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09070148 CITY OF CUPERTINO !,' BUILDING DIVISION PERMIT : /) /�j BUILD ADDRESS PERMIT NO.0C1 �l� 766M h Ile • , PERMIT ISSUE DATE OWNER'S NAME: e 9 ` �/y y� �j SANITARY NO. CONTROL NO. ,ONE: O9_ — 1173 �/f/1/f ) V/�� BUILDING PERMrrINFO ARCHI IECffENGINEER: -Ile —1103 )O(/ BLDG E PLUMB M q p pLICENSED CONTRACTOR'S DECLARATION IOb Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 7000)of Division 3 of the Business and Professions Code.and my license is le CA in full force and effectj��� �� ���� ^� ? License Claratf 20' Lle•8 0? ( 7 '��/vel n F Date " ,rL It-!_C.... ARCHITECTS DECLAAA A a-, I understand my plans shall he used as public records DWU 4 O y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the i O O following reason.(Section 7031.5,Business and Professions Code:Any city or county S Pi which requires a permit to construct,alter.improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation Cthat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area �y L� >c t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or / O y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). ❑1,as owner of the property,or my employees with wages as their sole compensation, L will do the work and the structure is not intended or offered for sale(Sec.7044.Business ns Required Inspections and Professions Code:The Contractors License Law does not apply to an owner of q P property who builds 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, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not(wild or improve for purpose of sale.). ❑1,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li. cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractors License Law. ❑I am exempt under Sea .B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Carrier. 57_A:1 t of A)18 Polley No.: 1841"11 s� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensadon Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ',Z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY (~i ham. I hereby affirm that there is a construction lending agency for the performance of (Y.h 5 the work for which this permit is issued(Sec.3097,Civ.C.) QLenders Name Lender's Address U 0 I certify that 1 have read this application and state that the above information is V.►' correct.I agree to comply with all city and county ordinances and state laws relating to 0building construction.and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. 1. (We)agree to save,indemnify and keep harmless the City of Cupertino against rHc(n liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date h"t APPLICANT UNDERSTAN AND WILL COMPLY WITH ALL NON-POINT Issued by / SOURCE REGUL ONS. 1"Z I"Uj Re-roofs Signature of Applicant/Conuactor Date Type of]Roof / HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes 94 If a roof i;installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which MR hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection. District? ; [:]Yes Ps. I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building does not cumend have a tenant,that it is my responsibility to notify the occupant of the req' b' us<be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date 1"7-I""A All roof coverings to be Class'A"'or better Owner or authorized agent Date CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot : APN 32(44017 . 00 DATE ISSUED. . . . . . . : 07/21/2009 RECEIPT #. . . . . . . . . : BSC00008235 REFERENCE ID # . . . : 09C70148 SITE ADDRESS . . . . . : 21_ 58 METEOR DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TSAI STEPHEN S ADDRESS . . . . . . . . . . : 21: 58 METEOR DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1324 RECEIVED FROM . . . . : DAVID KESTER CONTRACTOR . . . . . . . : KESSTER, DAVID M LIC # 22101 COMPANY . . . . . . . . . . : KESSTER HEATING AND AIR CONDITI ADDRESS . . . . . . . . . . : 43` 1 GLENPARK DR CITY/STATE/ZIP . . . : SNA JOSE, CA 95136 TELEPHONE . . . . . . . . : (408) 265-1103 FEE ID UNIT QUANTITY INOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 000 .00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 7, 000 . 00 0 .70 0 . 00 0 .70 0 .00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 .00 lEPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1MPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 .00 1MRRAA UNITS 2 . 00 126 . 00 0 .00 126 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 409 .70 0 . 00 409 . 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 409 .70 VISA --------------- TOTAL RECEIPT 409. 70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 0q 0 CITY OF CUPERTINO FUIViACE/AC CU CITY OF INO PERMIT APPLICATION FORM APN # � © � � � Date: 5 •-2� -� Building Address: o� 1 3� 0 1M ivy► ��� i>� Owner's Name: Phone#: Contractor: Phone#: Fax#: -i o It — -t5Z—t-z4 S Contractor License#: -7 5-5-1 f bD Cupertino Business License#: Contact: Phone#: 5 z 4-5 A-13c-1 r- ' Fax#: • r Building Permit Info: Elect Plumb Mech ❑_ Residential Commercial ❑ Job Description: For Residential Installations: Attic F-11st floor []� 2"d floor ❑ Adhere to minimum setback requirement [�- For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction(Usage Class): ate. Strapped F1 On PlatformEl Bond�d New Location Replacement Project Size: Ex ress Standard ❑ Large [] Major❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Revised 01/07/09 CITY OF C UPERTINO lk FURNA,CE/AC CUPE(�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units <= l Ok CFM B 1 MCRAA Commercial Mech Repair/alt/add M IB BSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICO Seismic Commercial B 1 PGASCOM Commerical for e i gas piping System P 1-4 outlets I PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. C omm/Resid 1BREMAIRHAN Residential A/C units<= IOk CFM B IMRRAA Residential Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES I BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Perm it M 1 PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B ' 1BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .;UPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: ;5P17-PPHONE # 411 --437-1 GENERAL CONTRACTOR {,gee_ ,,A. 4 FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date