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03010043 CITY OF CUPERTINO - >' BUILDING DIVISION PERMI'Y ",CONTR'ACTORIN'EORMAT BUILDING ADDRESS: �FISCHER PLUMBING & CONST PERMIT NO. 20818 GARDEN GATE DR. 03010043 41 WNER'S NAME: 2766 SCOTT BLVD APPLICATION SUB DATE DUANA NELSON 01/08/2003 PHONE: 408 727-2426 SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH woo LICENSED CONTRACTOR'S DECLARATION O I hereby affirm that l am liceexd under provisions of Chapter 9(commencing Job Description with Section]000)of Division 3 of the Bosinns and professions Code,and my license is ,Do. in full forte and 3 /U REPAIR HALL BATHRM z o'=0,_ Lkenx CI ad '6 L Lic.N F_1'uq Dam contracror NEW PLUMBING FIXTURE/NEW TUB WALL/SURRANDED �E2— ARCHITECTS DECLA 10 2 O 1 u 1 undersand my dans shall he used as Public records F LL Lrcnxd Prufcasronal / g OWNER BUILDER DECLARATION Is <S 1 hcuby affirm that 1 am exempt from but,Contractor's License Law for the I n O following mason.(Section 7031.5.Business and Professions Codc:Any City or County a�$8� which requires a Permit on convect,alter,improve,demolish,or mpair any strucwm 2 F,zy Prior to its issuance,also requires the applicantfor such Permit to Glc a signed statement ce�o that he is licensed Pursuant to she provision of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuat w (commencing with Section 7000)of Division 3 of Ne Business and Professions Cook)or y _ that he u exempt therefrom and the basis for the alleged exemption.Any violation of $ 000 Section]031.5 by any applicant for a permit subjects the applicant o Advil penalty of APN Number Occupancy p y YP net more than five hundred dollars(s500). 32630037 . 00 T e C]1,u owner of lie progeny,or my employees with wages u their sole compensation. will do the work,and the immel m is not intended or offered for sale(Sec.7064•Busineu ,gQp(k1; and Professions Code:The Conuumrs License law does not apply to an owner of 101 — FOUNDA"I'11J1V ed Inspections prop property who builds or improves thereon,and who d.essuch work himer for through his own employee,provided dot such improvements are not intended or Opened forsale.if. 102 — PIERS however.the building or improvement is sold within one year of completion,the owner. Wilder will have the Wrden of proving that he did not Wild or improve for purpose of 103 — UFER 311. 104 — REBAR ❑1,as aveer of ct property,,B eadusivnd conumting with licensed Cooea tors i- 10 5 — ANCHOR BOLTS ,uneven Ne project(Sec.]044,Business end Profusions Codc:)The Contractors Li- cense law does not apply to an owner or property who Wilda or improves themon,and. 106 — SEWER & WATER who contracts for such projects with a convacmr(s)licensed pursuant to the Cormanm'e License law. 202 — UNDERFLOOR PLUMBING ❑l am exempt andcf Sec. .B&PC for this reuom 203 — UNDERFLOOR MECHANICAL Date 204 — UNDERFLOOR FRAME Wm KERunder S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION ihandwilereby l mai under Penalty of of Coyoneof lb,following or declarations: 301 — ROUGH PLUMBING ❑1 have and will maintain a Certificate of Conem m ulGinurt for Workers Campem cation,az provided for by Section 3700 of me Labor Code for the par ofmance of the 302 — TUB & OR SHOWER wok forhich ills permit is issued. 303 — ROUGH MECHANICAL ❑1 naveaveand orad will maintain Worker's Compensation Insurance,az required by Section 304 — ROUGH ELECTRICAL CAL 1700 of the labor Code,for the Performance of the wort for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number art: 305 — FRAME cam"" Policy 306 — HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATIONiNSURANCE 307 — INSULATION or less.> (This section need not W complctod irthe permit is forum,hundred dollar a nIM) 308 — SHEETROCK certify that the performance of the wp k for which Nis pc n is issued.1 ansa 309 — EXTERIOR LATH e not 310 - INTERIOR LATH employ any proton iramanyycrypas yl ub)e5tm pp Workers Compensation LAlicant aws of Calif.mia.Datete_CA 311 - SCRATCH COAT NOTICE TO APPLICANT:If, cM1a ilg (a�-df Escmption,you should 313 - ROOF NAIL become subject to tW Workers Compensation provision of he Labor Cod,,you most OZ rorthwimcomply with such provisions orthis Permit shall he,deemed mvoked. 501 — FINAL ELECTRICAL ENERGY z Eti CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY F IWomYti0irmthat thereisaconwcdonlending agency for Weperformameof 503 — FINAL MECHANICAL ENERGY a. 0 thcwLender's work for which NamethisPermit isissued(See.J097,Civ.CJ Q 504 — FINAL BUILDING ENERGY W� 7 L <ndriAdeess 505 — FINAL ELECTRICAL U p 1 certify that 1 have mad this application and sum Nat the above information is 506 GAS TEST Ifr F corren.I agree to comply with all city and county ordinance and state laws relating to p U buuding c.nwn=Y heteby auWnme roprexmativn of this city'.enter upon the 5 FINAL PLUMBING W above-mend.ncUPmpcny for irctrimonpurposes. OB FIN a. (Wry 49MC to save,indemnify and keep blandest the City of Cupertino against C L h Babirtimsjudgments.ImeaanUexpenues which may inMYway accmcagainst aidCity 5 N t.) Z in consequence of me granting of this Permit. r SOURCE APPLICANT REGULATIONS.ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by51 NG Dale Srgeamre.f AppimaMComractorDare Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne applicant or fulum Wilding occupam smr,or handle hav4fdi us material az defined by the Cupertino Municipal Calc.CWpmr 9.12,and the Hcalth and Safety Code,Section 25532ddl ❑Yea ')�`N. All roofs shall be inspected prior to any roofing material being installed. Will the applicant of future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hmandous air contaminants az dcfincd by the Bay Area Air Quality Management all new materials for inspection. Dis ict? ❑Yes YNu 1 have mad Ne Wvafdnusmamrials requirements under Chapmr 695 of the Califon not Health&Safmy Calc,Savor 25505,2553 of 255M,l undersand that iflhc Wilding does not Currently have a mnam.beat it is m ponibill y to nobly the neap of W, myuiremcnts wM1' mu e(Morroi cc ofa cerdficam of win LI SlgnatureofApplicant Dale ownef.r.ut micdagent Date All roof coverings to be Class "B"or better (S Sri f s� d -Zvag✓11�?<3 IL l N m y N C C p 11 Ga gN =d � d3 � n . l �°� � I q � U � O N O � � PJn�•� 4lv/\ O d W y L C 'l ' N J I i CITY OF CUPERTINO 63 o v o CITY OF CUPERTINO PERMIT APPLICATION FORM APN # 6 Date: / 3 : Building Address: Owner's Name: Phone#: Con�ctor: w License#: �sc�ie,T Plu�,�ip aha( lQrs� 33SG/�l Contact: Phone -rP2 2L7�2 -7"�2�12 ro ApplicanVCoytr ctor: Fax #: in P_r �L�J7 Building Permit Info: Oi-� 222 , 2 -2 Bldg Elect Plumb Mech Job Description: Reeaa.ias Tc a s Residential: r j e ial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer:l Valuation: CJQ� - Type of Construction: Occupancy roup: QuantityFee ID Fee Description Fee Grou BAPPLOTHER Other A liances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi BUILDING BCONSTAXB Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING 13ELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Ener Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL N BNEWMULTI ew Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING I of 4, -?_4 Z ,97 CITY OF CUPERTINO • 011-ur PERMIT APPLICATION FORM CUPEkTINO Quantiq Fee ID Fee Description Fee Group BNUMULTI New Multi-family Res PLUMBING BOVERTEAE lnspection 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 Re2ipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pipe PLUMBING BPWHEATER Water Heater[Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPffT_ Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN — .A/C Units <= lopo cfm MECHANICAL BREMAPPLI �,221iance Install MECHANICAL BREM13USWAY Remodel Busways ELECTRICAL BREMFIXT Liohtina ELECTRICAL BREMFURN Relocation of Furnace— MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEA', Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL B B B B B B B R BR EM R R R R F F E E E E EA F INP 3U I H I X A S PL SW T T 0 C I Ay OV OD Hood E L =�E ELECTRICAL A Installation of Hoo ABB st c A aratus PJC B P Mis EC RE Rem Non-Res A liance ELECTRICAL Pole/Platform Fixture ELECTRICAL 1 BREMPOWER Power Device/Apparatus ELECTRICAL c t 81 t '4 BREMRECEVI' R 1, Switch & Outlets ELECTRICAL BREMRELOCA — Relocation of Hood MECHANICAL BREMREPALT —.Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Applinnce ELECTRICAL BREMSlGN ELECTRICAL BREMSIGNS oo Remodel Si s, Marquee ELECTRICAL L jBREMTHEA11R Theatrical Lighting Fix ELECTRICAL 2 of 3 CITY OF CUPERTINO Stain CITY OF PERMIT APPLICATION FORM CUPEkTINO �anfity Fee ID Fee Description Fee Group BREMVENFAN Vent Fan Single Duct MECHANICAL BRFMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING M Single& 2 Family —BUILDING BSFNA Single Family New Add BUILDING BSPECIAL S2ecial Inspection BUILDING BSWIM Swimming Pool BUILDING _BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electricals foot ELECTRICAL EPERMITFEE Elee Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL • PPERMITFEE Plumbing Permit Issue ' PLUMBING PPLBG Plumbing Fees foot PLUMBING ZADDCHG Address Change BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500E—Btu —MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5— Boiler> 1—.75M Btu MECHANICAL • 3 of 3 CITY OF CUPERTINos ' BUILDING DIVISION PERMIT wCONTRACTOWINFORMATION " BDILDINGAUDRUSS: FISCHER PLUMBING IS, CONST PERMrr NO. 20818 GARDEN GATE DR. 03010043 NER'S NAME: 2766 SCOTT BLVD APPLICATION SUB DATE DUANA NELSON 01/08/2003 PHONE: 408 727-2426 SANITARY NO. CONTROL NO. ARCHITEC HINGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH M02., LICENSED CONTRACTORS DLCLARA'1')ON a u— 1 bercby affirm that l am licensed antler provisions of Chapter 9(commencing Job Description eZw with Section 7000)m Division Sof Rhe Bmmessard ProfrAinns CuJe,ard Rny ticenm is r^ad in full totes and cl. OK ,f 3 /�� REPAIR HALL BATHRM �,,p�,q,� zo.y? l.Aense er s ` 3L ue.a NEW PLUMBING FIXTURE/NEW T> SO w>myd�,yDED OZFp Uam Cunvacmr FNq,� ARc111T1:CT'SDISLA b K yviyQ Iwlderuand my plansahall be used as public records ° JAN'2 8 2003 t-u. Licensed PnRlcsslnnal a OWNERBUILDER DECLARATION atala I hereby affirm that I on exempt from the Contractor's Lieeme law for me L. �S00 following reason.(Section 7031.5.Business and Professions Code:Any city of county BUILDING m which requires a permit In construct,alter,improve,demolish,or repair any structure _Zy ptio to its iss.ance.alsu magiics the applicant forschperminn file a signed statement a thatheislicensed pursuant to the provisions of the Contractor's License Low(Cha mr9 S Ft. Floor Area s=o d 9 Valuation rat- (nthe isc umpt ncroSectirnd andd(ff Of basis for theof alleged pion.nd Any Gtion of or i 3$ tate io is exempt tang indicant n m and Be hasis fm the alleged exemption.Any lineation Of $7000 Section than03 Sbyaundredicanlfor a rs(S50rmitsubjectsmeapplicantmacivilpenallyOf APN Number nm moa than five n.wmd donors(scan. 3 2 6 3 0037 . 00 Occupancy Type ❑I,as owner of the properly,or my employees with wages a their sole compensation, will do the work,and the sanctum is not intended or offered for sale Sic.7046,Business and Profusions Code:The Contacme,License Law does not apply m an owner of 101 — FOUNDArfgt�jred Inspections pmperly who builds or improve Ihemon,and who does such work himself orthrough his own employees.provided that such improvements are not intended or offered formic.If. 102 — PIERS however,me building or improvement is sold within one year of completion,the owner- builder will have me burden of proving that M did not build or improve for purpose of 103 — UFER aale). 104 — REBAR ❑ 1,as or,of the pfopeny,am exclusively contacting with licensed contractors to 1 O 5 — ANCHOR BOLTS construct the project(Sec.7044.Business and Professions Code:)The Contractors Li-aeLaw does not apply to an owner of property who wads or improves themon,and, 106 — SEWER & WATER who contracts lot such projects with a contractor(s)licensed puauam to the Contractor's License Law. 202 — UNDERFLOOR PLUMBING ❑1amexempt under Sec. B&P C for this match 203 — UNDERFLOOR MECHANICAL Dat 204 — UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION I hereby mllrm under Penalty of perjury one of the following declarations: 3O1 — ROUGH PLUMBING ❑I bars and will maintain a Cenificare of Conscrt to self insum for Worker'sCompen- satinn,a provided for by Section 3701 of the labor COde,fur the performance of the 302 — TUB & OR SHOWER work for which this perms is ksaued. 303 — ROUGH MECHANICAL ❑1 have and will maintain Worker's Compemation Insumnce,as required by Section 3 04 — ROUGH ELECTRICAL 3700 of the labor Code,for the performance of the wog for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: 305 — FRAME Carrier: Poll,Nx: 306 — HOEDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 307 — INSULATION (This section need Out he cnmpined if the permit is for are hundred dollars(5110)) 308 — SHEETROCK "ca") 309 — EXTERIOR LATH 1 certify mal in,an p a,,,rm f the p k! which this permit is issued.I shall not 310 — INTERIOR LATH employ anypccnia inanyma ws Wppc.mc suhjcynntlrc Wnrkcrs'Compcnxatinn AApppliaCarirnmia.Dam_ '��555////'7 311 — SCRATCH COAT NOTICETOAPPLICANT:eL' c ' g Rr t fExemption.you should 313 — ROOF NAIL hecome subject to the Worker's Compensation provisions of the labor Q,de.you must Z fistwhbeomplywithaachprovisions III this permilahall Ise deemedre„IXed. 501 — FINAL ELECTRICAL ENERGY z 0 CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY I hereby alllrm thin tactic is a clms.uction lending agency l its the perrormance of 503 — FINAL MECHANICAL ENERGY C > mework sName cbmispemthisiss.ed(ses.3(19zem.c.)Lan504 — FINAL BUILDING ENERGY W Q ,fdcr'a Add. �Z 1<ndcr'sAddrcss 505 — FINAL ELECTRICAL V O I cranny that I have mad this application and sate that the above lofmosmant is 506 — GAS TEST Il. corrcn.l ogres to comply with all city and county ordinances and sate laws mining to Q U building conswction,and hereby authorn,representative.aofthis City toenter upon the 5 FINAL PLUMBING W anovrmcmioncJ propcny for inspection purposes. O B %NFF y (We)agree m save,indemnify and keep hatmlcss the City of Cop odo against C L liabilities.judgment,costs and eapciocs which may in any way acerae against said City 5 E U z APPLICANce NDERthe STANDnting STAND WILL Issued by51 NG Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT SOURCE REGULATIONS. Signature of ApplicanUContrxctor Date Re-roofs' HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me applicant nr(.lore building occupant atom or handle hazardous material as defined by the Culaninu Municipal Code,Chantcr 9.12.and the health and Safety ode.Section 25531(a)+ ❑ LAll roofs shall be inspected prior to any roofing material being installed. Will the applicant lit mare but ace. equipment If a roof is installed without first obtaining an inspection, I agree to remove PP 6 rent use c t Ot device wblcn P •mit hatardnus air contaminants as defined by the Bay Area Air Quality Mawgcment all new materials for inspection. District? \> ❑Yes y_{NII 1 have read me havam.,brocrokox,iauarm,under Chapter 6.95 of he Califon ria Health A Safety Code.Scctirm25505,25534d 25534,1 understand that ifdle building tees not comently have.tenant.ma it ism spnnsibilily u,notify the Iecup 1 me lcquilcmcnL\wit ' mu e�pflll(1111 ceof.CCni(Il'ale�(k t1.N 8` Signature of Applicant Dale Owner oraat ari,.eaageIn Dale All roof coverings to be Class "B" or better