08110097 BUILDING DIVISION PERMIT .C1�?, RAt:•�.TQRTQRMtT7OI
BUILDING ADDRESS: PERMIT NO.
22
R'S NAME: PERMIT ISSUE DATE
5 Y CONTROLNO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
ELECTREPAIR SHOWER PAN WALLS S, BLDG O O PO O
coo LICENSED CONTRACTOR'S DECLARATION TILEJob Description
i� 1 hereby affirm Nat 1 w linnsnd under Pmvitions o(Chapar 9(commencing
wish Section 7 andd effect.Oitidan 3.font.Budneu ana Profusi.Code.and my license u
jn k full to= P C•
Ll? Licersa Clan
= Dow
Fo //— —Contrvsor .zul Cc..afh
uuuARCHITECTS DECLARATION
iE< 1 undersand my plans"I be urAu public meoNe
k Licensed Prokstional
3 OWNER-BUILDER DECLARATION
7 1 Wrtby alliime Nn 1 am ucmpt from Its,Contrenoh Lknse Law for the
2 00 following mount.(Section]031.5,Budeu nand Pmfcctions Code:My city or county
E
_� which ox uirn a Permit to construct.alter.impron.demolla,or repair any suwtum
prior Wits in..slm numoru dc.1lipnt for such Permit M file.signed suvmcal
"heielimuedparamount mthe pmadonsarthe connaemrsLiemes,Law(enape,9 Sq.Ft. Floor Area Valuation
yI- (commencing with Section 7000)of0ividon SoftW Budwssand Profeaiaru Code)w
y $ dist he is exempt therefore and the basis for IW allegod aaemPli m My Noladon of
Section 7031.5 by any applicant fns a permit stbiccu Nuc APPliwnt In a civil-penalty of APN Number Occupancy Type
cot mom Wm fin hundred"IIs,(SS(10).
I.mo ofdepropety.wmyemployerwithwagsuNebmkcompcnudon,
and Prthcwon,mail,-The CaeuwtinaMWwartuWfwukpply Us a owner
Required Inspections
and Profession Caac Th ConmctoY. nd.1ho law ams cot appy if an awns of q P
ow nerr who employees,MrA impmtvs demon.ana« s area aucn wort in oro lrwuhougn his
owntWiping or idalsuchimprotemntsarenot our ofomoResed far Saler,
Wilderhumans.Ne Wilding or impmmneetg chat I o Within or mmpkuon,thepose Of
Wilder will baro IW butdn of provin6 dist W did rot Wild m improve for propose of
sake).
❑1.u owner of that property.am ncluairoly conuutint with licensed commiserates;m
consrme,de Amis,(Sec.70aa,Busing and Professions Cade:)The Cootraemfs U.
cease law dons oat apply an an owner of property who Wilds or Impmros thereon.and.
who contracts for such projects with a conuacmr(s)liesm ad p roma nt un the Conuactoh
Licosa Law.
❑l con mcmpt under Sce .B&PC far this recon
Data
WORKER'S COMPENSATION DECLARATION
I hereby air under penalty of perjury arc or dm following declarations:
ha.e and will maintain a CanJne of Consent to self-iuum for WorkoesCompcn-
ration,u poo,ided for by Section 3700 of the labor Code.for the performance of IW
work for whicp this permit is issued
oil an and will maintain Wor aces Compensation Insurance,u required by Section
3"o of the labor Cade.forme performance of IW work far which this permit is issued.
My Wortafs Compensation Insurance nrkr and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
i lTismctlon need not W conpkad lines renai,is forone hundred dollars(SIW)
or lnss)
1 certify mat in the performa..of the work for which Nis Permit is issued.l.hail not
employ any person in any man0cm come �cFtmlW Warken'Compcnsauon
Laws of California.p
Applicant f -r
NOTICE TO APP&CAM:1L oMr making this Certificate of Eacmpium you should
become subject ro the Worker's Compensation pmvisiom Of the lahmr Coag.you mmt
.JO faMwith comply with such Provisions or this permitshdl W damnd revoked.
'E` CONSTRUCTION LENDING AGENCY
[-i I Wmby af0rm situ do m is a construction lending agency for me perro mamx of
p: me work for which this permit is issued(Sec.309'1,Civ,C.)
!L7 0 Ianacts Name _
M lancers Address
U 0 1 cardfy that I have mad this application and sass mu the aWro information is
IT.F coma I agrn m amply with W city and county aNinancu and ma laws rotating at
0L) Wilding conmuction.and hereby authorise rcpresentauvn ofthis city a order upon tW
aWn-menuaned Property for inspection purposes
(~ G
(Wo)seg.to ate,indemnity and keep barnleas the City of Commurro.gaiut
rw V) Iiabilitlm.judgments,ccau and expenses which may In any way same against said City
V z in eomequatce of me granting of this permit Date /Z(f V�/—t.•1--+
^ APPLICANT UNDERSTAN/DS//AND WALL COMPLY WITH ALL NON-POINT Issued by:
SOURCE 0
DI9C /
fG l/'Z6-' Re-roofs C7f�
Sigwum of ApplicanufGholaann, Date
HAZA
xnznaDOoous MATERIALS o1sCl.osuRE Type of Roof
Will the appliont w forum Wilding oceupantsrare m hamate hauNans massrial
.eared by site Cupenina Mudeiryi Cane.Chapter 9.13.and IW HnIN and Safety
.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs fQNa
Will the applicant or fuwre Wading wnpant em equipment or dedms which If a roof is installed without first obtaining an inspection,I agree to remove
it huudau air cmurninmu as defined by the Bay A.Air Quality Management all new materials for inspection.
m]
❑Yrs gA'o
I have read the ha sNous matcddt nequiremew under Chi mcr&95 aftim Cdifor.
.in Health&Safety Coda,Seem.25505.25533 and Mill.l undersand met ifmn Wilding
does net commonly has a UmmL mu it is my responsibility m ratify the aaupant of the,
rtquim whkhmtm t arloissnarocnf.CufemOfOaopmcy. Signature of Applicant Date
Owrormaamarivsd agent / 2G D a All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35709045 . 00
DATE ISSUED. . . . . . . : 11/26/2008
RECEIPT # . . . . . . . . . : BS000006697
REFERENCE ID # . . . : 08110097
SITE ADDRESS . . . . . : 22113 STOCKLMEIR CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PRALL ROBERT H JR
ADDRESS . . . . . . . . . . : 22113 STOCKLMEIR CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2727
RECEIVED FROM . . . . : VANNI BROTHERS
CONTRACTOR . . . . . . . : VANNI, MICHAEL LIC # 18307
COMPANY . . . . . . . . . . : VANNI BROTHERS CONSTRUCTION
ADDRESS . . . . . . . . . . : 914 HYDE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 253-7028
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- ----- ---- ------- ---- ---------- ---------- ----------
1BSEISMICR VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0. 00
1TRAVDOC FLAT RATE 1. 00 40 . 79 0 . 00 40.. 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 82 . 18 0 . 00 82 . 18 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- --------------------
CREDIT CARD 82 . 18 master card
------ --
TOTAL RECEIPT 82 . 18
•
4 *F
Assessor's Parcel Number:
Name of owner. �—o Pro,
Project address. 22- 11 3 S i-Z:3 C In, e
Contact person. Nei Phone qo(f- GOA- -5 -5
Fax. q0 e- .z s-3- 7 6 2-
Net square footage of lot.
Existing Propose
Square footage: First floor:
Second floor:
Garage:
TOTAL:
e there at least two 10 foot by 20 foot clear spaces inside the garage? 13t—N
Is privacy protection planting required for the project? y N RECEIVED
NOV 262008
On what floor(s) is work being done?
BY:�
Brief description of work. RIO CID ,J&Z-- A uJ Pq7J
r-z % r,& /U o 9 h2n ,
7' No 1?)`?-OC,�6:�.,'�d. /If 4hi�
Code editions: 2008 CBC /(V- N)2008 CFC (Y- N)2008 CMC (Y-N)
2008 CPC N)2008 NEC (Y - N)
K4P-b-KC�N#tULA
A006AM W41M RE(OMW
Effective 1/1/08
GWMM=6
Do kept on t -nd it is ur,
Iffftl to Ma
911 sameW-f) Or alteration-
rMssion iron
the building t,,p . L-ne;tino.
rhe $tBMPif1g of A, ,, ',Pecjfication,
10 INALL NOT be heal I. pe,mit or to be af
WrOval of the violation of any provisim,
4 any Citv Or(lin8rice' or State I-Aw
Plan Review Process Work Book Page-8-Revised I/l/08
F
CITY OF CUPERTINO
CUPER,11NU I GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date: —Z 6-
Building Address:
221/3 S�o���s-h
Mailing Address (if different from building address):
Owner's Name: Phone#:
TD n ►�l'q �� 6S-
Contractor: y� Phone: c� V p 6 o S'S -;z r:7—
V,q'L/✓✓ . C, co^j Fax: 0 8 2 S3-7 o2
Contractor License#: �3 7?-
Cupertino
ZCupertino Business License#:
Contact: ,N� /� q(/ Phone:
• !V of 14A/�, Fax:
Residential Commercial
Job Description:
A?e Ues f 6a7ti Shower . �gN we�] Is T,% .
Building Permit Info:
Bldg OR" Elect ❑ Plumb C�-� Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B �� 3
Valuation: Square Footage:
6 o8, . "a
Project Size: Express [D/Standard ❑ Lar e ❑ Ma'or ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
• Points Achieved:
For help, contact Build it Green at www.buflditgreen.org
Revised 10/20/08
a1F
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 BBOILERI For the installation or relocation of ea M
boiler/compressor to &including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h 29.3kw)
1 BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
11313OILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M •
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
I BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P
per hour
1MEETINGIHR Application Meeting B •