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06020081CITY OF CUPERTINO INF, OlZMATION BUILDING DIVISION PERMITCONTRACTOR ,'.: BUR DINGADDRFSS: MI ELECTRIC INC PERMIT NO, 06020081 OWNER'S NAME: PERMR 11i6iIIE DATE JAMES BROWN 5255 STEVENS CREEK BLVD 300 02/13/2006 NE: SANITARY NO. CONTROL NO. (408)366-0100 ARCF:I]ECT/ENGINEFR: BUILDING PERMIT INFO BLDG ELECT PLUMB NFffI p LICENSED CONTRACTOR'S DECLARATION Job Description P F W I hereby" m taut I w I{anrcd undo pro. ooas of Cnaper 9 (�nmmeing wlth$mtkn]IXp)af Diviumvlalhe BudteuW Fofr•a ^•GOEe. old mylh.a•u ge� gs p,�p,�{ t5 A a _ terwlram.merrat Licxmc Chir L'c.. MAIN PANEL/SUBPANEL. �(�'��"'{{{ O Dmc conuanm !ill ARCHRF.Cr'S DECLARATION I undcrsund my Plan"" be ural as public remr0 d Pmfcotul titheao 3 OWNER-BUILDER DECLARATION I I baehy Orion Net 1 em e.emp from the Conuacnor'a License Law for tnd a following mason. (Salim TBJI3. Bu4ecss and PodC&%dm Code: My City or m my which mgu'..s a permit to costume.. ahcr, Improve. demolish, or ufuir any structure ,I';. _f •110 0 prior to lis iits..dw rtNomi thcspplicavt for such pumitur fik. signnl sutctmm thaeK ulkcmml the Convctori lJl<iuc lAw (Chapiv9 Sq. Ft. Floor Area Valua[ioo ,,Q loraunttolhc povidonsof (commencing with $atom 7000) of Dinswo 3 of the Bung rind Cork) w $ dhe..pt wetamm and the basis for the all cd eremplon. Any= of ist ..pt r Occupancy Type Scmlm 7031.5 by my applicant for a pamlt subjecu the applicant to a civil pmrihy of not mom than fire hmdrt4 dal Wer ($500). 0 1, as mwom a the F.Paty on my wpoycu with wags as thew ank com'.tbn, eft R uired Ins ections will nd the work and the stnrtum is not lntcodcd oroffoW for ask( Sec. 7(A1, Busi. and Prof.. code: Tbc Contrctd L.. Taw dais not apply h, an owxr a P pmpmty wbo bolds or ftr,o rthmeon, and who docs such work hirmelferr though his own cmdoyrn, pmvlded that such impmsemenu art vat Intuded or offered for sah, 1L bower, the building err unprownsem is sold wldJn oro year of mmpktlsv, the owoc,� builds will have Ne buNut of pm.ing Nat be did not boW a Im r o.e fm pini ose of sales). 1, as manes of the popcny, .m eacltwrely conuacOn, rith 1'....-1 convectors to o ..sure the project (Su. 7014, Businm rind PraeaYau Code:) The Coouriaola Li- ccmc Law dors not apply to .n owner of popmsy oho wilds or Imp ,,Cs tlemub ard . whoemuacu for such proem with s eoo1r tot(r) HCco,,d puratunt to ttr Cmtmuts Lace. Law. ❑Iammc�m]p�um�a See ,BkPCfmthlsreuav g'IfKd'-� 1 �t� lJuc 1 3 0 - WORKERS OMPENSATION DECLARATION I hereby aR under penalty of wrJury one of the following der5unlats: 1 lbs a and will wlntain • CW fiom of Consent In rJf usne fa Workels Compere on. as pravidcd fu by mon 3R)0 of the Iaba Code. far Ifs pedorm.orc of dr work for which Nis permituissucl 0 1 han and will maintain Worio is Co rcostatkv Insunn¢. u icqu'ued by Sccdm J70o of do tabor Codc, for tic perfarmarcc of du work for which this pCnnit is issued. My Worker;Cmnpemuim lovuasce curio and Polity Rumor arc: Cuda: Policy No.: CERTIFICATE OF FXEMP ION FROM WORKERS COMPENSATION INSURANCE (Ubu accurst need not wcampktcd ff ft permu u (aero huvdmd loans (5100) orku) 1 canih thea M th perforon.. of de work fa which this permit u usuM, 1 null not cmplmy any permn In sty mnnersuum CCmncsv. bKcyto Ne WortuYCunpcnudov laws of Califrynp. Disc 'a- LG:(� A,bcam f NOTICE TO APPLICANT. If, d cr making this CcniPote of Eaempum. you shoutl become subject n the Woha's Carnpevatim Pm,,W ro of the IaMv Calc, you mon Z foMwith comply with such pmvinom or olds permit shag h deemed rooked. O LENDING AGENCY .~N.CONSTRUCTION I hereby affirm that dem u s cmwuedon ktding agcmy for do s rromrancC of i the oak far which this pemvlt Is Wood (Sri. 3M. Civ. C.) AI ,r Name Ietdvl Addtrr z C) 1 ratify that I have read nor aPilkuhm and Sum that too abo,e infamatum u Fcomma. I .gmc to comply with all city and county adirwoes and sate laws reusing to U wilting conwuctim, red herebyrothorise rtocsontaiw of Nis city to nuxupm the [Tt shove-mcntiancd property for impution pu7a¢k (We) agree to ave. indemnify and keep haemlcss the City of Cupeniw.gaimc I, Rtblli a,ludg"Knts,cow and espca.er which may In any way xcmc.gdmt add city Z lo mrt¢gtcnce of the granting of dos permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ^� SOUR EGULATIONS. '( /Cl/A,F- / Re-roofs Situ of Apel' or H RDOUS MATERIALS DISCLOSURE Type of Roof Will t4 Wplimnt Co futum Wilding acupnt stat or hulk barudous ttuerW as defined by thC Cupenim Municipal Crick. Chaps 9.12, and the Halth and Safety Awlcode, Scrum 25532(.)' Yu Nu All roofs shall be inspected prior to any roofing material being installed. (t-, If a roof is installed without first obtaining an inspection, I agree to remove Will me.pplient a ftdsm, wilding acupam. cgopmmt adevices which oavardmr air mnumiw iCt n dcfued by th Bay Ams Air Quality Man4Fmcnt all new materials for inspection. inT 0y. 1-0No I bare mrl the ho rmtoii, m ucrials tCW itCmenu order Chsprr 495 of tM Cdifa- 7�q'Ctrc�hkb kalth 6 WuyCoh,S tiae25SQ5. 25533 and! 2553...1 uthrwM Nn Bole wilting nor cvrenUs bac . Ic amt ton it u my ooordhilhy n mdfy uc aetqunt sir the him matPr;atoi,n,a,reaacen;B4rora<t�ry. Signature of Applicant Date 0 , ` I / / s, / ,5x � All roof coverings to be Class "B" or better a nor rod F D SUPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 44 l3 / b,56pm PERMIT # 0d 2 OWNER'S NAME: 7cun 6 B+ ora PHONE # o GENERAL CONTRACTOR I 64,,G r N FAX # 4ocf' 2 D cv • 0 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information ner/Contractor Signature t63 Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical / t,--I,�C�r (C //VC - NLExcavation 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 ner/Contractor Signature t63 Date Cmk an o CUPERJINO CITY OF CUPERTINO PERMIT APPLICATION FORM D b 0a.60Ql .PN # 3 y z Fee Description D ate:2/13Xd uilding Address: ° Mailing Address (if different from building address): Owner's Name: BBOILERI Phone #: v] BBOILER2 4`G) 3.6 at b - Contractor: BBOILER3 License #: I CA- f- i AJ BBOILER4 s b i Contact: Phone: Cupertino Busine s License#: 1<-,w— ( Fax: 8)3 — BCONSTAX BuildingPermitInfo: 6�-Vtl Sk-6 hR�w Q BCONSTAX Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: BUILDING BCONSTAXH Residential K BUILDING Commercial ❑ Sq -Ft. Floor Area: BUILDING q.Ft.: Cost of Proi ect: ELECTRICAL Occupancy GrouD: IDO ELECTRICAL BELEC200 _ Type of Construction: ELECTRICAL Please check this box if the project is a .i� BUILDING second -story addition: El ,'ro'ect Size: Standard ❑ Lar e ❑ Ma'or ❑ BINVESTIGA 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 BCONSTA-XBQ 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 1 of 3 -3 ?& �d 13 2, 17 CITY OF CUPERTINO CUF ERD PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCO2� ME New Comm Electric ELECTRICAL BNUCONIIvIM New Comm Mechanical MECHANICAL BNUCOhQv2 New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERAIE EE Bldg Permit Fees BUILDING BPFIXTLTRE 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 BREINSPECT Reinspection Fee BUILDING BRFMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAUM AN A/C Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Li ting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMENMOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appbance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREAIPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRES APP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sigas, Marquez ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMNENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEL4NIICOAI Seismic Commercial BUILDING BSELSAHCRE Seismic Fee Res BU LDING BSPECIAL Special ection BUILDING BSWRA ;' Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERAI Temporary Bldg Permit BUILDING BTEMPSVCS Temp. Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERNUTFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERNIITFEE A1ech Permit Issuance MECHANICAL PPERAHTFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Commel Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3of3 MAR -08-2006 11:10 DeSTRICT MANAGER -ENGINEER MARK THOMAS & COMPANY, INC. )� DAVID E. ROSS DISTRICT COUNSEL ATKINSON • FARASYN, LLP HAROLD S, TOPPEL MARK THOMAS CUP Fs. r48LISHE1 20833 STEVENS CREEK BOULEVARD, SUITE 104 CUPERTINO, CALIFORNIA 950142154 (408) 2537071 PHONE • (408) 2535173 FAX File Community Development Department—Building City of Cupertino 10300 Torre Ave. Cupertino, CA 95014-3202 Subject: Sanitary Sewer Repair Name: Tony Nguyen Address: 5923 Bollinger Road APN: 375-35-021 Permit No. 06030008 4082535173 P.01i01 BOARD OF DIRECTORS WILLIAM A. BOSWORTH DR. JOSEPH F. BROWN JOHN M. GATTO CURTIS B. HARRISON WENDELL H. KERR, JR. CuSD — MOP Building Dept. — Cupertino ■ Videotape and Property Line Cleanout inspected. No additional conditions/requirements by the District. Inspector: Tony Soares/George Santos..........................................:..� Date: 3-08-2006 ...................... Sanitary Sewer Location: *Backflow Device Inspected cc: Home owner SONEYINR SANITARY SPNEuOf SERVI(ff FOC CITY Of CUNEITIND, PORTIONS Of 1NI CITIES OF SARATOGA, SURNYVA F, LOS ALTOS AND SUIROUNDINR UNIN(ONIOIATED AREAS www. rupertinosanitaryi/150k t. rom TOTAL P.01