02030075 (2) CITY OF CUPERTINO X �' "iwoi "7 t - "-` r R wi, naso..
BUILDING DIVISION PERMIT ,'CON,rRAtTOR"elNFORMATIQ
BUILDING ADDRESS: PERMIT NO.
10280 PHAR LAP DRIVE H.D. MILLER CONSTRUCTIOIN CO 02030075
OWNER'S NAME: APPLICATION SUB DATE
RUTTER, GILLIAN 745 CHIMALUS DR 03/14/2002
e 10NE: SANITARY NO. CONTROL NO.
(650) 968-0291
Matz ARCHITECT/ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
�a
tion
ib Descr
E LICENSED CONTRACTOR'S DECLARATION
Z= I hereby affirm that Imp licensed ander provisions of Chapter 9(cm
omencing Jop
„t-� wimSection 7000) fDivision 3ofthe Bosine and Profession,Csdeaodmylicense WINDOW REPLACEMENT, SERSMIC UPGRADE
o Wu pX` fO`'eV pec � SL
Convenor F<
ARCHITECT'S DECON
1 understand my plans shall be used as public records /O
Ei p O Ucensetl Profesnonal ��/ as
' e�
OWNER-BUILDER LDER m the CoATION
v,
1 hereby affirm that 1 an exempt from the Convector's License Law for the O
?C following massa(Section]0315,Business and Professions Code:Any city m county
whichitsissuance,
requires permit re cores tet,aper,improve,demolish,fi mpainy suunore $2 0 0 0 0
3$ _pdono iu nalso requires movisio s ofthe Cormanrduoicensles,signed wstatement _
tryst ne is t[ccnzed peroneal to lit provisions of the Conwnols License Lew ons Code)
- - - "-
,(comrt�cncing with Sccuon]0 )ofDivision3ofthe Business end ProfSssions Code) (vr`., { Si3'i� :t9�� ,: ,:`t t;'•:';,i{. ;: Valuation
or that he 19 exempt therefrom and the basis for the all4ged exemptibd.Any violation
of Section 7031.3 byony applicant for a Permit subjects the applicant to a civil penalty
fof not more man five hundred dollars($500). 10�1"N NF"DATION it, Occupancy Type
01,simmer ofthepropeny,ormyemployees with wages as their sole compensation, i nq -
will do the'wmIt.end the strocmrc is not intended or offered for sale(Sec.7094,
Business and Professions Cade:The Commnor's License Law does not apply to an 10 3 - UFER Required Inspections'
owner of propcny Who builds or improves thereon,and who does such work himself
or through his own employees.provided that such improvements arc not intended or 104 - REBAR
`offered fT sale:If,howeventhe buildin ._............ .
° the improvement nsold-within one build of -"-..._.. _. . .._ ..__ ......... . ....
"compinion,the owner-builder will have the burden of proving that he did not build or 105 - ANCHOR BOLTS • . . _ .
improve for purpose of sale.). 106 - SEWER & WATER
G _ "o 1;es owner of lite prnpeny,am ex<Iuxively mnwning with licenses contmgors to 202 UNDERFLOOR PLUMBING -
commit the project(Sec.7094,Business and Professions Code)The Contractor's
ppr 203 - UNDERFLOOR MECHANICAL"
License Lew dyes nota man owner of who builds or improves thereon,
:. ..end who contracts tor.auah projects with a commissariat)licensed puraunnt.to.the ",.... ..._..- 2 O4"' "' UNDERFLOOR-"'FRAME"-
" : Convector's License Law.. .. --._.._. . ... ._. -_ ... ._ .... ".-. . .
❑lata exempt under 5th. ' 8&PCfor this ran in 205 - UNDERFLOOR -INSUL'�'ATION
own, ' ''';. "oath 301 - ROUGH PLUMBING
: WORRER'SCOMPENSATION DECLARATION 302 - TUB & OR SHOWER
l ion:hereby aBrm under penalty of actim,one ofthe following declamations: 303 — ROUGH MECHANICAL
I have and wit[madman a'Cenificne of Consent to self-insure far worker's 3O4 — ROUGH ELECTRICAL
_ompenst -..provided for by Section 3700 oftheLabor Code, for the
peaftimmanctofthewselifinowhich thio permit is issued. 305 - FRAME
❑1 have and w 11 malate work is Compensation-in[uhnce.u requirad by Sccdoin 306 - HOLDOWNS
37M M the Lab -Cade for the performance of hic work for which this permit is
d My Worker's Carnpaauthor t ran < ,rappPoIy her arc 307 — INSULATION
SnfnF%�vV11 roimy b3�O �Z U! ,
7 " a 308' -;'SHEFTROCK. ,..
ceRThFlccomPsnnorvll°suR�AtoaMc£oRicerssl s``` Zt "309'I�-'''EXTER•TORYLATH•
.µ _.-.,.. Permit is for one hundrcddoll -__•....-..` .. _.__.
37'0 'INTERIOR"'TAT13"
' (Th s as than heed not be completed rf the an
(¢I00)ar less.) 311 - SCRATCH COAT .
1 Ally tit t m me parrs o - f me Wdh f f me m petnui s issueeJ -- _ . 313
-ROOF,- NAI L
shell t mPl y nY Person
_.. _.:.....,.:- .::
y manner sa aat beoanu sag tit oath;wgrkera• 501 - FINAL ELECTRICAL' ENERGY-'"
Compensation Laws of California.Dae'
Nti]iceioAPPL.1.1. : .• t , - '-- 502 -- FINAL- PLUMBING ENERGY-�—_. _.._.-
IN ebb uo the If. (tanking this Cemfcate.FExmpto,you aboard -` -"
ti WolxernCamonsorti pe iitt'haofechar Cdeyoumost 503 - FINAL MECHANICAL ENERGY
Z y ns apo s a it permit'hall see drevoked. 504 _- . FINAL.. BUILDING. ENERGY
0
�ftfiew rk fo hen CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL ,
anew tit c mply t
I hereb R that them sconstruction I nd' enc far tit
a > g agency x °mance 5.06 - GAS TEST
W.f+ tars perm t s t sued(Sec 309] p C.) '
pn.(a Lender N m •. ..:. ._... i., ... .. ._. _
p � Lende ,Address - PLUMBING.. "
. .t
WQ 1 centfy shat I have mad this 508 FINAL application and auto that the above information is HAN I CAL
[r cone" 1 gree toComplywmall ityand cunty rd antes and sum laws palating 509 - FINAL GRADE
0_V it
to to busdng consuaction,and hereby aumbrize mprwemnims of this city to enter upon
s rW the above-mentioned property for inspection mrst ,
4 )agsave;in
ree todemnify andkeep numless the City of Cupulas against SIO - FINAL PLANNING
Fr�'LI)` Haitilide ju menu,cos.and a penes which may in any way action,against said 514 - F I NA PU I C WORKS
in n cncE me'g igofthis permit' "'' "' '• '` *Date
, A NON. INTIn.AT ; -. Z Issued by:• Si oIPP c nVConvbr:' c,.,'.;:,.. ate -.. Re-roofs
A7AjtDOU¢MA'IERIALS DSCLOSURElr : Ypcant r f nue b tie hg oc pant store or handle hamdous meimalType Of.ROOFas deli ed by the Cupem Mu pal Cod Chapin ll 12 d tit Health d Safety Coat acuan 25¢77(,)1 it
k . .vv' fl :!'•l ":q s i .
ave, a All roofs shall tie ms ectad' nor to ati roofing P P X g material bemg,mstalled
dish applicant or fym budding oc p.nt use equipment or aewtiea wmtin If a roof is installed without first obtaining an,inspection;I agree to remove
arms
humid ns elf c ntimrmuds d�efined by the Bay A Au Qusl ry Management
California all new materials for inspection. Applicant understands and will comply,with
r❑Yes` Ig"•O t.. ..- ,.
P
all non-pomfsource regulations .
1 M1a `read the hazard e, e toners regain 533a under 4,1 u r 6.95 M the
Io to Health s.Safety Code,Sections m un it I and 25534 I undersand that
-Rfhe bpi ing tloean contend ave,amount,meth is my responsibility,to notify the
-setups' t e requir 'ch must be met prior m issue ties a Cenificate of
Signature of Applicant
g. PP Date
All roof coverings to be Class "Bit or better '
. . ,OFFICE"
.., .... . ,3-, i y _e.•. •,r, :.Lae,
INVOICE INVOICE INVOICE INVOICEONVOICE INVOICE INVOICE INVOIR INVOICE
CITY OF CUPERTINO
• PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32639028 .00
INVOICE DATE. . . . . . : 03/14/2002
REFERENCE ID # . . . : 02030075
SITE ADDRESS . . . . . : 10280 PHAR LAP DRIVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RUTTER, GILLIAN
ADDRESS . . . . . . . . . . :
• CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
CONTRACTOR . . . . . . . : JEFF MILLER LIC # 22854
COMPANY . . . . . . . . . . : H.D. MILLER CONSTRUCTION CO
ADDRESS . . . . . . . . . . : 745 CHIMALUS DR
CITY/STATE/ZIP . . . : PALO ALTO, CA 94306
TELEPHONE . . . . . . . . : (650) 968-0291
FEE DESCRIPTION ACCT NUM CHK TOTAL FEE PD TO DATE BAL DUE
------------------------ ------------ --- ---------- --------- ----------
Y 4119 A 77.10 0.00 77.10
B PERMIT FEES 4116 P 257. 00 0. 00 257.00
PLAN CHECK FEE 4111 A 218.45 0.00 218 .45
SEISMIC FEE RES 2013 P 2.00 0.00 2 .00
------------ ------------ ------------
554.55 0.00 554.55
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- --______ ____________________________
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
3b3 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
3.09 EXTERIOR LATH 310 INTERIOR LATH
311 SCRATCH COAT 313 ROOF NAIL
501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY
503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
509 FINAL GRADE 510 FINAL PLANNING
514 FINAL PUBLIC WORKS .
0
Dz..o3 0 � 7 �
GU - CITY OF CUPERTINO
iTv o
• CUPERTINO PERMIT APPLICATION FORM
APN# 3 Z� ' 3 �. � Z�. Od Date: 311�/Arz
Building Address:
Owner's Name: Phone#: �
G.yccstl v leuMe !°r- ZS3 -ST77
Contractor: License#:
�f�tifZ'cCEQ 7 S7 8'SL
Contact: Phone#:
G .�-rycect Ya r - s7o- 6 q z.f
Applicant/Contractor: Fax#:
.TEFF .irfc rE2 y6 je-
Building,Permit Info:
Bldg /1%/ Elect Plumb Mech
Job Description: � 46
Residential: G�/ /d�w /E?E/�CAnF NF.dT SE�S.�,sr Commercial: �(
Sq.Ft. Floor Area: ? � $/Sq.Ft.:
Architect/Engineer: J Valuat'
Type of Construction u Occup cy Group:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
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/ uasi . BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 oEnergv
00V> 1000A ELECTRICAL
BELEC200 vcs 600V<=200A ELECTRICAL
BENERGY BUILDING
BENERGYADD Add MulBUILDING
BINVESTIGA ation fee BUILDING
BMITIGATC . Housin Mit. Fee BUILDIN'' 1G
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