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07110064 CITY OF CUPERTINO ' BWLDING DIVISION PERMIT ���� ������������' ,,;>: ;. _ _::. _... . . , _ . BUILDING ADDRESS: PERMIT NO. 10461 GLENVIEW AVE MP3 MAS��NRY 07110064 . VER'S NAME: � �� DA � PATIBANDIA 4530 FALRVIEW RD � 11/13/2007 PHONE: SANITARY NO. CONTROL NO. (831)637-6663 ARCHI7ECT/ENGINEER: BUILDING PERMff INFO BLDG ELECI' PLUMB MECH 0 0 0 � u O p LICENSED CON'lRACfOR oecuaanoN Job Description i� V C I Mrcby afYrm that I am liccnscd undcr provisions of Chaptcr 9(commencing _ z�� wilh Sccdon 700()) of �wion 3 mc suvnc�c ana Pro�css�ons Codc, and y �iccnsc is RE PA I R(�) CMNEY F RM 2' F E LOW R00 F� T I E n t a �n fu0 force and effefiC � j�? L'uensc �•/ ��-+► INTO (E) 3REEL&RBLD TO CODE HEIGHT y �, � Da�c Conlrac ARCHTIECI'S D �� � 1 undcrsund my plans s6a116c uscd as public recarda �yU 4 O y Liccnsed Pnifcuianal y � OWNER-BUILDER DECLARATION +� I hcrcby alTirm �hat I am excmp� from ihc Conuactors Liccnsc Law far thc ` O � following reason. (Sccdan 7031.5, Business and Profcssians Ca1c: Any ci�y ar county K,°, Pi which iequi�es a pe�mit w conswct, altet improve, demolich, or m�wir any swcw�e y z� prior w i�s issuancc, also rt;quims thc applicant for such permit io filc a signcd summent ` i �< tha� dc is liccnscd pursuanl ta thc provisions o[ Ihc Conuactor's Liccnsc Law (Chaptcr 9 q. Ft. Floor Area Valuation y t- �(commcncing wi�h Scction 7000) of Division 3 of ihc Busincss and Profcssions Codc) or $ 212 5 y �.. that he ia exempt the�efrom and the bssis Cor the alleged eumption. Any violarion of Section 7031.5 by a�ry applicant for a pertnit subjecu �e applicant w a civii penaity of Number Oecupaney Type not more than five dundmd dollan (5500). 3 6 9110 3 3` Q I. u ownec o[ tlie property. ar my employces with wages u the'v solc compensation, wiU do the work and �he suucwce is not intended or ofteced for sale (Sa. 7044, Businesa Re uired Ins ections and Professions Code: The Conuutor's License Law docs not apply w an ownw of 9 P property who 6uilds or improves thercon, and who das such woric himself or Nenugh his own employca, provided that such improvemenn ue not intended or oQered for sala !f. however, the building or impmvement is sold wi�hin one yeer oC compleGon, the owner- builder wiU have the burden o[ proving Ihat he did not buiid ar improvc tor purpose of sakJ. ❑ I. ss owner of the propeny. am weclusively conuacting wiW Gcensed rnntncwrs w consuvct the projett (Sec. 7044. Business and Pro[essions Code:) The Convacmr's Li. cenu I,aw dou not apply in an owner of propeny w6o builds or improves ihereon, and , who contracts for such projects wiW a contractor(s) licensed pursuant to �he Convactors License Law. r"1 1 am uempt unda See. . B de P C for �his rcason , na Date WORKF1t'S COMPENSATION DECLARATION 1 hercby affirm under penalty o[ perjury one of the fallawing decluations: ❑ I hsve and will maintain a Cenificate of Consent to ulf-insurc fw Workcrs Compen- uGon, u provided far by Section 3700 of Uu [abor Code, for �he performance of thc work Cor which thu pertnit is issued. ❑ I havc and will maintain Workcr's Campensation Insurana, u rcquired 6y Scction 3700 oC the Labor Codc, for the pcdormance of �he wort for which �his permit is issued. My Worke�s Compensi on l�su�ancc carrier and num er arc: � T 1 Cartier. ��� /'�!J n.� Poli No.y CERTIFICATE OF EXFINPI70N FROM WORKERS' COMPENSATION 1NSURANCE ' (I'his section necd irot bc completed it the pecmit is for onc hundrcd dollars (5100) or Icss.) ' I cenify tM� in thc perfwmance of �hc work for which ihis �ermi� is issucd, ! shall not employ any person in any manncr so u w bcwmc subject w the Worl�crs' Compcnsatlon Laws o[ Califomia. Daic Applicant NOTICE TO APPL.ICANT: lf, af�cr making Uiis Ccnitica�c of Excmp6on, you should become subject to thc W+orkcr's Compcnsadon provisions of thc l.s6or Codc, you must � z forlhwilh comply with such provisions or this permit shall bc decmcd Rwokcd. z O CONSTRUCiION LENDING AGENCY (— � 1 heroby afGrm Wt there is a conswction Icnding agcnry for �hc nerfurmance of (S� � �he work [ur which ihis permit u iuued (Scc. 3097, Civ. C.) W� A ��a�rs N�� • Lcnde�s Address V � I cenify iha� I have read this application and stalc thu ihc abovc infortnauun is w � cortccL I a6rce to comply with all city and counry ordinances and sute laws rolating w 0 U buildin6 conswction, and hc�eby authori�t represcntaUvcs of this city w en�cr upon the � a abovc-mentio�rcd propcny far inspenion purposes (Wc) agrce to save, indcmnity and kecp harmless ihe Ci�y of Cupertino against �� liabilitiea, Judgmcnls, cosLS and expenses which may in any way accnu against said City V z in conuquencc oC tAc granting ot this permit. �"� APPLICA NDERSTA AND W1LL COMPLY WITH ALL NON-PO1NT Issued by: Date �� SOUR E ` � Q Re-roofs Signuure of ApplicanVC tor e� �_ HAZARDOUS MATERIALS DISCLOSURE Type of Rc �of Will Ihc applicant or futurc building acupant starc or handlc ha•rardous ma�criil dcfined by thc Cupenino Municipal Codc. Chapter 9.12, and �he Hcalth and Safety k. Scc�ion 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0 Ycs �o wll the a�licant o future building occupant use equipmenl or Jevices which If a roof is installed without first obtaining an inspection, I agree to remove emi� ha•r.ardous air conuminants u dcfincd by the Bay Area Air Quality Managcmcnt all new m�.terials for inspeccion. Disuict? ❑ Ycs Nu 1 havc rcad ihe has ous ma�erials requiremcnls umicr Chap�er 6.95 of the Glifor- nia Hca1N & Safcry Codc, Sections 25505.25533 anJ 25534.1 undcrsund � if ihc building docs rw� c nUy havc a tenan�, ihat it is my responaibiliry w noufy �hc occupant of �he rcyui n � h muu o m issuarkc ota Cenir�ca�c of oc a Signature � if Applicant Date oW���o�a�ma��.�aas� D„� All roof coverings to be Class "B" or better o�ii o r� �� � CITY OF (�UPERTINO . � � �4 .... ,... ��TM�F pERMIT APPLICATION FORM CUPEI�,TINO APN #� �/ o � . �� p �� Date: / 3/ ��`� Building Address: Ma;ling Address (if different from building address): � Yl t-� � Owner's Name• � Phone #: �'3/-��?���3 Contractor: License #: /� � � . Con� ne:�j/' .37 Cupertino Business License#: Fax:� G ' > d''� / Building P it Info: Bld Elect ❑ Plumb ❑ Mech ❑ Job D scription:���.4// E'� G�l' �r!'!�'/'e� � y�1�! Z' a� �4-ara� y`i � �y11v ��-' S�"�' Residential � ,bv � GD /�l c/ ���Comrnercial ❑ Sq.Ft. Flo Area: Sq.Ft.: Cost of Project: � Occupanc Group: �%�-S � Type of Constructio �, + � Please check this box if t� project is a ��r��- second-sto addition: Project Size: Standard ❑ Large ❑ Ma �or ❑ Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER Other A liances MECHANICAL BBOILERl Bc iler <= 100,000 Btu MECHA1vICAL BBOILER2 Boilf;r > 100K to SOOK Btu MECHANICAL BBOILER3 Boi:.er > SOOK to 1M Btu MECHANICAL BBOILER4 Boil�,r > 1M to 1.75 M Btu MECHA1�iICAL BBOILERS Fcoiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Cc�n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Ccnstax — Resi/Mobile BUILDING BELEC 1000 E: ec 600V <= 1 OOOA ELECTRICAL BELEC1001 E1ec 600V > 1000A ELECTRICAL BELEC200 ' Ele�� Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD �nergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING l of 3 CITY OF CUPERTINO CuPE�,T�NO PE�IT APPLICATION FORM Quanti Fee ID Fee Descri tion Fee Grou BMISCELL P✓Iiscellaneous Fee BUILDING BMITIGATC Conun. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM Ne�v Comm Mechanical MECHANICAL BNUCOMMP 1`lew Comm Plumb PLUMBING BOVERTIME Ir.s ection Overtime BUILDING BPBACKFLOW Atmos heric Vacuum PLUMBING BPCESSPOOL Cess ool PLL7MBING BPERMFEE ]31d Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS Ga� Pi ing S stem Fee PLUMBING BPINTERCEP In�i Waste Interce tor PLUMBING BPLANCHK � Plan Check Fee BUILDING � BPLANCKADD Pl<<n Check Add Multi BUILDING BPLANCKREP Plan Check Re eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK La�✓n S rinklerBackflo PLUMBING BPSTORM �itorm/Rain Water PLUMBING BPTRAP Kitchen Tra PLLTMBING BPVENT A lt of Drain & Vent PLUMBING BPWATER InstalVAlter Water Pi e PLUMBING BPWHEATER V��ater Heater/Vent PLUMBING BPWSVCS 1�[ain Water Service PLUMBING BREINSPECT [�eins ection Fee BUILDING BREMACOVER A/�� Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHAIVICAL BREMAPPLI Appliance Install MECHAIVICAL BREMBUSWAY �Zemodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Re location of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT lieater Installation MECHAlvICAL BREMINHOOD In stallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREI��INRAPP Reni Non-Res Ap liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA R.elocation of Hood MECHANICAL BREMREPALT R �pair/Alter Heating MECHANICAL BREMRESAPP Rernodel Res Appliance ELECTRICAL 2 of 3 # � CITY OF (:UPERTINO CUPEI�TINO PE�IT APPLICATION FORM Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rmdl Si s Add Branch ELECTRICAL BREMSIGNS Reniodel Signs, Mar uee ELECTRICAL BREMTHEATR Th �atrical Lightin Fix ELECTRICAL BREMVENFAN Vent Fan Sin le Duct MECHANICAL BREMVENSYS V entilation S stems MECHANICAL BSCBLVD Scb S ecific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL ;i eciallns ection BUILDING BSWIM Swimmin Pool BUILDING BTEMP 7'em ora Power ELECTRICAL BTEMPPERM Te�� orar Bld Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC 6usiness License BUILDING ELECTRIC Electrical s foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE nZechanical sq. foot MECHANICAL MPERMITFEE ME ch Permit Issuance MECHANICAL PPERMITFEE Plumbin Permit Issue PLUMBING PPLBG Plumbin Fee s foot PLIJMBING PLLONGRNGC Plannin ; LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin ; Lon Ran e Residential PLANNING : of 3 CITY OF �UPERTINO 2 ITEMS OF 2 PERMIT RECEIPT. OPERATOR: patg - COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36911033.00 DATE ISSUED.......: 11/13/2007 RECEIPT #.........: B50�0003217 REFERENCE ID # ...: 07110064 SITE ADDRESS .....: 10461 GLENVIEW AVE SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............. PATIBANDIA ADDRESS ..........: 10461 GLENVIEW AVE CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4512 RECEIVED FROM ....: MP3 ENTERPRISES CONTRACTOR .......: PATRICIA GERE LIC # 27197 COMPANY ........... MP3 MASONRY ADDRESS ..........: 4530 FAIRVIEW RD CITY/STATE/ZIP ...: HOLLISTER; CA 95023 TELEPHONE ........: (831)637 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 2,125.00 83.16 0.00 83.16 0.00 BSEISMICRE VALUATION 2, 125.00 0.50 0.00 0.50 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 83.66 0.00 83.66 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 83.66 #3420 --------------- TOTAL RECEIPT : 83.66 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 514 FINAL PUBLIC WORKS �;, _ .: : Community Development � 10300 Torre Avenue ��' '��� ' Cupertino CA 95014 �;�.. ' Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEI�TIN� Buildin De artment JOB ADDRESS: PERMIT # i� � �7 C�o 0 6� OWNER'S NAME:��, � PHONE # %�,�7 - �(� GENERAL CONTRACTOR: FAX ## �',3 – � - �' ;�' I am not using any subcontractors: Si;;nature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIrTESS NAME SUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathirig Masonry p 7/�'/ Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile — � Owner/C ntractor Signature Date