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10080061 CITY OF CUPERTINO BUILDING PERMIT UILDING ADDRESS: 7920 FALL CT CONTRACTOR:AMERICAN RESIDENTIAL PERMIT NO: 10080061 SERVICES OF CA "NER'S NAME: JOANNE SMARTT 965 RIDGE,LAKE BLVD STE 201 DATE ISSUED:08/09/2010 MEMPHII TN 38120 PHONE NO:(408)982-0405 OWNER'S PHONE: 4082531247 LICENSED CONTRACTOR'S DECLA3RATION BUILDIr G PERMIT INFO: BLDG r ELECT r PLUMB icense Class # MECH r RESIDENTIAL r COM RCIAL r- Date / - ontract JOB DEr,CRIPTION:PROPERTY LINE CLEAN OUT hereby affir at I am licensed under the provisions of Chapter 9 :ommencing with Section 7000)of Division 3 of the Business&Professions 'ode and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: have and will maintain a certificate of consent to self-insure for Worker's ` ;ompensation,as provided for by Section 3700 of the Labor Code,for the eerformance of the work for which this permit is issued. Sq.Ft Floor Area: e —tkValuation:$169 .� have and will maintain Worker's Compensation Insurance,as provided for by >ection 3700 of the Labor Code,for the performance of the work for which this —;PN Nun fiber: 62I3®Q8 Occupancy Type: >ermit is issued. APPLICANT CERTIFICATION [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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the appl• understands and will comply Date: with all non- • t s re ro er t pertino Municipal Code,Section Issued 1 y: 9.18. �atur ` Date RE-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: Date: I,as owner of the property,or my employees with wages as their sole compensation, Signature;of Applicant: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's Califori iia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. ed for by contain should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as providam contHantnt s as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health 8r Safety Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent: Date: Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereb•�affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for whish this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lendej•'s Address 'he above mentioned property for inspection purposes.(We)agree to save nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,andZexp�enses which may a rtC in consequence of the granting pe d • onally, derstands and will comply I under stand my plans shall be used as public records. with all nsourc egulatio o Municipal Code,Section9.18. Licensed Professional Signatur CITY OF CUPI:RTINO FEE ESTIMATOR-BUIILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: x4,500 "PERMIT TYPE: Plumbing Permit PLAN CHE:K TYPE: Alteration/Addition / Repair PRIMARY /�)l_: I APPLICATION 1 RPSS USE: SFD or Duplex .,��t�F: r ,�_�-� TYPE: �940W as 00 3 � FLR AREA BP FEES APPLIANCE/EQUIP TYPE CAPACITY s f QTY Sewer, Sanitary 1PRSEWER 1 $21 TOTALS: $21.00 Plumb.Plan Check 0.0 hrs $0.00 0", fi�,r t rfr,N. a t,.,,.r 1,cc Plumb.Pert Fee: IPPERMIT I is t I °rr,;i!h �c_ �, Other Plumb Insp. 0.() hrs $42.00 trr f,�l_7 , Ilrs,t7. NOTE. These fees are based on the preliminary in ormation available and are onl an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 .F,ff.' 7/1/0.9) FEE MISC ITEMS 1"on C`lwch /`cct PME Plan Check: $0.00 l r!;at trf,tit � _c PME Unit Fee: $21.00 PME Permit Fee: $42.00 C'oilsow',Iioa -T cott.eticcxl Rcvicw Work Without Permit? Q Yes 0 No $63.00 1'lr�r,rirtg 1��°crs: Travel Documentation Fee: ITRA VDOC $42.00 i S'7a+�,r r a-1��tror2 V'v: Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $169.00 $0.00 TOTAL EE $169.00 Revised: 8/06/2010 CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECECPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36213008 .00 DATE ISSUED. . . . . . . : 08/09/2010 RECEIPT #. . • . . . . . . : BS000011127 REFERENCE ID # . . . : 10080061 SITE ADDRESS . . . . . : 7920 FAIL CT SUBDIVISION . . . . . . CITY CUPERT I l'O IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . JOANNE SMARTT ADDRESS . 7920 FALL CT CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM AMERICAN RES SVCS CONTRACTOR DONALD KARNES LIC # 21504 COMPANY AMERICAJ4 RESIDENTIAL SERVICES ADDRESS 965 RIDGE LAKE BLVD STE 201 CITY/STATE/ZIP . . . : MEMPHIS, TN 38120 TELEPHONE (408) 932-0405 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL- ---------- ------------- ---------- ---------- ---- 1BCBSC VALUATION 169. 00 1 .00 0. 00 1. 00 0 .0 1PPERMITFE FLAT RATE 1. 00 84 .00 0. 00 84 . 00 0 .00 1PRSEWER UNITS 1. 00 42 .00 0.00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 ------0_00 ---------- ---------- ---------- TOTAL PERMIT 169 .00 0 .00 169.00 0 .00 METHOD OF PAYMENT AMOUNT --- ----------------- E-NUMBER --------------- ----- CHECK 169 . 00 #8128005310 --------------- TOTAL RECEIPT 169 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION --------- -------- ------------------- --- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING 0 CITY OF CUPI"RTINO -0 REPIPE/SEWER/ -�JN SERVICE M CITY OF CUPEkTINO PERMIT APPLICATION FORM Date42, A N PN Building Add Phone#: Owner's Name: _Z3 _ 12-1(7 FContrac �r: Phone#: Fax #- P 0;e#- _ _ ( —P97? 7e Phone#- Contact: 7 1� F9 7? Fax#: Contractor License#:_ ' Cup-.rtino Business License#: Job Description: IAU (��&&29tJ 6L Residential Commercial M Valuati Project Size: - Express 7Standard _j 3rge Major7111 — Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Green Buildin Points: Quantity Fee ID Fee Description Fee Permit Type Grou m 1bull Quantity Commercial building P 1CPSS rcl sewer/sanitary st sewer 7!E Commercial re-pipe per fixture P 1CPRP IBPREPIP IPGASCOM Commercial Gas Piping System P 1-4 Outlets IBCBSC Cal Bldg Standards Commission.. B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7920 FALL CT CONTIU CTOR:' aERMIT NO: 10080045 DV4NER'S NAME: BRAIN SMART (��Qr( 'j" (L if,1� (� (LT DATE ISSUED:08/05/2010 PHONE NO: NER'S PHONE: 4084891528 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB r License Class Lic.# 06 MECH r RESIDENTIAL r COMMERCIAL r Contractor tjC/�t���l (_�✓NL-�_�Date � b JOB DI,SCRIPTION: REPLACING DECK-LANDING PRESSURE TREATED I hereby affirm that I am licensed under the provision of Cha ter 9 LUMBER & (commencing with Section 7000)of Division 3 of the Business&Professions REDWOOD DECKING Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,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 provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft FI oor Area: Valuation:$2000 permit is issued. APPLICANT CERTIFICATION APN Number:36213008.00 Occupancy Type: 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 constriction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, W[THIN 18 YS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 18 DAY LAST CALLED INSPECTION. with all non-poin so ce a lations per the Cupertino Municipal Code Section _ _�� 9.18. / Issued by: R Date: Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All root i shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installer without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspecti m. will do the work,and the stricture is not intended or offered for sale(Sec.7044, Business&Professions Code) Signatu a of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have -ead the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. Califon nia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compli ince with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall mainto in compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Healthtaffithat ode,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must OK ered agent: Date: � forthwith comply with such provisions or this permit shall be deemed revoked. yAk CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I heret there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for wh ch this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save i- --nnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the g—ging of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-iA ations per the Cupertino Municipal Code,Section 9.18. I unde stand my plans shall be used as public records. Signature Date Licen;ed Professional CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: DACE: REVIEWED BY: APN: BP#: *VALUATION: $2,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY OVER THE APPLICATION USE: SFD or Duplex COUNTER? E Yes D No TYPE: MECHANICAL 0 Yes (F) No PLUMBING Q Yes Q No ELECTRICAL Yes Q No � W as O O 3 � OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. (Sq-ft-) R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 '? _ T?ut;f (;ern t , 1. 1;.<jt)h`�e lrunrt% ,'nj,, C7 ,•1'r: r NOTE: Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (fee Resolution 29-051 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT r 0.01 hrs $0.00 _T PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: Yes Q No $0.00 0 Work Without Permit? Q Yes 0 No $0.00 0 Planning Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 7i'ut'c'f L)Uttf71?E'77r'UficTfZ l'('t'-.5: / Strong Motion Fee: IBSEISMICR $0.50 I 2.0 hrs Standard Hourly Rate Bld-_ Stds Commission Fee: IBCBSC $1.00 $252.00 SUBTOTALS: $1.507 $252.00 TOTAL FEE: $253.50 Revised: 7/28/2010 CITY OF CUPE&TINO RECEIPT NUMBER: BS000011099 RECEIVED BY: PATG PAYOR: WALTER FINNERTY TODAY'S DATE: 08/05/10 REGISTER DATE: 08/05/10 TIME: 12 : 01 4 1BCBSC 10080045 $1.00 1BSEISMICR 10080045 $ .50 1SUPPKFEE 10080045 $252 .00 BUSINESS LICENSE TAX NEW- WALTER FINNERTY 00 _-_-_----$114_ TOTAL DUE: $367 .50 CREDIT CARD: $367 .50 RE7 NUM: VISA TE14DERED CHANGE $ 367 .50 $. 00 IR CITY OF CUPERTINO OF CUCITY RTiNO GENERAL BUILDING PERMIT APPLICATION FORM APN # - Date: Building Address: / O r V `• � O r Mailing Address (if different from building address): Are Hazardous Materials being used as part of this proj,;ct? Yes No HOA: (Exterior work only) Yes ❑ No If yes, p rovide letter from HOA Ownwrj'I r M/T S aid /7e• _ Phone#: Contracto &-1 — Fax: V IV2 Zr 0 Contractor License#: 9C1 -7 2 ©-X Cupertino Business License#: Contact: Phone: Fax: Residential Commercial Job Description: L �� t�G Lam! C L '�� �G'" t \ n� i� �' r: i 1� A/ Z) 'Z a 00 Building Permit Info: Bldg Elect ❑ Plum ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B �� a Valuatio O Square Footage: 2- 0it Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Bu' ding/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.oig Revised 07/14/09 s a. I � � 0 Vz Nj, � o o J ` CJ Cno Au - A }� VI s