08110078 CITY OF CUPERTINO
BUILDING DIVIS10N PERNIITCONTtRAC�pOR�TNFU$N7ATTON
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BUILDING ADDRESS: PERMIT NO,
7652 WEST HILL LN NORM GALYEAN ELECTRIC -
OWNER'S NAME: PERMIT ISSUE DATE
)NE: A 0. CONTROL NO.
(408) 978-8196
ARCHITEC IEPIGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
upp
LICENSED CONTRACIOR'SDECLARATION Job Description
U 1 h
hereby aline Wal l son licensed under provisions of Chaplet 9(commencing
wide Station 7000)of Division 3 of de Business uLPmfessi. my licencets
^�F in con rotas ane /� INSTL FLECTRCL CONDUIT(CAPPED) FOR FUTURE HOT TUB
2 y�z Licence , Lk.g
cri
n=p Da¢ C!i DEC P
��7W7W met W use DEC me N
U I uMersand my plans shall W used u public moral
6
s a Licensed Professional ,
c 3
OWNER-BUILDERDECLARATIONum Com ems
Sy�ys1 I hereby alien Nal 1 a.1. exempt from tW Cmives Co license Law far the
no whichfollowingem massa ermii 1 7031.5,Business and Improve.
daioas Cade:My cky or county
$(L which roquina a Permit to rnnamc4 eltu,impmw,demnlLsh,nr repair anY stmttuw
to prior to its issuance,also mquims the,applicant for such permit to rile a signed ma cuu m
–Zi Nat he if liaucdpor,amiW Ne povisi^nadf the Communes licence Law(Chap.9 Sq.Ft.Floor Area Valuation
Y�$ (commencing wits Section 700M of Division 3 of the B.M.and Prefcasiou Code)or 1500
that he u exempt therefrom and Ne basis far the aticgcd eumpdon.My violation of
Section 7031.5 by my applicants for a permit subjects the applicant In a civil Penalty of APN Number Occupancy Type
not mom Nan firs hundred dollars( sol, 36227022 . 00
0 1,u owes of the pmpmy.or my employm wide nge u Noir salt compemdon,
and do WCwmIC Code:
The
Conloam,Liessd maBCRdforut-(SCL.7-comer Of
and Proresdam cone:Th conteumra Licvtce law ase tmt.pvly m an owner ar Required Inspections
pmNny who Wilda orimprove themn,and whodoessuchworkhimselforNrough his
own employs),Provided that such improsements not not intended maQemd for sale B.
however the bWkling an,improveman is sold within one year of completion.the aa er-
builder will have the burden of proving that he did cot Wild Or improve for Increase of
ask:.).
0 I.u ow.a the Property,w Delusively contracting with Rants c^ntranms to
construct Ne project(Sec.7014.Business and Pratcash ns Cade:)The Cmtreno's LI-
ceue law dee am apply to an owner of property who Wilds ar improves Nem),and.
wine carnfaN for Such Pm)CN wit.men f licensed pmSuam N the cormame,
nY Ltw.
Iam eempt sande a .B@P C for thin wan
am Y_"St
WORK- ENSATION DECLARATION
I by arum ty of perjury an:of the following declaration¢
I its. nd will us CertifiuNofcouent to self-iuumfor WorkersCompen-
sedan.as for by Section 37M of the Labor Cade,for the performure of the
work for which Wa permit is issued.
0 I have and will maintain Workers Compensation Insurance,as valuated by Section
3700 of de labor Code,for dee perfmam.of tlme work for which this permit is issued
My Wereme,Compeuadun Isssanae carrier and Policy number tie:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
musacttim recd mtbccomplemd if dee permit is fdrarc hundred dollar(1100)
or leu)
1 cortifr Not I.the Perfomance df Ne work raw which this Permit is issued,l shall not
employ any person in any manber se u N became subject to tie Worimfe Compeua0an -
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenincae of EwmpOon,you Nouhl
bamme subj=he the Workers Compensation provisions of Ne LsEar Cade you most
.J 0MWoe
rowith comply wide such Provisions or this Permit shall dmcd revoked.
z CONSTRUCTION LENDING AGENCY
[r I hereby affirm ttit there is.muwmcdnn lendingage^ry for the Fefommem of
p�. m7 the work for which this permit is issued(Sec.3097,Civ.C.)
14 0 Lenders Name
rat Lender:Addw
U 0 1 com y t 1 have
mad t
his and am a aW formation In
t" co.I a W comply with ay o r andJ�ylaIn relating W
�V Wilding on.WherebriQ ty m enter upon tieaboveetimed propcnY faries) ree indecite ty of GYPed10aagainst
tieJgntstossodeNanY Ysmance i sissoCity
zm PPLICceAI.'I�'UNDERSTof the nn CO Y WITH ALL NON-POINT Issued by: DateSOURCE REGULATI20 09'
Re-roofs
Signature of br ATEDam
u RIAIDISCLOSURE Type of Roof
will tmf p ildingacouanlmmm MMle havudou material
Recd Municipal Cade.Chapter 9.1].and the Health and Safety
C ,)+ All roofs shall be inspected prior to any roofing material being installed.
CYD
Will the applicant o 'Iding aauW^t uce eyvipmnt dr devices which If a roof is installed without first obtaining an inspection,I agree to remove
sit huaNnu air cm mons as de rA by the day A Qua ity Management all new materials for inspection.
J Wc(T
Y. m ❑ u
Ihmm the herudous qts' der Chaper6.95ofthe Califon
nia HcalNkSafe Code,Sect, 5: 5 .IuederssndthmifNe Wilding
doer rmt cumn haw a tiny m notify de occupant of the
mquiemcntsw bon afandican, ra .aSignature of Applicant Date
rn.n< on mmcrir<
Date. All roof coverings to be Class'%¢"or better
• CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36227022 . 00
DATE ISSUED. . . . . . . : 11/20/2008
RECEIPT # . . . . . . . : . : BS000006664
REFERENCE ID # . . . : 08110078
SITE ADDRESS . . . . . : 7652 WEST HILL LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. KIDD LEWIS L AND CAROL A
ADDRESS . . . . . . . . . . : 7652 WEST HILL LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5057
RECEIVED FROM . . . . : NORMAN GALYEAN
CONTRACTOR . . . . . . . : NORM GALYEAN LIC # 30556
COMPANY . . . . . . . . . . : NORM GALYEAN ELECTRIC
ADDRESS . . . . . . . . . . : 4930 HARWOOD RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 978-8196
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BREMMISC FLAT RATE 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1BSEISMICR VALUATION 1, 500 . 00 0 . 50 0 . 00 0,. 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
' ITRAVDOC 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 #7734
---------------
TOTAL RECEIPT 204 . 46
•
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CITY OF CUPERTINO
cmoF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN #� / -7 a O C.) Date: �l aD O
Building
Address:
zGSa �C.s 7
Mailing Address (if different from building address):
Owner's Name: Phone#:
cwY08 Sly 0.I'-08
Contractor: Phone: 41�0S F7 e &'I9C
�O� ri C> /�.✓ �C��yi c Fax:
Contractor License#: 34o6g/
Cupertino Business License#: .30jr' 4
Contact: Phone:
• Residential Commercial Fax:
Job Description:
/NS7ALL E/e�7I/ Ga � t10w����C(� � toi �Fv7jJ/P
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 (12—3
Valu on: Square Footage:
/S'Do.o0
Project Size: Ex ress Standard ❑ 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.buflditllreen.org
Revised 10/20/08
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
(juantity/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
absorotion sys over 100,000 Btu/h
1BBOILER3 Installation/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
1BBOILER4 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
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 •