The URL can be used to link to this page

03040020 CITY OF CUPERTINO ° ''•�' '` �C•' +�" _ : BUILDING DIVISION PERMIT 1NTsRk�C'IROWNFO A'I'IQN R, i drA' 5)+�^^n'i9n'" Bu1LD�(�40�BOLLINGER RD PERMIT 440.03040020 OWNSME: - PERMIT ISSUE DATE 6EIROS MANUEL C 04/03/2003 ' - SANITARY NO. CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO ZZ BLDO ELECT PLUMB MBCH 1� �95 LICENSED CONTRACTOR'S DECLARATION Job Description I hneby affirm dust 1 am licensed under remAshan of Chapter 9(commencing p With Section 7rK)B)ofDWidon 3 o the 8uiota and Professlmu Cade,mad my Ilcene is �'� WronWma.neercea ase. REPLACE WINDOWS (6) & 2 D0009G��ALED meow class « Dain if c ARCHITECTS DEC" ION CONTRACTOR: J S CONSTRUCTION I encountered Licensed Prortastlondypuaaanan Kaedae publiccaw de MAY 2 3 2003 OWNER-BUILDER DECLARATION E 1 hereby affirm that I .exempt from the ContramYa License Law for the p I�^�p Vp� 02 fallowing won.(Sedan 7031.5,Busbua and Rofesduna Code:Any city m ®county L t g which requlrna a Permit to consuva.atter,improv,demolish,m repair any aaucare I,�S^ pdnr W Its Issuance.also requires the applicant fmweh pemmiHn rile a Signed mumant ggg that he is licensed ranninum tothe provisiotsnftheContractor's Umrueiaw(Chapter 9 Sq.Ft.Floor Area Valuation g ® (commencing with Section7B00)of Division 3 of the Buaincu and Profcadoru Com)or that he is eumpt duenrram and We basis for me alleged eumption.Any violation of Semon,7031.5 by soy applicant for a permit subjects the applicant at a Null penalty of APN Number ccupancy Type War come than Oe hundred dolura(SM. D tesownerof the property,ormyomploycuwiduwaguu thstrsolecempemu0m, 1599,40114 00 .111 do the work,and the cuacturt is.1 Intended or offered for sale(Sec.7044.Business and Pmleaslons Code:The Common's Licenw law does not apply to an owner of Required Inspections property who buildsorimpmvu memos,and whodocssuch wmkhimeAforduoaghhis 101 - FOUNDATION oweemployva,provided that such impwwmanuare aattneded oraBered funis.if. howeue she building or improvement is mid within off year arwmpledon.The mmer- 102 — PIERS Wilda will have the burdw of proving that he did not build or Impme for purpose of 103 - UFER nW.). D 1,as owner of the property.am eulaivtly eomracMg with licensed cennacWn W 104 - REBAR mrstmm the pm)cut(Sec.7044,Business and Profession Coe:)The Comncmr's Li- 105 - ANCHOR BOLTS cetue law does not apply W an owns of property soba bull"or hap.thd emaN a . who contnma m for such projects Mthmmrseam(a)licensed intensities no theCuanos 106 — SEWER & WATER License law. Dlameaempturul See. ,B&PCfmdularcuon 202 - UNDERFLOOR PLUMBING owner Data 203 - UNDERFLOOR MECHANICAL WORKERS COMPENSATION DECLARATION 204 - UNDERFLOOR FRAME I hamby affirm under Penalty of perjury ane oftha following dedantlone 205 - UNDERFLOOR INSULATION ❑Ihevoad will matnuln a CeNOcemafConsent W sel6Wsum fmwarker'sCompen- 301 — ROUGH PLUMBING udon,u provided for by Section 3700 or due labor Coe,fm the pcAormswe of dan work for which this permit is caned. 302 - TUB & OR SHOWER D T Nva and will maintain Wm4f,Competw0on].an,u required by Section 303 - ROUGH MECHANICAL 3700ofthc Labor Cor,far the performance ofthe wort for which this permit Is Issued. ,304 — ROUGH ELECTRICAL My Workth mpenenion Inwnna a Mer and Polity number art: sick. �T //ssi� PoIIry N.A9P9 0-I 00)2 305 - FRAME CERTIFICATE OF EKEMPTION FROM WORKERS' 306 - HOLDOWNS COMPENSATION INSURANCE (ILuectim need act becamplead lithe pennk lsfarone hundred dollars(SIM) 307 - INSULATION 308 - SHEETROCK 1 ccnify that In the part"&=of the work for which this Mrmll is issued.I Mail not 309 .- EXTERIOR LATH employ any person In any manner an as W brcreme subject to the Worlom'Compcnaadon I." fcdimmle.Dam 310 - INTERIOR LATH Applicant 311 - SCRATCH COAT NOTICE TO APPLICANT.If,afar making this Cmiricam or Exemption,you should became subjecl W the Worker's Compensation provision of the Nbm Co",you must 313 - ROOF NAIL .JO forthwith comply with such provisions orthis permit mail Welected mmled. 501 - FINAL ELECTRICAL ENERGY T n CONSMUCIIONLENDING AGENCY 502 - FINAL PLUMBING ENERGY F. I hereby alMom that them is s construction lending agency for me perrormmem of CX the warkfor Which this permit Ishand(Sm.3097.CIv.C.) 503 - FINAL MECHANICAL ENERGY W Ian"r'sAamo z Leader's Address 504 - FINAL BUILDING ENERGY =z UO 1ocNfythatIhanmadthisapplindonandaamwttheabe"Wramationis 505 - FINAL ELECTRICAL Y. buNxI T agree W comply hem ail city and countymimbes or and Late caw muting e 5 6 _ GAS TEST C.a2" 0 building cages a,co and hereby athode rtpru ordiran of dub city W ems upon the W above-mendnned property for Inspection purpowe 0 FINAL PLUMB NG (We)agree to cave,indemnify and keep harmless the City of Cupertino against 8 F I AL ,I IlabilWu•judgmenu,cuts and expansion which may in any sty accmo against Wd City ()7 io wmtgmnce of the treating of this rmll 5jM. t1— APPLICA UNDERSTANDS AI WILL OMPLY WITH ALL NON-POINT Issued by: Date SOUR AULATI' S. — _ _ -4 Re-roofs 514 INAL PUBLIC WORKS ort olA t tor HAZARDOUS ATERIAIS DISCLOSURE Dau Type of Roof Will the applicant or future building occupant pore or handle hassrdoue mausisi udinned by me Cupertino unI'Pal Coe.Chapter 9,11,and the Health and Safety Code•Sodium 35531(m)7 All roofs shall be inspected prior to any roofing material being installed. Dyeso Wild me applicant or future building occuWm w equipment or devka which If a roof is installed without first obtaining an inspection,I agree to remove hnardous air commWanu a conned by the Bay Ams Air Dowty Management all new materials for inspection. iavict7 DYcs )6- I hats mad the harabousmatedais mquiren esu undcrChapwr6.95 of due Califar. nu Nalth&WetyCade,Sections 25505.23533od2553/.I undenud lhatifthe building data not currently haw a unwt,Wt 11 is my mspomibllity m notify dm eactIPand N the nequlremenu which must be met prior W luuance or&cerurmau of Occupancy. Signature Of Applicant Date Owner or wthodud agent Dam All roof coverings to be Class "B"or better CITY OF CUPERTINO BUILDING DIVISION PERMIT y �. i SF^tn .x �cd (�.• BUILD ESS; BOLLINGER RD PaRMrrNo.03040020 DwNBUE DATE vigbl-IROS MANUEL C PERWIT�04/03/2003 SANITARY NO. CONTROL NO. ARCHITECT/BNOINWR: BUIIDINO PERMR INFO BLDO ELECT PLUMB MBCH +�0''8 LICENSED CONTRACTORS DECLARATION O I hemby&Mrm Out 1 am Seemed urWor providom of Chapmr 9(commencing Job Description wish scetim 76O)OrDWIsdon S of she Business and Profeulem Code,and my lieewIs In full Pomo aM eRecL Q,� Iae�L,Hs , cvute '�2 REPLACE WINDOWS (6) ' & 2 DOOI '��® Data , �.�s�ujr ytt7q�� ARCHITECTS DECLon AR oN CONTRACTOR: J S CONSTRUCTIO �6 underatusdmyplan bull he used upublic records MAY 2. 3 2003 4� 5� LicrnW sed Professional ry OWNSR•BUILDER DECLARATION 1 I hereby amum shat I am exempt from she CenuctoYs Lkenm law for tie ��y 02 rnnnwlna macer.(smmn 7N45,Business and Nereasium code:Any city or county D(/IL®ING which requban•pnmlt m coulmn,alar,b Iumm.demolish,or repair any swdum prior in its inusme.also requires UH applicant forwch Permit to Ek a signed consent gg < Net he is licensed pursuant to she provislom of the ContrctWs ldceme law(Chapull Sq.Ft.Floor Area Valuation 4 $ (commencing with Section 7000)efD1viden3 of the Bushman out Prormthm Cookie, ese //BTuat he Is mpt therefore and the basis for Oe alleged exemption.Any victWw or 'SecUa 7031.5 by any applicant res•permit objects the applicant in a civil penalty of not am shoe nus handed dolws(3,50(1 APN Number ccupancy Type 0 1.m ownerof the proputy,or my employees with wage u thebsole cmpensation, 'Aq994nn4 nn wiUdo IlewmL andshe stromum bmtintended moRered fmsak(San.7044,Bodmss and Protmorm Code The Cenumwfs L..law dean can apply to an owner of Required Inspections property who btuds or tearoom themom and who detanuch weds Mmsdfor thmegh his 101 — FOUNDATION care etnployw.provided evatmahimprowmentsambut ntendedmReredfar uILIf, ] O2 — PIERS however,the building myear completion.ire rovement is old within oro ar ofsheowmr- la>will have cite burden of proving that be did not build m Improve for purpose or 103 — UFER ❑L an owmr of the Property.on exclusively controlling with Roamed anoanen in 104 - REBAR amrmtron to projen(sec.7044,Salinas,mal ProfeWets Code:)The CamracmM1 Li- 105 - ANCHOR BOLTS an=law dean not apply to an owner of property who buiMa or Improm themom and, - wM1omninctafmochpmjecuwishaconoow(a)IlaenedpunuanlmNeCmuanNs 106 - SEWER & WATER Lkcae law. O lumexemptunder Sec .B@PCfmlhIs. 202 - UNDERFLOOR PLUMBING owner Dale 203 - UNDERFLOOR MECHANICAL WORK ERS COMPENSATION DECLARATION 204 — UNDERFLOOR FRAME Ihereby ammtunder penalty ofpeduryamofshe following dmwmme: 205 — UNDERFLOOR INSULATION w and will maintain Certificate oreememmaairImam r.wmkelsCompa- 301 — ROUGH PLUMBING wwadforwh hthispemiiis s:tool.tion rthe lateCode,resthe peeamuaseruse 302 — TUB & OR SHOWER ❑1 haw and will maintain Wosme,CompenuOon Incomes,u required by Section 303 - ROUGH MECHANICAL 3700 of the labor Code,fn W performance orthe work for which this u« d permkisbwed MyWandwT and Po304 - ROUGH ELECTRICAL !J Lail Policy Na.:0fq6.0 00?2 305 - FRAME CERTIFICATE OF EXEMPTION FROM WORKERS 306 - HOLDOWNS COMPENSATION INSURANCE (Dais HNmnaed but e,completed If the permit is mane hundred doltus(g10030 ) 308 - INSULATION or Less) 8 - SHEETROCK I oeNfy Out In the performance of the work fm which this Vomit b isncd.I awl rot 309 - EXTERIOR LATH employ any pence In My manmrm as in human object to tie WaftW Compensation lawsafCWfamla.Data 310 - INTERIOR LATH AteICE 311 - SCRATCH COAT bbecome,eeubjectpus the e�anif'sC cepcoucaloNpprroc`"w�iueFUharcmc you Metal; 313 — ROOF NAIL Z mnhwith amply with such InovWom or this permit awl be demand tawbad. O0 501 - FINAL ELECTRICAL ENERGY rn CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY a that them it&commearlon NenryrmJepMamamxo the work or which this permit 503 - FINAL MECHANICAL ENERGY W 41aleM1 Nurse 504 - FINAL BUILDING ENERGY �z IanicesAddtas U0 Icoolly that Ihaw rtJdthis application and sum that she seen Information Is 505 - FINAL ELECTRICAL W` arm u.I agree m comply with all city and county ordinances and sue Ian mINnS ho 5 6 - GAS TES T 0 building connotation,and hereby othadm represenww iofshts city m der upon Oe dhow-menuencdpopenyrmlmpec0ovpuPrsea 0 "- FIN�� PLUMB NG(We)agttt to caw,indemnify cad keep harmess Ute City of Cupertino against 8 AL coats Nd expenses which may in Ny ny aegYe again Hid Cityzw� incensequofNe grandngofshts emit.APPLICA UNDERSTANDS AI WILL OMPLY WITH ALL NON•POINT Issued by: 5 DateSOUR CULATI S. tW If y9-4"9 Re-roofs 514 INAL PUBLIC WORKS um orA maHAZARDOUS NIATERIALS DISCLOSURE Data Type of Roof Will the applicant m future building mcupantume mMedia haHNoua material as;de0ted by Oe CupeNno unelpal Code.Chapter 9.12.and the Health and Safety Code,Section 25532(4)7 All roofs shall be inspected prior to any roofing material being installed.❑vex WIII the applicant or It building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove I motion air conumlmnts H de0md by she Bay Arta Air Quality Management all new materials for inspection. District? Dyes u I haw mal the hmrdnm mamsida mqulmmentsundo r CNpo 6.93 of she CalIfor• nt,Haltha:SafetyCodc,SccUom25505,25533am125531.Iwmcmv4thai(Le building dm not cumentiy haw a tenam;ibat It ts my moonde1hy b mdry the aceupMt efOe requirements which must be metpdorw issuanaofa Caulksm of Occupoey. Signature Of Applicant Date Owner or autharl7rA agent D0e All roof coverings to be Class"B"or better CRY OF CUPERTINO o Z CUPEkTINO PERMIT APPLICATION FORM 03 APN# 3S p oqL,/ DO�/ Date: 3 ^ Building Address: 7 Owne 's ame: Phone#: /'�� - X225 Co tractor: License#: Contact: J aR s£RP�A.-, _ �1 Cupertino Business License#: Building Permit Info: Bldg Elect Plumb ❑ Mech ❑ Job Description: Residential e Commercial ❑ Sq.Ft. Floor Area: ,o $/Sq.Ft.: Cost of Project: Occupancy Group: o`� S'. Soo pG Type of Construction: 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 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 1of3 7 0 a"ITY0 C*Y OF CUPERTINO cu vo PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BM VRvfULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING 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 hiterceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe 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 Pipe. PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAUUiAN A/C Units<= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDCT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL - BREMFURNOV Relo Furnace> IOK 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 2 of 3 • CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEIIiTINO Quantity Fee ID Fee Description Fee Group 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 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3