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05050033 (4) CITY OF CUPERTINO BUILDING DIVISION PESIT CONTRACTOR INFOR�TION "; 3 FOR v Yam_. BUILDING ADDRESS: PERMIT NO. CRW INDUSTRIES 05050033 OWNER'S NAME: PERMIT ISSUE DATE TIAUTT-) WAT 1<17R NE: SANITARY OL NO. wRCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 _00 LICENSED CONTRACTOR'SDECLARATION Job Description pp 1 hcmby affirm that 1 am licensed maker provisions of Chapter 9(commencing iW with Section]IXIU)sfDi' on3of NC Busin nand Professions Code,andmyliccnsc is n<n, in full fomeandcffec = Li' Lik: IREPLACE 5 'WINDOWS/1 PATIO DOOR n—E Date `;7 Contractor ARCHITECTS DECLARATION 5a 9, 1 understand my plans shall be used as public records oau 0G ; Licensed Professional S OWNER-BUILDER DECLARATIONcto E a q 1 hereby affirm Nat I L. exempt from Nedmioncror's Code:Any law for the pC followwhichinguires.permit n 703 1.cmnaeel,.iner.apr Profdeolih. Any city structuy Ire m whichfeyuimsae.also requires the improve,h Permit,merepair gany suomum priors,its issuance.alsoLoins tW,inionant for mchpcmtr's Limas signed statement S a (commencing ecingwitpumtion70hepmviinnsnf the ofthe usines'sLlrenfalaw(Chapter 9rux)of Sq. F[. Floor Area Valuator x~$ dreg M at exemt arefeananddobDivisions3 of the Business and Professions Crux)or 3— Nal W u exempt Ncmfrom and the buil for Ne alleged exemption.Any violation of - Section]031.5 by any applicant for a permit subjects me applicant o a civil penalty of 3 YDLJyr )SrO 9 ecupancy Type nomom than five hundred dollars(S!iM. ❑I,as owner of the property,or my employees with wages of dmirsole compensation, _ will do the work and the$=store u notinmaded oroffcmd for sale(Sec.]Oba,Business Required Ins ections and Professions Code:The Contractor's Licence Law docs not apply to an owner of q p property who builds.,improve thereon,and whodoessuch work himself.,through his own employees,provided that such impr.vemcats art not mumdcd or offered forsale.If. however,Nc 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 fur l uryosc of sale.). ❑1,as owner of the property.am exclusively contracting with licensed eoneacmrs on - constmet the project(Sec.PWC,Business and Professions Code:)The Contractor's Li come law does not apply to an owner of property who bulids or improve Neeson,and who contracts for such projects with a cummmor(s)liunsed pursuant to the Contractors License Law. ❑I am exempt under See. ,B&P C for this reason Owner Das: WORKER'S COMPENSATION DECLARATION 1 hereby of ton under penally of perjury one of the following declaration: 40 1 have and will maintain a Certificme of Consent to self-insure for Wmk<r'sCompco- on,u provided for by Section 37W of Ne Labor Code,for Ne performance of the wmk for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of the labor Code,for tW performance of the work for which but pefruit is issued. My Wark s Compesatan Insurance easier and Policy number aa: Garr ort e� e �..: 5�i—W � CERTIFICATE FEXENIPTIONFROM WORKERS' COMPENSATION INSURANCE Cnif faction need not becompleted H the permit is fmone hundred dollars(SIM) or less.) ' 1 certify that in the performoncc of the work for which this permit is issued,1 shall not employ any pefson in my manner an u In become subject o the Workers''Compewtion Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Cenificate of Exemption,you should become subject to the Worker's Comite motion previsions of the labor Code,you most .J O forthwith comply with such provision or this permit shall be domed revoked. Z� CONSTRUCTION LENDING AGENCY I-. 1 hereby olBfm that Vert is a construction lending agency for Ne Performance of E 7 the work for which this pemtit Is issued(Sec.309],Civ.C.) W Q Lender's Nome z Underi Address U Q 1 codify that I have read this application and state that the above information is lL f"' correct.1 agree to comply with all city and county oNinances and sum laws relating to 0U building convection,and hereby outhorim mprescmatives of this ci ty to enter upon the r W move-mentioned property for iro,mm.purpose. (We)agree m save.indemnify and keep barmkss the City of Cupertino against liabilities,judgments.costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit- r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date CURCER�cULATIO S. -} ' l N� h tOW� 51 C31 Re-roofs Signature of ApplicanUConbactor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle hararmus material as defined by the Cupertino Municipal Coat,Chapter 9.12.and the Health and Safety Code.Section25532(a)? All roofs shall be inspected prior.to any roofing material being installed. ❑Yes tiy<. Will thea applicant or future building t use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove pp sby occupant yup a navamnma air conmmmaau as dcpnd by the Bay Area Air Quality Management all new materials for inspection. isoia] ❑Yes LRT! I have mad the h t araous materials requirements under Chapmr6.95 of the Caldora Iia Health&Safety Coat,Secdon sViS15,25533 and 25534.1 n&.d thruif tM building Jars not currently have a tenant,that it u my fam ombil'ny to notify the ottupant of the qucmens which\mu�ts�`mctpdamissuancc ofd CeNhomo( panes Signature of Applicant Date A��t"'�'"`Q"��'"- 5 'Qm All roof coverings to be Class "B" or better Owner o,authorized agcm Dam i • s 0 � COMNOM wat.t.. 14 �^ In N X- ijp F E d ' N • $ '^ [ 0 PL N m 00 w � a .r • IA m - -- - - COMMOK W 4u.. • . • Fill AO d= • too v eCD x O tA o xx z b x w ,s • n Ce'+rteN wcw�. to 0 c g o o � g CITY OF CUPERTIlA CU CI YOF PERMIT APPLICATION FORM N # Date: - 3wz 32 voS S a Building Address: Mailing Address (if different from building address): 225`7 Lq2 c><<l< cc��sE- Owner's Name: Phone#: �>A-Q S 1 15 czr 2 S-5-- f27� Contractor: License#: CFZVJ C;e s o2qOD Contact: Phone: 37$'2�-177 Cupertino Business License#: Atip f;o. Fax: 2 3 S2S Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ JobDescription: cyto ndow�o c 1VnA \moor. Residential 0 Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Protect: Occupancy Group: f z h I , c� Type of Cons ction: Please check this box if the project is a ;tic�o-,J e-Cl4Cw.e,V-N second-story addition: ❑ roject Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 5OOK Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILERS 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 <= IOOOA 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 �- 2 3�- r6 age, CITY OF CUPERTIT* CITY OF PERMIT APPLICATION FORM CUPEkTINO uanti 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 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 BREWSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BRENL4JMAN 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 2of3 � - (I'Y OF CUPERTINO CITY0 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 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 Chane BUILDING 3 of 3