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04050015 CITY OF CUPERTINO 7777-77777777' A BUILDING DIVISION - PERMIT CUNTkXC-T0RJNF0R4,ATIQW:`s!. BUIL DING ADDRESS: CRW INDUSTRIES PERMIT 11004.050015 40 TUSCANY PT. OWNER'S NAME: PERMIT IMIJB DATE JERRY & APRIL SCOTT 1157 DEL E: SANITARY NO. CONTROL NO. yOg '/.2G^081- 408) 378-2477 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH = 0 0 0 y o p LICENSED CONTRACTOR'S DECLARATION U 1 hereby at Orm that 1 am licensed under provisims of Chapter 9(commencing Job Description whir Sermon 7")of Division 3 of the Business and Professions Cade,and my license is inmummeaad em. O Y0'/ REPLACE 2 PATIO DOOR/2 WINDOWS S'u3? Li¢nu Ire Lic.p o Dam CuntrecmrAt N Y A SDECLA TION Yrs rsu my pl du Public records ''G Licen eJ Pm(c innel OWNER-BUILDER DECLARATION aI I hereby.(firm that 11. exempt Imre Pr commdC's :Any c Low for the p O following reosan. Peron t 71131.5, r,Business and improve, de Professions Cade:Any city or county K$ which reyui issuance.a a permit re ennaWm,alma improve,demolish,or repair any structure �Haw�'^ LWIlanalcamdpunanttaimadmisionsofthecant for ont=ch dllVBlemLaw(Ced ha meal (commencing co be escingwiit pSectio 7the provisionsn ofrCo hUcnsalsw(C Code) Sq.F[.Floor Area Valuatwn H$ (cat he xempth Section]000)th Walson3 the glan Businessedxandon.Aaynvi Codc)of .. Net Ire u exempt Nmcfrom and dte baso for Ne alleged exemption.Any violation of Section 7031.5 by arty applicant for a Permit subjects the applicanuo a civil penalty of wO 0 Occupancy s e not mom than five hundred unit.($500). P y ST']P ❑I.as owner attain property,or my employees with wages as their sole compensation, willdo the work,and theaVmture hs not intended mothered formic(Sec.70W,Business and Professions Cede:The Contractor's License Law does not apply to an owner of Required Inspections pre,amy who buildsorimpmves thereon.and who doessuchworkhimselfor lluuughhis oow..,,in. aildiprovidedg Imtruach noprovrnim I. to within are intended a. fomin,Rercd foraale.r. builder,Nc building or improvement ie sold within ane yeti ofimpro a for Ne owe of builder will have the burden of proving Net he did not build or improve for purpose of sale.). / ❑L u owner of the property,.B exclusively Persuading wird;)The Communions ions m come La the project(See.n an Business and property who Cade:)The Conuemon.Li- L cave Law docs not apply m an owner of pmpeny who builds or improves thereon.and / who contracts for such projects with u a canacwrpm)licensed pursuant the Contmdor'a Law. 0 1..am LLare exempt under See ,B&PC for this reason lw;!k , Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declmnime: ave and will maintain a CeniBeom ofCdpxmt to self-insure for worker's Compere ,as provided for by Section 3700 of the Labor Code.for the Performance of the for which Nis permit is issued. ave and will maintain Worker's Compensation loorrance,u required by Section of the Labor Cade,for Ne performance of the work for which this Permit is issued. orkeh Compensation Insurance carrier and Policy number am: r: 5V4rr A.WD PpucyNo.:IMrDOfIA-2ce3_ CERTIFICATE OF EKEMFI'ION FROM WORKERS' COMPENSATION INSURANCE . mussocim med net heeampleted if the Permit isforonc hundred dollars($100) or less.) 1 certify that in the performance of the work for which this Permit is Issued,I shall not employ any person in any manner an as to become subject to the Workers'Compematlon Laws of California Data Applicant NOTICE TO APPLICANT:If,error making this Ccnificam of Exemption,you should become subject to the Worker's Compensation previsions of the Labor Code,you must ,J Z forthwith comply with such previsions or this permit shall be deemed revoked. ,Zvi O CONSTRUCTION LENDING AGENCY r� (~ Ihor by which that there isaed(Sec.i097.Cing agency lar to perfarmonce of Na the work for which this permit is issued(Sm.J097,Civ.Cd GQ I-endcr's Nmnc v7. Z Lender's Address U Q I certify Nat 1 have read this application and sum Nu the above information is Hcannot.I agree m comply with all city and county aNir antes and sum lawn relating to 0U building construction.and hereby auNoriae mpmsenmtises of this city to enter open the ra shove-mentioned property for inspection which m. (We)agree he save,had...ify and keep harmless the City of Capone.against rFr y liebilities,judgmenu.casu and expenses whicM1 may in any way eccme against said City Uz in con m"of the grmling of Nis Permit, APPLI NT U1N/.D¢7/E7$$f�BB'f��4N 5 AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SO R " --uTar te Re-roofs Signature of Appuca RDO Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant ar future building e,Capt store orhandIchazaarrous ad as defined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety code, en2s532')? 0 Yea XNo All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant on equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hazardous air contaminants as defined bielly dm Bay Area Air Quality Management ;igg w materials for inspection. Yes 1V IIV 1 have mad the hasardmemamrialshequeemenu under Chapter6.95 of the Califar. is Heddi&5afetyCode,Se cdmu25M5,25533md25534.lund mwdNallfthc buiidi docs n t currently haw a tenant. al it is my remomibiliry m m tl'y dte acupxal M the mq mama rehm riorninumanceofaComftem, (Occupancy. ureofApplicanit Date ( � / x-17-0�/ cr ser aumonzcd igml Date All roof coverings to be Class"B"or better MATE CITY OF CUPERTINO , L t�Txa BUILDING DIVISION PER �� + TOI � ��1IQ � VU BUILDING ADDRESS: CRW INDUSTRIES PERMITNcb4-050015 1,040 TUSCANY PT, OWNER'S NAME: PERMIT ISSUE DATE JERRY & APRIL SCOTT 1157 DELL NE: SANITARY NO. CONTROL NO. t40$ 17`96-08/5 (408) 378-2477 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +�+o z LICENSED CONTRACTOR'S DECLARATION Job Description tfirm the,l am licensed under provisions of Chapter 9(commencing P with Section 7001)ofDivishm 3.fdm Busawaisnd Pmfcssions Codo,and my[fear.is ate„ inrmlmmeana o2y®'/ REPLACE 2 PATIO DOOR/2 WIN I �� $`',. ? Lian. itis— Lic.s Da f e_ cantr.tar_ lanwt�as A S DECLA ATION 2-5-2004 � crsta my pl sed as Public recnNs MAY (.a7 2004 Ou 3 o G Licensed Pnsfc ional S OWNER-BUILDER DECLARATION w 6 os. I hereby infirm that 1 em exempt from the Contractor's License Law for the K,1�1 ®yg�� no following reason.(Sectian 703 1.5,Business and Professions Code:Any city or county YYYY Ib Y,d s�2�i which requires a permit to construct,alter,improve,demolish,or repair any suumum Fi< primm i6 issuance,also reclaims the applicant forsuch .it,.flea signed statement ,haLhc is licensed pursuant to the provisions of the Commcmr'sLicense Law(Chapter 9 Sq.Ft.Floor Area Valuation isFG (commencing with Section]BBB)of Division 3 of the B usincs,and Pmfcaions Cade)or i that he is exempt thcrefmm and the basis for the alleged exemption.Any violation or Section 7031.5 by any applicant for a permit subjects she applicant o a civil penalty ofaro 0 Occupancy Type no,more man rim hundred dollars($50M. P Y YP D 1,as owner of the property,or my employees with wages u their Sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044.Business and Professions Chile:The ConuacmYs License Lew docs not apply man owner of Required Inspections property who builds or improves thereon,and who doessuch work himselfor through his own employees.provided that such improvements are notimmnded.Tottered persalt.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 build at improve for purpose of sale.). ❑I.as owner of the property,am exclusively contracting with licensed commotion to conswet me pm/act(See.7044.Business and Professions Code:)The Cormacmr's Li. cense law does not apply to an owner of property,who Wilds or improves demon,and who co uractefor such pmjem with a convaemr(s)licensed pursuant to the Convenor's License Law. D l am exempt under See .B&P C for this mason Owner Date I WORKER'S COMPENSATION DECLARATION 1 hereby affimt under penalty of perjury one of do following declarations: have and will maintain aCertircam inconstant o self-insure for Worker's Compen- 737 n.ns provided for by Section 3]00 of the Inbar Code.for the performance of the for which this permit is issued. have and will maintain Worker's Compensation Insurance,as required by section ofdc Labor Cade,for me performance otthe work Tor which this permit is issued. er 544PT 6wo Policy No.;W16078-2M_4 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Mis section need not he completed!fine permit is forum.hundmddol[ars(SIM) HE leas.) I certify that in the performance of me work for which this permit is issued,I shall net employ any person in my mannerso as to become subject to the Workeri Compensadon Laws of Califmnia Dam APTimmit NOTICE TO APPLICANT.If,after making this Ccnifieme of Exemption,you should become subject to the Worker's Compensation provisions of me Labor Code.you muss �p forthwith comply with such provisions Or this permit mall be deemed revoked. Z y CONSTRUCTION LENDING AGENCY [—t I hereby affirm dal there is a construction lending agency for the performance of (?$ the work fur which this permit is issued(Sec.3097,Civ.C.) Is1 Q Lender's Nem. z Lamites Address V C) I certify that 1 have read this application and stem that the above information is torten.I agree to comply with all city and county ordinances and state laws relating m V building construction,and hereby audorize represenmtims of this city to enter upon the L2a above-mcnduned pmperty for inspection purposes L1r (We)agree to save,indemnify and keep harmless the City of Cupertino against ti h liabilities,judgment,cuss and expenses which may in any way incense against mid City V(� ineon ame,.fthegmnnegofthispermit. APPLI NT UNDE��$dBB��14N s AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SO R UN /' Re-roofs Signature OrAekan c.nttaemr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant stratum building acculeal stare or handle haardeus material as refined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Scnion 25532(a)? ❑Yes XNa All roofs shall be inspected prior to any roofing material being installed. Will the applicant or Future building occumm use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove . hazardous air contaminants as defined by the Bay Area Air Quality Management al w materials for inspection. _loci? DYcs, KN. 1 have mad the havaNnus materials mquimmcnv under Chapter 6.95 of the Califor- nia Health&SafelyCodo,Soctiuns 25505,25533 a d 25534.1 ovirrsmnd that it ma huildi does n t currently haw tenant at it is my responsibility m Madly the oecupant of me ray ' mens mom HOT missuance ofaccrur.ateorOccupancy. ignatureofApplicant Date a � .1-I]-Oe{ Owner ser aumarizcd S ant Date All roof coverings to be Class"B" or better ALL �A�e1D �t?oRSl4St^1DOWS �At'ER LAI-14C Ti1S EGfteN `J'CJGCO EXiE2ltsvL e e PASio D°orL Sx(�g PactO D�2 IN ACCDR "ICE Wirt — (CUP � E PAT ions R Si KiTcr{EN 7w C t plans and e 1 times and it $Ea rCoow IC3 pe We the any changes of alter w; C � lawful itbout written Pe eCityBrno r iZE rRo-FiT .z the build 8 Deft a 1 d specie s in8 of airs P or to be ar. FwsrF - FtN beld to permit 311ALL NOT be eppcoval� Ocdmat�isa Qt� proYra►4or > _ I I DiN6 at aml . E � Iilll P ��D�Y Y v ssatas 6ZoO1A' LtYtw& Roow, ff (01{0 T05644PL. &ARA(9 E Fr v 6A RSoty jERR �GOT�'i R. �ND�SFR.a WITY OF CUPERTINOO CUP TYOF O PERMIT APPLICATION FORM JFLPN# 7 2 Date: 5. 11-oil J O Building Address: Mailing Address (if different from building address): ONO ?'O5744N ?I- . Owner's Name: Phone #- Tdea. 4 'fob)725-o2i9 Contractor: License #: ,R, l.), 'yNDJd4/trdS LIo2t/$y Contact: Phone:14*-S78-2g77 Cupertino Business License#: /ND414 Fax: EXT. ZL Building Permit Info: Bldg 9 Elect ❑ Plumb ❑ Mech ❑ Job Description: 13apwur ;aS*74,rk, VOORS FWD 2aa. ILSINAWa5 user Residential Q Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: . Occu cy Group: 36oc7 Kf., Type of Construct i P4se check this box if the RWiect is a Oxy Woav sec d-stor addition: roject Size: Standard El/ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI 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 Elee 600V> 1000A ELECTRICAL BELEC200 Elee Svcs 600V<=200A ELECTRICAL BENERGY Energy ING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investi ation fee C /^BUILDING 2- -L- I l of 3 91 WITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPE YOTINO SQuantity I Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCONIME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTEvIE 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 I 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 Stonn/Rain Water - PLUMBING IdIllk 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 cf n MECHANICAL BRENLUMAN 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 Furnac&1OK u MECHANICAL BREMHEAT Heater Ins MECHANICAL BREMINHOOD InstallatioMECHANICAL BREMMISC Misc A ELECTRICAL BREMNRAPP Rem Non-Ree ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rept], Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL 2 of 3 II 1 � VITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BREMRESAPP Remodel Res Appliance ELECTRICAL. BREMSIGNAD Rmdl Sips 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 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 WERMFEE 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