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07060098CITE' OF,CUPERTINO BUILDING DIVISION PERMIT N BulLMl;1c, ApI�REMEADOWVI EW LA PERMIT NO. DON WADE; ELECTRIC CO 07060098 OWNER'S NAME: GARLAND RAYMOND L AND MARILEE 1 1632 HARWOOD RD )NE: ARCHITECI7ENGINEER: ce p LICENSED CONTRACTOR'S DECLARATION v I hereby affirm that I am licensed under provisions of Chapter 9 (commencing z with Section 7000) of Division 3 of the Business and Professions Code, and my license is o in full force and effec License tass 3 Lic. N t- � Date ' '' � Contractor ARCHITECT'S DECLffATION i a a I understand my plans shall be used as public records �yU U. y Licensed Professional O a OWNER -BUILDER DECLARATION i< I hereby alTirm that I am exempt from the Contractor's License Law for the '0 O following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure Z y prior to its issuance, also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 e.t– $ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basic for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- ccnse Law does not apply to an owner of property who builds or improves thereon, and, who contracts for such projects with a contractor(s) licensed pursuant to the contractor's License Law. ❑ I am exempt under Sec. B & P C for this reason Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L] I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensa'on Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be compictcd if the permit is Cor one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ. C.) Lender's Name Lcnder s Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE R TIONS • �f 'l ,C:0 /�—/3t-y7 Si Applican tMontrictor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes Flo Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑Yes 1.6Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building docs not currently have a tenant, that it is my responsibility to notify the occupant M the rcquircmcnts w ' c nor to i cc of a Certificate of Occupancy. +� �-t ---, 6.-4> /el Owner or authorized atcnl Date (408)37 —2323 PERMIT ISSUE DATE 06/13/2007 SANITARY NO. CONTROL NO. Job Description SERVICE CHANGE TO 200 AMP. 3q. Ft. Floor Area 3264502 5 Issued by Re -roofs Type of Roof BUILDING PERMIT INFO BLDG $2200 valuation Occupancy Type Required Inspections All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT' RECEIPT Sec: Twp: Rng: Sub: B11:: Lot: APN ........: 32645025.00 DATE ISSUED.......: 06,113/2007 RECEIPT #.........: BS000001635 REFERENCE ID # ...: 07060098 SITE ADDRESS 21390 MEADOWVIEW LA SUBDIVISION ...... CITY CU ?ERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER ............: GARLAND RAYMOND L AND MARILEE ADDRESS CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1143 RECEIVED FROM ....: DOVALD R WADE CONTRACTOR .......: WADE, DON LIC # 18388 COMPANY DOV WADE ELECTRIC CO ADDRESS 16320 HARWOOD RD CITY/STATE/ZIP ...: LOS GATOS, CA 95032 TELEPHONE (408)377-2323 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ----------------------- BELEC200 METERS ---------- 1.00 -------------------- 29.43 0.00 29.43 0.00 BSEISMICRE VALUATION 2,200.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT RATE 1.00 38.37 -----0_00 ------ ------ ---- TOTAL PERMIT 68.30 0.00 68.30 0.00 METHOD OF PAYMENT AMOUNT REFERENCE ------------ NUMBER ----------------- --------------- CREDIT CARD 68.30 VISA --------------- TOTAL RECEIPT 68.30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL �t. CITY Of CUPEkTINO CITY OF CL PERTINO PERMIT APPLICATION FORM t%rlN rt .✓C�i-- A h:7 T-1- n-onvinfi An* [-1r( HLUUU i-AJL 111Vva. Fee ID BAPPLOTHER BCONSTAX BCONSTAX BCONSTAXBQ BCONSTAXH BCONSTAXR BELEC 1000 BELEC1001 BELEC200 BENERGY BENERGYADD BINVESTIGA BMITIGATC BMITIGATR Bl�ITEWMULTI BNEWMULTI BNUCOMME BNUCOMMM BNUCOMMP Date: 1 -i Phone #: -&�� License #: Phone #: Fax #: �CDL� — Commercial: $/Sq.Ft.: Valuation: 27 Fee Description Other r App fiances Construction Tax Ind/O cff/C/C ,mm/Quasi iffo—nTax Jbr BQ Zone Hotel and Motel Con Resi/Mobile Elec 6 V00V00 <= 1000A Elec60 `0 " > 1000A Elec Svcs 600V <= 200A Enregy Energy A id Multi Investi gation fee Comm* ousing Mit. Fee ging Mit Fee ti -Family Res ti -family Res Electric in Mechanical in Plumb 0 1 of 3 CITY OF CUPEf�T1NO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BNIJMULTI New Multi--.'arnily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmos heri , Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixtut-e PLUMBING BPGAS Gas Piping 3 stem Fee PLUMBING BPINTERCEP Ind Waste I iterce for PLUMBING BPLANCHK Plan Checl: 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 Sp rinklerBackflo PLUMBING BPSTORM Stonn/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alte- Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units -- 10,000 cfm MECHANICAL BREMAPPLI A liance .[nstall MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lightin2 Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 1 O btu MECHANICAL BRENiHEAT Heater Installation MECHANICAL BREMINHOODInstallation. of Hood MECHANICAL BREMMISC Misc A aratus ELECTRICAL BRENINRAPP Rem Non-:Zes Appliance ELECTRICAL BREMPOLE Pole/Platfc rm Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Re air/Alter Heating MECHANICAL BREMRESAPP Remodel Fres Appliance ELECTRICAL BREMSIGNAD Rmdl Sigr s Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL I7VVMTWPATR Theatrical LiLyhtina Fix ELECTRICAL l/y\y/y�y y yaYa a i a 2 of 3 CITY OF '-UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 12, ) ?l'Yv PERMIT # 0 `7 pi, BUSINESS NAME OWNER'S NAME: PHONE # 9 c? . ,% ZZ3-2-3 GENERAL CONTRACTOR: FAX # 4— - I am not using any subcontrac Si;nature Date a,,,,lirahle c„hrnntrartnrS and complete the following information: Owner/ Contractor Signature Date y �y SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing f/ Electrical e� 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