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06040039 CITY OF CUPERTINO BUILDINGDIVISION PERMIT CONTRW ORINF�ORMATION, RUILDINGADDRESS: WEST VALLEY ELECTRIC PERMIT"°'06040039 10223 SPORTAL AV OWNER'S NAME: PERMIT LSSUE DATE PICKLE ROBERT M AND LEONA 1374 ANNAPOLIS 6 NE: SANITARY NO. CONTROL NO. (408) 448-0983 ARC HI'IECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 so, LICENSED CONTRACTOR'S DECLARATION I hereby affirm Nat 1 am licensed under provisions of Chapter 9(commencing Job Description wits Section 7")of Division 3 of the,Business and Professions Code.and my license is in full fora and eff Z 3 . 200 AMP PANEL REPLACEMENT ,j24 Licensee Lic.Is Eructur- ARCNTTECI'S DEC A ® m f�� I undersand my It shall be used as public records �NI■■9//p� JyU B e 0 Licensed Professional I�aCgrV 3 OWNER-BUILDER DECORATION E I berhy affirm Nat 1 am cscmpt form he Conuactofs Umt.Law for the 20 following mason.(Section 7031.5,Business and Professions Code:Any city or county <m ff. which reqtes uia permit m construct star.improv.demolish.or repair any atructure 2000 �mur prior un is issuance.also requites the applicant forsvch permit file asigned shtemcm i=`o Coal he u licensed pursuanth the pmrisions of time Contractor''s hxnm taw(Chaptn9 Sq.Ft.Floor Area aluation egg (commencing suit Sation]0007 of DivuionJofhc Businessand Profession Cade)or .. that be u esempt therefrom and the basis for the alleged eumpuon.Any violation of section 7031.5 by airy applicinl for a permit subjects the applicants in a civil penalty of not mart mat five hundred dollen(5500). r cy Type ❑1.uowner of Ne Lh.serty,amyemployeessumowages asdte'vsoleco ,Be nus will dohewalk ands: he Cornunot intendede ane dalorsEa(sec.]044,Business Nd property Cade:The CAnaaebYa LICe ie IoW deet not apply ll ot aWKr is Required Inspections property who b.provided quiwsch improvements and who ar essuch waked himulydrhrough his Own employees,providedtsarstetimprovementin ne year fc mpleu s,tarsale r. builder ,,me building or impmwment u old within one year of improv for he owned builder will taw me burden of proving that k did Out Wild er improve for purpose of sale.). ❑1.as owner of du Property am uUusively convening with Hemosed convectors h construct 0th project(sec.7044,Basin.and Profecooms Cade:)The Con.,'.Li- enee law does cot apply in an owner of property who builds or improves hereon,and. who contracts for such projects with a conuacturts)licensed p,muam w die Convutor's License law. ❑ lam"CoopteukrSee ,BAPCforhismamn , Owns Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declamations: I have and will maintain a CeniOeate of Corsens in self-imam for WorlbresCompen- sxvon,as provided for by Section 3700 of time Labor Code.for the performance of the work for which this permit is issued. ❑1 have and will maintain Worteri Compewtion Imuran¢,as required by Section 37W of the labor Code,for me performance of the wort for which mu permit is issued. ' My Worker's Cconpmess on Insuource Cartier and policy number are: Cartier. -ar✓l" 0sk 'Polity No:J 3'=9110 RIIFlCA OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu uctim need ort be completed ifde Permit is foronc hundred dollars($IBM a or lcsa) I certify out in We performance of tbe wort for which this Permit is issued.I shall WE employ any person in any mernerm as in become subject in the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Cenifiwre of Exemption,you should become subject to the Worker's Compensation provisions of he Labor Code,you must .Jz forthwith comply with such provisions or this Permit shall k deemed rewkcd. z'O CONSTRUCTION LENDING AGENCY [-, I wroby affirm titan pert a a construction lending agency,for the performance of lY he work for which thin permit Is Earned(Sec.3097,Civ.C.) �W Q Lender's Name z Under's Address U Q I Certify hal I haw mad his application and store dust the above information is U.E^ correct.I agree to comply Width all city and county ordinances and state laws relating to 0O Wilding connection,and hereby aumosict remexnutives of his city to enter upon he 0. ahovc-memiuned prperty for inspection purpores (We)agree to saw,indemnify and kap harmless he City of CupCnino against tF.rn liebilitiet,judgments.casts anduPertses which may in any way acera against said City V z APPCof tho grandog of m LICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date y- J 6 SOU E CATIONS. 14/7 n� 1 Re-roofs S{gnxure ApplicaroulComaractor Dare H "for=b ildinFRIAl3 DISCLOSURE Type of Roof Will he aCupeo applicant or four building i cc Capt r 9.1 or handle havrdom material u dc.Sed by t25 32(a)?tm Municipal Code.Chapter 9.12.and Be Health and Safety Calc.Section 25532(a)? ❑Yu All roofs shall be inspected prior to any roofing material being installed. 41 Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emlt hanrdnm air coutaminsots at de0rted by he Bay Ama Air Quality Management all new materials for inspection. District? ❑Yes I have read he harardors materials requirements under Chapter 6.95 of he Calif.,. nia Health&Safety Code.Sectiw 25505,25533 and 25534.1 urxersund that if he building dors not currently taw a tenant,hx is is my responsibility in notify the occupant of he, mu' hichmumbemetpoor Winodn"o(dCnti6CareofOCNanry Signature of Applicant Date Owner Lir auherived agent Date All roof coverings to be Class"B"or better CITY OF CUPERTINO Wem 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36909003 . 00 DATE ISSUED. . . . . . . : 04/07/2006 RECEIPT # . . . . . . . . . : 33888 REFERENCE ID # . . . : 06040039 SITE ADDRESS . . . . . : 10223 S PORTAL AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : PICKLE ROBERT M AND LEONA A ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3349 RECEIVED FROM . . . . : MIKE STUEHLER CONTRACTOR . . . . . . . : MIKE STVEHLER LIC # 26082 COMPANY . . . . . . . . . . : WEST VALLEY ELECTRIC ADDRESS . . . . . . . . . . : 1374 ANNAPOLIS WAY CITY/STATE/ZIP . . . : SAN JOSE, CA 95118 TELEPHONE . . . . . . . . : (408) 448-0983 •FEE ID UNIT QUANTITY AMOUNT 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 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICRE VALUATION 2, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- --------- - ---------- TOTAL PERMIT 103 . 16 0 . 00 103 . 16 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 103 . 16 2331 TOTAL RECEIPT 103 . 16 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------------- -- - 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • b Community Development 4 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 $[UPEkTINO Building Department JOB ADDRESS: PERMIT # I R� �qHvd 6 c- o - - OWNER'SNAME: �>krVLe PHONE # q,4&-0qp3 GENERAL CONTRACTOR:WQs�- J &4 Gfc— 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 �(,Sif, CITY OF CUPERTINO 0(0 0 4 00 clrvor PERMIT APPLICATION FORM CUPEkTINO Akk APN# �3 r„(a O Date: '11-7 1-7 I O Building Address: VJ"� Mailing Address (if different from building address): 1 o Owner's Name: t� Phone#: Contractor: License#: Wa_ v C( CIO - 77Z38' Contact: IPhone: gy13j--pg3.3 Cupertino Business License#: vy)i S ( Fax: Building Permit Info: Bldg ❑ 1, Elect eET Plumb ❑ Mech ❑ Job Descriptiolo", Residential El 1,1r;qpA pot4VI P2 l Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: roupTCost of Project: _ Occupancy Group- Type ype of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard 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 BBOILERS 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<= 100oA ELECTRICAL BELFC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 d- CITY OF CUPERTINO CdYbF PERMIT APPLICATION FORM CUPERTINO Quantity 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 Pb1g 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 rinklerBackflo 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 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 Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL P"BREMRECEPT ISC Misc Apparatus ELECTRICAL APP Rem Non-Res A liance ELECTRICAL OLE Pole/Platform Fixture ELECTRICAL WER Power Device/Apparatus ELECTRICAL Rc tl, Switch & Outlets ELECTRICAL LOCA Relocation of Hood MECHANICAL PALT I Repair/Alter Heating MECHANICAL • BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 Silo- bny-UF CITY OF CUPERTINO PERMIT APPLICATION FORM CUPEkTINO AlQuantity 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 Mecb Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING AIL PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3