06120053 CITY OF CUPERTINO
BUILDING DIVISION PER IT INka�ORMATIQN
BOILDINGADDRESS: WESTWOOD- CONSTRUCTION FERMITNU.06120053
7529 DE FOE DR
OW NER'S NAME: PERMIT ISSUE DATE
LESLIE JEFFRIES 223 N SANTA CRUZ AVE 12/13/2006
IRPONE SANITARY NO. CONTROL NO.
(408) 395-9231
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
,00 LICENSED CONTRACTOR'S DECLARATION IOb Description'05 j 1 beri afi�Out 1 am licensed under previsions of Chnn er 9(commencing
inwith Section 70f fb of Division 3 of the Business end Professions Code,and my license is
in ren aforce Class d erred B �{,Z'J�' 200 AMP PANEL UPGRADE
z octose aria Lle.p
k•o Da¢ ai
—Li�Con Dr L
7� 1'ARCNrtECTS ARATION
i < 1 undc.unJ m
DECLy plans shall W used u public records
ito
GM Licensed Professional
3 OWNER-BUILDER DECLARATION
}<I I hereby alirm that I am caempt from the,Canuecon s License Law for f
:00 following reason.(Section 7031.5,Business and Profession Code:Any city or county
j$ff which requires a permit to consu act.alter,improve,demolish,or repair any stmcum $2000
-Iiprimas iml uamc.amreuir=tWappdieantfarsuehpermiso Rkasignedsummem
wtWis Bcemcd pamuntm Nc proNsdos sur Nc canuacur's Licmtx L,w(atapmr9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of Ne Business and Professions Cask)or
$ that W is aaempt therefrom and Ore basis for the alleged compdm.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of r Occupancy Type
not mort Nan five hundred dollars(SSW7.
O I,as owner of the Property,or my employe=with wage as Nen rode compewdon,
will do dm work and Ne aura Curt u net inmMcd marfcred sur side(Sec.7014.Business
and Profcviom Code:The Comracm',License law does ret apply to an owner of Required Inspections
Property who builds in improv=thereon,and who domsuch work himselforthrough his
ownemployces,provided that such improvements art not intended Untrained fdrsale.If. -
however.the Wilding or improvement is old within arc year of comidetion,the owner. --
builder will lave the Widen of proving that W did not build at improve for purpose of
sale.). .
❑1,u done,of the property.or=elusively contracting with licensed contract..to
construct Ne project(Sec.7044.B=i.and Professions Cade:)The Canlraemr's Li-
cense law does not apply to in owner a property who W ids or improves themon,anil.
who contracts for such projects with a con iactsu s)licensed porstant in the Contncm/s
License Law.
l am sem der Se Bk PC(or/Nu�re/aW�n
OwDat
ner �A e
WORKERS MP ATION DECLARATION T�
1 hereby aRes rmiler pcvhy of perjury one or the following dechnsmce
1 have and will maintain aCer-ifem,of Consent to self;insum for Workcfs Compere
inion.as provided for by Section 37M of da,Labor Code.for the indentations of the
worts for which this permit is issued.
1 have and will main..WmkerS Compematim Insurance.u required by Seem.
3]00 of Ne labor Code,for Ne performance of the work for which Nu permit is issuN.
My Wixi Compensation Insurance sumer and Policy ionme,are:
Cartier. Policy No.:
CERTIFICATE OF EKFMMON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not bo cmnpleud drive permit is forone hund il dollars($100)
to I=s)
I certify Nat in the perflumance of thd work for which this pe=on is issued.1 shill not
employ any person in any manmrm as ur bceomc subject to die Wdrkni Compenssdm
Laws of California.eau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject ed the Workcla Compenwuen Provisions of doe labor Code.you muss
.JO faMwldt comply with such provisions of Nu permit shall W deemed revoked.
Z N CONSTRUCTION LENDING AGENCY
(-s IWreby affirm d.t ft.ua emsuacdnn lending agency,for Ne ,(a...of
C the work for which this permit is issued(Sec.3097,Civ.C.) -
QLenders Name
lL z Lenders Address
V C) I certify Nat 1 have mad this application and sum Nat the above information is '
u, Pcorrect.I agree m comply with all city and county ordinmem and sure laws relating to
O U building consuuction,and hereby auNorire representatives of Nis city to enter upon Ne
above-mc judgm propertysit for inspection purportswhichm.
Er"y (We)agree to save,indemnify and keep harmless Ne City of Cupcnina against ,
f/1 incoisegjne of thecostsend upcv=mit. may in anyway acern against said City n
CJ z APPLLICANTeUNDERSTANDS Athis
ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicauftContrachar Oat.
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Willy applicantmfuture Wildinge.Chapterroom 9.12,handle Health tomamris
az de0md by the 324), d Municipal Code.Chapter 9.12.end the Health and Sefcty
Code,Section 255R(a)? ,
❑Y= ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicmt or future building occupant use equipment or devieca which If a roof is installed without first obtaining an inspection,I agree to remove
ork hvardous air comamioars 0 defined by f Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ON.
1 have mad the Wrardms materials requirements under Chapkr 6.95 of thc Califor-
nia Hcai &Safety Code.Secdom 25505,25533 and 25534.1 understand Nxt if the building
dors not currently ass a tm nt.that it u my respdntlbility in ratify Nc occupant of the
reyuiremcn nun W_m_e_t_p�sior�y uutaJ�c�NCw O
arOtcupairpy Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or mNorimd agcm are coverg
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35924022 . 00
DATE ISSUED. . . . . . . : 12/13/2006
RECEIPT # . . . . . . . . . : 37027
REFERENCE ID # . . . : 06120053
SITE ADDRESS 7529 DE FOE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER LESLIE JEFFRIES
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : WESTWOOD CONSTRUCTIO
CONTRACTOR . . . . . . . : ROBERT D. STROH LIC # 27923
COMPANY . . . . . . . . . . : WESTWOOD CONSTRUCTION
ADDRESS 223 N SANTA CRUZ AVE
CITY/STATE/ZIP . . . : LOS GATOS, CA 95030
TELEPHONE . . . . . . . . : (408) 395-9231
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- -------- ------------- ---------- -- -------- ---------- ---------- ------ ----
BELEC200 METERS 1 . 00 29 .43 0 . 00 29 . 43 0 . 00
BSEISMICRE VALUATION 2, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
----- - ---- ---------- --------- - ------ ----
TOTAL PERMIT 68 . 30 0 . 00 68 . 30 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-------- --------- -------- ---- ------------------
CHECK 68 . 30 10110
TOTAL RECEIPT 68 . 30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
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Community Development
: 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4UPERTINO
Building Department
JOB ADDRESS: PERMIT #
OWNERS NAME: PHONE # e/ = 9?9 31
GENERAL CONTRACTOR. Gi/3,I��vo/J FAX # J:z931
I am not using any subcontractors: / !3 g'
Signature Date
Please check applicable subcontractors and complete the followinginformation
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/Contract Signature Date
Sir,- CITY OF CUPERTINO �(�I2 0055
CUP TYOF O PERMIT APPLICATION FORM
PN# Date:
Building Address: Mailing Address (if different from building address):
Owner's Name: Phone#:
ze - -coOBC? y- 9Z3
Contractor: License #:
/Di✓ Z/✓C. ZS d
Contact: Phone: & 9/- V20Z Cupertino Business License#:
S71-4014W Fax: 9l- /93/
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description:
Residential (/ EZ ,401/° Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
900 d
Cost of Project- Occupan Gr p:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro'ect Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK 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 Elee 600V<= I OOOA ELECTRICAL
BELEC1001 Elec 600V > IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
CUPEfZTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BM,ITIGATC 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 Pian Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Dis osal 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
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAERHAN 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> I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNR APP Rem Non-Res Ap2liance 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 A liance ELECTRICAL
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Cay CITY OF CUPERTINO
c'fy°F PERMIT APPLICATION FORM
CUPE(�TINO
.Quantity 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 Change BUILDING
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