06060207 CITY OF CUPERTINO �.� ' ` "%&' C
BUILDING DIVISION PERMIT C�NTRACTWIZANMI`'OI2MA TIgN ,.
BUILDING ADDRESS: NOBLE CONST PERMIT NO 06060207
0 SRS NAME: PERMrT ISSUE DATE
MR. VU 259 N CAP
PHONE SANITARY N0, CONTROL NO.
(408) 205-3692
ARCHTrECl/ENGINEER: BUILDING PERMMINFO
BLDG F1ECT PWMB MECFi
u Wp LICENSFD CONTRACTOR'S DECLARATION Job Descflption
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�Z WWS¢lim lglllla Ir ]af Jn Butl.ev sods Pm( sam Cadc.W mY 4Tnu Il
< mmummamadr O REBUILD CHIMNEY FROM�HOULDERS UP
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which oeuNd.iz l pcmir re amW ft dkr,'v for h PermiA,c rti ig NY Lrvnurc
uZY PMRbiL51OUL,LS..IW trym(tl me Willi[fM(R LICK pr+milb Rk.tltlnd LLemmlt Valuation
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NEI (cwnntmdng wim Sed{on 7000)dDivulavJdJn ButlIIa+W Nafmimu Cade)m
}I _ mu be 1.ewnp Jaye(tom and the Will for the tlhYcd eremptlon.Any Nolation of
Semlan10313bysoIyappllantfor,Pumiltobi-I Jm.ppl{cmlmarivet puuhya .-�t?&N'M#ftrU U a 11 cupancy Type
nor mare m,v Me hodmd do1Ln(15W0
1,u owner of Jie poPM,or my empbycat w'uh vgn u ttrL mlc mmpewdoq
win do Jc wort sold Js momurt a not Intended ac offered for uk(Sm.106 a,Budncv Required Inspections
W Pmrmdom cads The Co.maemt,Unna law dom coo amy n m woo or 9
poppy who buiid,.tort smsoean.Wwindomuchwork humvfm mroa{h bur
ow employm,provided mu lsb impowmenu K mrdle8kd aaffered for alr:If.
haw .the boidios m unpmwmmt it fold mduo arc ye,rdmmpkdav,dewner-
bunder w i Ww tb<burtrn of promn{du be,did nm bmld m uro m fa pumoe or
I.u wIc a the Property.run eacludwly vim Ikwed tmV.oars b
cvuavn the pmjcm(See 1(M4,B..:..«.rd Pm.tic-Cade:)The Comr.e t U.
ccou Law dams Kply m m awma a pmpwy who bdW or improm dtetem,md,
orbs mmr,ell far truth pnjttu wllh,..OKI)ticeNCd porroam m me C'ViVCIMI
Lica Y Law.
❑I dm.Loo order 5 ,B S P C fa tNtr leum
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WORKERS COMPENSATION DECLARATION
I koeby ull.order pecalty of pmjmy arc of ted follawin{dOcuraducrut
1 W w sod win Iadn Wv,CcniOmk dCmanl Io uV-ivmm fa WarheltrCwnPm-
anon,u provided fa by Semlm 3700 of the Ubar Code,fe,the Pelformm of the
wok for which mil permit u uLd.
❑1 h.w sod w U muou o Warkcfl Compenutlal Iuu , u required by Secoon .
3700 a dee Ubar Code.far me prfarmroa ofted work for w Ihu Pelmet u Luaed.
My Workers commmuuon InLL.tvz Cro cr and Policy numbs orb:
6rtiw.. Policy No:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION BNSURANCE
(rhuucdm reed Outbecompic d Jose pxmit uforamhurdm5doliva(5100)
or )
I certify mel ironn,na a me work fc whkh m' pump u laijdd,I"I era
employ mmom munbemine, a m .
Uwl
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NO PPUC cl m.k) L u f EaempJm,you iltmd
bemm nlbjat m Ih/Work Cmopc Jo povisw,d I labor Code you IeuL .
,JO fanhrim mmplyw LlCh pravulam permit flJl bc dctlud mokN.
z� CONSTRUCTION LENDING AGENCY
I booby dfirm rho Vert 4•mnLnxilnnkrdivt,gcmy far me Perfart—a
> Jn work Or chive ted patnit u iaucd(See 3099.Civ.C)
6W.Q Lcrdd,Num
.7 z Londe's Addw
C)o Iattisy Jut IWwrt,d mu poicd.rods oak do,the.bow idemWmu
�^F COrrecL 1.1.W ccaPly w 01.11 city ud coamty oldinarcm tod,me laws muting to
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wildin{comuactian,and W rtby emnif, nrt e p hOrrnke; d mu my m MidO.9 -L
W above-mentimed plorcrty for impection pnpkea
FV) (Wc)agla nam.ind"ptooe- Yeepharmka the C'lyaf Cupmlim.tumt
In n.bWJm,jud{me ,ewtlwmpmva whkM1 m,y.tokroy..y,mue•{dmlrud City
V z APPLIC UND ANDS AND Wit.n1 COMPLY WRM All NON-POINT Issued by: Date
SOUR U 0
r Re-roofs
Si{ afAPpionVCmtnmar
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII Jc wiovt ar rorrc widint aaupuu Lmc c bardk baaNnu mucnal -
AdW de,S by Je 32(c)7 m MvMCIp,I CLde m.dtt 9.11 W I)Y Fidm ard Sdcty
me,sari^^I7m2(,)7 All roofs shall be inspected prior to any roofing material being installed.
Ym
If a roof is installed without first obtaining an inspection,I agree to remove
WJI Jn,pplir m or mtmc Wilding oampvm=Ndpmm or cholas which
emit hoodoo,dr mnmmimnu n dcOmG by the Bay Area Au Quality Msou{mmu all new materials for inspection.
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1 w do haaMwtr muc+i,I,tWu^o"'"b•urdc Qupc 6.".f&C.Iif.-
nu h myC S 25505,25533 d25534.1tndrmudmatffJ Wi g
dma l c Orton.J,L Il v my rt,Po„vway n tntifY oaupnl or the
wnieh eemerp;cturt- ear,cwrn,n Signature of Applicant Date
All roof coverings to be Class "B"or better
Owaraw agcm
CITY OF CUPERTINO
I• 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36204016.00
DATE ISSUED. . . . . . . : 06/26/2006
RECEIPT #. . . . . . . . . : 35008
REFERENCE ID # . . . : 06060207
SITE ADDRESS . . . . . : 1044 BUBB RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MR. VU
ADDRESS . . . . . . .. . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . LARRY BARRAGAN
CONTRACTOR . . . . . . . : LARRY BARRAGAN LIC # 24654
COMPANY NOBLE CONST "
ADDRESS . . . . . . . . . . : 259 N CAPITOL AVE #152
CITY/STATE/ZIP . . . : SAN 'JOSE, CA' 95127
• TELEPHONE . . . . . . . . : (408)205-3692 '
FEE ID' UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW, BAL ,
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY --: PERMIT FEE 83.16 39.92 '0.00 39.92 , x,0'.00 ,.
BPERMFEE VALUATION 3, 000.00 83 .16 0.00 83.16 :, ,+0.00
BSEISMICRE VALUATION 2, 655.00 0.50 0.00 0.50 ; -0.00 _
BPLANCHK PERMIT FEE 1.00 83.16 0.00 83.16 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 206.74 0.00 206.74 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ---_------____--__
OTHER 206.74 MASTERCARD
TOTAL RECEIPT 206.74
VOICE IO DESCRIPTION VOICE ID DESCRIPTION
101 FOUNDATION 312 CHIMNEY REBAR & STRAPS
514 FINAL PUBLIC WORKS
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Community Development
10300 Torre Avenue
' I. Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
UPEIjTIN0
Building De artment
JOB ADDRESS: M 6� / / � PERMIT O�
/j(
OWNER'S NAME: PHONE #
GENERAL CO OR FAX #
I am not using any subcontractors:
ell Dat
Please check apphcable subcontra rs an complete ollowing info tion:
60 SUBCONTRACTOR AUSINESS 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
t Rock
• Til
� a
1OVon a or Signature Date
CITY OF CUPERTINO
CITYOF PERMIT APPLICATION FORM
• CUPEkTINO
APN # 3/ Date:
Building Address: Mailing Address (if different from building address):
k./
Owne s Name: Phone #: s 2<!
Contra tor' °fie# D
Contact: ° Phone: Cupertino Business License#:
Fax: 7 7 DS
Building Permit I fo:
Bldg Elect ❑ Plu b ❑ Mech ❑
Job Description:
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
y�CO C.r�
Cost of Project: �6 7 Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
1P1ro'ec:tSi1ze: Standard ❑ Lar e 11Ma'or ❑
Quantity ::
Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to SOOK Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M 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 60OV <= 1000A • ELECTRICAL
BELEC1001 Elec 600V > I OOOA ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Ener y BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
W05, CITY OF CUPERTINO
�I�'0 PERMIT APPLICATION FORM
CUPEIi,TINO
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
BPINITRCEP 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 HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRIIAN A/C Units <= 10,000 cfm 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
(� CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
Ahk CUPEkTINO
VVQuantity 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 Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection 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
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
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