Loading...
05060175 CITY OF CUPERTINO rrdcx� ;z.+•^ , �ta�P?atxx"�Y', BUILDING DIVISION PERMIT CONTRACTOR INFORMATION BUILDING ADDRESS: PERMIT NOO 5 0 6 0 17 5 10237 CRESTON DR OWNER'S NAME: PERMrr ISSUE DATE DONALD ROBERTSON 06/27/2005 ONE: SANITARY NO. CONTROL NO. ARCHITECT/ !NEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O +�+Op LICENSED CONTRACTOR'S DECLARATION Job Descri von wC 1 thereby firm Wm li t 1 am under pm risioos or Chapter 9(commencing p iW with Section701or Division 3 of the Business and Professions Code,and my license is e<n, in full force and effect. REMODEL � MS . BATHR E®LhZ Liense Class Lik.IX M FQ ® S Dam r nZ ARCHITECTS DECLARATION y5 < 1 understand my plans shall he used o public records JtoU �6GLiu. censed Professional 40 'tt- 03 OWNER-BUILDER DECLARATION ZOOS I hereby a furs that 1 am exempt from the Contractors License Law for the CO following mason.(Section]ID L5,Business and Professions Code:Any city or county y which requites a permit to cn..I,ither.Improve,demoleo,or repair any sumsom oil hk a $9000 prior in its issuance,also mruiims the applicant for such Permit to File a signed statement < that hs is licensed pursuant 10 the provisions of the COnomchn's Ucense law(Chaper 9 Sq. Ft. Floor Area luation Estis-O (commencing with Section 3000)of Division 3 of the B usiness and Professions Code)or y that he is exempt therefrom and Ne bus for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofCr Q not mom than five hundred dollars(1500). Occupancy Y Type ❑L u owner of the pmpemy,or is emntendes with wages r their sole70m1.B sinis3 will do Professions work,and the he Com is no's Licensor Law do for ale(Sec.to an,Business dna eny wh ous ldsdc:The vesthecmra fid who Law acre not apply ff at owner is Required Inspections .a em who bunds nrimprorca Jerson,and who am matin wire himelfe!through his ownsmployeWiprovidedthio Ouchimprovementsarc.sun dcdor mxwm.Tar ow.,- however.the building or improvement is sale within one Sear Or completion,the owner- builder will bane the burden of proving that be did fist build or improve for purpose Of ark.). I,as owner of Je property.am exclusively contracting with licensed contractors to emsuuct the pmjca(Sec.]BOJ,Business and Prefessioa Cade:)The Contractors Li. cats law does not apply in an owner of property who Wilds or Improve themon,and. - whocontraforsuchprojectswithacanumucmKs)licensed purimand to the Comeacaors License Law. ❑I am exempt under See a 4 B&P CT r this moon Owner Data WORKERS COMPENSATIONOECLARATION 1 hereby affirm under penalty of perjury ore of the(allowing declarations: 1 have and will maintain a Certificate of Co scat to self-insure for Workers Compsm sation,as provided for by Seeton 37M of Use labor Code,for the Performance of the work for which Nis permit is issued. 1 have and will maintain Workers Compensation Insurance,o required by Section 37W of the Tahor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance omicr and Policy number are: Career. Polity No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE O'his tectum nccd not W completed if tie permit Is for one hundred dollars(SIM) m les') 1 certify Not in the performance of Ne work for which this permit is issued.I shell nut employ any person in any manner an o in become subject to the Workers'Compersofion Uwe of Califf a.Dam Applicant NOTICE APPLICYANI:ff.a er making Nis Cenificae of Exemption,you shoul0 become subject 10 the Worker's Compensation provisions of the Labor Code,you must .JO foMwith comply with such pnivismos or this Permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY [-+� I hereby affirm that there is a construction lending agency for the Performance of CG rho work for which this Pemot Is issued(Sec.3W7.Civ.C.) W Q Lender's Name r7 z Isndcr'sAddmss U 0 1 cenify that 1 have read this application and sue that the above information is LL F comet.1 agree to comply with all city and county ordinances and sue laws relating to 0U building construction,and hereby authorim representatives citrus city to enter upon the . r W ahovc-menti0ned property for inspection purposes. f1 (We)agree to save.indemnify and keep bartnless the City of Cupertino against % liabilidea,judgments,costs and ex,eoes which may in any way amme against said City of the U Z APPLICANTeUNDERSTANDSthis AND WILL COMPLY WITH ALL NON-POINT Issued by: Date i / r—�—kP SOO E REGU ATIONS i . /Re-roofs gnacre orApP icaC HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Je applicant or future Wilding Occupant store or handle haessomis material u de0red by thc Cupertino Municipal Code.Chapter 9.12,and the Health and Safety AMijodc.Section 35532(x)? / Y ON. AAllroofs 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 m future building..Pat use cyuipmem Or devices which g II harafron air contaminants as defined by IM Bay Arta Air Quality Management all new materials for inspection. District ❑Yes ❑Nu 1 have maJ Ne hvardous materials rtyuirtmcnu unJcr Chaper6.Y5 of the Califon iia HcalthA Safety CrAc.Satiou 25N15.35533 and 255JJ.1 undersmnd Notifthc Wilding docs not curtemly have a tenant Net it is my msponsihility to nodly the aceupant of Oc myvi nuwh'chmux AormissuanccoraCcnifcalcofu'Fey Signature of Applicant Date C"'z All roof coverings to be Class "B"or better ter or autli Igent - m sla Community Development CuTorre Avenue p Oertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 �UPEI�TINO Building De artment JOB ADDRESS`, PERMIT # )02"37 CRES7a,v �.ne -?-S� OWNER'S NAME: NAL-b O(?EPHONE # z/Off 2o GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following ' 0 tion: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date anmCITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO APN" 226 3z / 2-1 O �y Building Address: `f I Mailing Address (if different from building address): Owner's Name: Phone#: AD b9 Contractor: 7—&—D License#: Contact: Phone: Cupertino Business License#: Fax: Building A' lPermit Info: AZ[2 0/4-W/20001k-V//q O L)f7 . IVO 1AlcWie L BldgR/ Elect [9/ Plumb [k/ Me_ /ch El Job Description: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a Ah second-story addition: ❑ Pro'ect Size: Standard � Lare ❑ Ma'or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM 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 1 of 3 p, n C. CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Ali-Quantity 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 InstaWAlter 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 BRENLkMiAN A/C Units <= 10,000 cfin 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 2 of 3 A^+ CITY OF CUPERTINO CITY Of. PERMIT APPLICATION FORM CUPE TINO' Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmd] 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 6 . 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 3 of 3