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07110066 CITY OF CUPERTINO � Bi;ILD1IVGL;iVISION PERMIT ���:��������������'� . , , .,. <,:: ; : .. :. . .:;r ;:: BUILDING ADDRESS: PERMIT NO. 1129 STAFFORD DR TBD —'I'0 BE DETERMINED 07110066 . YER'S NAME: PERMIT L56UE DATE DAVID & MAILING LIN WOOD � 11/13/2007 PHONE: SAMTARY NO. CONTROL NO. ARCHIT'ECT/ENGINEER: BUiLDING PERMIT INFO BLDG ELECT PLUMH MECH � � 0 0 u O p LICENSED CON7RACTOR'S DECLARATION V � Yr,�cby a(Iicm that 1 am lixnscd undcr provisions of Chaptcr 9(commencing Job Description �z�� wiuiScction7U00)ofDivision3ofineBusinessandPra� ons � a n d, myliccnscis ELCTRC PNL SAME L�C � 2�� AMPS ^� y in full force and eftat (� p � Z I,icenac Class L�. � �'-� �, � Da�c Conuactor � A H CI'S DECLAAATION � 1 undcrsund my plans shall bc wcd as public rccords m< a� U 4 Q y Licensed Pn�fessionel y � OWNER-BUILDER DECI.ARATlON I hcrc6y alTirtn �at 1 am axcmp� Gum ihc Con�raaors Liccnse Law Cor tNc ` � ra L p O following rcason. (Scction 7U31.5, Business and Profcssians Caic: Any ciiy or counry K$ Pi which rcquiccs a pertnit to canslruc� aimr, impmve, dcmolish, or iepuir any structwc y^ y, prior ui i�s issuancc, alsu rcquims thc applicani for such permit to filc a signcd siatcmcm F � that hc is IicenxJ putsuant to Ihc pmvisions o[ thc Conuactors Li��cnsc Law (Chaptcr 9 Sq. Ft. Floor Area $15 0 0 Valuation y i- �(commencing wiih Secdon 7000) af Division 3 of ihe Business and Profeuions Cade) w y �.. that he is e�cempt therefrom �nd �e bssis for �e sllcged exemption. Any vioiarion o[ Section 7031.5 by arty applicant (or a permit subjecu �he applicant to a civi] penaity of Number Oeeupaney Type not moie �han five dundmd dollars (5500). 3 2 6 0 6 0 � 3��Y ❑ I, u owner of tt�e property, or my cmployces with wages az their solc compensatlon, will do the worlc. and ihe stcuctme is not intended or atCered for sale (Sa. 7044. Busi�rcss Re uired Ins eetions and Professions Cade: The Conuxtor's License Law da� not apply w an owner of q p property who builds ot improves thercon, and who does such work himultor Uvough his own employces, provided that such improvemenu a¢ not imm�ded ar oReeed Cor sale. l[, hawever, ihe building or impmvanenl ia soid within one year ot compledon, the owner- builder will have the burden o[ proving Wat he did not build or improve for purpoae af sale.). 0 I, as owner o[ the propeny, am wectusively contracting with Gmnaed rnnuxtors w wnstnut the pmject (See. 7044. Eusiness and Professiom Code:) The Conuactors Li- cense Law does nat spply �n an owner of propeny who builds or improves thereon, and , who conuacls for such pmjccLS with a contnctor(s) licensed pursuant to the ConuscWr's License Law. ' I am exempt under Sec. , B& P C for this rcawn � Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty ot peryury nne o( the foliowing declaruions: ! hsve and will meinuin a Ccnifica�e of Conaent to ulf-insure for Worlrcr's Compen- t, as provided for by Secdon 3700 af che Labor Code, far �he pedormance ot the work tor which this permit is issued. ❑ I have and wiU maimain Workcrs Compensadon Insurancc, at rcquired by Scction 3700 of the Labor Codc. Cor thc pcdormance of �he work for which this permit is issued. My Worke�s Compenaation Insurance carticr and Poliry number a�c: Cartier: Poliry No.: CER7'[FICA'I'E OF EXEMPI70N FROM WORKERS' COMPENSA710N INSURANCE • (Chis scctian need not bc completed if �he pecmit is for onc hundred doilara (S I00) or Icss) , ' I cenify Ihat in thc performance of work for wAich ih' permi� is istucd, l shall not employ any person in any man u to bccom bjec t �he �brkcrs' Compcnuuon Laws of Califomia. Duc Applicml N0T7CE TO APPLICANT. If, alYcr making ihis Ccrti ca�c of Eumption, you should become subjxt to thc Worlccr'� Compcnsation provisions of thc lsbor Codc, you must � z foMwiih comply with wch provisions or this pecmit shall bc dccmcd mrokcd. z O CONSTRUCfION LENDING AGENCY [- '-�. 1 hc�eby aRrtn Uwt thcre is a coRSUUCtion Icnding agency Cor ihc performance of p; � ihc work fur which �his permit is issucd (Scc. 3097. Civ. C.) W� Q Lendcr's Namc ^ � z Lender's Addres: () 0 1 cectify that I have rcad �his applicuion and sutc �u the abovc infamatiun is w�" cortcc�. I agree w comply wiih all city and counry anlinances and state laws relating w � U buildin6 consuuction, and hereby authoria mprcsentadvcs of ihis ciry w cn�cr upan �hc W ahovc-mcntioned piopeny tor inspenion purposes �y (Wc) agree to save, indemnify and keep harmless �he City o( Cupertino against �„ � liabilities, judgmcnla, costs and expenses which may in any way accruc against said City V z in consequencc o[ thc granung of Ihis permil. Date / /J � '-1 �"'� APPLICANT UNDERSTAN AND WILL COMP Y WITH ALL NON-POINT Issued by; / SOURCE REGULATlON . �- � � r i Re-roofs -�� Signuure of Applican nuscwr Date HAZARDOUS MATERIALS D SCLOSURE Type of R oof wll thc applicant or fuwrc building occupsnt storc or handlc ha•rardous ma�crial �cfincd by thc Cupenino Municipal Codc. Chaplcr 9.12, and the Health and Safcty �, Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed. ❑Ycs �No Will the applicant or fuwre building accupant use equipment or Jeviccs which If a roof i:� installed without first obtaining an inspeetion, I agree to remove emit ha•r.ardous air coniaminants az dcfincd by the Bay Area Air Quality Managcmcm all new m aterials for inspection. as�;��� Q Ycs �Nu ! havc read ihe haia�dau maierisls requiremcn�s under Chapicr 6.95 of ihc Califor- nia Flcalth & Safcty Codc. Scctians 25505. 25533 arul 25534.1 undcrsrand Uiat iC ihc building docs not curtenUy havc a icnan4 � it is my rcspoasibiliry w nodfy thc occupant of the requircmcnls which mus� be mct prior W issuance of a Ccnificale of Occupancy. Signature of Applicant Date owner or authari�ca agcni � p„� � All roof coverings to be Class "B" or better ���/ � a � � CITY OF �CUPERTINO L CUPE(�TINO PERMIT APPI.ICATION FORM APN #� � �P � � G � ��, � � Date: � I � `. 3 _ � Buildin Address: , Mailing Address (if different from building address): � z �S`-�� . v ra� l� r �' ' �s`� � Owner's Nam : ^ � , Phone #: t'9 �., � � - � I � .,� � � ontractor: License #: � . _ � go�-�6 � Contact• � Phone: Cupertino Business License#: � nn � F� � 4���3 �.' -� � 3 Buildin Permit Info: Bld ❑ Elect � Plumb ❑ Mech ❑ Job Descripti ,p��'�-j �q�-� S�� �oGcf.f,�iL. Residential � Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: � Occupancy Group: �� Type of Construction: Please check this box if the project is a second-sto addition: � Project Size: Standard � Large ❑ M;�'or ❑ Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER Other A liances MECHANICAL BBOILERI Bc>iler <= 100,000 Btu MECHANICAL BBOILER2 Boil�;r > 100K to SOOK Btu MECHANICAL BBOILER3 Boiler > SOOK to 1M Btu MECHANICAL BBOILER4 Boil �r > 1M to 1.75 M Btu MECHAlvICAL BBOILERS �3oiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ir d/Off/Comm/Quasi BUILDING BCONSTAXBQ Cc,n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Cc�nstax — Resi/Mobile BUILDING BELEC 1000 E�ec 600V <= 1 OOOA ELECTRICAL BELEC1001 F;lec 600V > 1000A ELECTRICAL BELEC200 � Ele�� Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING : of 3 CITY OF ��UPERTINO CUPEI�TINO PERMIT APPI,ICATION FORM Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD RrYtdl Signs Add Branch ELECTRICAL BREMSIGNS Reinodel Si s, Mar uee ELECTRICAL BREMTHEATR Tr_eatrical Lighting Fix ELECTRICAL BREMVENFAN V��nt Fan Sin le Duct MECHANICAL BREMVENSYS `�entilation S stems MECHANICAL BSCBLVD Scb S ecific Plan BUILDING BSEISMICOM S��ismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL S ecialIns ection BUILDING BSWIM Swimming Pool BUILDING BTEMP 'Cem ora Power ELECTRICAL BTEMPPERM Ter.n ora Bld Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical s foot ELECTRICAL EPERMITFEE El ec Permit Issuance ELECTRICAL MPERMFEE r✓Iechanical sq. foot MECHANICAL MPERMITFEE Mr.ch Permit Issuance MECHANICAL PPERMITFEE P1L;mbin Permit Issue PLUMBING PPLBG P:umbin Fee s foot PLiJMBING PLLONGRNGC Plannin;T LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin�T Lon Ran e Residential PLANNING :� of 3 CITY OF CUPERTINO 5 ITEMS OF 5 PERMI7' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN ......... 32E�06013.00 DATE ISSUED.......: 11�13/2007 RECEIPT #.........: BS(�00003221 REFERENCE ID # . ..: 07�.10066 SITE ADDRESS .....: 11�;9 STAFFORD DR SUBDIVISION ....... CITY .............. CU�'ERTINO IMPACT AREA ....... OWNER ............: DA�'ID & MAILING LIN WOOD ADDRESS ..........: 11�;9 STAFFORD DR CITY/STATE/ZIP ...: CUI'ERTINO, CA 95014 RECEIVED FROM ....: JESI-I PI CONTRACTOR .......: TBI) - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBI) - TO BE DETERMINED ADDRESS ........... CITY/STATE/ZIP ...: , TELEPHONE ......... FEE ID UNIT QUANTITY [�'IOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BELEC200 METERS 1.00 29.43 0.00 29.43 0.00 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BSEISMICRE VALUATION 1,500.00 0.50 0.00 0.50 0.00 BUSLIC FLAT R.ATE 1.00 107.00 0.00 107.00 0.00 EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 ----------- ---------- ---------- ---------- TOTAL PERMIT : 212.58 0.00 212.58 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 212.58 #2434 --------------- TOTAL RECEIPT : 212.58 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL _ Community Development . �,: +,. r , 10300 Torre Avenue r�' ' ���• Cupertino CA 95014 Telephone (408) 777-3228 C(TY OF Fax (408) 777-3333 CUPE�TINO Buildin De artment JOB ADDRE �:� f�G �,r PERM � � ( � � C'� � � OWNER'S NAME: G�-z'S� �� PHONE #��-- � 7 GENERAL CONTRACTOR: � � �` (� � , FAX # � I am not using any subcontractors: � << � 3 �� , Si �natur Date Please check a licable subcontractors and com��lete the followin information: SUBCONTRACTOR BUSIl`JESS 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 — 9" � _ t! !3 �� Owner/Contrac or Signature Date