Arta Air Qu.lity M.upcmant all new materials for inspection. ❑ Ya t Ilett mid tCd,, N1s 2(..v. un&rLT.pch.95Mth fi i, dm 255M. 5533 25533W2 nkti. d:SMl, ft ft thxt it. Mitt 0nxim tncWof loo Trot cwrtulY b.K. ta.rc, dor It 4 my responslhilOY m adfY dm ¢sulwu N Nc hit. naw of c rmmnr norm. Signature of Applicant Date uInmw=% d�� "� ^ �4'�1� All roof coverings to be Class "B" or better 0w0=or mNorir Font Dom I` CITY OF CUPERTINO \•m l.of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31621074.00 DATE ISSUED.......: 03/15/2006 RECEIPT #.........: 33571 REFERENCE ID # ...: 06030077 SITE ADDRESS .....: 10140 N BLANEY AV SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: suem COPY # : 3 OWNER ............: JIM MCAFEE ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2330 RECEIVED FROM ....: PHILLIP J COOL CONTRACTOR .......: PHILLIP COOL LIC # 22976 COMPANY ..........: COOL'S CUSTOM ADDRESS ..........: 4718 MERIDIAN AVE, STE 131 .CITY/STATE/ZIP ...: SAN JOSE, CA 95118 TELEPHONE ........: (408)353-9692 r L J FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BPGAS OULETS 1.00 5.40 0.00 5.40 0.00 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BSEISMICRE VALUATION 1,500.00 0.50 0.00 0.50 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 TOTAL PERMIT 117.50 0.00 117.50 0.00 METHOD OF PAYMENT AMOUNT OTHER 117.50 TOTAL RECEIPT 117.50 VOICE ID DESCRIPTION 106 SEWER & WATER 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING • NUMBER ------------------ VISA VOICE ID DESCRIPTION 202 UNDERFLOOR PLUMBING 302 TUB & OR SHOWER 506 GAS TEST CITY OF �UPERTINO is • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESSS:r cm '� I 1`t Acge . cc*,� PERMIT # l/ OWNER'S NAME: J iw1 ?,e1L PHONE # GENERAL CONTRACTOR S S M FAX # I am not using any subcontractors: ` 3 b ICY - Signature Date Please check applicable subcontractors and complete the following information L t10 =-! •Contractor Signature O� Date 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 L t10 =-! •Contractor Signature O� Date • 0 CUPERTINO Assessor's Parcel Number: Name of owner. Project address. 1 O Contact person. , )� C . Phone.)53 Fax. Net square footage of lot. �! Existing Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot 1 spaces inside the garage? Is privacy protection planting required for the project? On what floor(s) is work being done? \ -St F�eOr of work. Code editions: 2001 CBC 2001 CPC 2'7A 1)2001 CFC 14)2001 NEC Effective 11/1/02 gm IMP (Y; N)2001 CMC (DN) Plan Review Process Work Book Page -8-Revised 4/28/04 Proposed '7 • 3 1 m mc-�� A CITY OF CUPERTINO CITE' OF CUPERTINO PERMIT APPLICATION FORINT 0603=7� N # 02' O Dat S 2010 Buil ddress: Mailing Address (if different frrom�;in address): t4b r`� MECHANICAL O's Name: �- Pho #: D 16)�s3 a2 C frac or: License #; Boiler> 100K to 500K Btu S BB.,QILER3. Boiler > 500K to 1M Btu Contact: Phone: Cupertino Business License-#: Fant: G� � Building Permit Info: N r� �`�e k T*iAj��k A• cPCtca �xrr+;r�t Bldg ❑ Elect Plumb Mech ❑ Job Descriptio Residential Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of proie Occup cv GrouD: 1 G comQ BUILDING -3 Type of Cons ctiQn:—, Please check this box if the project is a BCONSTAXH second-storyaddition: ❑ _ ro'ect Size: Standard Eg-, Large ❑ Major ❑ BCONSTAXR Quant Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BB.,QILER3. Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1-.75 M Btu MECHANICAL BBOILER5 Boiler>1.75MBtu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi 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 n U 1 of 3 C1 DF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 2 of 3 /Quantity Fee ID Fee Descri tion Fee Group BMISCELL Miscellaneous Fee BUILDINTG BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUC01\IIvJ11 New Comm Mechanical MECHANICAL BNUCOAMI? New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERA'Ii+EE Bldg Permit Fees BUILDING BPFMURE Pb1g Fixture PLUAEBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUTIBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDII\TG BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUAILBING BPSEWER Sewers PLUAOING BPSPRINK Lawn S rinkler/Backflo PLUh4BING BPSTORM Storm/Rain Water PLUMBIINTG BPTRAP Kitchen Trap PLUMBING BPVENT A3t of Drain & Vent PLUMBING BPWATER InstaU/Alter Water Pie PLUMBING BPWHEATER WaterHeater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Rein3pectionFee BUILDING BREMACOVER A/C Unit > 10,000 c1m MECHANICAL BREMAHGAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM BUSWAY Remodel Busways ELECTRICAL BREAUIXT Lighting Fixtures ELECTRICAL BREMgLTRN Relocation of Furnace MECHANICAL BRE1\9URN0V Relo Furnace > 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BRE1\Mi_HOOD Installation of Hood Al-EMANICAL BREMNIISC Misc Apparatus ELECTRICAL BREN2ZZAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power DevicyApparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL RRRMRRSAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO PERMIT APPLICATION FORM nand Fee ID Fee Descri tion rou _ BREMSIGNAD Rmdl Si AdEBraDnch RICAL BREMSIGNS Remodel Si RICALBREMTHEATR Theatrical Li RICALBREMVENFAN Vent FanSin NICALBREMVENSYS Ventilation SNICALBSCBLVD Scb S ecificDINGBSEISMICOA4 p Seismic ComDINGBSEISMICRE Seismic FeDINGBSPEClAL S ecial DINGBSW1M Swimmin DINGBTENIP Tem ora PowerRICAL BTEATPERM Tem ora Bld Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUELDING ELECTRIC Electrical s foot ELECTRICAL EPERAHTFEE Elec Permit Issuance ELECTRICAL MPERAIFEE Mechanical s . foot MECHANICAL MPERMTTFEE AZech Permit Issuance MECHANICAL PPERMTTFEE Plumbin Permit Issue PLUA�ING PPLBG PLLONGRNGC PLLONGRNGR Plumbin Fees foot PlanningLR Comme/ Multi-Fam PlanningLon Range Residential PLUMBING PLANNING PLANNING , ZADDCHG Address Chane BUILDING 3of3