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07110013 CITY OF �UPERTINO ` ' ' BUILDIIVG DIVISIGN pERMIT �� ' <. ;: ,...;. ..::<.:: .. .,:, . .;:r. _. � . �.,, :. , .. .... BUILDING ADDRESS: PERMIT NO. 21403 SHANNON CT A PERFE�`�' CLIMATE 07110013 . dER'S NAME: P6RMTT LS6UE DATE WAGNER JOSEPH F AND MARILYN H 8375 BRENTWOOD BLVD STE B 11/02/2007 PHONE: SANITARY NO. CONTROL NO. (408)861 9545 ARCHITECT/ENGiNEER: BUILDING PERM[tINFO BLDG ELECT PLUMB MECH � � 0 � � o o LICENSED CONTRAC!'OR'S DECLARATION J0�7 DeSCiIpC1011 V I hcreby �rm that I am liccnscd undcr provisions oC Chapicr 9(commcncing �� wit6 SecGon 70(x)) af oivision 3 of thc Busincss and Profcssiuns Codc, and my �icensc is g�U � RE P LAC E FURNAC E 1 � � KBTU & AC 4 TON S AME " a in full foree and e![ ;�z t,;co„scclasa��•x � LOCATIO�IS � F, p Da�c f_/ —2 — UZ Contrutor �'+ ARCHIT'ECI'S DECLARA770N � '.i 1 undcrstand my plsns shall be uscd u public recards w� d U ; u. y Liccnsed Prufcssional � y � OWNER-BUILDER DECLARATION � <� I hcrcby alTirtn �at I am racempt frum �hc Canvactor's Liccnsc Law for thc i p O lollowing mason. (Sccdon 7031.5, Busincu and Protcssions Calc: Any city ar counry k,°, � which rcquires a pcimit to cnnsuuc4 a��. �provc, dcmnl'ish, ar repair any swnurc y Z y prior to i�s issuancc, alw rcquims thc applicam for such pertnit ta filc a signcd s�a�mcn� _< that Me is IicenscJ pursuant ta thc pmvisions of �hc Convactor's Licentc [aw (Chaptcr 9 3q. Ft. Floor Area Valuation y F$ (commencing wi�h Section 7000) of Division 3 of ihe Business nnd Prokssions Code) or $ 9 615 y �'. that he is exempt thGefrom and the basis Cor the atlegcd eumpdon. Any violaGon o[ Section 7031.5 by a�ry appiicant fw a permit subjecu ihe applicant to s civil pcnaity of Number Oeeupaney Type no t more � han f iw hun dre d d o l l a r s ( 5 5 0 0). 3 6 2 0 1 0 0 1 `.�'(�� 0 I. u owner of the property. or my employces with wages as their sok compensaUon, wiU do the work, and ihe stcuctuee is not inknded or otTered forsale (Sec.7044. Businesa Re uired Ins ections and PcoCessions Cade: The CanuacWr's I.icense Law does not spply W an owner of Q P property who builda or improves �hercon, and who does such work himself or tArough his own employces, provided thot such improvemen�s ue not in�ended or ofCeced [or sala If. however, the building or impmvemrnt ia sold wi�hin one year of compkGon, the owner- builder will have the burden a[ proving Uut he did not buiid or improvc Car purpose of sakJ. : Q I. at owner o( the property. am exclmively contracting wilh licenaed rnnvuWrs W wnswct the project (Sec. 7044. Businw and Pro(essions Code:)'fhe Convacwr's Li- cente Law docs aot apply W an owner of propeny who builds or impmves themon. �nd . who wmrac�s tor such projects wi�h a conuactar(s) licenxd pursuant to �he Conwctors License Law. '� I am exempt under Sec. . B dc P C for this rcason mv Date WORKER'S COMPENSA170N DECLARATION I hereby adirm under penalty o[ peryury one of the following declarations: ❑ I hsve and will mainuin a Certificate of Consent W u1f-insure Cor Workcr's Campen- sation, u provided for by Secdon 3700 of �he Iabor Code, for �he perfom�ance o[ the work for whicA �his pertnit is issued. I have and wil! muntain Workefs Compensation Insurana, u�cquired by Scction 00 of the I�bar Code, Car the performance of Ihe work for w6ich �his permit is issued. My Worket ompensaGon Insurana nrticr and Policy� j u�bcr arc: Cartim �u /ti%�. (.(/ r Poliry No.: "" Q w(�(�2 6� �6 �1 CERTIF[CATE OF EXE ON FROM WORKERS' COMPENSATION [NSURANCE • (This scction need not be complctcd if �he permit is fa onc hundred dollars (5100) or Icss.) ' I certify �hat in lhc performancc of ihc work [or which �his permil is istucd, I shall nol employ any peesbn in any manner so u w become subject to ihe Woricers' CompensaGan Laws of Cali(omia Datc Applicant NOTICE 7'O APPLICAM: If, ahcr making �his CcrtiCca�c of ExcmpGon, you should baome subject in the Workcr's CompcnsaUon provisions of �hc Labor Codc, you must , O forthwi�h comply with such provisions or this pecmit sha0 bc dccmcd awokcd. z '"'' CONSTRUGTION LENDING AGENCY (— �—�i 1 hcrchy affirm U�at thcre is s conswcrian Icnding agenry for thc performance of ai � ihe work fur which �his permit is iuued (Scc. 3097, Civ. C.) � A Lendefs Namc ' � z Lcnder's Address V Q 1 certify that 1 havc rcad ihis applica�ion and s�a� �hu Wc abovc informatiun is w � cortcn. I ag�ee w comply wi�h all city and county onlinances and sute laws ccladng w 0 U building consuuction, and hcreby autharia ccpreuntaGvcs of this ci�y w cn�cr upan thc above-mentioned propcny for inspecuon purposes. �" a (Wc) ag¢e to save, indcmnify and kecp harmless the City of Cupenino against � �' �„� � liabilitiu, judgments, cos�s and expenses which may in any way accrue against said City () z in consequencc oC thc granGng ot Ihis permi� Date �� '� ! ""� APPLICANT UNDERSTANDS AND W1LL COMPLY WITH ALL NON-PO1NT Issued by: �c—� SOUR R ULATION � '` � 2 � Re-roofs �'� Signature oF ApplicanUConuacar Da1c HAZARDOUS MATER[ D SURE Type of R �)Of Will the applicant or futurc building xcupant store or handlc hanrdous ma�crial dcfincd by thc Cupertino Municipal Codc. Chaplcr 9.12, and thc Hcal�h and Safcty .�. Scction 25532(a)? All roofs : hall be inspected prior to any roofing materiai being installed. ❑ Yu �o f` If a roof i: installed without first obtaining an inspection, I agree to remove �II thc applicam or future building accupant usc cquipmcnt or dcvices which � cmi� ha•r.ardous air conuminan�s u dcfincd by the Bay Area Air Qualily ManagcmcM all new m; iterials for inspection. Disuict? ❑ Ycs u � 1 havc rcaA the hvardcws ma�crials requircmcnu undcr Chaptcr 6.95 of �c Glifor- nia Hcalih & Satcty Cadc, Six�ions 255Q5.25533 uNl Z5534.1 undcrsmnd �hu iCthc building d curtenUy have a �enan4 � it is my responsibility W notify Ihe occupent of ihe en�s whic mus e( pcior to issuance of a Cenificate of Occupanry. S IgII3Ll1Le ��f Applicant Date l � Z " �� All roof coverings to be Class "B" or better Owncr or authori�.cd gc Da�c CITY OF CUPERTINO 7 ITEMS OF 7 PERMIZ RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ... ...... 36201001.00 DATE ISSUED.......: 11/02/2007 RECEIPT #.......... BSC00003146 REFERENCE ID # ...: 07110013 SITE ADDRESS .....: 21903 SHANNON CT SUBDIVISION ....... CITY .............. CUF'ERTINO IMPACT AREA .. ... OWNER ............: WACNER JOSEPH F AND MARILYN H ADDRESS ........... 21903 SHANNON CT CITY/STATE/ZIP ...: CUF'ERTINO CA, 95014-4970 RECEIVED FROM ....: EDU'ARD A GREGORY CONTRACTOR .......: SMITH, BYRON E LIC # 21144 COMPANY ..........: A f'ERFECT CLIMATE ADDRESS ..........: 83i5 BRENTWOOD BLVD STE B CITY/STATE/ZIP ...: BRF;NTWOOD, CA 94513 TELEPHONE ......... (4C8)861 9545 FEE ID UNIT QUANTITY �,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00 BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00 BSEISMICRE VALUATION 9,615.00 1.00 0.00 1.00 0.00 EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 182.80 0.00 182.80 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 182.80 MC --------------- TOTAL RECEIPT : 182.80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING :303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL o�i�oo�3 . CITY OF C UPERTIliTO �� ::_� ��:T�.1�.��/�.� ..UPE�TINO PERMIT APPL]_CATION FORM APN # � / a U ( � � � . � � Date: /� � _ � � l0 Building Address: � � � / �/�? � J � � �� v;,c C� �L Owner's Name: Phone #� � yo d� - z.S� 7- �s � fs _ �- � � � � �_�—_��__�� _�? J — � C:onfracfor: 1'hone: - — License �': � �� v� C�� Q � �"a{� ��/ �.��,, Contact: v � �� Phone: ��G�� Cupertino Business License #: � ��y Building Permit Info: Bldg ❑ Elect C� Plumb I�� Mech Job Description: %�' � � � - . ...f ur ✓� ��e- /U��z ,Q / U -� � C- Y / �� . �� ,��v�s Residential � Commercial ❑ For Residential Ins allations: Attic � 1 floor /�' 2 floor � �dhere to min set back requirement ❑ r'or Commercial Installations: Replacement same weight ❑ Additional weight (s �jctural calcs) � Structural Calculations required for new instal ation New installation Planning Ap roval Required Cost of Project: Type ofrConstruction: Occupancy group: �61�" �� -� Strapped ❑ On Platform � Bonded 0 Sq.Ft. Floor Area: New Location � Replacement � Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Er�ergy BUILDING BREMF'URN FL mace MECHANICAL BREMACOVER A�C Unit > 10,000 cfin MECHANICAL BREMAIRHAN AiC Units <= 10, 000 cfin MECHANICAL BREMRECEPT R�;cp�l, Switch & Outlets ELECTRICAL / BSEISMICRE Sf:ismic Fee Res BUILDING BSEISMICOM Se:ismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Pernut Issuance MECHANICAL PPERMTTFEE Pl ambing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Pl �.n Check Fee BUILDING BPGAS G�s Piping System Fee PLUMBING BUSLIC B��siness License BUILDING Community Development ' �; 10300 Torre Avenue �� ' �,/: Cupertino CA 95014 `'" � Telephone (408) 777-3228 ClTY OF Fax (408) 777-3333 CUPEI�TINO Buildi:n De artment JOB ADDRESS: PERMIT # .�� Y � . ��, 4 .�.� �� -�— Q `� C � � � . OWNER'S NAME: �. W� ,� e f- PHONE #"�� Z s�- s 5 J GENERAL CONTRACTOR: �� ,~ ��- Gl; � � FAX # �� ,� // Z —�.' � I am not using any subcontractors: �� Si�;nature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSITfESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Fini.shing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering � Plumbing � �i�ee�1 � ��;,�-�.�� Le. �L� �� Roofing Septic Tank Sheet Metal Sheet Rock Tile ��t.v��c.�— _ /� �— Z `"°� Owner/Contractor Signature `- Date