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03090148 (2) CITY OF CUPER'PINO ? .les >vy BUILDING DIVISION PERNO CONTRACTOR INkOXtON `; BUILDING ADDRESS: PERMIT Nd.3 090148 OWNER'S NAME: PERMGP ISSUUE DATE IFE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 10=p LICENSED CONTRACT'OR'S DECLARATION E I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description withse" 7NKB.f Division Sof the Busir:e d Profcuions Cole,and my license is infull co.ticrt.�/� LIC-b/� BATHROOM REMODEL Ike loss ''99 t Date 9_i r-a z C.mr.p. oa o7 Ks4- CONTRACTOR: T.A. TODD CONSTRUCTION Q ARCHITECTS D ARATION �undcr$ my plansahal� Jps pubyc record, FINAL �D )a u /.a..-. ./ `g r0I­ Licensed Procasiottal 7v, OWNER BUILDER DECLARATION Contractor's ON NOV .a ^ 2003 2 a O I hereby maso .(firm on I am exempt from the Cnnuactoo :License Low for the 1 lJ L Vf CMO following reason.(Section IIP I.9.Business and Professions Code:Any city s county which rcyvis a a permit reconstruct,aalter.pplicant improve,demolish,or repair any statement u-m pdonn its tensed e,also pursuant to the the mavimusof for such Corrector's icese Lawdammmem SSUILI®IN Cama 5 mm that he isliccnscJ pursuant ua thepmvisions of the Conuacwr's Wccnse Ww(Chepmr9 Val 2 F$ kst be is Ang withthArefo rn And the basis(r or IN, Busallegedss and Professions Code)or Nat he u exempt mcmfrom and IM basis far Ne alleged exemption.Any violation of Section?031.5 by any applicant for a permit subjects the applicant to a civil penalty or 396AN34Ifln§er00. . OccupancyType not more than five hundred dollars(SSW). "-" '" '" '-" '•--� - - -- - ------ ❑'1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the Andante is not intended or offered for sale(Sec.7W,Business �� and Professions Code:The Contractor's License Law does not apply to an owner of 101 - FOUNDATIRequired Inspections property who build,or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If. 102 - PIERS however,the building or improvement is sold within one year of completion,the owner. -- - bander will have the burden of proving that he did not wild or improve for purpose of 103 - UFE R 0e I 1, 104 - REBAR ❑1,a owner of the properly,,B tine si and contracting with:)Tha C mnbaton 1. -- --- - constructthe projed(Sec.]D44,Bmincu and Professions Cacti The C.nlraurer's Li. 105 - ANCHOR BOLTS cense Law does not apply to an owner of property who wilds or improves themon.and 106 - SEWER & WATER who contracts for such pmjecN with a contractor($)licensed pursuant o Ne Contractor's t,tceLaw. 202 - UNDERFLOOR PLUMBING �jl nu am exempt under See. .B&PCfonhls rcazon 203 - UNDERFLOOR MECHANICAL Owner WORKER'S COMPENSATION DECLARATION ata 204 - UNDERFLOOR' FRAME' - - - ' T hereby aMo.ends,Penalty.(pedur,one of the following decimations: 205 - UNDERFLOOR, INSULATION- _ ave and will maintain a Certificate of Consent msalr-maumfor Worke.aC.mpcn- 301 - ROUGH PLUMBING n as provided for by Section 3]11(1 of the Labor Code.for the performance of the 302 - TUB & OR SHOWER - work for which this Permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 303 - ROUGH MECHANICAL 37M of the Labor Code,for me performance.(me work for which this permit is issued. - 304 - ROUGH ELECTRICAL My Worker's Compensation lnsumnce carrier and Policy number ate: 305 - FRAME, Carrier: Pol icy No.: CERTIFICATE OFEXEMPTION FROM WORKERS' 306 - HOLDOWNS COMPENSATION INSURANCE 307 - INSULATION - (This section need not w completed if the permit is for one hundred dollars(S 100) 308 - SHEETROCK of leas.) 309 - EXTERIOR LATH 'Certify Nat in the erfomiance of the work for which this permit u issued,l shell not employ any person in mpnn�sntbecy.m .bject to the wortcrs'ComPcnsati.n 310 - INTERIOR LATH Lala orpaljibrr� �J 311 - SCRATCH COAT NO,bC itadt� NOome APPLICANT: raCo pensitionierviameamtheLabrode,youmost 313 - ROOF NAIL become subjection the Worker's Compensation pmvisions.(the Whnr Code,you mesa � ,$ forthwith comply with such provisions or this Permit shall be deemed revoked. 501 - FINAL ELECTRICAL ENERGY Z O - CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY I hereby alarm that there is a conawction lending agency for the Performance of 503 - FINAL MECHANICAL ENERGY x the work for which this permit is issued(Sec.309],Civ.C.7 17 p Lendc�a N.m. 504 - FINAL BUILDING ENERGY � Z Wndr'sAddreas 505 - FINAL ELECTRICAL J O f I certify that 1 have read this application and sum that me above information is 5 0 6 - GAS TEST J Ubuilding agree to comply with all city and county ordinances and cute laws relating a '^ buiwe-roe uncoil constriction,And hereby authori>pure.resemetivea of this city mcnmr upon the FIN , PLUMBI G W ahovc(We)agree to save, for im indemnify fy an Purposes. (We)agree to save,indemnity and keep harmless the City.(Cupertino against 0 B F I L V) Imbilities,judgments,costs and expenses which may in any way accroc ageinsl said Cily 5 J z his Permit. APPL CANTeUNDERSTANDSof the granting of IAND WILL COMPLY WITH ALL NON POINT Issued by:5 NG Date SOURCE Rrfi1J✓!1sT10NS. Re-roofs514_3��;ZNALP B I WOR ,Signature of ApplocantiContractor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Of(muds building Occupant amt or handle heatodous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code, on 25532(a)? 0 Yes 1AN. All roofs shall be inspected prior to any roofing material being installed. Wi II 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 c ,00doua air contaminants as dcOned by the Bay Area Air Quality Management all new materials for inspection. i ? ❑Yes r%Nn I have mad the haraNnusmamrials mquirements under Chapter 6.95 of Iw Califon nix Health I Safety Code,Steven 25505.25533 and 25534.1 undimmed that if the wilding docs not currently have a tenant,that it is my responsibility to nod(y the Occupant of the rcquimmcnts ItWndtpoor( cp.r emreataoracf cy.o3 Signature of Applicant Date wner m.tioamieed agent %/1 Date All roof coverings to be Class I'BI'or better l 1 lf�l� A -�, „N` t r`d'/4�., •• RECEIVED SEP 1 9 2003 BY: APPROVED IN AtCORM E WITH THE CITY Oh f;UAERT 9 DIN I) T This set set of 's and specitications 'MUST be kept on the job at all times and itisum lawful to make any changes or alterations ` on game without written permission ifrum the building Dept., City of Cupertino, The stamping of this plan and specificatio aii JHALL NOT be held to permit or.to be ar, approval of the violation of any protisilm of any City Ordinance or 5tata Lm OCITY OF CUPERTINOR CITY OF PERMIT APPLICATION FORM CUPERTINO N# / Date:- .15 p Building M dr ss: /09,23 WO Ki,4 z v,.. ✓-e" Owner's Name: Phone #: /or Contractor: License#: ./ Contact: Cupertino Business License#: Bui ding Permit Info: . ,Bldg S Elect Plumb R Mech Job Description: f A Residential U1�at� �'""" 10 '°` Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Pro' ct: Occupancy Group: J10' o- � Type of C nstruction: (/ 7 • Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK 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 BMITIGATC Comm. Housing Mit. Fee BUILDING , v3 .2 3 / 1of3 Ste ' I X73 WITY OF CUPERTINO* CUP TYOF O PERMIT APPLICATION FORM uanti Fee ID . Fee Description Fee Grou . BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE —Bldg Permit Fees BUILDING MIXTURE 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 ISewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM 3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l 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 • 2of3 VITY OF CUPERTINO CUPEkTTYOF O PERMIT APPLICATION FORM. QuantityFee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res ApEliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Maz uee 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 Insection BUILDING BSWIM Swinuning Pool BUILDING BTENT Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MF MPEREE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3 CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng: Sub : Blk: Lot : APN . . . . . . . . : 35613019 . 00 DATE ISSUED. . .. . . . : 09/19/2003 RECEIPT # . . . . . . . . . :23203 REFERENCE ID # . . . : 03090148 SITE ADDRESS . . . . . : 10823 WILKINSON AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA OWNER CAROLINE & DIETER MULLER ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4733 RECEIVED FROM . . . . : T.A. TODD CONSTRUCTIO CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : 0EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - -------- - ------------ ---------- ---------- ----- - ---- -------- -- ----- - ---- BPERMFEE VALUATION 10, 875 . 00 167 . 00 0 . 00 167 . 00 0 . 00 BPFIXTURE UNITS 2 . 00 16 . 66 0 . 00 16 . 66 0 . 00 BPLANCHK PERMIT FEE 167 . 00 141 . 95 0 . 00 141 . 95 0 . 00 BPSEWAGE UNITS 1 . 00 62 . 16 0 . 00 62 . 16 0 . 00 BPSEWER SEWER SYSTEM 1 . 00 19 . 98 0 . 00 19 . 98 0 . 00 BPVENT UNITS 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00 BPWATER UNIT 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00 BENERGY PERMIT FEE 167 . 00 50 . 10 0 . 00 50 . 10 0 . 00 BREMPOLE NO. FIXTURES 1 . 00 1 . 11 0 . 00 1 . 11 0 . 00 PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 11 0 . 00 1 . 110 . 00 BREMVENFAN NO UNITS 1 . 00 42 . 02 0 . 00 42 . 02 0 . 00 BREMVENSYS NO UNITS 1 . 00. 9 . 50 0 . 00 9 . 50 0 . 00 BSEISMICRE VALUATION 10, 875 . 00 1 . 10 0 . 00 1 . 10 0 . 00 BUSLIC FLAT RATE 1 . 00 100 . 00 0 . 00 100 . 00 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 ---- ------ ---- ------ -- - - ------ --- - - ----- TOTAL PERMIT 735 . 91 0 . 00 735 . 91 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ----- ------- ------------------ CHECK 735 . 91 2811 TWL RECEIPT 735 . 91 r