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05040140
CI'T'Y Or CUPEWfINO WINE BUILDING DIVISION PERMIT CONTRACTOR`�INFORMATION y ;'tea, f� A' Bu1LDINGADDRFSS: FALCONE PLUMBING & HEATING �PCNg15010140 OWNER'S NAME: PERMIT MUE DATE WILLIAM THROM 650 L 01/25/2005 31,; CIITFT)T7.N WY ONE: SANITARY NO. CONTROL NO. (408) 293-5676 ARCHOTMIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 100 LICENSED CONTRACTOR'S DECLARATION' wp I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description �4W with Solution 70W)uf Division Sof Ne Busircssanl profeeim,Codc.inl my license is +« in fall fnwiaderree" GAS LINE TO FIREPLACE K License Clan Lk.p ,Fn Dam Contract., qqt9 ARCHITECTS DECLARATION �J f ed< 1 undcnund my plans shall he used as public acnrm / ,e c i u u. Licensed Pmfcssional =ct g OWNER-BUILDER DECLARATION Conl ON v - C OO 1 hereby,(Sete Nat 1 1. .sump!from the Cssors Cm :License Law for my Oo following reason, (anion ]nnstr Business and mprve,Professors Cod:Any city of county COO v` which n:yuires a e.also re crnswm,alma improve,h port(li or repair any structure 3 0 0 °=�, that he isRefits used pursuant to the the ovisiosofcant for such portfolio Liec is Lawdstatemcm -zp (com encinnwdPuction7thkofDiviomofof flat ftBuinessadPr41L2W(Chapter ods)9 Sq.Ft. Floor Area Valuation e� feat he (commencingwith and die ivision)nftheeged exemtlon.Anyoslaumn ser Nat M1e is evempt therefrom and Ne buil for the alleged exemption.Any violation of Section 7831.5 by any applicant for a Penn it subjects the applicant to a civi l Penalty of 3Ft0 (;r00 Occupancy Type not more man five hundred dollars(SSW). P Y YP ❑I,as owner of the pommy,or my cmployces with wag.as thcir.mle cote srouni.a. will do the work,and the structure,is not intended or offered for sale(Sec.)OM,Business and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improve%thereon,and who does such work himself or through his tun employe.,provided that such improvements are not intended or offered for sale.11, however,the building or improvement is sold within one year of completion,the owncr- but Her will have the burden of moving that he did not build or improve for purpose of Walk.). ❑1,as owner of the popery.am exclusively contacting with licensed contractors to construct the pmjem(Sec.7044,Business and Professions Cale:)The Contractor's Li- . cense Law does not apply to an owner of progeny who builds or improve them.n,and who contracts for such projects with a contraator(s)licensed pursuant o the Contractor's Ore.law. J-]1 am/'exempt a der Sec. B&P C for this mason WORKER'S'SCOM NSATION DECLARATION 1 hereby affirm under pcnahy of perjury one of the following declarations: 1 haw and will maintain a Certificate of Consent to self-imsum for Worker's Compcm cation,u provided for by Section 37W of the labor Cock,for me 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 W.rlmes Compensation Instance carrier and Policy number aa: CaricC Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE mail sectio recd not he completed if(be Permit is fm one hundred dollars(SLOB) or loss.) 1 comfy mat in the pert.rmancc of lM1e work for which This per 'l a rss d,l sM1all ns. q em ploy any person in any..no,soaWr�c`mc�bjR5. W��ompcnsation (\\ Laws of Cahromia.Da¢ 6' + Applicant 14(1�a.Wjy 'NOTICE TO APPLICANT:If.alter makin this Cenificam of Exemption,you should �bccome subject to the Worker's Compensation provisions of me Tither Codc,yen and Oforthwith comply with such provisions or this Permit shall be deemed revoked. 7 CONSTRUCTION LENDING AGENCY I hereby affirm that them is a construction lending ageney for the performance of Y dur work for which this permit is issued(Sec.309],Civ.C.) s.7 QLender's Name 4 Under'a Address =) z U Q I certify that 1 have read this application and stem not the above information is yP correct.l agree to comply with all city and county ordinances and slam laws relating to 0U building construction,and hereby authorim cepreaemativea of this city to enter upon the W above mentioned proPcny for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against f, Liabilities.judgments.coals and expenses which may in any way Mende againstacid City in of the his famit. Z APPLICANT eUNDERrSTANDSand ag Of tAND WILL COMPLY WITH ALL NON,POINT Issued by: Date a EGUL IONS. .W� Ito Re-roofs Sig store ApprcanufContractor m HAZARDOUS MA ERIALS DISCLOSURE Type of Roof me applicant or Town building Occupant store or handle haaNuus material y ft CuMnino Municipal Code.Chapter 9.12.and the Health and Safety m 2ss3zanAll roofs shall be ins ected rlor to an roofin material bei.. oNt P P Y g g installed. the a licantor future buildin ant use a nt at device which If a roof is installed without first obtaining an inspection,I agree to remove jrP g bymop a Air Q�us cur conaminants a dcMcd by the Bay Arca Air Quality Managcmcnt all new materials for inspection. es ❑N. 1 have read!the hvamtcs materials myuhanism s trick,Chapmr695 of the Califon riia Health K Safety Code,Secuuus 25505:25533 and 25534.1 understood mat it the budding does not currently have a¢rant,that it is my respomihility to anu ly the occupant of the myolmmcnts whim I"the mkt vrwiast icmmrc,mproccupaney Signature of Applicant Date o rte or nihmircdagcat vim/ Datc All roof coverings to be Class "B" or better £ - Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT # t .� oDiosD OWNER'S NAME: L,(� ' ,' p VY, PHONE # 0 — �{ GENERAL CONTRACTOR:.r-,yif 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 JGlass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 1u, a O caner o tractor Signature Date - CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM APN # 3KY 3 Date: d /f t/1 00 Building Address: Mailing Address (if different from building address): 'Q©33'3 Owner's Name: Phone#: Al O - a "! Contractor: J License#: - o � Contact: Phone: •a y�9/ ! Cupertino Business License#: Fax: /f Building Permit Info: Bldg ❑ Elect ❑ Plumb IIs Mech ❑ Job Description: Residential D, to I repla6 ommercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Proje r� d� Occupancy Group: y 5'O,mO 3 90. Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard B. 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> IM to 1.75 M Btu MEC14ANICAL 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 I of } -� g : S.6 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee 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/After Water Pie PLUMBING BPWHEATER Water Heater/Vent 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 BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT _ Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> 1 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 2 of 3 CITY OF CUPERTINO CITYOP PERMIT APPLICATION FORM CUPEkTINO 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 Inscction BUILDING BS WIM Swimming Pool BUILDING BTEMP 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 MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3of3