06060014 (2) CITY OF CUPERTINO e s�aha<,.��y.�P;a2��'�* >r°-t> 9�T� �7�'�♦ `r`•""�'r' -?
BUILDING DIVISION PERMIT �L�(',L l�ti.®t Q 1E�F [4YltfAL\
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BUILDING ADDRESS: , CLARENCE PETERSON PERMITNo.06060014
10332 CRESTON DR
OWNER'S NAME: PERMIT ISSUE DATE
A
CLARENCE PETERSON 06
E: SANITARY NO. CONTROL NO.
ARCHITEC17 E GINEER: BUILDING PERMIT INFO
BLDG ELECT PlLiJMB MECH
O
pop LICENSED CONTRACTOR'S DECLARATION Job Description I hereby of im Na
at I am Basad under provisions of Chapter 9(commencing
ath Section 70W)of Division 3 ofdse Business and Profcu m s Cod.,and my license is
inrwlllorceanee RESTORE ELECTRIC POWER
;'(az Lieenaclaa o co u 1µ b VCM NOW SERVICES PAID FOR BL 6/2/06
Dam
I
ARCHITECTS DECLARATION
i I understand my plans shall he used As public rantde
f
.LLp Licensed Professional
OW NER-BUIIDER DECLARATION
ip I hmaso .(Sect this 1 1. exempt from Ne fes ons or'sCod :Any c law for Ne
p O whichfollowing mason.(Section NO 1.5.Business and Praere.ft ium Code:Any coy at county
:22 which rcgoires a permit m corWtsm,alcor.vnptme,demMmh,or mpsir any ewcmm
.sy prior at its issuance,also inquires use appliant for such permit to Me A signed summer
.€C Nat he is leaned pursuant to the provisions of the Contractor's Liana Law(Chapter 9 Sq.Ft.Floor Area Valuat 2 0 0
8 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt amsefrous and the imam for the ateged Assumption.Any violation of
Section 7031.5 by any applicant ror a permit subjects the appllant to a Civil penahy ofe p �m er 0 0 Occupancy Type
sec N3
at man five hundmd dollars a� 4
❑1,as owner of the property,or my wployew with wages as their ale compensation,
will do Ne work ad the structure is at intended or offered rot Axis(Sec.7044,Business Required Inspections
ad Professions Code:The Conuacmes Liceme law docs at apply m an owner of q P
property who but ids ser im proves thaem.and who does such wart himself ser dunugh his
own employers,provided Nat such improamats as nuc intended aro@rod forsale If.
however.the building w improvement Is mid within one year of eempledm.the awner-
builder will have the burden of purring that he did not build or Improve for purpose or
ale,).
❑I,as arm of the property,an exclusively contracting with licensed contractors In
construct the project(See.7044.Business and Professions Cade)The Contractor's U-
come law docs not apply m an Owner of property who build$or Improves themon,ad,
who contracts for such projects with a canua.5or(U licensed Parasol m the Conttatar's
Lima law.
❑I an exempt under See .B&PC I.,this mann
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby air=under penalty of perjury one of Iha following declatWou
I have and will maims.a Cenifmm ofcom.nt m elf-Inum for Workers Compcn-
ation•As provided far by Section 3700 of the labra Cade.rex she perm lit.of the
work far which this permit Is issue&
fAI have ad will maintain Workers Compensation Inwma,As mqulad by Section
of the labor Cade.for the performance of the work for which this permit is laved.
My Warlmr.Comp,.d.a buutma anis ad Policy number am:
Carer. IrkA9_1 fa Policy No.:" 1
CERTIFICATE OF EXEMFnON FROM WOR S'
FR
COMPENSATION INSURANCE
from radon need at I ecanplewd if the permit is form hundred dollars($100)
lir Ica.)
I artry that In the performance of the work for which this permit is im ed,I shall not
employ any person in my muncr m a m bauma abject to the Waken Compar adon
Laws of California.Date
Applicant
NOTICE TO APPLICANT`.If.arm,making this Certificate of Faemption.you should
become=him to the Workers Comperoation previsions or W labra Code,you muni
Oforthwith comply with such provision m this permit shall he deemed reeked.
z ,^N.� CONSIRUCfION LENDING AGENCY
(.n Ihe¢by affirm dw theaI..construction ending agency forma performana of
!>r > the work for which this permit Is issued(Sec.3097,CW.C.)
aQ Iandcr's Name
z Lenders Address
U Q I certify that I have road this application ad mate that Na above InfmmNun Is
II.F correct.l agree to comply with all city and county ordinances and stem laws rcladng m
pU building construction,And hereby authorize representatives or this city to Amer upon the
4 aWa A-nvmi...d Pmpeny for inspection p.,pmea.
(We)agree to ave•indemnity ad Ftp hamlets tM City of Cupertino against
vFr y
liabilities.judgments,costs ad expenses which may in my way acme against mid City
U',Z, in consequence or the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
soearsIlV'qEcu^A ._ -A DZNo- Re-roofs
Signmorree or Appliam/Conuacmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nc applicant Or future building aaoprst stare or handle haa,dous material
As donned by the Cupertino Municipal Code.Chapter 9.12.ad the Health ad Safety
Cade.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
ya
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hemodues air conmminnts As dcnaed by the Bay Ara Air Quality Management all new materials for inspection.
District? >r
an
>
[have road the haardsmsmacriam mqumuncnn wader Clupter6.95 ofthe Califer-
niaHahh&SafetyCedc.Seem=255W,25533 a 425534.1 understood thuirthe building
does not cammly haw a comm,Lou It u my responsibility In notify Iha oecupat Of the
coq `�icn et 'asap lmuana ofa Cruraate ora Signature Of Applicant Date
--�17 I7lo�bpatcy All roof coverings to be Class"B"or better
Owner or mNo r agem Due
CITY OF CUPERTINO
.m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32637042. 00
DATE ISSUED. . . . . . . : 06/02/2006
RECEIPT # . . . . . . . . . : 34659
REFERENCE ID # . . . : 06060014
SITE ADDRESS . . . . . : 10332 CRESTON DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CLARENCE PETERSON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : NOW SERVICES
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : CLARENCE PETERSON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
OEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 1, 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 178 . 73 0 . 00 178 . 73 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 178 . 73 5034
TOTAL RECEIPT 178 . 73
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
•
Q- CITY OF CUPERTINO Q10D((0 0�q
CUPER,TINO PERMIT APPLICATION FORM
N# 31- O n' Date:
Building Address: L- Mailing Address (if different from building address):
rb3 2- Cr �c �V2 r ��
Owner's Name: Phone#:
Gare. ��� r L\O Zys- 27-23
Contractor: License#:
Vv()W r \csz S �1 (.02(pse)
"tact: Phone:(r4S73-5$5 Cupertino Business License#:
\ Fax: 585- 2-S%(r>
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description:
Residential yg�) �L- \ mmercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro'ect Size: Standard Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
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/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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aCEOF
CITY OF CUPERTINO
CUfPERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC, Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING'
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterlVent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special hispection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
I BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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