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10050048 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20634 MAPLETREE PL CONI RACTOR:JOHN BYRNES PERMIT NO: 10050048 CONS(RUCTION ' `"NER'S NAME: LARRY CHAMPAGNONI&ABBIE LAYTON 710 CAYUGA ST DATE ISSUED:05/04/2010 1 PHONE NO:(831)809-4226 %,.JNER'S PHONE: 6504683717 SANTA CRUZ,CA 95062 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class l_- Lie.# e-3 ( 10 MECH r RESIDENTIAL I- COMMERCIAL Contractor, 1\r Date JOB DESCRIPTION:REMV EXISTING NATURAL GAS FIREPLACE,INSTALL I hereby affirm that I am licensed under the provisions of Chapter 9 NEW (commencing with Section 7000)of Division 3 of the Business&Professions GAS 11REPLACE WTIH NEW VENTING(DU),3 MINOR Code and that my license is in full force and effect. FRANIING,SHEETROCK,EXISTING FRAMING TO REMAIN 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 Valuation:$5000 permit is issued. Sq.Ft Floor Area: APPLICANT CERTIFICATION anc Occu Type: I certify that I have read this application and state that the above information is APN Number:32344031.00 P Y 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. C F;-naturenature Dat_9g40L= e r / Issued by: Date: ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All i oofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, insp:ction. Business&Professions Code) Sigr ature of Applicant: Date: 1,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: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I h:ve read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by conipliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall cor taminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I He filth&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must CG ner t: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION ` CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I h correct.I agree to comply with all city and county ordinances and state laws relating ;reby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) 7 the above mentioned property for inspection purposes.(We)agree to save Lender's Name anify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address custs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional Wil. CITY OF CUPERTINO 7 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lct: APN . . . . . . . . : 32344031 . 00 DATE ISSUED. . . . . . . : 05/04/2010 RECEIPT # . . . . . . . . . : BS000010319 REFERENCE ID # . . . : 10050048 SITE ADDRESS . . . . . : 20634 NAPLETREE PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LARRY CHAMPAGNONI & ABBIE LAYT ADDRESS . . . . . . . . . . : 20634 NAPLETREE PL CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0449 RECEIVED FROM . . . . : JOHN S BYRNES III CONTRACTOR . . . . . . . : JOHN BYRNES LIC # 30790 COMPANY . . . . . . . . . . : JOHN BYRNES CONSTRUCTION ADDRESS . . . . . . . . . . : 710 CAYUGA ST CITY/STATE/ZIP . . . : SANTA CRUZ, CA 95062 TELEPHONE . . . . . . . . : (831) 809-4226 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 000 . 00 1. 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0. 00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0. 00 1MPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0. 00 1PGASRES OUTLETS 1. 00 63 . 00 0 . 00 63 . 00 0 . 00 1PPERMITFE FLAT RATE 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 232 . 50 0 .00 232 .50 0. 00 CITY OF CUPERTINO RECEIPT NUMBER: BS000010319 RECEIVED BY: PATRICIAG PAYOR: JOHN S BYRNES III TODAY' S DATE: 05/04/10 REG::STER DATE: 05/04/10 TIME: 09:51 8 1BCBSC 10050048 $1 .00 1BSEISMICR 10050048 $ .50 1EPERMITFE 10050048 $42 . 00 1MPERMITFE 10050048 $42 .00 1PGASRES 10050048 $63 . 00 1PPERMITFE 10050048 $42 . 00 1TRAVDOC 10050048 $42 .00 BUSINESS LICENSE TAX RENW JOHN BYRN&3 $114 . 00 ---------------- TOTAL DUE: $346 .50 CREDIT CARD: $346 . 50 REF NUM: VISA TENDERED CHANGE $ 346 . 50 $ . 00 SM CITY OF CUPERTINO CUPEt�TINO GENERAL BUILDING PERMIT APPLICYkTION FORM APN# Date: r- Building Address: I o6 q I')IQ A��£ \)C,L Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No � If es, rovide letter from HOA Owner's Name: Phone#: R►�h- �0'1 ILc4rr*, CyM(-,�-A 6 0 �6r -3717 Contractor: Phone: 5>► -3 `i --v v -} ,5vI,�. � t�r��S CU n S'}1`� c. >>CJ� Fax: Contractor Licefise#: q tor_, Cupertino Business License#: Contact: Phone: �3►- U - Z G "3V Nr 13 $ S Fax: Residential t6 I Commercial ❑ Job Description:�� 2 M i..�. � k � S� . �� 1`� t�•••^^� �h`�� t- •r-��k.� c � Building Permit Info: Bldg Elect E[-�.. Plumb n Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-13 ❑ II/III/V-A ❑ II/III B, IV-HT, V-B R Valuation: Square Footage: Project Size: Express n--- tandard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of this Green Building/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.oi Revised 07/14/09 CITY OF CUP,ERTINO `yin of GENERAL BUILDING APPLICATION CUTiNO FEE SCHEDULE Fee Permit Type Fee Description Group 1GENRES or Quantity/Sf Fee ID 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application ass B sliding l Replacement windows/ sliding door (ea 8 win3ows) B 1WlNMEWSTR New Window-;structural shear wall/masonry (includes plan ck fee) IEPERMITFEE Electrical Perrlit Fee E 1MPERMITFEE Mechanical P(,rmit Fee M .� 1PPERMITFEE Plumbing Pernit Fee P r IELCPLNCK Stand Alone electric Pin Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pin Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pin Ck (hrly) P 1 STP -(3 Hr Min Standard PJan Check(when no E/M/P) B when not over counter) hourly-stand alone B ALL PERMIT 1BCBSC Cal Bldg Standards Commission Fee TYPES 1BSEISMICR Seismic Residential B 1BSEISMIC0 Seismic Commercial B B 1TRAVD0C Travel &Documentation — � B 1BUSLIC Business license I � of5