08020142 CITY OF CUPERTINO * +7s+kaa ,,,,a5' +g "_ +
BUILDING DIVISION PERMIT ` CON TRACTORfINFOItMA1It)N:"
z_t'�J tfi'ry1 _. �=..e..,
BWL�Ir�G,A.-5]�1�REsMPE MIT NO.
ENHART LN TBD — TO BE DETERMINED 08020142
ER'SNAME: PERMIT SUE DATE
ARMIDA AVILA 02/21/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIJ:CT PLUMB .MECH
0 0 0 0
4 3oii LICENSED CONTRACTOR'S derp DECLARATION
I wroby Ra( that 1 am Ilaoscd under provisions o(C audet. 9(commencing 6 Job Description
n� with Se orcumn00ynr Dlvialan 3ofthe Business and Profcatiunt Cotla.and my license ie FRNT KITCHN WINDOW
in full mica and ercecL
Data Claes Conti
3F
Data TS Death
As shall
DECLARATION
l� Imdenend my Pknt elWlwuutlaspublk recoNs
a
50� Licensed Professional
nal
DECLARATION
COS 1 memereby.(lire on 1 em exempts an the Coronal Co :A License Law for many COO o following meson.(Smites 703 1.5, t.Business and n.dcaum Code:Any city or county
9 r which rets oma n Permit to conWuct alcor,lmpmvs,do anvils ore repair ed awnum
z8n priwtoitscensed Ins ort 1.tic thes,dimm.1 for achperminofienseianedwmmem
(atwire lfceoseJ purAenito the Provitinnt of the ContrectoesLwnA Law(CNptm9 Sq.Ft. Floor Area Valuation
(commencingwithS m70110)of Division3ofde Bu4n end Rafeuiam Code)or $2701
S that m is exempt therefrom and the bask for the Alleged mmpdm.Any vlaladan of
Section 7051.5 by any applicant for a permit subjects the applicant to a civil penalty of �,p7�Number - Occas
not more than five hundred danan($30y. 37515048 .•VV' Occupancy Type
❑1,as owner of the property,or my employees with wages As their sok compensation,
will do the work,and the sraclum Is not Inmnded or offered for Ak(See.7014.Business
and Rafestions Cade:The Contramena License law ems ret apply to an awxr of Required Inspections
pmpenY who wilds c r im proms thmcon,and wm doessuch work himul f or through his _
own employees,provided thatsuch improvements am not inmMW araRcrtd forule.If,
however,)m building our Improvement Is sold within am year of completion.the owner,
builder wN hero Ne wrden er pmving des w did not WiM car improve for purpm of
ask �
1.as owner of to property-am exclusively contracting with licensed cumme as to
contract the project(Sec.7014,Business and promotion Cade:)The Contractor's U.
ce..-Law does not apply to an owner of property who woks or Improves themon,and
ram contracts,for such Projects with AcantruYorrs)lammed punoom to the Commerce.
Lic..Law.
I am esempt under S. zq B d P C for this mason
r
WORKER'S COMPENSATION DECLARATION
I wreby affirm under pemlty of perjury ore of the following duckradons
❑Imveand will mainuin•Cenifiwu ofCanAnt to¢IfdnturtfosworkceaCompen-
Adan,as provided for by Section 3700 of the Labour Cade,far the performance of the
.,it for which this pcmh is ounce.
❑1 rove and will maintain Worker's Compensation InAranw,as required by Section
5700 of the Labor Code,for the peRormance of the work for which this Permit Is Wood. '
My Workees Compensation lasom me venin and Poliry number tic:
Cartier. policy No.:
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSA71ON INSURANCE
rOtkuetlnn recd nmhecomplemd lithe Permit is foranc hundred dollen(SIM)
m less)
1 caNrv- that in the pato m of the work fm w'h this Perml k lasmd,I shall not
employ any pervert inApplr ectm�My�'Joets Compentadm
law of Giifomis Da /'/�/{�
NOTICE
Nmmon s7O APPLICANT:If.es after malting this Certificate of Eaemptien.you should
m
common moms m it Worhero Compenudon emulsions of the Labor Code,you mut
.J O forthwith comply with Inch provisions mthk permit shall wdeemed revoked.
'z 0 CONSTRUCTION LENDING AGENCY
.y
F Lwrwhichimthat there ka issued IS.
agenry for the performart¢uf
ai the work for which this permit k iifue4lScc.]097,Ch.CJ
0. Q Undoes Num
r7 z Undoes Address
U Q 1 certify that I have read this aPPHwtlan and mete that the amve information is
comtt 1 agree to comply with all city and county oNinames and sere laws relating to
building construction.and hereby audeorim nprwenudvw of this city to enter upon the
above-mentiosed Properly for inspection purposes
(We)agree to Ave,indemnify and kwp harmtess the City of Cupenino agsiost
,.y to liabilities Judgments.comet and expentu which may in Ay way acme agalmt Aid City
V 7 in comegmue of the granting of this pomp.
'7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: Date _0141
SOURCE
/ Re-roofs
Signature of AppliwnVConuector Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy t applicant or mfobum building 1A.CMnt son mmndle Hcm1 os material
de0md by dm Cupertino Mum' 1 Code.Gapmr 9.1;and tiro Heslth and Safety
Pro
Scotian 25532(a)7[3y. All roofs shall be inspected prior to any roofing material being installed.
Na
If a roof is installed without first obtainingan inspection,I ree to remove
WIII the applicant our future wilding occupant case cyulpment os dcviw which P _ ag
emit husrch us air concerti nsnu as road by On Bay Ana Air Quality Management all new materials for inspection.
Olson.?
❑Yes Nu
I have read the hVlydons materials requiremcntsundcr Chapmr6.95 ofthe Califor.
ria Health d:SafmYCade,Sections 25505.25537 and25534.I undemvtd thuif the wilding
does not cumntly hew•temnL that it k my mapomibiloy to ratify the occupant of the
requlrem - hush room be=IMor to f CmdT afawpACY. Signature of Applicant Date
Own
or awharisd agent Dam g
All roof coverings to be Class"B"or better
'
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37515048. 00
DATE ISSUED. . . . . . . : 02/21/2008
RECEIPT #. . . . . . . . . : BS000004001
REFERENCE ID # . . . : 08020142
SITE ADDRESS . . . . . : 10391 MENHART LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ARMIDA AVILA
ADDRESS . . . . . . . . . . : 10391 MENHART LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AARMIDA C AVILA
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
• TELEPHONE . . . . . . . . :
FEE ID UNIT -
QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 2, 701.00 0 .50 0. 00 0.50 0. 00
1WINREP EACH 8 1. 00 367 . 00 -- 0_00 367 . 00 --- 0_00
---------- ---------- -
TOTAL PERMIT 367 .50 0 . 00 367 .50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 367 . 50 VISA
---------------
TOTAL RECEIPT 367 .50
O� oaa � �f�
CITY OF CUPERTINO
• CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# O L
F, d Date:
Building Address:
/03 q1
Mailing Address (if different from building address):
Owner's Name: Phone#:
Contractor: /eeg Phone: qd'ff` 9 7 7d !
Fax: `l'6Y 977
Contractor License#: 8 5`9
• Cupertino Business License#:
Contact: Phone: fes_
Fax:
ResidentialM Commercial El
Job Description:
Building Permit Info:
Bldg � Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-lHR ❑ 11, 111, lV V-N Uj
Valuation: Square Footage:
7G l�
i
• Project Size: Standard ❑ Large ❑ Major ❑
CITY OF CUPERTINO •
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
113TEMPPER Temporary Building Permit (good for B
30 days)
1BBOILERI 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
1BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3 Installation/relocation ofea 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
IBBOILER5 Installation/relocation of ea boiler or M:
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH 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.
1ELECINSP Other Electrical Inspections (per hour) E
IMECHINSP Other Mechanical Inspections (per M
hour) •
IPLMBINSP Other Plumbing& Gas Inspections P
(per hour
1MEETINGiHR Application Meeting B
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
1ACOUSFDW SFDWL/Duplex New B
lACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHI1vfNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven(steel, pre- B
stressed concrete
3 of 5
CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
1 RETSP310 Special Design, 3-10' high (up to 50 `) B
IRETSP10 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high(up to B
50 ft
SIDING
1 SIDESTBK Siding, Stone &Brick Veneer B •
interior/exterior)
1 SIDEOTHER Siding all other B
SKYLIGHTS
I SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
•
4 of 5
(+ - CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
/ 1 WINREP Replacement windows/sliding glass B
door ea 8 windows)
I WINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
1EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln
Ck (hourly) E
IMECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B
when not over counter) hourly-stand alone
/ 1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel &Documentation B
1BUSLIC Business License B
•
5 of 5
r Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
qCITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: PERMIT#
1639/ 02�1Z
OWNER'S NAME: A Q PHONE # jo2-
GENERAL CONTRACTOR: et 177 ) ui 4deI25 FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS 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
Owner/Contractor Signature Date