06030044 (2) CITY OF CUPERTINO .
(BUILDING DIVISION PERMIT ; COly'TTTI'Z.� XOR.)INFF1 'I.A"fTO
BUILDING ADDRESS: HUCK CONST. COMPANY PERMIT NO.
06030044
10481 GLRNVTP.W All
ER'S NAME: PERMITIESUBDATH
DORIS YOUNG 695 S . 15TH 4
NE: SANITARY NO. CONTROL NO.
(408) 298-2374
ARCH17EC(ENGINEER: BUILDING PERMIT INFO
BLDG O PLO MEOCH
3oij LICENSED CONfRAC10R'9DECLARATION Job Description
1 thereby a01fm that 1 am licensed under pm'UY of Cluper 9(cmnmcncing
n� wha Schon ID110)u(DlWtlon]af the Bumneu and Pro(essians Cadeaed mylkenm4 MALTED
I.full fonre and eRea'� -70SEISMIC RETROFIT OF. (E) GIRDERS
Lkic en as�Contractor AND FOOTINGS
"gg �A�CFIITECr5 DECLARATION -
Q 1 understand my plans shall W used As public rernNs MAR G.qhy
C.yLo Oda11
O Licensed Profession]
y Oat I am exempt
from
DECLARATION
ze I I watt .(fon that 1 1. exempt from the Conlns Co :Any c law for sae
D p O fallowing mason(Section 703 L3.Business end Pmfnxinlls Code:Any city or county
116!N which requires a permit w account,aIICf.impmr<,demolish,m repair Any 6WCIan RUILDINa
Zpriorm its Issuance,alsurequie,the applicant forsuch penehia Bleasigacd moment
1.4
<
that he is licensed puroantmthe provimonsaf,kContracbsr'slaznmlaw(Chmucui? Sq.Ft.Floor Area a uauon
�$ (eommencingwith Secaon7003)of Division 3ofdw Businessand Pmfsedans Codc)m $195(]
`< that k h exempt therefrom and the basis for the alleged exemption Any violaion of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penally of APN Number Occupancy Type
.at mane than On hundred dolhn ISM �
❑1,As mwmr of tis property,or my employes with wages as their sale compensation,
wiB da the work and theawcmre h not imm�d.offered fmule(Sm.7044,B.I.0
and Profession Code:The Conmcmr'a License law does not apply in an owner of Required Inspections
property,who bur'ldsorimproves thereon,and wkdonsuch wart himse fmtiuough his
own employees,provided that such lmpmwmenu art notinunded oroRered ferule If,
Newcomer.the Wilding or improvement Is old within one year of compledon.the owner.
builder wall have this Wrden of paving dust k did act Wild or improve for purpose of
sale.).
❑1,as owner of tic property,am exclusively contracting with licensed canuacton in
construct the pmject(Sec.HOW.Business and Profcas a a Cade)The conuncar's Li!
town Lew dais not apply to An owner of Pmpeny who WRda or improv theaon.and,
who contracts for such projects with a conuumrp)licensed pununt to the GomaCtor'a '
Liuho Law.
❑I4m.1mptunder See ,B&PCfmthisreasm
C Dam
WORKERS COMPENSATION DECLARATION
1 hencby,&Man under penalty of perjury ane of the following declarations:
❑1 hawand will maintain a CerOcauofCenummolfduum for WormesCmnpen-
ation,u provided for by Sacdon 3700 of the labor,Code,for the Performance of the
work for which this pmm0la issued.
❑1 have and will maintain Worksr't Compensation losmence,as required by Seca.
3700 of the labor Code.for the perfom,.ee of the wank for which this Permit is Issued.
My Worker's Compensation Inorance carer and Policy number am:
— Policy No,:
0/ KEMCarrieraTZY1PIONFROM
WORKER$'
COMPENSATION INSURANCE
(Thu sermon need not k completed auto permit Is foronc hundred dollar(3100)
arWq
1 cerfy that in Ne perfnmanca of the work for which this permit is issued,l mull nut
employ any person in say manry�w became jeetmlkworkcn'Compenuuan
Laws of Cmifgnia DYe � sr�
Applicant /�JA mig
NGI7CE PPUCAM:1.e tmrkin& CeniOcem of Exempian.you should
become a Io tie Worker's Compensation provisions of Na Iabm Cade you mus
,J 0 faMwith comply with each provisions or this permit shill W deemed mvokod.
CONSTRUCTION LENDING AGENCY
[+ lkmbyalRar the,then is a CamWe p
Ctian lending.sency Im dcmmlN
� ceof
gr > the work for which this permit is issued(See.3041.Civ.C.)
W LanGer'e Name
0 z Landers Addmss
V O I ce diy dust I law and this aPpfcoon and tuts that the shove information is '
ILS fes COMCL 1&gime m Comply with all City and county imanalws and aim hest relating m
0 Vbuilding construction.and hereby auhreseudws
omme mpnof this city or enter upon the
W &boyo-mentioned property for Inspection purposes
CL (We)agree m saw.indemnify and keep harmless the City of Cupertino against
y Iialdiulm judgments.costs and expenses which may in say way same against aid City
()Z in conoyuence of the&Hoang of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.PO Nr Issued by: Date 3^ F_6,e
SO CE RE ULATI
Re-roofs =
Mo.of Appli ser Dau
A2ARDOUS MATERIALS DISCLOSURE Type of Roof
Will Tho applicant or future Wilding Occupant nom or handle hiardoos material
defined by the Cuperm Municipal Code.Gaper 9.12,and the Health and Safety
coda,sceYes uP6.53z(e)7 . All roofs shall be inspected prior to any roofing material being installed.
❑Ye
SAC
oda appliaanl or future Wilding Occupant two egaipmam or devices which If a roof is installed without first obtaining an inspection,I agree to remove
% emit hexaNnus :it conuminants u dermcd by the Bay Area Air Quality Management all new materials for inspection.
Murat?
❑Yes
I ban mail the huiNms an erials reyum meres under Gaper 6.95 of the Califor.
nia Health&SafctyCode.Sections 23505.25533 and 25534.1 understand that ifmc Wilding
dace no,commonly haw a Irnanr,that it b my nespomibiliry,to mtil'y the asap.,of sae
rtyvirtmenu ichmuR metpnormi umueaf&CeNfmaeafOe /''�S� Signature of Applicant Date
erunutharixcd agent peps All roof coverings to be Class "B"or better
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36911036.00
DATE ISSUED. . . . . . . : 03/09/2006
RECEIPT #. . . . . . . . . : 33509
REFERENCE ID # . . . : 06030044
SITE ADDRESS . . . . . : 10481 GLENVIEW AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DORIS YOUNG
ADDRESS . . . . . . ... . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4512
RECEIVED FROM . . . . : JOHN HUCKLE
CONTRACTOR . . . . . . . : JOHN HUCKLE LIC # 23822
COMPANY . . . . . . . . . . : HUCK CONST. COMPANY
ADDRESS . . . . . . . . . . : 695 S. 15TH ST.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408)298-2374
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 83.16 39.92 0.00 39.92 0.00
BPERMFEE VALUATION 11950.00 83.16 0.00 83.16 0.00
BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 0.00
BSEISMICRE VALUATION 1,950.00 0.50 0.00 0.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 228.58 0.00 228.58 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CASH 228.58
TOTAL RECEIPT 228.58
Community Development
10300 Torre Avenue
� .
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
/o . 060360 " Ll
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX # —'
I am not using any subcontractors: 3
Signature bate
Please check applicable subcon tors and complete the following information:
60 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/Contractor Signature ate
4
CITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM
Ove L3C y-
N# / / Date: . �=0�
[O —
Building Address: Mailing Address (if different from building address):
/C!1/
Owner's Ram–e–:, Phone#:
`1"^44 1 G ZI
Contractor: License#:
Contact: Phone: Z<&Z3 74t- Cupertino Business License#:
011 HVFax:
Building Permit Info: S jf7�}?ET,�O�/TmT� 'Lev ➢lZ77,2)2r25�,/-3
BldgN4 Elect ❑ Plumb ❑ Mech ❑
Job Description: 5,E51n/G )j�GT�pr/� CX/57/n�fs
Residential Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
Cost of Proiec /yea Occupancy Gro
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro'ect Size: Standard ❑ Laze ❑ major ❑
uant ity 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> IM to 1,75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
13CONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXI2 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
CITY OF CUPERTINO
CUPEf�TINO
PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
13MTTIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMIvB4 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 PbIg 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 Pipe PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT' Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm, MECHANICAL
BREIvIAIRHAN A/C Units <= 10,000 cfan MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY .. Remodel Busways ELECTRICAL
BREMFIXT Lightin Fixtures ELECTRICAL
BRENf URN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> IOK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BRE114INHOOD• Installation of Hood MECHANICAL
BREMIvIISC 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
13REMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3 °
CITY OF CUPERTINO
cuPE o PERMIT APPLICATION FORM
uanti 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 I MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSVJM 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
EPERMTTFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MYERMITFEE AZech Permit Issuance MECHLINICAL
PPERMITFEE PlumbingPermit Issue PLUMBING
PPLBG PlumbingFees foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
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