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03050146 CITY OF CUPERTINO 9s�+@, " BUILDING DIVISION PERMIT �G�ONTRMTOR.INFt1RMATION - 'aK a<E, e �E•,+5ab.+4Y�'a�u".n,uw?$E'al.i4 '9! BUILDING ADDRESS: ROBERT J FAVERO PEaMTTNo.03050146 10223 PRAno VISTA T)R OWNER'S NAME: FBI..n mltl`B)i'�9/2 0 03 OBERT J FAVERO V7 NE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDO ELECT PLUMB BIRCH YC Zp LICENSED CONTRACTOR'S DECLARATION O O O O 1 hereby affirm that 1 un licensed under previaiens of Chapter 9(commencing Job Description with Smtion 70M)ofDiAsion 3 of the Business rood Profession,Cade,and my Bcenx is infullClean Affect. FINAL BLDG. INSPECTION �® ? DateLicense Clean Contractor ORIG.. ##27560 JUN 0 2 2003 ARCHITECTS DECLARATION 1 undeuund my plena shall W used an public rtcortlr t� Licensed Pmfesslonel BUILDING g OWNER-BUILDER DECORATION 4<f 1 hereby affirm that I am exempt from the Connector's License Law for the p O following mason.(Section 711313,Business and Professions Code:Any city or county s$E which requires a Permit to consumer.alter.Ww sco ,demolish,or repair my structure :12E Z'y^ prior to its issuance.also routines the applicant forsuch Permit to rile a signed statement thel he i,llcemed pumbar,to site provisions nftbe Cmnumtor's Limme Law(Chapter 9 Sq.Ft. Floor Area Valuation y (Commencing with Section700(I)m Divlsian 3 of the Business and Professions Gude)or 0 3.. that he is evm pt therefrom and the loads for the alleged cumpOm.Any violatue of Smile.7031.5 by any applicant for a permit subjects the applicant la.&H penalty of APN Number Occupancy Type out ream Nm Rw hundred dollars(5500). ❑I.as ownu of sin property,a my employees with wa{u u their=to enmpensatimn. 34214046 . 00 will do the were,and the structure is not ku red or offered for oak(See.7044,Business gp�tltje and Professions Code:The Conuacwes rs License law donot apply u an owner of 101 — FOUNDA'1'1'V d Inspections property who builds or im proves thetmn,and who dou ouch wane himseif or umugh his own employee.provided thauuch improwmenu art not intended endured formic.If. 102 — PIERS however,the Wilding or improvement is mid within one roar of completion.the went. W ilder wiU haw the Wrdcn of storing that he did net Wild or imprew for purpose of 103 — UFER . asle)' 104 - REBAR 01,as owner of the property.am exclusively contracting with licensed summons to 105 - ANCHOR BOLTS convect the project(Sec.7044.Business and Profession,Cade:)The Commetor,Li. mean Law does not apply in in owner of propwy who Nil&or improws tomon.And, 106 — SEWER & WATER who contracts for projects with a conuxtor(O llmnxd puuvant to the Contractor's Lienee law, 202 - UNDERFLOOR PLUMBING AIarm exempt underSm. pAB-KY B&P C for this Mason 203 - UNDERFLOOR MECHANICAL Owne/1 `Q0 ^ l )UDate S-2 —075 204 - UNDERFLOOR FRAME WORKERS COMPENSATION DEC N 205 - UNDERFLOOR INSULATION Ihertby einem under penalty of perjury one of the fdgdecluatinna: 301 — ROUGH PLUMBING 1 hew and will maintain•CcnlOoae tof Consent to self-inseam for Woher's Cmmpen- astlon,a provided for by Section 3700 of the Labor Code.for the performance of the 302 - TUB & OR SHOWER work for which this permit is issued. 303 - ROUGH MECHANICAL ❑I Mw and will maintain Worlds Compensation Imurance.An required by Section 304 — ROUGH ELECTRICAL 37W of the LaWr Code.for me petfoomance of the woh for which thio permit is issued. My Worker's Compensation resource carrier and Policy number are: 3055 — FRAME Carrier: Policy No.: 306 - HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 307 - INSULATION (71,11reetion beth not W completed ifthc permit lsfmom hundred lobane(5100) 308 — SHEETROCK muss.) 309 - EXTERIOR LATH 1-"try that in the pe rm.rxe mf the work for which this permit u issued,l ahW not 310 — INTERIOR LATH employ any semen ymmm,xu k tccomc object to the drys oto ns Bon law,mfeanfom Date VLX4 -phi 311 - SCRATCH COAT Ap'll am O FPT —J 5=A _Eyr4 NOl7 APPLICANT.ILanermWngthis cmdricateorExemption,you should 313 - ROOF NAIL becood s Joe tto the Woricer'sCompensation proviuonsofdid,Labor Crum.you must 501 - FINAL ELECTRICAL ENERGY ,JO forthwith comply with such previsions or this Permit mail be deemed revoked. ? coNSTRucrIGNLeNDINcnGENCY '502 - FINAL PLUMBING ENERGY F.wVI+ Ibomhy a(Rrm umucre ise cmuvunlnn lending agency for the perkrmmm of 503 - FINAL MECHANICAL ENERGY C> dim work for which thin permit laWood(Sm.7097,Civ,C.) Lender's Name 504 - FINAL BUILDING ENERGY W Q 'z Lender's Address 505 - FINAL ELECTRICAL U O 1 certify Nat 1 haw road this application and state met Otc W.in(monadun u 506 - GAS TEST LU correct.I agree to comply with all city and county ordinances and sum law'relating to O bmaein{eonswnion.anahereby Authorizemprexnwiwa of this city to now ulnn the FINAL PLUMBING r W above-mentioned pmpcny for Inspection purposes. 08 FIN L (~rA (We)ju ague to ave,indemnify and tech harmless Ne City ro Cupertino agsiml rq flabilirtmosmiad{menti Standing ofpenusmit. may in any way mcroc agalmusidCiry I / f U Z A PLLIICCANf UNDERSTANDS ANDWILLWILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date 7 URC"EGULATIONS. ji9 cwtl� 5-2,4-03 Re-roofs Sign...ofApcsur Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applianl or to,=Wilding occupant pore or handle haa,duu material as defined by the Cupertino Municipal Code.Chapter 9.12.and vs.Health and Safety Code.Section 25532ra)7 ❑Yn, No All roofs shall be inspected prior to any roofing material being installed. Y Will the applicant or fu't`ure Wilding occupant use equipment ser dcvicea which If a roof is installed without first obtaining an inspection,I agree to remove emit haardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yu gU No In mad the huaNtmsmaterials requirements under@spier 6.95 ofthe Califor- nia Hcalth&Safmy Code,Smtion,25305,35533md2.553e.1muse d the i(the Wilding dow.nol currently how•tcoane mat h u my ma Q hility to notify ant of the mgm whkhawAMAk toiuuonccofeCcnifcateorOce Signature of Applicant Date r �cl -w 5-Zi-o3 Owme,or Authorized ageni Date All roof coverings to be Class"B"or better ' alabn-&�: CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM ° CUPEkTINO 14 N # 342 - 14- ^ 2 _ I L` _ © 4( Date: 5 _ Z C( - ZW 3 Building Address: � , 0223 o V Sicr Owner's Name: Phone #: TDZEIIz 3 eAS)EIL0 488 a66 -17,V6 Contractor: WLicense#: (� 'R�� Contact: Cupertino Business License#: Building Permit Info: Bldg /;2 Elect Plumb Mech ] Job Description: Residential ❑ ommerci Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: R- 3 Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> l OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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 <= 1O00A ELECTRICAL BELEC1001 Elec 600V > 1 OOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 alyo CITY OF CUPERTINO PERMIT APPLICATION FORM CUPEkTINO uanti Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamil Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREN AIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM13USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> l 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 2 of 3 CITY OF CUPERTINO CUPl OFT O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 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 Inection 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 � ZHUCITY OF CUPERTINO CITY OF PERMIT APPLICATION FO CUPEkTINO 14 N# / Date: S , 2q _ Building Add ss: O 2 Z (� �5 �tL v J Owner's Name: \ , t J � Phone#: 8) Contractor: Licens c3 !o Contact: C ertino Business License#: Buil 'ngPermit Info: Id t lect lu ch/CT, ob De ption: �/ Resl ential El �• Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 1 Occupancy Grou Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHE Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER Boiler<= 100,000 Btu MECHANICAL BBOILE Boiler> 100K to 500K Btu MECHANICAL BBOIL R3 Boiler> 500K to 1M Btu MECHANICAL BBO ER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOfLER5 Boiler> 1.75M Btu MECHANICAL BC STAX Construction Tax BUILDING BC NSTAX Ind/Off/Comm/ nasi BUILDING BC NSTAXBQ Con. Tax for BQ Zone BUILDING B ONSTAXH Hotel and Motel BUILDING CONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL IBBELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Ener rAdd Multi BUILDING INVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of I �1'- CITY OF CUPERTINO �'TM° PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamil Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT . Reinspection Fee BUILDING . BREMACOVER A/C Unit> 10,000 din 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> 10K btu MECHANICAL BREWMAT - Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRA.PP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 CITY OF CUPERTINO CIrYOFPERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 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 Inection BUILDING BSWIM Swinuning 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3 CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY# 3 Sec : Twp: Rng : Sub: Blk: Lot : APN . . . . . . . . : 34214046 . 00 DATE ISSUED. . . . . . . : 05/29/2003 RECEIPT 4 . . . . . . . . . : 21981 REFERENCE ID # . . . : 03050146 SITE ADDRESS . . . . . : 10223 PRADO VISTA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ROBERT J FAVERO ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2621 RECEIVED FROM . . . . : ROBERT FAVERO CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : ROBERT J FAVERO ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2621 TELEPHONE . . . . . . . . : •EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ------ ---- ---------- BPLANCKREP HOURS 4 . 00 222 . 00 0 . 00 222 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 222 . 00 0 . 00 222 . 00 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 222 . 00 M/C TOTAL RECEIPT 222 . 00