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06120101 CITY OF CUPERTINO '" X9''4 BUILDING DIVISION PE , CONTRAC°TORjNFORMATION a BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: YE�11�6A POOLE MARGARET J 12/19/2006 NE: SANITARY NO. CONTROL NO. ARCHITER/ENGINEER: BUILDING PERMMNFO BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION lac 3C 1 hemby affirm that 1 am licensed under provisions of Chapter 9(commencing lob Description LI withSection 70fis,ofDivision 3ofthe Random andProftema�-d,-sCods,andmylicenseu 200AMP PANEL UPGRADE e. in full farce arced effect /�1 i ? License �s{-.— —Lic.g —1 1 Fp Date Contractor tJa ARCHTfELI a DECLARATION i Icar' 1 understand my plans shall k used as public mcofds yU Licensed Professional Oat I am C ILDER DECLARATION C F I mehy.(Tete that 11. eumpt(tete Ne Commusn'sCar Licence Law for the spa which ng mason.(Sauun]831.3, t,aims and om asomfi Carlo:Any city or county $Rei which its ises a pmmit m eoruuuet aline,improve,h Permit( fi lepair anY someture ,2< that he its ed .than pursuant to tkyisions ofcam fqrmcthe Counselor's tLacense Law s hapten t Nm he¢licenud pursuant to the provisiooa of thefontrxmh ldanm law(ChaPter9 Sq. Ft.Floor AreaValuation EFG (commencing with Section 7080)of Division 3 of NC Business and Professions Cede)or 2400 $ that k is naempt therefrom and the basis for the alleged••ompuan.Any violation of Schon 7031.5 by say applicant for a permit subjects the applicant to a civil penalty of yp�j Number Oeeu ane T e oat mine roan five handled donate(S500). 36227011 ,:V G� p y yp 0 1,...,of Ne properly,a my employ.with wages zatab saw campewdon, Will do da wark,and theslNemse v noUnmosed arffeddi Roaske(Sac.7066,Business; Required Inspections and Professions Code:The Conmewe,License Law d.tet apply m ne an owr of q p properly who Wilds orimprevas thereon,and who doessuch work hineself or through his own employ.,provided that such improvements art not intended onoffeed for sale.If. however,0e Wilding or improvement is sold within one year of completion,the owner- builder will have the burden of proving Nat k did not Wild or improve for purpose of Yw.). 0 1.u owner of the propen,sm eacluvvcly contracting wits licensed ma."to construct the project(Sec.]Obs.Business and Professions Cade:)The Convector's Li. cense Law does not apply to an owner of property who Wilds or improves thereon.and who contracts tar such projects wit a eontrxtae(s)licensed versant on the Conuacsor's License law. 0 l em exempt under Sec. ,B At P C for this reason Owner Data WORKERS COMPENSATION DECLARATION 1 kreby affirm under Wealty of perjury oro of tk following declarations: 1 art and will maintain a Cenifiate of Consent to self-inwle for Warier',Compco- sadon,az provided for by Section 37W of the Labor Code,for the performance of the work for ich this permit u issued. have sed will maintain Worker's Compensation Immrance,az omifl ed by Scmiad 3700 of thc Labor Cade,for the performance of the work for which this permit is issued. My Warkcr's Canpemstian Inwmna carrier and Policy number art: Cartier. - Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ITU lectins need not kcompleted if tk Permit ir foram hundred dollars(SIM) or Ices) 1 certify Nal in the perfarnanm of Ne work for which this permit is issued.1 mall not amployanypermm I.my reams,, b�mCyTtm Warkcn'Catamaran. Laws of Cantonal.,Dau Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you.Nauta beano,subject m Ne Waher's Compensation provisions of the Labor Code,you muse .7 z forthwith comply with such provisions or this permit Nall W scorned revoked. zO` CONSTRUCTION LENDING AGENCY 'r+ (hereby air,.that Nem lea construction lending agency for the mfurrow.uf the work for which this Permit is issued(Sec.3097,Civ.C.) 1 Q Lender's Name ' 7 z LCMer's Addmas U O 1 certify that 1 have rad this application and scam that the above informauun is LL P comma.I agree m comply with all city and county ordlnamcs and sum laws missing to 0U Wilding canstrvction.and hereby amhomc represvnmi.ce of this city to enter upon the ahavrmcnuudcd.roperly fond espouses purposewhich m. F 0. (We)agree to save,indemnify and kap harmless the City of Cupertino against y incoitia,jnem of the Starting espouses which may in any any accrue again.said City s pormil, U APPLICANT ArNO VILL COMPLY WITH ALL NOWPOINT Issued by: 04 Date SOURCE REGULATIONS 1,v 1a), ILL / Re-roofs HAZARDOUS Stgnatule of AppliaODataOa HAZAADOUS MATERIALS DISCLOSURE Type Of ROOF Will the applicant or futureni Wilding occupant role or addle Health and Safer h az defined by Ne Cupertino Municipal Code.Chapter 9.13.and the Ha1N and Safety Code,Sccuon 25533(.)7 All roofs shall be inspected prior to any roofing material being installed. DYesNa If a roof is installed without first obtaining an inspection, I Will circ applicant or future Wilding Occupant use equipment or device which g agree to remove P emit hardous air conmminan¢y✓dcfncd by me Bay Arca Air Quality Management all new materials for inspection. District! '�j/ DYes No - I have read the haardous mnmrialsmquircnwnts undcrCap car 6.95of Ne Califon nu Health d:SafetyCode.Sceumu 25505.35533 am125536.I wboaMmnd Jut ifum Wilding does not curcntly w a tenant mat it u my lemOnSibilby m notify tk occupant Of the royuimm h'h as t ac met pdof m issuance of a Cmiec m Qcupane �� �t7t% n Signature of Applicant Date Owner or authoHaedagent D,te All roof coverings to be Class "B"or better Community Development i 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 40UPEkTINO Building Department JOB ADDRESS: -741(,,-7 S6Zi1 �Yewoo� jq`� PERMIT # Cu CA o 6( ZJ ( ° OWNER'S NAME: t�AY er o PHONE #`10 g-2-13 7-U I GENERAL CONTRACTOR -. r (� FAX # -- 9 I am not using any subcontractors: I^ �. _lam- Q-1 �� 1 0 Signature Date Please check applicable subcontractors and complete the following information: 60 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 • CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36227011. 00 DATE ISSUED. . . . . . . : 12/19/2006 RECEIPT # . . . . . . . . . : BS000000032 REFERENCE ID # . . . : 06120101 SITE ADDRESS . . . . . : 7647 SQUIREWOOD WY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : POOLE MARGARET J ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5054 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : POOLE MARGARET J ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5054 TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BELEC200 METERS 1. 00 29 .43 0. 00 29 .43 0. 00 BSEISMICRE VALUATION 2, 400. 00 0. 50 0. 00 0 .50 0. 00 BUSLIC FLAT RATE 1 . 00 107 . 00 0. 00 107 .00 0 . 00 EPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38. 37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 175'. 30 0. 00 175 .30 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 175 . 30 5353 --------------- TOTAL RECEIPT 175 .30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------- ---------------------------- --------- -------------------------- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • - CITY OF CUPERTINO CXO�20 1 C CITY OF PERMIT APPLICATION FORM CUPERTINO q1kPN it Date: Building Address: 7 040 Mailing Address (if different from building address): Cu A7� n C A -16-014Q Owner's Name: n' Phone#: Iv�a�'. �' �fie— 1-I 7- 2613 Contractor: License #: 156-7q r Contact: I Q�j hone: qoy-36,vglol Cupertino Business License#: a YI Fax: AA Building Permit Info: (�� 14 " 52'T�` \QO f1� Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Descriptio Residential ( Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: �/ Occupancy Gro : Type of Construction: `tel T' q Please check this box if the project is a 12G t f second-story addition: ❑ roject 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 j BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/OfFComm/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 Flee Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 CITY OF CUPERTINO CiWbF PERMIT APPLICATION FORM CUPEkTINO 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 cfm MECHANICAL BREMAMHAN 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> 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 EaBREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc t1, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 (d CITY OF CUPERTINO CUP fyor O PERMIT APPLICATION FORM Quantity 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 Mechanical sq. 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 Change BUILDING • 3of3