08040028 CITY OF CUPERTINO
BpILDINO'MVISION PERMIT CONTRt1CTQRIPik'U).tMAT ON 4
BUI I G G FSS: _ PERMIT NO.
5 WILKINSON AVE ROYAL SERVICES 08040028
OWNER'S NAME: PERMIT ISSUE DATE
SMITH BRUCE F AND WENDY W 4398 NICKER COURT 04/07/2008
PHONE: SANITARY NO. CONTROL NO.
(831) 462-0539
RCHITEC AINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Sop LICENSED CONTRACTORS DECLARATION Job Description
1 MNn O
mby affirm 1 em licensed under provisions or Chapter 9(cammcncin{
MZ with Section 7000)of Division JafNeOman.andPro[I/.m.Code,andmylice.I. REBUILD CHIMNEY SHLDER UP
^<
= bfullfoaea delf
License
e Date Ca ec DECDEC
S ARCHR belLARATION
1 understood my plana Mall k useJ as public records
J U
50 Licensed PrepositiPrepositionalciunal
Gus I am eUnDER DECLARATION
.�A 1 thereby.(firm on I am exempt Item the Cssions ed Licence Law for Ne
A O following memo..Permit
t 7031.5.Business and Pmfr_vtioli Code:Any city or county
$ which m9uima s issuance,also nes umsthe alma improve,demolish,care a sig ed sucrate
3y thior t he isl ensedeleumquime tkvisio of for such Contrarminm ObseLaw(etatemmt
< NubercceueJ mere...in the7")ofDiNimuor theeBeat bre License Law(LTapim9 Sq.FI. Floor Area Valuation
�ro
(commencing with Stein.and the
Division l them Winged
g ei cam and Frufeay d Code)or $2 5 0 0
s
that io r exempt Nemfrom end or aper for the subjects
h 0...mpdon.Any it penalty of
Section than
hundred
aPPlmant fora pertain Subjccu the applicant to a civil penalty of Number Occupancye
mtmore Nan five hundrtd dollen(SSW). 35613027 ?f�� TYP
0 1,pe owner of dw property.sir my cmploym with wages a Meir ante campeuxdon,
aid Prthework,andeg awnomrnotintended w Law
does
act a(Sec.to a4,Businw
and Pro who Wild,
Cada:mThatpr canuacmn Licence law dam net apply to rt owner of Required Inspections
propertyow.un whobeilds orimpmwm the prove who,luxamuch mounted
ainuelforNmu{h his ,
however.ft n,pmvlded Arum improwmmtaamnet inmMed oroeertd foraver.
however. avetiearlmpmvanmtlseald theiiinomyeaormproeforNeownv-
Wildm will have the WNm of proving that h did rot dtiW or improv for puryue of
per.).
0 1,as avmr of the Property,am exclusively...road.,with licensed murmurs to
constct the project(Sec 7014,Business and Prefc d.0 Code:)The Co neaten LI-
«"••raw does wt apply b an owner of property who Wilds or improwa Nemo..and,
who mnuxcu for such projects;with a conirabr(s)nceued potential to the Commencers
Limes law.
0lamaemptum get ,B&PCfm Niameen
Owner Data
WORKER'S COMPENSATION DECLARATION
I Mmby afBm under penury or perjury,one of iW following declarations,
haw and will maintain a Cer ificamof Conant b seif-lucre for WurkcM1Compete.
u provided for by Section 37W of the labor Code.for Na Performance of the
for which Nr permit is issued-
0 1 have and will mYmain Walkers Campermumm.I.,as received by S'eeim.
3700ofik Labor Code,for the performance ofthe weds for which this permit is issned. '
My Workers Compensation Inandance carrier and Policy number am:
Carrier, Policy No.:
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
Ohracemm.need not he complete)if the perch la future hunNNdallen($1011)
mine.)
1 unify thm in the performance of the work for which his permit Is blued,l shell not
employa.y Perron in any manrcrsepeb��eq e)rclm Ne Wad¢rs'Compeuadon
Tawe of California.Date /.O
Applicant ; r: - ,
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become Subject b Ibe Workers Compensation provisions of the labor Code,you mum
.J O forthwith comply with such pmvisiou or this permit shall k deemeinv
d oked.
,zy y CONSTRUCTION LENDING AGENCY
E•r I hereby gnmi Nn then r a commends.tending agency for the perfonnanert of
rSi i the work for which this permit Is issued(Sec 309'1,Civ.C.) '
M lenders Name ,
.1. z Lenders Add.
V Q I certify that 1 haw mad this application sib state Nu tic show information is "
(y correct.I agree to comply with all city and county on insecus and sate Ian mining te
.0 building construction,and hereby mahame representatives of this tiny he enter upon the
W above-mentioned properly for Inspection puryomL
G (We)agree b ase.indemnify and keep h timlea the City of Cupertino against
C,) liabilities,judgments,toms and eapeiuu which may in my way xmue against said City
V z in conmgmam of the granting of this permit.
�+ APPLICANT UNDERST NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date-
SOURCE CULATI 5
,i/G rk Re-roofs
Sigunum of Applickc/Cantnxctor 6Due
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or rut=building occupant ebur or handle haaNuue material
as,deneed by the Cupertino Municipal Code.Chapter 9,13,ad tic Health and Safety
Code.Seeder,25572U)7
ps No All roofs shall be inspected nor to an roofingmaterial bei. Installed.
WIII the applicant or(atom Wilding occupant pee equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t I haaNnus air cutwormsdefined by the Bay Arta Air Quality Management all new materials for inspection.
nisi
t7
No
I haw mad the haudau materials myuimmenu undcrchapmrb.95 ofdte Califor.
car HeolthhS�odc.unum, b is yeand LS5liLywmnbnd Nulfthe Wilding
dura not curtendy how a mnanL t r Y mepomibiliiy b nwdl'Y tbe occupann of dm
equiremenu which mom W mar ipeuaraor.Cmifmamo"Cocupancy. Signature OfA plicant Date
Ower car anA res. a Date All roof coverings to be Class'n}'or better
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35613027 . 00
DATE ISSUED. . . . . . . : 04/07/2008
RECEIPT # . . . . . . . . . : BS000004368
REFERENCE ID # . . . : 08040028
SITE ADDRESS . . . . . : 10933 WILKINSON AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SMITH BRUCE F AND WENDY W
ADDRESS . . . . . . . . . . : 10933 WILKINSON
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4774
RECEIVED FROM . . . . : ANTHONY XAVIEL
CONTRACTOR . . . . . . . : TONY XAVIEL LIC # 22767
COMPANY . . . . . . . . . . : ROYAL SERVICES
ADDRESS . . . . . . . . . . : 4398 NICKER COURT
CITY/STATE/ZIP . . . : SOQUEL, CA 95073
TELEPHONE . . . . . . . . : (831) 462-0539
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -
------------ ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 2, 500. 00 0 .50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1. 00 110 .00 0. 00 110 . 00 0 . 00
1CHIMNEYRE EACH 1 . 00 + `490: 00 0. 00 490. 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 600. 50 0. 00 600. 50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 600. 50 #19870
---------------
TOTAL RECEIPT 600. 50
e
0, o oa f
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN 11 3 3 o a-7v v Date:
Building Address:
10M w,1k�jus6in
Mailing Address (if different from building address):
Owner's Name: Phone#:
jyvj af3 illy
Contractor: Phone:
puy a� �ru I C1✓j `/09 97,)-J
Fax:
Contractor License #: 7416611
Cupertino Business License#:
Contact: Phone:
Fax:
Residential Commercial
Job Description:
Building Permit Info:
Bldg74 Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
I FR, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N SF 7,)
Valuation: ;?SOG p O Square Footage:
Project Size: Standard Lar e ❑ Major ❑
O
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
IBTEMPPER Temporary Building Permit(good for B
30 days)
1BBOILERI For the installation 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 sys over 100,000 Btu/h
1BBOILER3 histallation/relocation 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
113BOILER4 Instal lation/relocati on of ea M •
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btwb to
&incl 1,750,000 Btu/h
113BOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH 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
1MECHINSP Other Mechanical Inspections (per M
hour)
1 PLMBINSP Other Plumbing & Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B
1Gr - CITY OF CUPERTINO
PE I GENERAL BUILDING APPLICATION
CU R.TNO
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/DuplexNew B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
lACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
I 1 CHIMNEYR Chimney Repair B
J FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
IFIREPLMAS 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
1PILEDR.fV Pile Foundation Driven (steel, pre- B
stressed concrete
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CITY OF CUPERTINO
CUPEi�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSP10 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1 SIDESTBK Siding, Stone & Brick Veneer B
interior/exterior
1SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 so B
additional stucco application_T
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CII CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1 WINREP Replacement windows/sliding glass B
door ea 8 windows
1WINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
IMPERMITFEE Mechanical Permit Fee M
IPPERMITFEE Plumbing Permit Fee P
lELCPLNCK 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
IBSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVD0C Travel &Documentation B
/ 1BUSLIC Business License B
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