06080217 CITY OF CUPERTINO
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BUILDINGDIVISION PERMIT 4CO�NTE&ORilio, RA,.-a' , -
BUILDING ADDRESS: ALBERT WAISSMAN �Nli I NO.06080217
22013 BAXLEY CT
OWN W NERs NAME PFRNM ISSUE DATE
ALBERT WAISSMAN
NE SANrrARY NO. COMROL N0.
ARCH=M-NCINEER: BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
O O O O
;Too UCENSEOCONfitACTORSDECLARAFION Job Description
FC 1 b«cby affirm Wu I r.[i .n i ,nk7 pm^ca^a W Ch'.9(c emmM
cn{
•�; W NN Sstim]O iaanJaf me BwlrcsS and Rofuaou Codc..d mY lkuxb
infell rmaameffrlr.l.«L REVISING EXISTING OUTLET TO TOPE OF CEILING
�q LDooCOa9 co.uanar USING "HIDE ME" MERCHANDISE TO COVER WIRE ON WA
ARCHITECTS DECLARArION
1 umderwnnd my Pbru shall m wed u puDBc ruaN,
raU
Lktvcd Pm(asi.ral
w� Oal i ant rnpi r DECLARATION
C 5 1 hdebr.Rum W.I I am eumpl from the,f. mmar.Liecme Lav for do
:O O foll.winL oras,.(Scum 7D3I5.Buaeeu and Pdnanu Code:Any d,Y w corny ,
a$�i which mgdm,a pmnit b emWnual alar,knP°vet demwJW,m mpa'v ml Rmttum
!iI prlarn iu bswnc.elm mquw tm apPlkant Torsmh pdmi,m Ole ad{rcd.uxmcmValuation 50
�< w,It,blkmxd Nmm,w wPmviaaas N do Ccan w'%ua.=La.(O.0.9 Sq.F[. Floor Area
i 0 (cemmcning a tit Secum 7000)al Diviaon 3 of lm Bmrcn and Pmfcaimu Ca/c)«
. _ Wal hc'a ememp,Ibetermm rd ee but+f«lm allerd nempdm,My ,-laden of
Smion 70315 by airyamlinm W.permit mbjeeu the appliam In a QQ Pmaty or NN gg p y'[}ape
mm mart thm ails buedmd dollar(Slap). 3 5 6 0 6 0 21 r 0 0 u enc
❑Luewerorae e,, tee,mmy uoplo5sra rhbr+W al le salee.mp11mmci,
WN themork ardwmudmeb V3t`3Imhd«oRded kr ale awy W aa,B of Required Inspections
ud Pm(ctiom Cadc Tm Conuacmh LJ®x In son ort apply n m°ewer u q l�
{rageny rho mBw m imposss acmm,sed rm don each wale h:n^If«Wrm{h bb
ow.«°ploys,,pwwdeE wt welt imPva.emenu are nla imemdN«.(Teas]fm Ne B. '
twsesc.me miWlnL m®P°`er°rnt b sold rimin ore Isar arcomPkum.w wm-
bwldv riB haw Im binder at povin{wl m did m btiW«naPrvae Ica Ptep°Q N
1.u.eweof me prop
r my.am ea,cu is y^""u.din{v ith Bse¢d azrvlraraa W
c re. me M)cel(Sec 7B,e,Basins sad Rofealam C(ade:)The ComuxWes Li-
.Lav door ort apply m mare.of PMPMY arm htilca m lrcmwsmm,and.
.m. ..fm such Mjem rim.mneme-14)m d gvaoanl m me CmmrmK.
I kmac mow.
p lun...,M at,PCrrc w,nam
o.mr 1 SATION m.,,
mg. a.
woRKERs cohPNsnnoN DrrS.IaATION
1 hmby affirm order Pcealty Of Pcrjury Tse or w fallen,[dedraamtc
I ha.c and ll man We a Cetdriute el Comamt to aem-Inuvc r«Wccas Cmnpca
amn,n pmMd d for by Sat eem 3700 N de Labor Code,fm me pelfarmms of de
.ark rm which oris Permit i.netted,
❑1 bac am ll mantel,Wore(.C.,anteaden Inatrm¢,u rrydmd by Sectim
]700 of w tabor Cntle,far l e perfam.aec of lm Toric f«rbich oris M..b bard
My wctrsCcMaM ma beers mz carrier and Pdky MM,ber me:
Carrier Policy Na.: -
CERTIFICATE OF EXEMMON FROM WORKERS' _
COMPENSATION INSURANCE
(Mia cetlm.sE ort be cumpkacl Ifine panic Is for am nmded colla,($109)
m k„)
I Cuuf.w,in me parr m.of Im vale r«Which oris pm.h b isemd.I marl n«
emp"my,crmn'n Y rmuw1xsmew1bjsmmme WartaYCcm
lA,v,.(Cali
NCTICm
NOTICE l0 APPLICANT:If,after matin[orb Ccnl/lua°(Ficmpllmi.yvu,mutl
bcmrx b Wortrr.Campemaum pro+bl«u of me lab«Cade yaw mu¢
.,O fmWwiWmmply CLW such pr.vi,iam«orb pmnil.Lll be dsmd metre. -
Z� COVSfRl1Cf10N LENDING AGENCY
E.. I hemby altm m
hm Ihem n. far Wa(e Perform.> me Work fm ankh dks permit b iauee(sec.5071,CN.C.)
6W.^n- Lender.Nanm
0. Z L<M Add
ma
U O 1 mn1rY oral l nuc rtad whit applica,im aM sax du tm amw kfomauu.b
w L ..IL[.,R L.cernply e1N all City aMl COun[y 0ldlnaKn",,talc lata ml ting W
OCU' Wilding snsuucum.and bereby aumorix mpraunuuaes of Wb city en enter upon tk
6Wi amve-r enti. d prep ,,far irupcctian NrPeam
(We).{tee la ave,indemnify and tecp hamlet the Cly of afemino.yawl
fiablhlta,rdLmems.ceras mdcxpu"ea which way in my Way accme i{ai°v ad City
U in eoex,c.dw trmun{cf N,permit
'—' APPLICANT UNDERSTANDS AND WILL COMPLY Wm1 ALL NON-POINT Issued by: Date GJ
SWRCyE�R/E�/ULA 0 c Z .anLli
//IL.(i CLL(.SL'• D""tr Re-roofs
Sin dAppliaWC.ntnrlm Drc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de appliam m fatwc mlld gar'upant nmc m handle hanndm,materia
as dc4ned by w Cupenko M—ppal Code.Cb.per 9.11,"me Fkam rd Safdy '
Carle.scat..255324)1TalYA'(n'„ All roofs shall be inspected prior to any roofing material being installed.
❑Yn
If a roof is installed without first obtaining an inspection,I agree to remove
wul ee.ppliamm fulurc eilan,adtwm as eadpman m daMcca. icb
emit bavxdvm air emearninmu as cefimd by the Bay Arca Ah Qdity ManaVMM all new materials for inspection.
Diu=?
❑Ya o
1 Arvc mad de banNna maltcr l m,lydlenta under Chapter 6.95 e(We Cali(«
Mat halm h safety Cadc,Sectima 25505,21533 and 25534.1�thatit dx Wild,{
dam ml CVrtrrllY ha.e.lcn dealt b my rnmMIWI1Y W netey lm mLPaml nrme
mqutrcaemawhkbm ee and oriam�Ww�.r.cenira�eoromapamy. Signature of Applicant Date
iF f &( (fir7- 1� All roof coverings to be Class "B"or better
Ovncr Ihori,cda{cnt Dax-
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN 35606021 . 00
DATE ISSUED. . . . . . . : 08/25/2006
RECEIPT # . . . . ... . . . : 35774
REFERENCE ID # . . . : 06080217
SITE ADDRESS . . . . . : 22013 BAXLEY CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ALBERT WAISSMAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : ALBERT WAISSMAN
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : ALBERT WAISSMAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
'FEE 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 50 . 00 0 . 50 0 . 00 0 . 50 0 . 00
EPERMITFEE 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
-------- ---------------------------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
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CITY OF CUPERTINOUf���
Amor PERMIT APPLICATION FORM
CUPEkTINO �7
N # 35 _Oto _� Date: d 2 F. Z9�c Co
Building Address: ^ ^ n Q Mailing Address (if different from building address):
p(Ot 17 Y
Owner's Name: d / Phone#:
Contractor: /� License#:
Contact: �b 10��,� Phone: Cupertino Business License#:
Fax: r�
Building Permit Info: ; Z,'„ ex;s 4 i 1 ��yy o,46 {0 -Eop 4
USi•aQ la,,de tee" �cAeAdi?V{ �`c Govel2 Uu i LL On tk.a eL,
Bld El Elect 9 Plumb ❑ Mech ❑
Job Description:
Residential Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: S� Occupancy Gro :
Type of Construction: Please check this box if the project is a
second-story addition: ❑
roject Size: Standard ❑ Lar e ❑ Ma'or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elee 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTWE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees -BUILDING
BPFIXTURE Pblg 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 :p Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Stonn/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Furnace> I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC 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
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
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 MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM 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
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
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