06080269` CITY OF CUPERTINO �
BCILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: CAL-AIR INC PERMITNo.06080169
10100 N TANTAU AVE
OWNER'S NAME: PERhLT LSSLIE DATE
SAND HILL PROPERTIES 1555 S 7TH ST #K 08/21/2006
NE:
SANITARY NO. CONTROL NO.
(408) 283-2300
ARCHIIECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
0 0 0 0
C, LICENSED CONTRACTOR'S DECLARATION
wF I hereby affirm Nat 1 me llstiwd under pmvition of Ch leer 9(mmmcMIAS Job Description
:z le
with Section 700[t)mf Division 3 of the Business and profession Cole.and my license is
!zN in full fame and effect r 120 VAC 20AMP BRANCH TO NEW FIRE ALARM MONITORI
z License ClLr.. 137<9S
�k-w Dau:-f_ CoSYSTEM
ARCHITECTS DECLARATION
i e< 1 understand my plans shall W used m public would,
iyU
G Licensed Fluentanal
OWNER-BUILDER DECLARATION
f I hererim t
by&fhat i am exempt from the Convector's Llmnse Law for the
p o following mason.(Smooth IID L5,Business and Pmfessinm Cade:Any city or county
$ which requires a Permit to construct.altar,improve,demolish,or repair my swcmta
spm
prior to its issuaaL.also requires the appluml for Such Permit to file a signed statement
- < that he is Bccmed pursuant w the provisions of the Conaaewr•s Lbae=law(Chapum 9 Sq.Ft.Floor Area Valuati$IP 5 0 0
%r$ (commencing with Seed.7000)of Division 3 of the Bestow..and Professions Cock)or
Nat he is eumpt themfmm and the bus for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant m a civil penalty of pEN Number. Occupancy Type
not mom than five hundred dollars ISM 31619061 . 00
❑1,u owner of the prvperry,a my cmploycu with sago ss the'vulc eompewuon,
ill do the work.and Ne svucture is not inandod or offered forsake(Sec.7044,Business ,
Required Inspections
and Pm(essions Code:The Comments's Limits,Law don not apply b an owner of
propeny who builds arimproves tharemo and who dam such.,it himself athough his
owncer.thers,prog or i proverimPmvimmtsue not year
WaaQered fa sok mare,1
builder.the Wilding or improvementuoldwithinas ild of mmPkuon theoseof
builder will have the burden of proving Nat he did rot WiW er improve(or puryose of
sale.).
❑I,as owner of thm pmpeny,am exclusively cartooning with licensed c nsamers to /
mntma the net
(gee.7044,Business and property
who
Cade:)The Ca themor, cad !�l
sou law don wt applyje ta owner of paper(who Wilds or impmvn Comor,and O
who coevals for such projetts with a contraemgs)licensed pursuant b the Convaemr's
License law.
❑lam exempt undo See .BAPCfor Nu rtuon
Owner Data
WORKER'S COMPENSATION DECLARATION
40 1 hereby affirm under penalty of perjury am of the following declarations.
❑1 have and will munuin a CertifiLate of Cortsem m ulbinsurt fa Worker'.Campen.
shim,u provided for by Smuon 3700 of the labor Code,for the performance of the
work for which this Permit is issued.
❑1 have and will maintain Workels Compensation Insurance,an required by Section
3700 of the labor Code.for the per(arananre of the work rue which this permit u brad.
My Worker's Compensation Insurance carrier and Policy number am:
Carrier..A la�Policy Ne:-AD-06-1 7J3'SY/
RTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITU semim need no tic completed if the pctmil is for atm hundred dollars($IW)
or Ins.)
I coolly that in the perfmmance of the work for which this Permit is issued,1 shall not
employ any person i.......w an to become subject to the Warlmoe Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT.If,after making this Ccnilicate of Exemption,you should
become subject ka the Worker's Compo ssumb provisions of the labor Cade,you muse
.J z forthwith comply with such provisions or thin Permit shall he domed revoked.
z O CONSTRUCTION LENDING AGENCY
(-+ I hemh,.M.that there ism carts .or.lemdingagency for the Perfurmanm of
rr!> the work for which door Permit U Issued(Sec.3191,Civ.C.)
Lindcls Namc
,7 z Lender's Address
U 0 1 minify thin 1 have read this application and stain that the shove ufo..onto is
Is. F corms.I agree 10 comply With all city and county ordinances and soon laws miming to
0building cons ctim.and hereby authorise nepnnenstises ofthis city to comr upon the
W dove-mcmiumni pmlveny for Ins,cdan purposes.
(We)acme to save,indemnify and keep harmless the City of Cupertino against
,F.,rA3 limiLumajudgumma,cosy and expenses which may in any wayocmc againstsaid city
Of thus XMIL
V z Aconsequence
PL CAM UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCER0NS
X
J Ll Re-roofs
glgmalYR or pelican ata
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will arc appImuu or future Wilding occupamstom or handle haeurdous material
as defined by Ux Cupertino Municipal Code,Chapter 9.12.end the Health and Safety
Code.senium 25532(a)7
❑Yu No
All roofs shall be inspected prior to any roofing material being installed.
t�
Will the applicant or future Wilding occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit horaohms it contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Disuicf7
CYex Q(Nu
1 have mad the harardousrmaterials requirements under Chaptarti.95 otf the Califor-
nisHmhh&SefcryCode,Seldom 25505.25533 and 8534.1 undersmnd thmifthe Wilding
does not cmmmky hese a inane that it u my reepanibinty In notify the=upset or dan
mquirtne, hmamtWmI�rtaitz"'"maf.cer,irnlLofam Signature of Applicant Date
`Sero
Owner araathor;padagemt � D,ta All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
46UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
loltz) fl/OAno i7-ai✓TA(I OG O (Ro l6 g
OWNER'S NAME: a/{ // PHONE # V08 (g3q
GENERAL CONTRACTOR: —A /Z3717,tca, FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical C - lNe--
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
-em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31619061 .'00
DATE ISSUED. . . . . . . : 08/21/2006
RECEIPT # . . . . . . . . . : 35699
REFERENCE ID # 06080169
SITE ADDRESS. . . . . . : 10100 N TANTAU AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SAND HILL PROPERTIES
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CESAR QUIJADA
CONTRACTOR . . . . . . . : MIDDLETON, STAN LIC # 398
COMPANY . . . . . . . . . . : CAL-AIR INC
ADDRESS . . . . . . . . . . 1555 S 7TH ST #K
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 283-2300
•
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
BREMMISC FLAT RATE 1 . 00 27 . 58 0 . 00 27 . 58 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 2 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- -- ---- --- - ---------- -- --------
TOTAL PERMIT 101 . 31 0 . 00 101 . 31 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 101 . 31 VISA
TOTAL RECEIPT 101 . 31
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
•
- CITY OF CUPERTINO pLIpgpt(p
CUP TYOF O PERMIT APPLICATION FORM
N# Date:
�iLP- 1 — clYI
1
Building Address: Mailing Address (if different from building address):
W '� O --RAJU
Owner's Name: Phone#:
r
Contractor: k / SOkflSon (!.c License #: 137 1 q S
Contact: Phone: 4C&(039-S--1t Cupertino Business License#: 39 Q
ez v Fax: O
Building Permit Info:
Bldg ❑ Elect 14 Plumb ❑ Mech ❑
Job Description: () 120 \)A-r- 2oA&tP mA-i —Ir2 .v^1 Mon; r,�J S
Residential ❑ Commercial
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
SOz) •OU
Type of Construction: Please check this box if the project is a
1,7P second-story addition: ❑
roject Size: Standards 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 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 <= 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
1 of 3
+ �- CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEIi;TINO
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 PbIg 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 Stonn/Ram 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 Fumace> I 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
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
2of3
L(I am- CITY OF CUPERTINO
` CITY or PERMIT APPLICATION FORM
CUPEkTINO
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 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
•
3 of 3