06050163 B61LDLNGVMVISION PERMIT M ONTRAG10 INF�ORMATIO
BUILDING ADDRESS: FRANZ TERMITE CONTROL PERMIT NO.06050163
10391 PINEVILLE AV
OWNER'S NAME: PERMIT ISSUE DATE
Ilk FINN 4041 TRANSPORT
WINE: SAN TARY NO. CONTROL NO.
(650) 493-0445
ARCHITECT/ENGINEFA:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i p p LICENSED CONTRACTOR'S DECLARATION lob Description
%wC 1 hereby affirm Nal 1 am licensed under provisions of Chapter 9(Commencing
tiW rids Section TflOU)ef Division 31nfde Business and Professions Code,ane my lice-.is
a« in fullforce an eftjL� O43 REPAIR ROT DAMAGE. REPLACE SHOWER
j�? l.icenac Clazs.2$�4kJ11—_Lis.a _
=� Dae_f-!�' Contractor
ARCHITECTS
DECLAITATIM
fwU IundcnunJ myideas shall wu.dazpublic mcorJs
LiOmeed Pmrcssional
3 OWNER-BUILDER DECLARATION
f 1 wrchy affirm that I am exempt from the Cantractors Liun.Law far Ice
a o following won.(Section 7031.5,Business and Profoasfons Code:Any city in county
5_ which requites a Permit to..alt aler.Improve,dcmdah.Or repair any stmcmm $6000
-zi Prior to its issuance.also.qumen Neapplicanr formch permit to file.signedsuenum
< thmw is licensed pursuant m lw previsions of the Contractors License Law(Chap=9 Sq.Ft,Floor Area Valuation
y (commencing with Section 7000)of Division 3 of the Business and Professions Cocke)or
y
that I e is exempt tbertmm and the We,for the alleged esempum Any violation of
Section 7031.5 by my applicant for a permit subjects the applicanu to a civil Penalty of. KwAser Occupancy Type
oat mart Nan firs hundred dollars($500).
1,asa worof the properly,rsmyemployee with wagsuNei(see.704A.B croons
will do ie work Amidcall
Thtnum Is ades Locks or offered wdo s.1 Apply ?oad.Business
and property
who s Code:Th.Canto moss License law des oat apply m an owner of Required Inspections
propeny who A,proaimpmsss thereon,and who drssuch work MmselrorNrough his
ow ever.the
Wilding
that such imPmm d within
art not ou didoft moQertd for sale r.
builder..ill building orimpmwment k mm within or Weld of completion,the Owner.
builder will haw the burden of proving Nat w did not build or improve for purpose of
sakJ.
0 1,as Owner of Its propeny,am esdmiwly contracting with licensed eontraemrs he
construct his project(Sec.7014.Business and Professions Cada:)The Coa rsens's V-
en.law cora not apply As an owns or property who builds or improves demon,and
who contracts for such projects with aunuacwr(s)licensed purswm m the Convenors
Law.
0 I ann am esempt under Sec. .B A P C for Nis mason /
owner Dee
Wm KERWon,S COMPENSATION DECLARATION Or—/
1 hereby affirm under penslry of perjury ane orde fallowing eeclaradons:
I heve and will numuin a Cenifiam of Consent to self-hoot.for Workers COmpcn. /
union,az provided far by Section 3700 of de Labor Code,for the performanee of due `/lO
work for which this permit is issued.
0 1 have and will mainain Workers Compensation Insurance,.mquimd by Section
3700 of Ne Labor Code,for de performance of the wart for which dus permit is issued '
My Workefs Compensation Insunn¢I anis and Policy number>R:
Cartier. !;t!fe T'gn+U- Policy No.:14-1
CERTFlGEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section reed net to completed if Ne Permit 4 Tanto huMmddouan(6100)
or less.)
I eerily Nat in N.performance of the wart far which this permit is issued,1 shall not
employ any person in any manner an As w became subject to Use Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become subjca an tie Wark043 Compensation provisions of Nc Lahr Codo you mus,
OroMwith comply with such previsions r tits Permit shall to decreed invoked.
Z'"" CONSTRUCTION LENDING AGENCY
.N
0- I wrebya(fthi that Vertu Wood
(Sec.3W7.nding agency for de perfurmanee of
2c rM Lo work fur which this permit is issued(Sec.709],Civ.C.)
6W.Q Lendcfs Nam.
z Lcndeh Add.
U Q I certify that I have read this application and sato Nm tw above information is
u, E" Corers.1 agree m comply with all city and county ordinances and sun laws mlating to
QU building construction.and hereby authority mprtunanves of this city to toter upon the
W move mentioned pmpcny far inspection purposes.
(~g), (We)agree to save,indemnify and keep harmlcm Ne City of Cupertino against
r/fliabilities.judgments.casts and expenses which may 0 my way accrue against said City
U Z APPLI�uenccU ILLa RSTANDSlM zmating of this Permit.WILL C0 PLY WITH ALL NON-POINT Issued by: Date �-Q 6/
s R' A SNS
Re-roofs
Ili of ApplianUConuacty Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the VPliant r future Wilding rcupant mora or hvMk baurdow material
az defined by the Cupenom Municipal Code.Chapter 9.11,and Ice Health and Safety
Code.Section 25533(.)? All roofs shall be inspected prior to any roofing material being installed.
40 0 Ya
Will tho applicant or mtore wilding OCCU,Am u.equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmh hmardoos air certsminsna az dc0eed by the Bay Area Air 0"ity Management all new materials for inspection.
Distdr? J
0Y. �g Nu
I have mad On harardsmsreaedals mq.in mem under Ch,.s6.95 of de Cdifor-
ma Health&Safety Code. 15505.25533 md25531.1 uMcrsaM thmiHhc wilding
Jons not Of haw .n.4 at it is my rtspomihility m notify Ne occupant of the
mw nes twma brtism.y ccoraCatnfiaear meocrry. Signature of Applicant Date
OwuronuNorimda All roof coverings to be Class °B" or better
s Dam g
CITY OF CUPERTINO
m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36913015 . 00
DATE ISSUED. . . . . . . : 05/18/2006
RECEIPT # . . . . . . . . . : 34449
REFERENCE ID # . . . : 06050163
SITE ADDRESS . . . . . : 10391 PINEVILLE AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FINN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : MICHAEL A JUDAS
CONTRACTOR . . . . . . . : MICHAEL JUDAS LIC # 27236
COMPANY . . . . . . . . . . : FRANZ TERMITE CONTROL
ADDRESS . . . . . . . . . . : 4041 TRANSPORT ST.
CITY/STATE/ZIP . . . : PALO ALTO, CA 94303
TELEPHONE . . . . . . . . : (650) 493-0445
•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
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 200 . 19 0 . 00 200 . 19 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 200 . 19 MASTERCARD
TOTAL RECEIPT 200 . 19
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Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
1&31f Piae V41I,e So7o ?
OWNER'S NAME: FeUt4 PHONE # Ssc, Y4;-o yrc —
GENERAL CONTRACTOR: , Ti, �; AX # 6 so _ r. e
I am not using any subcontracto
Signature Date
Please check applicable subcontractors and complete5d completefollowing 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
1 CITY OF CUPERTINO
Ulw OF PERMIT APPLICATION FORM
CUPEkTINO
7Building
N # Eam
q� 1Date:
(/�I D ss: Mailing Address (if different from building address):
� PkQner's e: Phone#: a/r, JacU,e' wd(•�e
Con ractor: / License#:
Q / v� P� 043
Contact: Phone:6so-Y13 -ovt5 Cupertino Business License#:
Xl%c1tae / do S Fax: 6z -Y4T—Cro
Building Permit Info:
Bldg ❑'' Elect ❑ Plumb L Mech ❑
Job Description: A f. aP .Ofe
Residential 6 Kt ,. Commercial ❑
Sq.Ft. Floor Area: ISq.Ft.:
Cost of Project: Occupancy Gro,
600u —
Type of Construction: Aa f Qee'4 Please check this box if the project is a
second-story addition:
Project Size: Standard 0` Large ❑ Major ❑
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 IndJOff/Comm/ uasi 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
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am CITY OF CUPERTINO
tW1 6F PERMIT APPLICATION FORM
CUPEkTINO
Quanti Fee ID Fee Description Fee Grou
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 nLawnnik /Backflo PLUMBING
BPSTORM Water PLUMBING
BPTRAP ra PLUMBING
BPVENT &Vent PLUMBING
BPWATER ater Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 ctrn MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMg•INT Li2htinp Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> 10K 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 Ap2liance ELECTRICAL
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- CITY OF CUPERTINO
CITMOF PERMIT APPLICATION FORM
CUPERTINO
uantity 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 Inspection 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
Amk PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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