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05090154 CITY OF CUPERTINO v, ,x+RvA,.,. BUILDING DIVISION PERMIT �CONTRACTzO�R�.MyyORr BUILDING ADDRESS: STAN SAKAI PERMITNO105090154 10325 MENHART LN ER'S NAME: PERMIT MUR DATE STAN SAKAI 10325 MENHART L 09/22/2005 NE: SANITARY NO. CONTROL NO. ARCHITECTYENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH l� 0 0 3 aD o LICENSED CONTRACTOR'S DECLARATION lob Description rd(Y 1 hereby&(firm Nat 1 w licensed under provisions of Chapter 9(cemmcncing wit Secdon 7M)of Division 3 of the Business and Promsainns Code,and my license Is n; in full to=and affect. NON-STRUC. INTER. REMODEL--NON-LOAD BEARIG WALL gg- DalesCl� Cmm�nor REPLACE WATERLINE, ELECT SERVICE, INSULATION, 9 ARCHITECTS DECLARATION I undenanJ my plans shill.11beused sed u public recmN SHEETROCK s PLYWOOD SHEAR WALL V g Licensed Professional g OWNER-BUILDER DECO Conte ON S a CaOI hereby.(firm thea 11. exempt from to Contractors License Law forte o following eaftt 7031.5.Businessand m.desia.Code:My city or county $ which its Wo n pmsnit re construct,ma alter.Improve,h permit t ear repair ed atnmwm prior.its iarourdpdmntquires provisions nt offer sucContractor Leele aniaw(Ch emenl �< tnhculimui,huuantbthat DO)ofD sion3te Businmr'snditelsw(Chopler9 Sq.F[. Floor Area Valuation $ oat he exem ith8Ocwnat and tf Dguisfr of theeged comp on.M vi Cede). $85637 - Nn k ts exempt therefrom and 0te bsa4 for dm sikged esemPOon.MY violation of Section 7031.5 by any applicant for a permit subjects to applicant o a civil penalty of APN Number Occupancy Type mat more than 0ve burMmd dollars(M). ❑1,as owrcr of tire property.or my employeast with wage"WIT som compensation, will do Newoh,&nd teaonnue It rmlintendedoroRered mnam(Sm.7044,Business 06 Required Inspections and Proteins..Cade Tha Commutes Lkan Taw does not apply m e an owner of q P property who builds or improves Lemon,end who dace such weak himself or trough his own employees.provided that such Improvements are not intended maaercd(or sak.lf. however,to building or Improvement is sold within one you of completion,to owner. Wilder will have the burden of proving tat he did not bulb or improve for purpose of ale) p .as mv.r of to property,.m exclusively conmning vest:)Tim ComeactnOr - FNA�v construct ft project of the (Sec. Beainw and Profession Cade:)The C.osemr's I.i- ��f/// "`��� cents law does nes apply m an owner of property who builds or improv Lemon,and who contacts fm such projects wit aeamecmr(A licensed purs.nt m me Comoanors //` Lkcm a Law. G ❑1 am eaemp under Sec B k P C fm tis reason '�` res 6 13700 r n few-Dao Q WORKERS COMPENSATION DECLARATION I hereby&M m under penlq of perjury am of the following dmimtio.: aw and will maintains CeNfte.w.f Consent to selFl.um for Work r'BCompen. ,as provided for by Section 1700 of to Labor Code,for to performance of the !l V1VU work,far which this permit Is issued ave and will maintain Worker's Compensation Insurance,as required by Section of the Labor Code,for the performance ofthe wort far which this permit Is isumd. orkers Compensation Wunnce carrier and Policy number am: Cartier: Pollry No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE mduscOmn.cd not hacampleted If the permit Is forone hundred&fire($100) or last.) I certify tot in to performance of to work for which this permit is wucd I guilt not employ any person in any man w so ...suis c to Worker'Compensation Lawsof Califamla-Date TA, r Appli aow^ NOTICE 7O APPLICANT:IG after making INS CertillOW of Exemption,you should become subject in the Worker's Compensation provisions of to Tibor Cede,you most O 0 formwit comply wit each Provisions or tis Permit shall be domed revoked. 'y► CONSTRUCTION LENDING AGENCY (-t I bmby atrmm that lime Is a construction mndingagency for the Icrfurmmm of !Yi> to work for which this permit is issued(Sec.3097,Civ.C.) Qfinders Name , z Lender's Address V Q 1 certify that 1 have mad tis application and tam that to show Information Is tP,^ comma I all in comply with ail city and county and tale laws misting In Q g`-J: building construction,and hereby audumme eprosenrdvef of this city to enter upon to W above-menuona i FMPenY for impedes p.POW& (Wes)agree In new,mal mnlfy and keep harmleu the City of Cupertino against i..� AA Ilabsliduj.dgmenr.emu and cape.&which may in any my..agamatsid City („)7 Inconsequentoftelpentrngoflhispermil. r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date T SOUTIONS '^ 9fs? G. Re-roofs "natu"nature of� re Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant 0,future building Occupant stn.or handle hasarda.material ' I 0ned by the Cupertino Municipal Code.Chapter 9.11.and to HW N and Safety Sewn 15532.)7 All roofs shall be inspected prior to any roofing material being installed. C]Yen ON- Will the applicant Or future building Occupant um equipment or devise which If a roof is installed without first obtaining an inspection,I agree,to remove hazardous air conami.nts sa termed by the Bay Area Air Quality Management ail new materials for inspection. ict? - ❑Yns 1]Dm� ' I ham mad to hvard.usu.onslseq.immaw under Chaptri95afdaCalifar- .l"Safely Cade,Seca=25505,25533 and 15534.1 undersand tati(ta building not currently how a tenant,tat it u my responsibility t nnufy to Occup&rit of to aw'cIt mug bemet ormmuanceofaCcnirme 9�c�a� Signature of Applicant Date wone%o ndscent, !/ Dam All roof coverings to be Class "B"or better c- CITY OF CUPERTINO BUILDING DIVISION PE �o � Q I •�dkY - y, , BUILDING ADDRESS: STAN SAKAI PERMITNO05090154 10325 MENHART LN OWNER'S NAME: PERMrr16URDATE STAN SAKAI 10325 MENHART LN 09/22/2005 NE: SANITARY NO. CONTROL NO. ARCHITER/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH j9 LICENSED CONTRACTORS DECLARATION Job Description 7Lq F I kmby Affirm use,1 am licensed under provision of Chapter 9(commcwlna P Inlillifc�Ndeffe DlNsion3o(Ne Budncu end Profesduru Code,and mylieense is m. NON-STRUC. INTER. REMODEL--NON-LOAD BEARIG WALL DuameCcl1S1 Contractor WATERLINE, ELECT SERVICE, INSULATION, ARCHITECTS DECLARATION SHEETROCK, PLYWOOD SHEAR WALL I understand my plain shall Mused as public=and, }� Licensed Professional m OWNER-BUILDER DECLARATION <2 I hereby a inial that I am exempt from the Contsmor&License law far the D o following reason.(section 7M I.S.Businets and Pmfadum Code:Any city or amity $ which requires a permit to conlrvc4 alley,hnpmw,demand,an repair any structure print m in imuanee.also Mquims tie applicant fotmch permit to file a signed command < thuMullansedparatantmNeptoviimOftMContrctor'slnxnscia-w•(Chapter9 Sq.Ft.Floor Area Valuation (e mmendng with Section 7000)of Division 3 of the Bud.W Prefe siom Cade)o $85637 that he is Attempt tltemfmm and the limit far the alleged exemption.My violation of Section 7031.5 by Any applicant for a permit subject,the Applicant 10 A civil penalty of APN Number Occupancy Type oro mom thin It.hundred dollars(M). C L as owner of it,property,o my amployw whit wain As tMb sole eompnastim, win do de work,and the awnum t,not IntndoM or anaed far nil(Sm.701./,Business Required Inspections and Profession Cade The Cmuniamtk Litemlana Utilities, w dnet apply he An outer Of q P ownertywho WilAsoimprowndh Imprisonments who am not muahhimseHothmoge his I{._ B �A �® pmartywhom.pm orImppa ithencPmwmnt,menatinwededeartemEfo Aaw is �I'Jf� IIIA 'rowewr,the building or knpmwment u mid within one year of eanPli uoe,the owner- • Milder will pave Use burden of proving that he did not build o improv far purpose of > u .,A aw.a the pmpmy am noludwly contracting with Bcened eonuactan in JUL r b 2006 comtruct ftproject(Sec.7044,Business and Profession Cade:)The Comnemr'a LI- come Law don not apply in An aaeee of proPetY who bolds or improwa thereon,and. who comment for such proJecu withaantrm7ortA)Ilcemed punwmsetpa Cmvanah f��I of��t} �t� L5 who co Law. (�,j4V+y(7(7U'f{U, ��I)L�✓�JJ� �Ufs..,��t(t/\�s,!LJ�� ❑1 em memryp)under Sec B&P C fo Nt,won \FUJI Owner ""^n fx�Dam %�wia� WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury,one of the following declarations, I law end Will maintain a Certificate of Commit be self-Inure for Wmkf,Compen- 73�1)0() Mo.u Provided for by Section 370D of de lobo Code,far the performance of the rk fm which this permit u issued. 1 haw and will maintain Wmkcf,Compensation Inmment,as muimd by Section of the Labor Code.fa the performance ofd a work for which this Permit b issued. Worker,Compenmrlon insmence canis and Policy number am: ner. Policy No.: CERTIFICATE OF EKEMPnON FROM WORKERS COMPENSATION INSURANCE frbk actin reed not bemmplew ifde Permit k fame hundreddeDm(2100) or kit) 1 candy that In the performance of 1W work for which this Permit is hotel l"I not employ any permit in any mom tOWorkrs'Compmmton Laws ofCalifomij;gM _ Applicant NOTICE TO APPLICANT:If.afar mW ni ibis Curiflead or Exemption,you Amid become mhJnt m the Workefa Compemtion pro rialom of the labor Code,you mum r O TaMwith comply with man previsions in this Permit shall he deemed revoked. l yN.eCONSTRUCTION LENDING AGENCY I hereby grim tea then is a coastructim lending agency for the perfomarce of Use wok fur which this permit k issued(Sec.3097.Civ.C.) i Q Lender's Name 1 Z Lender'.Addw e Q 1 ranee that 1 law read this city and coup aM Ne thu the am l iNomatim in r booms I onm m comply were y Nty and county orations or and awe lam mt,ting m t ,bon- eotionedro and herebyection sempwnmivuof Nis city to enter upon tui e 4[7 ,bon-mentioned popes for laspeNan purp=LN (Wo)agma m mw,indemnify and kap ha In m IM City of Cupertino id City ,y IIWIWn,judgmenu,cnuand 020fddtuu whirl mrykany myaarvc agaiasrnid City I N eoeuegmme of the granting of tet,permit. 2-0 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date � 2 SOUR�ONS., S" sire err App andCmvaclm Gal Data Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tM appllant orfuture Wilding=upon,nom a handle heaardous material As de0ned by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety Calc,section 75533()7 All roofs shall be inspected prior to any roofing material being installed. Oyu r)]No Will the applicant or future Wilding=upset um equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants As de0ned by the Bay Ams Air Quality Management all new materials for inspection. stdcR ❑Yen g'ni -.,.. I hew read Ne hazudwsmmdAlsmquimmenu underCNpmr 6.95 of dm caiifof• nk Health&SafmyCode.Secuom25505,25533mo125534.lundmmndmnifdm Wilding dna not currently haw a mount,that it is my o rpomlhilltY m notify the mvupant of me mq 1 0w' hmnrM�tp ormmuaeecancadrmemyfOc panty. Signature of Applicant Date �,l�Gs— /s,1 " 9127 65' , All roof coverings to be Class"B"Or better Owner or whanzedaentDom v Page 1 of 1 Susan Winslow . From: S Sakai [stansak@earthlink.net] Sent: Monday, October 03, 2005 9:28 AM To: Susan Winslow Cc: Stan Sakai Subject: Permit refund Hi Sue, Larry reviewed my permit and made an adjustment on the permit fee. As such he said that I should be receiving a refund of$1739.19. The permit ID and project address follows: Permit-05090154 Address: 10325 Menhart Lane Cupertino, CA 95014 Best, Stan Sakai 10325 Menhart Lane Cupertino, CA 95014 Ph (408)255-1224 • 10/3/05 INVOICE INVOICE INVOICE" INVOICE INVOICE INVOICO INVOICE INVOICE INVOICE CITY OF CUPERTINO • PERMIT INVOICE OPERATOR: conniew Sec : Twp: Rng: Sub: Blk: Lot : APN 37515037 . 00 INVOICE DATE. . . . . . : 09/30/2005 REFERENCE ID # . . . : 05090154 SITE ADDRESS . . . . . : 10325 MENHART LN SUBDIVISION . . . . . . . _ CITY . . . . . . . . . . . . . : IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : STAN SAKAI ADDRESS . . . . . . . . . : 10325 MENHART LN I / CITY/STATE/ZIP . . . : I ^ 5 CONTRACTOR . . . . . . . . LIC # *OWNER* I O IrI COMPANY . . . . . . . . . . : STAN SAKAI ADDRESS . . . . . . . . . . : 10325 MENHART LN CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : WIEE DESCRIPTION ACCT NUM CHK TOTAL FEE PD TO DATE BAL DUE W- SVCS-----600V-----<=200A-------- 4117------------ -P-- -----29 .43----- -----29 .43----- ---------- CT 0 . 00 ENERGY 4119 A 96 . 94 371 . 17 -274 . 23 BLDG PERMIT FEES 4116 P 201 . 96 773 . 28 -571 . 32 PLAN CHECK FEE 4111 A 269 . 52 1031 . 94 -762 . 42 INSTALL/ALTER WATERPIP 4117 P 9 . 00 9 . 00 0 . 00 SEISMIC FEE RES 2013 P 1 . 30 8 . 60 -7 . 30 ELECTRICAL SQ FOOT 4117 P 68 . 00 68 . 00 0 . 00 ELEC PERMIT ISSUANCE 4117 P 38 . 37 38 . 37 0 . 00 MECHANICAL SQ. FOOT 4117 P 0 . 06 68 . 00 -67 . 92 MECH PERMIT ISSUANCE 4117 P 38 . 37 38 . 37 0 . 00 PLUMBNG PERMIT ISSUE 4117 P 38 . 37 38 . 37 0 . 00 PLUMBING FEE SQ FOOT 4117 P 12 . 00 68 . 00 -5 ------------ ------------ --- - --- 803 . 34 2542 . 53 1739 . 19 • LkD 4" CITY OF CUPERTINO , em 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp:. Rng: Sub: Blk: Lot : APN . . . . . . . 1 : 37515037 . 00 DATE ISSUED. . . . . . . : 09/22/2005 RECEIPT # . . . . . . . . . : 31311 REFERENCE ID # . . . : 05090154 SITE ADDRESS . . . . . : 10325 MENHART IN SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . : IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : STAN SAKAI ADDRESS . . . . . . . . . . : 10325 MENHART LN CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : STANLEY H. SAKAI CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY STAN SAKAI ADDRESS . . . . . . . . . . 10325 MENHART .LN CITY/STATE/ZIP . , TELEPHONE . EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- 7--------- BENERGY PERMIT FEE 773 . 28 371 . 17 0 . 00 371 . 17 0 . 00 BPERMFEE VALUATION 85, 637 . 00 773 . 28 0 . 00 773 . 28 0 . 00 BPLANCHK PERMIT FEE 773 . 28 1031 . 94 0 . 00 1031 . 94 0 . 00 BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 BELEC200 METERS 1 . 00 29 .43 0 . 00 29 . 43 0 . 00 BSEISMICRE VALUATION 85, 637 . 00 8 . 60 0 . 00 8 . 60 0 . 00 PPLBG SQUARE FEET 850 . 00 68 . 00 0 . 00 68 . 00 0 . 00 ELECTRIC SQUARE FEET 850 . 00 68 . 00 0 . 00 68 . 00 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMFEE SQUARE FEET 850 . 00 68 . 00 0 . 00 68 . 00 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 PPERMITFEE FLAT RATE 1 . 00 -----38_37 ------0_00 -----38_37 ------0_00 TOTAL PERMIT 2542 . 53 0 . 00 2542 . 53 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 2542 . 53 154 TOTAL RECEIPT 2542 . S3 a ��TY OF CUPERTINO* b CUPEf�TINO PERMIT APPLICATION FORM S U ` / APN# Date: 3�5 - 15— 03L -15� ?a a�rns Building Address: / Mailing Address (if different from building address): /03y� / ler/,earL (fne Cu n.erne ca �J-0 'K Owner's Name: Phone #: Contractor: License#: Contact: Phone: 9��/15S- 2L Cupertino Business License#: 2r" �'` ,' Fax: Building Permit Info: Bldg LY Elect Plumb Er' F��"f Mech ❑ Job Description: Reolkw ^'s a - c`Pb'� u- "`� �/ rs r.c�� p Residential [Er' InfkIt /2r3 inrw/R+�oh �/� A�f. Commercial ❑ Sq.Ft. Floor Area: ` `,, ^�- lovw d q.Ft.: 806-19 lsW siLeslr,-eta � �Ry�- Cost ofPro'ect: + p yw •' s " ` Q"t' Occupancy p E� � O—r-b n..s+n slti .ceJ ��ane/. P YGT011 : . Type of Construction: Please check this box if the project is a second-story addition: ❑ ro'ect Size: Standard � Large ❑ Major ❑ uanti 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 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING . BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING � 3r3 � 1 1 of 3 zS'72 ,v . �'qTY OF CUPERTIN" CUPErZT1No PERMIT APPLICATION FORM -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 BOVERTIME 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 Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING . BPSTORM Storm/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 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDCT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREN20LE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MMHANICAL BREMREPALT Repair/Alter Heat'n MECHANICAL BREMRESAPP Remodel Res Ap Hance ELECTRICAL 2of3 QTY OF CUPERTINO,�& CUPEIZTINO PERMIT APPLICATION FORM ' QuantityFee 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 BS)VIM 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 `rS d 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 • 3of3 Ok,-ER-BUILDER VERIFICAT69 ' 1. (Check one) I or my immediate family (parent, spouse or child) will perform: • A. All the work authorized by this permit B. ✓A portion of the work C. _ None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. All of the work B. ✓ A portion of the work (complete section below) . Contractor Address/City Phone # State License # Type of work to be_C11 V34�Cd 7-6 1 3dro P7 74,,- 8 v 6. 11C Y -n 4�1 4 v FG�ci • 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer(see reverse side). A Certificate of Insurance covering workers compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be _performed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse side). Property Owner's Signature: � Date: Job Address: l�3�� " .�.c rf � M 9 � Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. City of Cupertino Building Department ' CITY40 10300 Torre Avenue • C U P Et�T I NO Phone: (408)777-3228 Dear Property Owner. An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family,and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and . you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation• contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the US. Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors State License Board in your community or at 1020 N Street,Sacramento,California 95814. • Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, . Building Department, City of Cupertino • Printed on Recycled Paper alo - CUPERTINO ` Assessor's Parcel Number: Name of owner. Project address.. Contact person. �' t Phone. Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: • Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N Is privacy protection planting required for the project? Y N On whai floor(s) is work being done? Brief description of work. roti✓ 2001 CFC (Y -N)2001 CMC Code editions:2001 CBC (�-N) (Y- M 2001 CPC N)2001 NEC ((DN) Effective 11/1/02 3 i• 6 k(3 • - 4.4 3 Plan Review Process Work Book Page-B-Revised 4/28/04 CITY OF CUPERTINO 0 CHECK REQUEST PAYEE DATE FORWARD .CHECK PROCESS DATE TO DATE CHECK REO'D /OhA DESCRIPTION ACCOUNT DISTRIBUTION AMOUNT -7�IR3 TOTAL FINANCE APPROVAL DEPARTMENT AUTHORIZATION WHITE-Finance Dept. YELLOW-Rname Dept. PINK-Dept.Copy . Page 1 of 1 Susan Winslow • From: S Sakai [stansak@earthlink.net] Sent: Monday, October 03, 2005 9:28 AM To: Susan Winslow Cc: Stan Sakai Subject: Permit refund Hi Sue, Larry reviewed my permit and made an adjustment on the permit fee. As such he said that I should be receiving a refund of$1739.19. The permit ID and project address follows: Permit-05090154 Address: 10325 Menhart Lane Cupertino, CA 95014 Best, Stan Sakai 10325 Menhart Lane Cupertino, CA 95014 . Ph (408)255-1224 • • 10/3/05 INVOICE INVOICE INVOICE -INVOICE INVOICE INVOICEI INVOICE INVOICE INVOICE CITY OF CUPERTINO • PERMIT INVOICE OPERATOR: conniew Sec : Twp: Rng: Sub: Blk: Lot : APN 37515037 . 00 q INVOICE DATE. . . . . . : 09/30/2005 REFERENCE ID # . . . : 05090154 SITE ADDRESS . . . . . : 10325 MENHART LN , SUBDIVISION . . . . . . . CITY . . . . . . . . �✓ IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : STAN SAKAI ADDRESS . . . . . . . . . . . 10325 MENHART LN CITY/STATE/ZIP . . . : , CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : STAN SAKAI ADDRESS . . . . . . . . . . : 10325 MENHART LN CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : •WLE DESCRIPTION ACCT NUM CHK TOTAL FEE PD TO DATE BAL DUE ----- - -------- ----- ----- ------ ---- -------- ---- ----- ----- ---- ECT SVCS 600V <=200A 4117 P 29 . 43 29 . 43 0 . 00 ENERGY 4119 A 96 . 94 371 . 17 -274 . 23 BLDG PERMIT FEES 4116 P 201 . 96 773 . 28 -571 . 32 PLAN CHECK FEE 4111 A 269 . 52 1031 . 94 -762 .42 INSTALL/ALTER WATERPIP 4117 P 9 . 00 9 . 00 0 . 00 SEISMIC FEE RES 2013 P 1 . 30 8 . 60 -7 . 30 ELECTRICAL SQ FOOT 4117 P 68 . 00 68 . 00 0 . 00 ELEC PERMIT ISSUANCE 4117 P 38 . 37 38 . 37 0 . 00 MECHANICAL SQ. FOOT 4117 P 0 . 08 68 . 00 -67 . 92 MECH PERMIT ISSUANCE 4117 P .38 . 37 38 . 37 0 . 00 PLUMBNG PERMIT ISSUE 4117 P 38 . 37 38 . 37 0 . 00 PLUMBING FEE SQ FOOT 4117 P 12 . 00 68 . 00 -56 . 00 ------------ ------------ ------------ 803 . 34 2542 . 53 -1739 . 19 • 1 • CITY OF CUPERTINO Idem 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # : . 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37515037 . 00 DATE ISSUED. . . . . . . : 09/22/2005 RECEIPT # • • • • • • • • • : 31311 REFERENCE ID # . . . : 05090154 SITE ADDRESS . . . . . : 10325 MENHART LN SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . IMPACT AREA REE . . . . . . : OWNER . . . . . . . . . . . . : STAN SAKAI �l ADDRESS . . . . . . . . . . : 10325 MENHART LN CITY/STATE/ZIP . . . : , RECEIVED FROM ' . . . . : STANLEY H. SAY-7&i CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY STAN SAKAI . ADDRESS . . 10325 MENHART ,LN CITY/STATE/ZIP . . TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------ - ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 773 . 28 371 . 17 0 . 00 371. 17 0 . 00 BPERMFEE VALUATION 85, 637 . 00 773 . 28 0 . 00 773 . 28 0 . 00 BPLANCHK PERMIT FEE 773 . 28 1031 . 94 0 . 00 1031 . 94 0 . 00 BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 BELEC200 METERS 1 . 00 29 .43 0 . 00 29 . 43 0 . 00 BSEISMICRE VALUATION 85, 637 . 00 8 . 60 0 . 00 8 . 60 . 0 . 00 PPLBG SQUARE FEET 850 . 00 68 . 00 0 . 00 68 . 00 0 . 00 ELECTRIC SQUARE FEET 850 . 00 68 . 00 0 . 00 68 . 00 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 .00 38 . 37 0 . 00 MPERMFEE SQUARE FEET 850 . 00 68 . 00 0 . 00 68 . 00 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 2542 . 53 0 . 00 2542 . 53 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 2542 . 53 154 TOTAL RECEIPT 2542 . 53 • INVOICE INVOICE INVOICE INI� INVOICE INVOICE INVOICE ACE INVOICE CITY OF CUPERTINO • PERMIT INVOICE OPERATOR: euem Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 37515037.00 INVOICE DATE. . . . . . : 09/29/2005 REFERENCE ID # . . . : 05090154 SITE ADDRESS . . . . . : 10325 MENHART LN SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : STAN SAKAI ADDRESS . . . . . . . . . . : 10325 MENHART IN CITY/STATE/ZIP . . . . , CONTRACTOR . . . . . . . . LIC # *OWNER* COMPANY . . . . . . . . . . : STAN SAKAI ADDRESS . . . . . . . . . . : 10325 MENHART IN CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : *EE DESCRIPTION I ACCT NUM CHK TOTAL FEE PD TO DATE SAL DUE 9CT SVCS 600V <=200A 4117 ' P 29.43 29.43 0.00 EEE ERGY 4119 A 371.17 371.17 0.00 BLDG PERMIT FEES 4116 P 773.28 773.28 0.00 PLAN CHECK FEE 4111 A 1031.94 1031.94 0.00 INSTALL/ALTER WATERPIP . 4117 P 9.00 9.00 0.00 SEISMIC FEE RES 2013 P 8.60 8.60 0.00 ELECTRICAL SQ FOOT 4117 P 68.00 68.00 0.00 ELEC PERMIT ISSUANCE 4117 P 38.37 38.37 0.00 MECHANICAL SQ. FOOT 4117 P 68.00 68.00 0.00 MECH PERMIT ISSUANCE 4117 P 38.37 38.37 0.00 PLUMBNG PERMIT ISSUE 4117 P 38.37 38.37 0.00 PLUMBING FEE SQ FOOT 4117 P 68.00 68.00 0.00 2542.53 2542.53 0.00 X -,�� �T _Ftf fPEPM1T` GTPEfJ). l'rU�E it WWF .EQWjgfr RE�'Ur'RT 59INIF {` swK9 OK Update n •is - n pe cor GonU,,o4c Lookup.. PERMIT:q 05090154 STATUS J OPEN APPLY DATE 09/22/2005 OPER canniew •–�---'�'1 .., „ --.--Y. Notepad MASTER ND' NOfiES} 0 PERMIT ISSUED 09/22/2005 DOER co nniew Nolds PROJECT �L �i ��� ° 1�4���k1 .CERT ISSUED; I OPER' J �Garicel`�,+� PROJ"DE•%Cmr CERT NUMBER _ TYPE 37515037.00 UPDATE ADDRESS N PARC ADDR 10325 MENHART LN C/S/2 _ $or1a8"y,,Col3: OWNERi; STRN SAKRI �IOWNER2 J O ,PDDR' 10325 MENHART LN C/S/2 J J yiew�Objach Geo Lin P_.ERMIf-TYPE SFDWL–REM US.0=404 TYPE 434 ENRGY CODE quit USAGE,_CLASS DWL–WREM PERMIT FORM iAPPLICATIO PP K/S'WER APPLIED UALURTION'_ 13000] RPPRUD BY: CALC -UAL°UATIOH' 850 85637 OWER PHp 4082551224 OWNERSHIPIN MENPRIURTE NOTES'{YIN/D), CONTR PHp J SPECIAL CONDITI,ONS'/N,OTES SCROW 'UER' QED R PLR WP R IN L@C SEMY!C , I SU A DN, IL LOC R HTROCK, PL WODp SH AR WA D PP CI i z,« 6Z 9M • Ice 1 � � gb .m� g O0 -07 � p o } EL U , c � r \ \ \ i amc 2L LL,9 4,S .9 O&Z koz Fc,", Z w a r = (apo o � m $ B . T C •N ,_ D m l0 C N c .E o F- a & '� D v vi y a c � 8 � � c Q o `S2E c oo m $ Pmy ' 0 N m � me E D E m « � i4i. E a L � a = o m o vi ca c � � c C O n0 - m Oc a E 3 o a v o Omi .o aMa ,cEN c a - a_ m L T C Y E :,e � c o � � E am V a C k D C OI O O C N O L N a O C W J m y 'm = m c N m m d E U cL SID Obi s � oo `° OE .2 m N N D o o m o c a v �i (n a a= n nW/ gg _o t c LL Jp N r ,31 wNc E 3 c ; c aoc ° 2 o E a a � W •-(1 stn C W y eem-- t� m.� N y $ g m m c y aDi ti y a m a o o v N C c _O D L G m a O C N m e N W t � ... O m E a y E N w d `o Z c a E 'c o fA cti h a m8 � Nt od oma - O Noom9 � o o D O M c '- — N m a Q � M U LL m+ c a m E 3 m = a: A2 o Q ' Q O sL o5o t r�' o' am3L a m' macoN CO E LO p N C j O c Z 0_ d C a w m N D d .a N m U m C OJ w C.1 4 O > m l0 m a .O d O U D: m C G E Q 0_ w « 0= w « - 0 A N O! V 0 V1 tV C] 4 N tC 1� OfAo� .6(Afeq uO I I I t4 yJP- A 6w -S" I 9' V Si9'�wa� T Gup6�f�'4� G.A ,;ywf i5r )unte ' uneciia Check all items Apeitain to the project to coni* completeness! is project in the City? Yes No_ ❑ School Fee's-inform applicant if required ❑ Business License Is annexation completed? Yes_Z_No _ ❑ APN# Name, Address of Project ❑ Change of Use fJ Name, Phone Number of Contact Person ❑ 4 Title Sheet 13L�j Cover Pa e Plan Documents ❑ T-24 Energy Plan 5heet(s) ❑ Complete Architectural Plan Sheet(s) ❑ T-24 Energy Calculations ❑ Structural Plan Sheets) ❑ plan pages signed and stam;2pd ❑ Structural Calculations ® # of Plan Sets submitted > ❑ Mechanical Plan Sheet(s) bL( # of Plan Sets required�_ ❑ Plumbing Plan Sheet(s) pg Plot/Site ❑ Electrical Plan Sheets) ❑ BMPs ❑ Accessibility Plan Sheet(s) Submittal application: Signature: - Date: ��2rlrot" Plan Distribution © Building .❑ HealthDeparbnent ❑ Planning— (Adding?d unit Commercial n w/change County Assessor (Final approved7fDra2 of use or exterior work and any food service application) projects) ❑ Public Works—(New SFDWL; addition/remodel ❑ Special Inspectors Copy w/25%increase in sq. footage; commercial addition; all „ hillside applications; grading and drainage permits; retaining wall permits; swimnang pool (new/demo) ❑ Fire Department- (All commercial, All new SFDWL) ❑ Health Department (Any food service, septic tanks) ❑ Sanitary-(E g) Plan Distribution: Signature: Date: gefUL' 0P Prior to issuing ANY,Permit,.ALL the applicable items below MUST be check off as completed IOS uilding Department Approval ❑ Workman's Comp. current lanning Department Approval ❑ Contractors License is current ublic Works Approval ❑ School Fees Paid ❑ Construction Tax Paid anitary Approval ❑ Planning Recovery Fee ealth Department Approval ❑ Housing Mitigation Fee ❑ Fire Department Approval ❑ Heart of the City Fee ❑ Sanitary Permit ❑ County Assessor Copy of Approved Plans !7 Sanitary Back Flow Noted ❑ Special Inspection . Date: • Permit issuance: Signature: Re 7sed 11/18/04