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04040158u 0 z �i W W U U t1 U CITY OF CUPERTINO +"� �• ' a n ¢`�`�' '�" •: BUILDING r>;ii DIVISION u. BUILDING ADDRESS:- 10099 RIDGEWAY DR CRW INDUSTRIES PERMIT NOO4O4O158 ERS NAME: PERMIT ISSUE DATE- ATEDAVID DAVIDTHOMPSON 1157 DELL AVE. 04/23/2004 PHONE: SANITARY NO. CONTROL NO. (408)378-2477 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDC ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 10IIB) er Division 3 O the Business and Professions Code, and my license is in full force anduffeo 8 EPLACE WINDOWS/PATLO DOOR y6d License Clm Lic.F Dale '1 /a23 2..w.a Contractor nw lir O17Ylif!'t .. ARCHITECrS DECLARATION I understand my plans shall be used as public records Licensed Pmfcssienal OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from Ne Contractor's License Law for the following reason. (Section 9031.5, Business and Professions Cade: Any city or county which requires a Permit In construct, alter, improve, demolish. or repair any .mmetme 87000 Ft. Floor Area Valuation ,Her bs its issuance, elxo roqu res the applicant foramen permit to file a signed statement that he is licensed ruminant a the Provisions of the Contractor's License Law (Chapter 9 Sq. (commencing wi tb Section 70(10) of Division 3 of the Business and Professions Code) or that he is exempl therefrom and Ne basis for me alleged exemption. Any violation Of 34g7g'��erO 0 Occupancy Type Section 7031.5 by any applicant for a permit subjects Ne applicant m a civil penally of nil more than five hundred dollars (55(X). 01, as owner of the property, or my employees with wages as their sole compensation, Required Ins - do mcwmk,ande:The wre iicmiatended Testi for a4,Bme, f AndPrll at Apply I. and Professions Code: The COvtranoti License Lew docs not apply man Busin of Livens La q P ec[iotl,�( property who builds or improves thereon, and who does such work himselfor through his - own employees, provided that such improvements are not intended or offered for sale. If, X/'�Li / however, the building or improvement is Sold within one you of completion, the owner- T / Ice, builder will have the burden or proving that he did not Wild or improve for propose of sale.). O ❑ 1. as owner Of the pr(perty. am exclusively contmcling with licensed contracmrs to Q p/ co durml the project (Sec. 1044, Business and Professions Code:) The C.mmmor's Li- cense Law does not apply to an owner Of property who builds or improves themon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec, B AS P C for this reason _ Date WORKER'S COMPENSATION DECLARATION I hereby affirm under Penally of perjury one of me following declarations: ❑ 1 have and will maintain a CeniGcale of Consent to self-insum for Worker's Compcn- sation, as provided for by Section 37M of the labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 31W of Ne Labor Code, for the performance Of the work far which this feted, is issued. My Worker's Compensation Insurance carrier and Policy number am: • Cartier: SFATU Ii 00 Policy NO.: /0915 �Z'd3 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE rlhlasectian need not hccompleted lithe Permit is forone hundred dollars ($1 00) or less.) I canary that in the perfmmance of the work for which this permit is issued. I shell not employ any person in any manner an ase became subject to the Workcrs'Compcnsation - Laws of California. Did Applicant NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should become subject to the Worker's Compensation previsions of the Labor Coca, you must forthwith comply with soeh provisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY hereby ding agency for the performance of Nmthere isswn(Sec. whefOrm ,len he work for which this permit is issued (Sec. 3(191, Civ. C.) Lender's Namc Lenders Address 1 certify goal l have read this application and state that the above information is correct. I agree to cannily with all city and county ordia nots and state lows relating to building consmuction. and hereby authorim mpmsemetives of this city to enter upon the above emotional property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupcnino against Ii abilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLIC T UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date OURC EGULATIONS. IZS�Z�a tip---- 4 l Re -roofs Type of Roof Signature of ApplimmUCommctof Dam HAZARDOUS MATERIALS DISCLOSURE Will me applicant or future building Accumulators or handle harardous material As defined by the Cupertino Municipal, Code, Chapter 9.12, and the Health and Safety 25532m)?Bae, Section zss)1 All roofs shall be inspected prior to an roofing material being Installed. P P Y g ❑Yea [I No $ If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant Or future building Occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District ❑Ycs - ❑Nm 1 have read the WMAJous materials requirements under Chapter 6.95 of the Califon nia Headi & Safety Code, Sections 25505,25533 and 25534.1 understand that flint bunking . does not currently have A tenant, that it is Any respond hility m imply the oecufam of me icy cars which must be mol prior m issuance of A Certificate ofOceJp p�y. —.. y/z la�$ta•Da Signature of Applicant Date !�'/�� All roof coverings to be Class "B't or better Owner amInwed agent Date 0 S X3° Kr2usr} 6 Y Krrc(,o owlMll f triSi ._rl� �ccd4bo+J • x5 IN ACc�11Y'�pi Ove G P�nOR CODA �f� ®1Ty o DATE SDE D ORDffdANct. SIGNEZ -3 De thikeSetoof p lawful to n the ' SP a;,catio 017 maks lob at all rusames . it the bu dh 4, trtRi/rn ���a or all The s;a A, ci in $Sion fn 3HP,t mPing of this PtYav7 (1Ps,Gha, 3PPrt"L GT be hed i. n Tr i-.'cir,::!isn r ^v rOf the violali'- fi� Gi t, sr. Ftp f" 134i -L4 6 X—>` Sx"t 1-1x9 g I Cdr Qq)[,;,' ,jV0 4;K4 ®rpt. W��6lAT —rFe0MPSDQ 00 Q � [Z lb&c- ui 44 M(5- 53c)VL • t'u---vn1 O.\U CITY OF • CUPERTINO &tITY OF CUPERTINO* PERMIT APPLICATION FORM APN# 3� Z ! r' 2 Z Date: �(IZ-OWC1 Building Address: Mailing Address (if different from building address): /0099 krokewA-I Da. Owner's Name: Phone #- 7WMPMAI PROD�V°8 996-,2�1/d Contractor: License #: Boiler <= 100,000 Btu MECHANICAL Contact: Phone: %B -/s& - oBBb Cupertino Business License#: ROBr"u e-tvAo"y Fax: 1352y Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: Aa to✓6 wrnrn°wr s P."o Su*&L I.iKe %t ug* pwh. A9M6 r/YouG Residential 9 Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: j®vo Construction Tax Type of Construction: Please check this box if the project is a Ind/Off/Comm/Quasi second -story addition: ❑ Ch Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K 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 1 of 3 OITY OF CUPERTINO CUPEt�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIl2HAN A/C Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace 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 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 BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL 2 of 3 a C - *CITY OF CUPERTINCO CITY PERMIT APPLICATION FORM CUPEI�TINO Quantity Fee ID Fee Description Fee Group 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 BSPECLU Special Insection BUILDING BSWIM 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 Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 0 E n LJ CITY OF CUPEW11N0 o BUILDING DIVISION PERMIT gC0NTRAbW1NFORMATI®N BUILDING ADDRESS: WAV np CRW INDUSTRIES PERMIT NO04040158 MS NAME: PERMIT ISSUE DATE DAVID THOMPSON 1157 DELL AVE,04/23/2004 PHONE SANITARY NO. CONTROL NO. (408)378-2477 ARCI IITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MIiCH LICENSED CONTRACTORS DECLARATION —i Job DBD7S'� esGrl Carrier 9 (Commencing I hereby air,,. that I am licensed under prmisioas of Charte P ❑ n ❑�� with Section FIDlq of Division 3 of the Business and Pruftasions Coda, and my license is in force3 c, 2 �l B 4F EPLACE WINDOWS/PATIO DOOR enseaanderra,' License �� ate. « Data 6/L3/OLP Contractor ave Bu IrMlfei SEP ARCHITECTS DECLARATION 2a 200 4 I understand my plans shall W used as public records Liccnsd PrOrdminnal OWNER -BUILDER DECLARATION a Licensee Law fou the 1 hereby .(Seto that I oto escort from the Comm, ions Coot: Any city or roomy following reason. ]1131.5, Business and C which de fie repair any structure which requires a Pani, improve armait t construct, almc i 0 FL Floor Area Valuation prior to lid issuance, e, also requires the applicant for such rector, m Glc signet natemcm h Permit t re t for such caommis License of thehee usino anProf pumuanL me.1 Sq. Diviam encansd (commencing With Section7")and of Division3 Professions Cmlc)or Businessandon. tof he al Any not he ix exempt them(rom and ,he basis for the alleged! exemption. Any violation of 3 44a4I�3iberO0 OCCU anc T e P Y. YP Section 7031.5 by soy applicant for a permit subjecu,he applicant o a civil penalty of net mare than me hundred dollars ($500). Q 1, a owner of the progeny, or my employees with wages as,bcir sole compensation, wi 11 do he work, and Be structure is not intended or offered farm[. (Sce. 7044, Business Required Inspections andmon Pmriftes Cade: The cuaamra Liana Law ane. not apply to ac, owner or Property who builds or improves thereon, and who docs such work himself or through his awn etoployd., provided Na, such improvements are not intended mofdmd for aid. If, however, Nc building or improvement is sold within ore or of completion, the owner builder will haw ,he burden of proving that be did not Wild or improve for purpose of Ile.). Q 1, as owner of Ne property, am exclusively contracting with licensed convenor 10 construct the pmjec, (Sec. 7044, Business and Professions CWC)The Contractor's U. cane law docs no, apply ,o an owner of property who Wilds or improves themon, and , who contracts for such projects with o comractor(s) licensed pursuant to the Contractor's License I. ❑ 1 am exempt under Sec. . B & P C for this reason r Date WORKER'S COMPENSATION DECLARATION .,U 1 hereby affirm under Penalty of Perjury one of the following decimations: Q Ihaw and will maintain a Certificate of Consent to self -insure for Worker's Comfort sation, as provided for by Section 3001 of the Labor Codc, for the scrammed of the work for which this permit is issued. 1 haw and will maintain Workers Compensation Insurance, as required by Section 3701 of Use labor Code, for Bic performance of she wark for which this permit is issued. My Worker's Compensa,in.r Insurance carrier and Policy number am: carrier SfATF I cVNO PolicyNO.: A> 1L3 —Z , CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be complcmd imhe Permit is for one hundred dollars (1101) ns Ices.) 1 certify cart in ,he performance of the work for which this Permit is issued, I shall no, employ any person in any manner so as to become subject o the Workers'Compensabon - Laws of California. Data , Applicant NOTICE TO APPLICANT: If, aRef making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the labor Code, you mus, - forthwith comply with such provisions or this parad, shall W deemed mvokcd. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a consroction lending agency [or the Performance of ,he work for which this permit is issued (Sec. 3097. Civ. C.) Lender's Name Lender's Address I amity 0x11 have read this applitninn and amid that the about information is ' correct. I agree to comply with all City and county ordinances and sure laws relating to building construction, and hereby authorine o pmadmatiwa of this city to enter upon the ahow-mentioned property for inspection purposes. (we) agree to save, indemnify and kap hornless ,be City of Cupertino against liabilities, judgmcnm, coxa and expenses which may in any way accme against mid City in consequence of the graining of this permit. APPLICNqT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date Ug CGULATIONS. U 123l?roD �1 Re -roofs Type of Roof SignxureofAppl;aamAdmraem, Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hamothous material m defined by the Catholic, Municipal Code, Chapur 9.12, and the Health and Safety c, Section 25532(a)? ❑Yes ONO All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future buildingcecupon, use equipment or devices which anvil hamrdnus air emnaminanu as defined by the Bay Arca Air Quality Managcmcm all new materials for inspection. District? ' Cl Yds C] No - I have mail the baaamaus mamrials requirements under Chapter 6.95 of the Cabror. ria Hard" licitly Codc, Sections 25505,15533 nod 25534.1 undarsu d has if dm Wilding does no, currently haw a team, cast it is my responsibility to nod I the wcuPanl of the rcy cru which must be ton pdonn issuance of a CeniOcau of Ocep y^c . Signature of Applicant Date y/Z3Di All roof coverings to be Class "B" or better Owner err au,horiecJ eFtnl Data