08100078 CITY OF f:UPERTINO t
BUILDING DIVISION PERMIT . CONTRACT(iR�INFORM T-ION y
BUILDING ADDRESS: PERMIT NO.
10171 DEEPROSE PL THE SHED SHOP INC 08100078
OWNER'S NAME: PERMIT ISSUE DATE
PROPHET ANDREW M AND JEAN A 37341 BLACOW RD 10/14/2008
Nee (510) 623-9100 SANT11ARY NO. CONTROL NO.
ARCHTTECTIENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u0o LICENSED CONTRACTOR'S DECLARATION Job Description.
"vd 1 bercby wT=t t I,m lire umcr pmvisiom of CNpmr 9(mmreming
with5ati.]WU)ofDiHsion3oftheBudneum/d�ProfadouGode.aMmyliccmeu ADD 700A SUBPNL & INSTL 50A RECPTCL & (4) 20A
+ „ in full to=and effecln_/d
D q z Llaenes am. Lk.g� 7JI`! �YLPCLS
Dam Com - criso SNea) -e.
` ARCHITECT'S DECD
LARAON
1 uMer mend my plans shNl he used as public records
JyU
g o In Lieeraed PrnfasbrW
3 OWNER-BUILDER DECLARATION
ii f I hereby a1Trm that I am eaempt from the Contractors License Law for the
E e O following retion.(Section 703 1.5,Business and Professions Cade:Any city or county
5 q which rtqu;,..a permit b ewmemL alfa.imprnve.demolLN,or repair try mmaum
_Zee, pnwbim issuanm.also�uima ebo appliont rors.hpamitm Bk aligned summcnt
< that he is licensed pursuant to the provisions of Ne Contractor's L omc LAW(Chapter 9 Sq.Ft. Floor Area
Valuation
y�$ (commencing with Section 7000)of Division 3 of de Businem and Proressions Code)or $1500
y`<g that he is uempt therefrom and the buds for the alleged exemption Any violauw of
Section 7011.5 by any,appliant for a Permit subjects the applicanua a civil penalty of Number Occu ane Type
not mart than five hundred d011ms(5500). 36905023A p y YP
1,u owmr of IN pvperty,m mY eroPloyeu wIN wage u tha'v sole campenution,
will Professions
r Newark,and theslc Com atotbendede awdornsak(Sec.70th,Butinw
ora property
lou Cam Tic c.marmr, dwhD law dao ret apply lf an Owner of Required Inspections
awit,dywho Wiprovidmpmm Ot mmounadwha doesamh wdkedork ar aeifor through his
Ower cmployraipmrided Nmamhcht Is semmm Are,not ear ofo maaered fres owner,r,
f.
however.line building brimProuemrmg drat
widenarc)emofmmpkum.INowmo-
sa..). vriB Noe IN boNm of proving Nat he did rot ladle m improve for puryose of
tile.).
❑1,As owner of the property.am exclusively coarsening with HandeE conamton in
constmn the project(see.70".Business arta Pmfestion code:)The coma mm's U. '
came Law does not apply to an owner of property who builds or improm thereon.and
who contracts for such protects with a e muactar(s)licensed pursuant tithe Contranars
License Law.
❑I mm exempt under STs .B&PC for Ods won
Owner Data
WORKER'S COMPENSATION DECLARATION
411 bcmby aavm under penalty of perjury nm of the following declarations:
I haw:and will maintain a Cerific eof Consent b self-insure for Wurkces Camper.
on,As provided for by Scotian 17W of Ne tabor Code,for the performane,of the
work for widens Nis Permit is issued.
❑I have and will maintain Workers Compensuuon Itwnnu,u requirnd by Scetim
3711(l me Labor Code,for the pcRormma of IN work forwbich this permit is iumd. '
My Workers artier and Policy number am:
Came'.(—Al [qxJ'/c+t 'S I/C oh Na.: 60-T-45r3-01 7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
(Thu seem.teed Out be completed lithe pewit Is faane hundred doll.(SIM) '
or leu)
1 anifv that in the pafore.of the work far which this pcsmit u lams.1 shall nm
employ anypceson in any mucor an a b become subject in the Workers'CompeuWon
Laws of California.Data
Appllant
NOTICE TO APPLICANT:IL after making this CeNftam of Exemption,you shone
become subject to the Workers Compensation provision of the tabor Com you most
0Mn fowith comply with such Provisions to this permit shall bo doro
med oked.
'Z CONSTRUCTION LENDING AGENCY
1 hereby affirm then there u a communion lending agency for Ne performance of
lYi i the work for which this permit Is issued(Sec 3097,Civ.C.)
1 Q Lenders Name
,Z Ianders Addw
V Q 1 modify Nat I have read this Applia0on,and sum that tem above inimma0un is
Ig. F correct.1 agree b comply with all city Nd county Ordinances and anile laws misting to
Q V Wilding construction,mil hereby mlborim mpraonmtim of this city to enter upon use
r above-m.tiomd prepery,for inspection purposes
LL (We)agree to save,indemnify and keep hamtku the City of Cupertino against
!n liabilities,judgmcnm,cmm eM,.Knam which may in try way a arm against said City
V'z in consegmnee Of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 6 f-.
SOURCE
10 /,tmRe-roofs ��
HAZARDOUS
Signe of AppliwDData
HAZARDOUS MATE RIALS DISCLOSURE Type of Roof
Will the applicant or future building e.occupant mom oradthandle hmardondSafrMaterial .
m defend by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.sales zs532(,)7
0Ya Nr All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding common rte equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I hmudnn eir c.mmium as defend by the Bay Area Air Quality Management all new materials for inspection.
nT
Dyes Pkn�
1 Nue read the hmaedau maeriaurequiremmu unhrChapmrd.95 alone Calife.
w Hetlth&Safny Cade,Sccuam 25505,M533 and n534.1 undcnLvtd thatif Ne Wilding
does ret currendy have a mnanL that it u my mapomibility,to notify Ne Occupant of the
roqulrenen Mchmumxmet 'Ortoimmnmor,cadremaalamp,my. Sig nature of Applicant Date
'� / O
Owner or suthomcd agcm Data All roof coverings to be Class';Iy'or better
'
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . .. 36905023 . 00
DATE ISSUED. . . . . . . : 10/14/2008
RECEIPT # . . . . . . . . . : BS000006347
REFERENCE ID # . . . : 08100078
SITE ADDRESS . . . . . .. 10171 DEEPROSE PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PROPHET ANDREW M AND JEAN A TR
ADDRESS . . . . . . . . . . : 10171 DEEPROSE PL
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3335
RECEIVED FROM . . . . : MATT BEHRENS
CONTRACTOR . . . . . . . : PAUL JOHNSTON LIC # 24190
COMPANY . . . . . . . . . . : THE SHED SHOP INC
ADDRESS . . . . . . . . . . : 37341 BLACOW RD
CITY/STATE/ZIP . . . : FREMONT, CA 94536
TELEPHONE . . . . . . . . : (510) 623-9100
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ ------------- --------- --- - --- ---------- ----------
1BSEISMICR VALUATION 1, 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
lEPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
IERT<200 UNITS 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 122 . 87 0 . 00 122 . 87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- --- ----------
CREDIT CARD 122 . 87 MC
---------------
TOTAL RECEIPT 122 . 87
•
U �fUOo7P
CITY OF CUPERTINO
CITY OF
• CUPEVINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # i� / U (3 Date:
Building Address:
Mailing Address (if different from building address):
q eh L
Ownel�N e: P O ��� PhonL#a _ 2 S 3 — 9 9 SZ
Contractor: Phone:5/ U _ ;;�y/ - 7�3-3
Tke' S p' I.p Fax:
Contractor License#: 3c*cf G-1
Cupertino Business License #:
Contact: Phone: 12-S - 3 8 3 ' cfq S3
• / /4 I Re, �oreK$ Fax:
Residential Commercial El
Job Description:
/add -2oA S Ci vts/ 5
( e c e p C I e A0 C42-a4- rccPp"c iej
Building Permit Info:
Bldg ❑ Elect �' Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B (z-- 7
Valuation: 15-a d fr-!5�- Square Footage:
Project Size: Express ,XStandard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved:
For help, contact Build it Green at www.buildit reen.or
Revised 7/01/08
a10
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING •
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 BBOILERI 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)
1 BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
I BBOILER3 Install ation/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
11313OILER4 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
11313OILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH 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)
1PLMBINSP Other Plumbing & Gas Inspections P
(per hour)
1MEETINGIHR Application Meeting B •