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08010025 . CITY OF CUPERTINO BUILDING DIV1.410N PERMIT CONTRACTORINF�ORMA.TIO.N PERMIT 140. BDILD3NGEgp '!gALLACE DR MICHELLE & RICHARD' 08010025 OWNELR'SLNAME: W PERMIT ISSUE DATE MICHELLE & RICHARD MATKOVICH 22129 WALLACE DR 01/04/2008 NE: SANITARY NO. CONTROL NO. ARCHr1ECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p p LICENSED CONTRACIOR'S DECLARATION Ib Description i U F 1 hereby affirm that l am licenseprovision of under provisioof Chapter 9(commenOIP cing !EI wiNSinimolOnu)ofDiviaion3afNc Business vld PmfcasiumCode,aM mylkrnmis INSTL/UPGRD ELECT PANEL in full forte end effcc. i License Class Uc. Dow.Commear ^� ARCHITECTS DECLARATION is 1 undcrsmnd my planashallbe.4 as public men,& )dU G Licensed Professional H 3 Oat I am exempt fr DECLARATION a0 I hereby."Sete that 11. exempt an to Cachou, o License c Law for Ile p o following maw a.(Sermon IM IA Business and .deoom Code:Any my or county 5$ which mquirea a permit m canswcL cher.imnmve,demolish,or repair any amnum prior in its issuance.).require,Ne applicant forsuch permit to file a signmiseteacot x� that he is licensed pursuant la the provision,of the Committees License Law(chapter9 Sq.F[. Floor Area $900 Valuation el- (commencing with Section 7W)of Division 3 of me Business it Profession.Code)or that he u exempt therefrom and Ne bei,for the alleged exemption.Any violation or Section 7031.5 by any applicant fora permit subjects me applicant in.civil penalty of Number - Occupancy Type our more the BK hundred billas,45(y). 32602044! � C I,a owner of the property,or my employees,with wages as their sole compensation, will do the work and the awcturt is not intended of offered fonae(See 7041,Business Required Inspections and Profenal...Code:The Commeme.License law do.not apply In an..of q P property who build,or im provrs ulerco n,and who da,mch wort himself ar tiwugh his own employee,pmvhird that such improvements tie not intended oroRered forsale IL however,the holding or improvement is said within one year of completion,the owner- builder will bare the burden of proving Nat he did not wild or improve fm purpose of ale.).. ,en owr of caw prapon eaclud,,aly comnt recting with licensed contraction;to �vlmons, ,am estrum the pmject(Sec.7(344,Beer.and Professions Code:)The ContaetaYs U- come Law don not apply to an owner of property who hulls,or impmvv Nem.n.ad, won conuans for such Prole with• tourist licensed paramount to that Conuactnes License law. 0lam aempr .B&PC fn ,r/etaLs�on Owner Dow `V t' ORKER'S COMPENSA ON DECLARATION I he by affnm under pc.",or perjury one of use following deelarWatc m and will maintain aCestificae of Consem m self-insert fa WorgeraCampen- vprovided for by Section 3700 of the Labor Code.for the Performance of the work for which this permit is issued. 0 I have and will maintain WarkerS Compensation Insurance,as required by Section 3700 of NC Labor Code,for the performance of the work for which this permit i,issued. My Worker.Compensation Inwmnce artier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thin section need not becampleted If the permit is forone hundred dollars($100) or less.) I certify Nat in the performance of the or ch Nis permit u issued,l NHI nm employ any Protan in an one ,Grob ,fie ab' roue WaNers'Campemation Laws of Calif..!..Dz• j� �I s //JJ ApPlis:ant NOTICET09RP rT:If .king u Cmuli a of Exan,dii .you should became suhjen m ly Worker's confirmation provisions of the labor Codc,you most .J O forthwith comply W web provision.or this permitshall w dmmcd iemkca. ZN CONSTRUC710N LENDING AGENCY [-n for which thi Natuertisaed(Sec.30 len ding agency for de lerformamm of 15 de wars fm which mu pcsmit u issued(Sec.J09'1,Civ.C.) OWi Q Lenders Name ]z Lender's Address J 0 I minify that 1 basso moa this application and nae that the above information is IL F conch.)agree to comply with all city and county eminences and mine laws miming on 0 t-) building consuuction,and hereby aumodm repnscmati,es ofthis the is city to enter union e � a .haro ve-mmnwocd ppeny for inslteeuon pmtwses. (We)agree to ave,indemml dna keep harmless the City of Cupertino against nFr h lotdiuea,judgommscmta ,which mey in any way acem itga osaid Cty U z in conncqucnce of Ne In, is Permit. („ ^ APPLICANT U STA S A L COMPLY WITH ALL NON-POINT Issued by: Date / —c9� SOURCER TI /y a C Re-roofs Si cart ApplicaUConua<mr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof III Nc applicant or future building occupant tore or handle havvdous material a defined by the Cupertino Municipal Calc,Chapter 9.12,and the Health ad Safety Code.Somout25532(a)1 All roofs shall be inspected prior to any roofing material being installed. ❑Ya Will the a"Iiianl.rmtare wilding«<.p.nt care equipment ordwiaa which If a roof is installed without firs[obtaining an inspection,I agree to remove havardous air common amu as defined by me Bay Am Air Quality Management all new material ection. O r p Yc, 'l have mail the hva s macerials o:quiscme.u.ndc,ompe ii.95ofineCalif.- nixHahm&safmy 25505. 533 and 25534.I.inxim and Neifthc Wilding /�L doca mol m, m ..n y ma nsihllity o toury Ne t of the rcquim Swhtr t te' .racewhamarOcea Signature of Applicant Date ow er.ramariyaa.smm Date' All roof coverings to be Class"B"Or better a CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# � � �� � � . Date: Building Address: I Mailing Address (if different from building address): s9-me Owner's Name: Phone Contractor: 6/ t� Phone: Fax: Contractor License#: Cupertino Business License#: • Contact: Phone: Y Fax: Residential Commercial Job Description: _ Building Permit Info: / Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupanpcy Type: 1 FR, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N Valuation: Square Footage: X140 Z`__ Project Size: Standard ❑ Laze ❑ Major ❑ • CITY OF CUPERTINO CUPERTiNO GENERAL BUILDING PERMIT APPLICATION FORM d Quantity/Sf Fee ID Fee Description Fee Permit Type Group ]GENRES or p r P I GENCOM IBBOILERI For the installa ' n or relocation of ea M boiler/compressor to & including 3 horsepower, or ea absorption sys to & incl 100,000 Btu/h 29.3kw 1BBOILER2 Installation /relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption ss over 100,000 Btu/h IBBOILER3 Instal lation/rel ocation of ea M boiler/compressor over 15 horsepower to & incl 30 horsepower, or ea absorption sys over 500,000 Btu/h to & incl 1,000,000 Btu/h IBBOILER4 Installation/relocation of ea M boiler/compressor over 30 hosepower • to & incl 50 horsepower, or for ea absorption sys over 1,000,000 Btu/h to &incl 1,750,000 Btu/h 1 BBOILER5 Installation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption sys over 1,750,000 Btu/h IBAPPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. IELECINSP Other Electrical Inspections (per hour) E IMECHINSP Other Mechanical Inspections (per M hour) IPLMBINSP Other Plumbing & Gas Inspections P (per hour 1MEETINGIHR Application Meeting B • CITY OF CUPERTINO CUPEf�TINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ACOUSTICAL REVIEW 1 1ACOUSFDW SFDWL/DuplexNew B 1ACOUSRESAD SFDWL/Duplex-Addition/Alteration B IACOUSCOM Multi-Family/Commercial B CHIMNEY'S 1 CHIMNEY Chimney B I CHIMNEYR Chimney Repair B FENCES IFENCE>6FT Non-masonry, over 6 ft in height B 1FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES 1FIREPLMAS Fireplace Masonry B 1FIREPLFAB Fireplace Pre-Fabricated/Metal B 1FLAGPOL>20 Flag pole (over 20 ft in height) B 1MODUSTRU Modular Structures B FOUNDATIONS 1FOUNDREP Foundation Repair B 1PILECAST Pile Foundation Cast in place concrete B 1PILEDRN Pile Foundation Driven (steel, pre- B stressed concrete 3of5 CITY OF CUPERTINO CUPEI�TINO GENERAL BUILDING APPLICATION FEE SCHEDULE .Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM RETAINING WALL(CONCRETE OR MASONRY 1RETSTN Standard (up to 50 ft) B IRETSP310 Special Design, 3-10' high (up to 50 `) B. IRETSPIO Special Design, over 10' high (up to B 50' 1RETCRB< Gravity/Crib Wall, 0-10'high (up to B 50 fl IRETCRB> Gravity/Crib Wall over 10' high (up to B 50 ft SIDING 1 SIDESTBK Siding, Stone &Brick Veneer B interior/exterior • 1 SIDEOTHER Siding all other B SKYLIGHTS 1 SKYL<10 SF Skylight less than 10 sf B 1SKYL>IOSF Skylight greater than 10sfor B structural 1STAIRS Stairs-first flight/ea addt'l B STORAGE RACKS 1SRACKS<=8 Storage Racks 0-8' high (up to 100 so . B ISRACKS>8 Storage Racks over 8' high (up to 100 B st 1STUCOAP Stucco Applications (up to 400 sl) B additional stucco application • 4of5 1 alF CITY OF CUPERTINO CUPkTINO GENERAL BUILDING APPLICATION FEESCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 WINREP Replacement windows/sliding glass B door ea 8 windows 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B / IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMPLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5 CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32602044 .00 DATE ISSUED. . . . . . . : 01/04/2008 RECEIPT #. . . . . . . . . : BS000003617 REFERENCE ID # . . . : 08010025 SITE ADDRESS . . . . . : 22129 WALLACE DR SUBDIVISION . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : MICHELLE & RICHARD MATKOVICH ADDRESS . . . . . . . . . . : 22129 WALLACE DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0118 RECEIVED FROM . . . . : RICHARD MATKOVICH CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : MICHELLE & RICHARD MATKOVICH ADDRESS . . . . . . . . . . : 22129 WALLACE DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0118 TELEPHONE . . . . . . . . : . FEE ID ----UNIT----- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 900. 00 0. 50 0. 00 0. 50 0. 00 1ELECINSP HOUR 1. 00 122 .38 0. 00 122 .38 0. 00 1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 204 .46 0. 00 204 .46 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 204 .46 #4596 --------------- TOTAL RECEIPT 204 .46 x Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: PERMIT # F/Z 020/ ©0 ,;? OWNER'SNAME: AerAe> PHONE #(W0-3T--9&2 - 099 GENERAL CONTRACTOR: o15 FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical 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 Own •/ ontractor Signature Date