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06030085 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONT,RA�C`fQ�IVP'URMATION BUILDING ADDRESS: PERMIT NO. 06030085 O "E:HOMESTEAD RD PERMIT L5UH DATE a: THUMA6 HAHRINGTON ( C0C*L NO. ARCHIT 1ENGINEER: BUILDINGPERMITINFO BLDG ELECT PLUMB MECH j� LICENSED CONTRACTOR'S DECLARATION Job Description 1 hreby afRrm Buam licensed 1 licensed underP.W.P. of Clupur 9(cemmencinj r wish Section 70W)Of Division 3 of see Business;and Pmfcuuro Cmc.and my license is i in full free eend affect. LkebseCln Jc. RELOCATE GASI 1Ew ERCIAL BUSINESSDem Comoun ARCHITECTS DECLARATION I ondemstad my plans shell he used as public records Licensed Profssioml ' JUN ,--�- .2006 r OWNER-BUILDER DECLARATION u 2 1 heathy.(Tare that 11. ,Bumps fare the ContnCocense Law for dm - l o following reason.(Section](BIS.Business and profession,Code:Any city or county 9 which mqulms a permit to construct,alar,impress,demolish,m repair any structure prior to its lauame,alae requires the Applicant for such permit in fee reigned wummm °< last he u Ocemd pursuant w see pmvisiau of see Carman's lMr�law(CMpmr9 Sq.FI. Floor Area VaIUBIlO ':11o (commencing wits Section7000)of Division 3 of the Businmakad Prefesinbs Cadc)or i Btu he is exempt sbestfrom and she hum far the alleged esemption.Any violaoon of �3 Section 7031.3 by a"applicant fur a permit subjects the applicant to s civil Penalty of ��pp7�T�] Occupancy 17,P nm amt then rive hundred dOlWs(MI ffe0�.7D�iQl. ooe wiLuhwne oftnd thesmuy,ar is Intended wlthwegeutsetrale ec.7044.Budess .JLO 1 0 wed OOBmwoR.Cde: rhe mumu not,Lia waw doesad ntapplcoan Rumbas Required Inspections and property who Cade:The Contractors and who 4w dose not apply lf kb owner of q P prepeny whoexilesmidprase Chimp endwhodoessuchworkhimselforthreugh his mm employee,p building" i tsar are ImprowmenU art oat InundW moRerrL Imine.if. builder . the building m en of proving herald within one ger of comple for the owner• builder will Mve the huhu of preying that h did nm bWld or improve for puryme of ale.). D4,u owner of the property.sit exclusively ennaaYlng with licensed conuanm to corotmct the project(Sec.7044.Businen and Professions Code:)The Contractors rs U. cense law dose not apply to an owner of pmpeny,who builds or improve tserton.and, who contracts for such projects with a eomruur(0 licensed pursuant to can Contnctorr License Law. ❑lam exempt ,See ,. .B As PC for this recon Owner Dew C=IwopOMPENSATION DECLARATION I hereby aBi oder penalty of perjury arc of the following declared.. be. ad will msintain a Certificate of Conant so self-inure for WorkersCmnpa- .yn,as provided for by Section 3700 of dm Labor Cade.For the performance of the work for which this permit is name. O 1 haw and will maintain Worker's Compemation luurenm,as required by Section 370Do1'the labor Code,far see performance of the work for which this permit is iexmd. My Workers Compensation Insurance carrier and Policy number am: Cartier. Policy No.; CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Thlasection need notbecompleted Him Permit isfarnu hundred dallaa(SI00) nr kis) 1 century that in the Performance of the work fm which this Permit is Issued.l shell are employ anyCIIf rs I lnany mm tpot,subjecuothe Worken'Campensnlon Laws of Califomia.De r A;Imat NOI7CE 'D Ah ,sfmr making this Certificate of Exemption,you should become objet msec\Narked Compensation provisions of toe Lasser Code,you must Ofarthwith comply with such provisions or this perm0 shall be domed revoked. y CONSTRUCTION LENDING AGENCY I hemhy Mmm ism thmrt u a construction lending agemy,fm the performance of 7 the work fm which this permit is issued(Sm.3097,Civ.C.) QLender.Name z Lenders Addma 0 1 unify that I haw mad this application ad sum that the know information Is !'. conam l agree to comply with all city and county ordinances nd sum laws misting to rV^ building constmcsinn.and herebyauthodn representatives Of this city to Omer upon the W ,hove-mentioned property for impaction purposes. .gyr (We)agree to saw,indemnify and kap hamilea the City of CupMino against V) Ilabilities,judgmenu.costs and expenses which may in shy my acme against said City 7 in consequence of the granting of this permit. r1 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR FM NS. -311G/0/6 Re-roofs Si ppliaHAZAR OU Data HAZARDOUS MATERIALSDISCLOSURE,slow OSURE Type of Roof W y teppliammfutuniipal Code. haptaoremhatMkh ealloumamdsi U defluedSec io dm 32(m)?Cupertino Municipal Coo.Chapter 9.12,aM the Health and Safety Code. 0 es zss32u)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ON. Will the ePPtm1fl or future building Occupant use Nolpment of devices which If a roof is installed without first obtaining an inspection,I agree to remove I hazardous air contaminants as defined by the Bay Arta Air Ouality Management all new materials for inspection. ,let? ❑Yes ONu 1 1 have reed the WAtdas mmedals mqu immenu under Chapur 6.95 of the Califon. nik Health@SalCtyCodc.Soctms253u5,25533 end 35534.1 undcnicam dim frim building Jae not cu ntly hew a unam,that It is my responsihility,m badly the occupant of see squirt h bcmespsiorwiuuenceofaceruncewofOccpancy. Signature of Applicant Date 1 CJ All roof coverings to be Class"B"or better O rat Data CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32601018.00 DATE ISSUED. . . . . . . : 03/16/2006 RECEIPT #. . . . . . . . . : 33597 REFERENCE ID # 06030085 SITE ADDRESS . . . . . : 22382 HOMESTEAD RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : THOMAS HARRINGTON ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014 RECEIVED FROM . . . . : GARY LEITH CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : 0EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34 .86 0.00 34.86 0.00 BSEISMICRE VALUATION 500.00 0.50 0.00 0.50 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 73.73 0. 00 73.73 0.00 METHOD OF PAYMENT AMOUNT NUMBER . ----------------- ------------ ------------------ OTHER .73.73 VISA TOTAL RECEIPT 73.73 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Cl OF Fax(408) 777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT # ,ZZ?�.L e ��n3ck�t3 S OWNER'S NAME: PHONE # qLt I_ GENERAL CONTRACTOR: Wpagxt3 .x N FAX# I am not using any subcontractors: iK ture Date Please check applicable subcontractors and da6plete the following information 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 TileQ r/Contractor Signature Date J iGy' J - .,, CITX OF CUPEI2TIN0 �l p o3c�L3s CITY OF PERMIT APPLICATION FORM CUPEPTINO t PN# Date:uilding Address: Mailing Address (if different from building address): wner's Name: Phone#: Contractor: License#: p�t� chot� C33.4i`�.3�1 _ ontact:_ PhoneL��1`{''S2to_ Cupertino Business License#: Building Permi o: (2¢loci t dJ �e h� C Omm2K",a l Q�sln¢t Bldg ❑. Elect ❑ Plumb (� Mech ❑ Job Description: Residential ❑ Commercial J�_ Sq.Ft. Floor Area: q.Ft.: Cost ofProiect: Occupancy GrouD: Type of Construction: 3 Please check this box if the project is a second-story addition: ro'ect Size: Standard a Laze ❑ Major ❑ Quant Fee ID Fee Description Fee Grou BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3. Boiler> 500K to lM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL 13BOILER5 Boiler> 1.75MBtu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi BUILDING BCONSTA)MQ 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 :1 Y. CITY OF CUPERTINO CUPEkTINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING • BMITIGATC Comm. Housing Nlit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIA\4E Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUIIfBING 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 BPgEPIP);i Re i e Of Fixtures PLUMBING BPSEWAGE. Sewage Disposal PLUMBING BPSEWER\ Sewers PLUMBING BPSPRD\rK Lawn S rinkler/BackElo PLUMBING BPSTORM Storm/Rain Water PLUMBING BpTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING . BPWATER InstalVAlter Water Pie PLUMBING =BREMACOVER WaterHeater/Vent PLUIIIBING Main Water Service PLUMBING Rein ection Fee BUILDING A/C Unit> 10,000 cfmMECHANICAL A/C Units <= 10,000 cfmMECHANICAL Appliance Install MECHANICAL BREMBUSWAY .. Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BR.EMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL 0 PBREM:POWER REMINHOOD Installation of Hood ISIECHANICAL SC Misc Apparatus ELECTRICAL App Rem Non-Res Appliance ELECTRICAL LE Pole/Platform Fixture ELECTRICAL Power Device/A aratusELECTRICAL EPT Rc tl, Switch & Outlets ELECTRICAL OCA Relocation of Hood MECHANICAL ALT Repair/Alter Heating 1\fCHAMCAL BRENMESApp Remodel Res Appliance ELECTRICAL • 2of3 CITY OF CUPERTINO CUP*775FPERMITPERT APPLICATI®N FORM antity Fee ID Fee Description Fee Grou BREMSIGNAD Rmd1 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix . ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL 13SCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSVVIIM 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 NTERMTTFEE 112ech Permit Issuance MECHANICAL PPERMTTFEE Plambing Permit Issue PLUMBING PPLBG Plumbing F5e sq foot PLUMBING PLLONGRNGC Planning LR Commet Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING � II 3of3