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05090235 (2) CITY OF CUPERTINO BUILDING DIVISIONPERMIT CONTRACTORINFORMATIOON -- BUILDING ADDRESS: PERMIT NO.05090235 5090235 11040 FTRFTHQRNF, DR OWNER'S NAME: PERMU MUE DATE AdIkk PAUL MCNICOL 2005 IF N@ SANITARY NO. CONTROL NO. ARCHITEC/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uOz LICENSED CONTRACTOR'S DECLARATION til F❑ 1 Wreby affirm mal I am licensed under provisions of chapter 9(commencing Job Description ;iW with Section 7") f Division 3 of the Business and Professions Code.and my licenstu e`i0."i inf ILL anitL;e t REPLACE 3 WINDOWS/1 . PATIO DOOR Littnse Cl C.� Lic.p Date- canto pr CONTRACTOR: AAMES WINDOSr mLtfNCtytt � ® y -1 mommuid my pins staff 11 used ass is —E A1� gQ� Licensed Professional g OWNER-BUILD DECLARATION ¢.005 S 1 Wrehy affirm that 1 em exempt form the ContractorL Contractor's License Law for the r�J y GQ 00 following reason.(Se,don 7W 1.5,Business and professions Cole:Any city or county i m which requires a ro rniI to epnslmel,alter,narrow,demolish,or repair any structure WZ4 A 'tibprior til its Issuance.also requites the applicant for such permit to file a signed Statement a Nat he is licensed pursuanuo the pmvisioas of the Carnation's Late.Law(Chapter 9 Sq.Ft. Floor Area ��r��rJJJJJJssyyay..� a(��Jf rr��JJfj WhYatti'$ 404455 yFC (commencing with Section 7")ofDivision 3ofthe Business and ProfessionsCode)or �TIL� t.`t$ that he is acmpt B¢rtfrom and the thou for the alleged oaemption.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 Bw hundred dollars(SSW). 32344003 . 00 ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work cad the structure is net intended or offered(crash,(Sec.7814,Business and Professions Code:The CmumetaYs License Law docs sol apply on as owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided mat such improvements me not intended proffered formic.If. however,the building or improvement is old within one year of camphrion,the owner. builder will have the burden of proving mat he did not pond or improve for puryese of sale.). ❑1,as owner of the pmpcny.am exclusively contracting with licensed contractors to construct the pmjecl(Sec.7014.Business and Professions Code:)The Contractors LI- cense taw docs not apply to an owner of property who Wilds or improves thureon,and who contracts for such projects with a eonuactor(s)Beamed pursuant to the Conternmes License Taw. ❑I am exempt under Sec. .B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury One of the following decimations: 1 have and will maintain a Ccnificme of Consent to self-insure for Worker's Campion. salon,as provided for by Section 37W of the lobar Code,far dte perfammana of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 37W of the Labor Code,for Ne performance of the..,it far which this permit is issued. My Warier.Co.pensatioa l no,carrier and Policy number are: Canicr. ��Z� /4 Polity No.: 1 Z 7-2 CERTIATEOF EXEMPTION FROM WORKERS' COMPENSATIONINSURANCE Tina section need nut W completed if the permit is(m one hundred unit=(SIOB) or less.) 1 century that in fee perfmnance of the work(or which this permit is issued.I shall not employ any Lemon in any Conform as w become Subject to the Wprkcrs'Compensation Laws of Califomia.Dale Applicant NOTICE TO APPLICANT:IL after making this Cenificaw of Exemption,you should become subject to the Worker's Compensation provisions or the Labor Code,you must .JO forthwith comply with such provisions or this Permit shall he dimmed revoked. Z CONSTRUCTION LENDING AGENCY (. 1 hereby affirm mm them is a constructinn lending agcwy for the performance or CC the work for which this permit is issued(Sec.3097,Co.C.) G] A Lender's Name 2 Lender's Address U O 1 Certify that 1 have read mil application and sum that the shove information is LLE correct.1 agree to comply with all city and county oNinanas and suite laws relating to 0 V building Construction,and hereby authorise minesematives of this city to enter upon the r~ a ahove-mentioned frostily for inspection purposes. (We)agree to saw,indemnify and kap harmless the City of Copeman against Fpl liabilities,judgments.case and expenses which may in any way¢cone against said City of to granting U z APPLICANTeUNDERSTANDf Athis ND WILL COMPLY WITH ALL NON INT Issued by: Date s D��P` SO"REGULATIONS. Re-roofs ;>tiSDate5 MATERIALS DISCLOSURE Type of Roof ums building occupant sore or handle harallous material defined by the Cupertino Municipal Cade,Chapter 9.13,and the Health and Safely we.Dyes s33(an All roofs shall be inspected prior to any roofing material being installed. Will thea scant or fut�tt nuildia Occupant sax equipment If a roof is installed without first obtaining an inspection,I agree to remove pp 6 p q it Qu or domain which mit hmaNnus air contaminants at Jcfincd by the Bay Area Air Quality Management all new materials for inspection. Districli C3 Yea I have read the havaNsmamaterials rtqulmmenu under Chapterb.95 of the Califon. ilia Sleuth At Safety Code Sectors 35505,35533 and 25534.lundersand Jw i(tW 'Ji dors not curreMy haw s mi,Nazi my texponsibility to notify the up of reyuir<mcnu hmh o"Wmcrp toissanataracertihtetepraaan Signature of Applicant Date Owns fauth.6.d agent Dau All roof coverings to be Class "B" or better. COF/ rK..32a/S ,r. l�/z -r� 32Me �r. 3 o zoos SkIp �owF-2 X0 `/S i�yo riz 72 kITGft�n �✓I TQ I l o Yo rw-riyo.a r, �R . 61L-P2T,,iof C4 95011-1 Tt : lv50 - 9Y� - 35Z � COS/�jc..323/ .13� 1 Bio Z --I SFA yo 'lz° 72X T� ITGFt�n ' .L71ni� 4 UL rIG/�IcoL .3TQo- T�7 wl�rc�c�s 7 & 50 - C CITY OF CUPERTINO CITY OF c CUPERTINO PERMIT APPLICATION FORM v S N # Date: Building Address: Mailing Address (if different from building address): / Ow 's Name: Phone #: 9 Ue- Contractor: 2410 -c License#: ,q //lE5 GcJ/�2vS L G9 SLc G9 71c3t�1/ Contact: Phoned?X-6?1-7g9s Cupertino Business License#: �AC1LCo Fax: Sts-&7/- 7S Building Permit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Job Description: 3 AFSvWe-, 7 wi�o�Y Residential Commercial ❑ Sq.Ft. Floor Area: AOL q.Ft.: Cost of Projec L/w Occupancy Group: Type of Co, ction: Please check this box if the project is a J� /1Q 1ns79�v»i�� second-storyaddition: El ro'ect Size: Standar Lar e ❑ Ma or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3_ Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75MBtu 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 1 of 3 3 � � F� 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 BNUCOM AE New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmos beric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUII,DING BPFIXTURE Pb1g 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 Stonn/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 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> 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, Switcb & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 r. '�: CITY OF CUPERTINO - CUP CITY OF O PERMIT APPLICATION FORM QuantityFee 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 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 PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING s 3of3