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03030157C CITY OF CUPERTINO 0NT"GT0R ?4,'0RMATTQN - BUILDING DIVISION PERMIT BUILDING ADDRESS:E QGSQ DR I rf LA MAR OWNER'S NAME: �U (J (C7' IQA PERM18/2003 E: SANITARY NO. CONTROL NO. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description oP 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Buain vv and Net csaions Code. and my license is infall force and effecu. ADD 473 SQ.FT./REALIGN GARAGE/RELOCATE KITCHEN License ClassLic.is Date Contractor UPGRADE INTERIOR TTr ARCHITECTS DECLARATION I understand my plans shall be used a public records MAR 1 7 2004 Licensed Professional OWNER -BUILDER DECLARATION 1 herchy. that 1 exempt fmm the Contractors law for the Profession. Code: Any city orcounty 9(131.5, Business antl e: Any c followingreason. (Sec 1. improve, permit ro eonetruet, alae improve, demolish, or repair any avumum which squires errant Prior to its issuance, also myuires the applicant for such permit to signed stammem n Sq. Ft. Floor Area I that licensedpSection7 th)pmvisionsoftheCo License Cnde)ser me usines'snProfLaw(C Code) or (commencingwith Division of the Businessandon. 8175000 herefro ado( Any that he u exempt therefrom and the baso for the alleged exemption. Any vinlarfon of APN Number Occupancy Type Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of not mare Nan five hundred dollars ($500). 36910019.00 01,uownerof the pmpeny, army employes with wasesu their sole eompensa0nn, RRe�qq [@d Inspections will do the work, and the awcture is natimended oroffered forsale(Sec.?044, Business and Profusions Code: The Contractors License Law docs not apply a an owner of property who builds or improves thereon, and who does such work himself or though his 101 - FOUNDAT i ON own employees, provided that such improvements are not intended oro@red formic. If. 102 — PIERS bowever, Ne building or improvement is said within one year of completion, the owner - builder will have Ne burden of proving Nat he did oat build or improve for purpose of 103 — OF ER Sale'I' 104 - REBAR 01. as owner of the property, am exclusively contracting with licensed contractor to 105 ANCHOR BOLTS consumer ND pmjecl (Sec. ]044. Business and Professions Code:) The Contractor's Li. — wide Lowdoesnet apply10 an owner of property wheWild, thimp rovesthemnn,and 106 - SEWER & WATER who contracts for such projects with act rmixer(s) licensed pursuant to the Contractors LomeLow. 202 - UNDERFLOOR PLUMBING ❑ I son exempt under Sec. . B h P C for this reason 203 - UNDERFLOOR MECHANICAL Owner Date 204 - 205 - UNDERFLOOR FRAME UNDERFLOOR INSULATION COMPENSATION DECLARATION I newt,alErrn ander Penalty of pe do, one of me following declarations: 301 — ROUGH PLUMBING . have and will mearrom a Ccrtificme of Coastal to self -insure for Worker's Crimper- .azpmvided for by section nao or the Labor endo, scuba performance of the 302 - TUB Sc OR SHOWER Wfar which this Permit is issued. IcamWORKER'S 303 - ROUGH MECHANICAL have and will maintain Worker's Compensation Insurance, m squired by Section of Me labor Code, ter the Performance of the work for which this permit is issued304 - ROUGH ELECTRICAL orkers Compensation Insurance carrier antl Policy number am: 305 — FRAME+er: Policy No: 306 - HOLDOWNS CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE 307 - INSULATION (This section need not he completed robe permit isroronc hundred dolars(g1aB 308 — SHEETROCK or leas.) 309 - EXTERIOR LATH I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so a to become subject to the Workers Compensation 310 - INTERIOR LATH Laws of California. Date 311 - SCRATCH COAT Applicant 313 — ROOF NAIL NOTICE TO APPLICANT If. after making MRS Cmonsof of Exemption, you should Inc Worker's Campeor provisions of the labor Cade, you suer become scoop 501 — FINAL ELECTRICAL ENERGY forthwith comply with such provisions or this permit shall bedeemed revoked. y this 502 - FINAL PLUMBING ENERGY CONSTRUMON LENDING AGENCY I hereby affirm Nat there is a can swetlon lending agency for the performance of 503 - FINAL MECHANICAL ENERGY forwhich Mrs permit is issued (Sec. 309?, Civ. C.) 504 - FINAL BUILDING ENERGY Lffic end5s Name Lender's 505 - FINAL ELECTRICAL Lender's Address j 1 certify that 1 have read this application and sista that the shove information is 506 - GAS TEST correct. I agree to comply with all city and county oNinances and sate laws relating on building construction, and hereby autnmier representatives ofthis city to enter upon the — FINAL PLUMBING fm iemnifyand l above -(we) L to averty keephs. greead (We) made to save, indemnify and keep harmless rhe City of Cupertino against liabilitics,judgmcna.cosls and capcnscs which may in any way acerae against said City VI—*FI in cnnuyuence of the grunting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: ING SOURCEREGULATIONS. _ Re -roofs Type of Roof Sianawre of ApplicaDale HAZARDOUS HAZARDOUS MATERIALS DISCLOSURE Will theapplicant orfuture building occupant store or handle hametions and Safety az defined by the Cupertino Municipal Code, Chapter 9.13. and the Health and Safety lifilme. Section 255]2(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes ❑ No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which RItin, hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. ❑Yes C1 No 1 have read Ne bazsrdous maadals requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505,25533 and 35534.1 understand that tithe building does not currently have a ¢nam, that it is my respenchility to notify Ne occupant of Ne requirements which must li, met poor in issuance of a Certificato of Occupancy, Signature of Applicant Date All roof coverings to be.Class "B" or better Owner or aa,h.ri,.cd agent Dore CITY OF CUPERTINO� BUILDING DIVISION PERMIT CONTRACTOR INFORMAW BUILDING ADDRESS: PERMIT NOO 3 0 7 0 0 7 3 OWNER'S NAME: PERMIT ISSUE DATE NELSON ALBERT P AND MARY E 07 PHONE: '/10/2003 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L= 0 0 0 O p LICENSED CONTRACTOR'S DECLARATION Job Description U (- 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing Z w with Section 7000) of Division 3 of the Business a Professions de, nd my license is ?may ) � Z in roll rct`and Tees �,s Liccns sr p REVISION --IN HOUSE USE ONLY �t - Dat �' con ctor ARCHITECTS D RATION NO NEW PERMIT ISSUED, ORIG. 403030157 a < understand my plansshall he uscd.as.p blit records CONTRACTOR: STONY RIDGE CONSTRUCTION (07/10/03) )wu p y Licensed Professional w OWNER -BUILDER DECLARATION <2 1 hereby affirm that I am exempt from the Contractor's License Law for the t D following reason. (Section 7031.5. Business and Professions Code: Any city or county K $ 0. o Z y which requires a permit to construct, alter, improve. demolish, or repair any structure prior ht its issuance, also requires the applicant for such permit to file a .signed statement Sq. Ft. Floor Area Valuation E = p that he is licensed pursuant to the provisions of the Contmctur's License Law (Chapter 9 r t— (commencing with Section 70(]0) of Division 3 of the Business and Professions Code) or $175000 i that he is exempt therefrom and the basis for the alleged exemption. 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 five hundred dollars ($500). 3 6910019.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business Required Inspections and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who docs such work himself or through his own employees, provided that such improvements arc not intended or offered for sale. If, 101 — FOUNDATION however, the building or improvement is sold within one year or completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of 10 2 - PIERS sale.). 103 - UFER ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to 10 4 - REBAR construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li cerise Law docs not apply to an owner or property who builds or improves thereon, and . 105 — ANCHOR BOLTS who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law, 106 - SEWER & WATER ❑ I am exempt under Sec. . B At P C for this reason 202 - UNDERFLOOR PLUMBING Owner Date 203 - UNDERFLOOR MECHANICAL WORKER'S COMPENSATION DECLARATION 204 - UNDERFLOOR FRAME I hereby affirm under penalty of perjury one of the following declarations: 205 - UNDERFLOOR INSULATION ❑ 1have and will maintain aCertificate ofConsent toself-insure for Worker'scumpen- cation, as provided for by Section 3700 of the Labor Code, for the performance of the 301 - ROUGH PLUMBING work for which this permit is issued. 302 - TUB & OR SHOWER ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 or the bor Code, for the performance of th work for which this permit is issued. 303 — ROUGH MECHANICAL ((((((My��^�,,W,orkc' ompnsationlnsurancccarrier Policynmberare 304 - ROUGH ELECTRICAL 'Act: CERTI Policy No.: IC—ATE OF MPTION FROM WORKERS' 3 05 - FRAME COMPENSATION INSURANCE 306 - HOLDOWNS (This section need not he completed if the permit is for one hundred dollars (5100) 307 - INSULATION or less.) 308 - SHEETROCK 1 certify that in the performance of the work for which this permit is issued. I shall not employ any person in any mannerso as to become subject to the Workcri compensation 309 - EXTERIOR LATH Laws o(California. Date 310 - INTERIOR LATH Applicant NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should 311 - SCRATCH COAT Zforthwith become subject to the Worker's Compensation provisions of the Labor Code, you must 313 — ROOF NAIL Z comply with such provisions or this permit shall be deemed revoked. 501 - FINAL ELECTRICAL ENERGY , r� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 502 - FINAL PLUMBING ENERGY Ix W Q the work for which this permit is issued (Sec. 3097, Civ. C.) Name Lender's503 - F I NAL MECHANICAL ENE a z LcndcisAddress 504 - FINAL BUILDING ENER U 0 1 certify that I have read this application and state that the above information is 505 - FINAL ELECTRICAL correct. I agree to comply with all city and county ordinances and state laws relating to 0 U building construction. and hereby aulhorim representatives of this city to enter upon the GAS E S T H a above-mentioned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against 0 7 N FIN Cn liabilities, judgments, costs and expenses which may in any way accrue against said City 5 A I CAL U Z in consequence of the granting of this permit. APPLIC NDERSTANDS AND WILL COMPL H ALL NON -POINT Issued by:5 4ate( 4 S R ULATIONS. — Signa rco(Applic�aVContractor 7��a��Re-roofs 54 - Lj INAL PUBLIC WORK HAZARDOUS MATERIALS DISCLOSURE Type of Roo Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code , Section 25532(a)? E] Yes All roofs 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 or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑ Yes [ u 1 have read the hazardous materials requirements under Chapicr 6.95 of thc Cali for- nia Hcalth& Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building IV not c'ITent have a tenant that it is my msponsihility t o the occupant of the rc i is ch must bcmet prior tuissuance o(aCcrtifi ate or cupancy. Signature of Applicant Date All roof coverings to be Class "B" or better wrier 'or authori'icd agent ate I C, aa, Y OF CUPERTINO CITY F R `r " CUFF -riNo PERMIT APPLICATION FO APN # 1 / fI ( Date: Tq-o�> Building Addr s : 6q Mailing Address (if different from building address): La Maw Dr i u -e- Owner' Na . e: Bldg Permits . foot Phone #: qac Contractor: Boiler <= 100,000 Btu License #: t C� Conta t h Phone: Yo j-'t-tO-` 070 Fax: Cupertino Business Tense#: B mg -?e '' i Info: Elect ❑ Plumb Mech ❑ Job Description: Residential 64 Boiler > 1 M to 1.75 M Btu MECHANICAL Sq.Ft. Floor Area: Boiler > 1.75M Btu $/Sq.Ft.: Cost of Project: Construction Tax Occupancy Group: Type of Construction: Ind/Off/Comm/ uasi Please check this box if the project is a second -story addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > l OOK to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1 M Btu MECHANICAL BBOILER4 Boiler > 1 M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi 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 1 of 3�.....% / F I'ln a ( CY OF CUPERTINO CUP TY OF O PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCON19M 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 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 Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo 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 BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin 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 Mise Apparatus ELECTRICAL BREN2 RAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPEf�TINO CITY OF CUPERTIP , J PERMIT APPLICATION FORM 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 Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL RSC BT.VD Scb Snecific 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 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: OWNER'S NAME: PHONE: A RCHITECf/ENG I NEER: 0 p LICENSED CONTRACTOR'S DECLARATION m I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing Zwith Section 7000) of Division 3 of the Business and Professions Code, and my license is r a a in full force and cffccL Licences Class Lic. • p Dam Contractor 1 C ARCHITECTS DECLARATION `d< 1 understand my plans shall be used as public records 7aU O H Licensed Professional 0 j OWNER -BUILDER DECLARATION ja 1 hereby affirm that I am exempt from the Contractors License Law for the n O following reason. (Section 7031.5. Business and Professions Code: Any city or county which requires a permit to construct. abet, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement - Z < that he is licensed pursuant to the provisions of the Contractor's License law (Chapter 9 7 F=- (commencing with Section 70(10) of Division 3 of the Businessand Professions Code) or r that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contactors License Law does not apply to an owner of property w ho builds or improves thereon, and who does such work himsel for through his own employees, provided that such improvements are not intended or offered for sale. If. however, the building or improvement is sold within one year of compbction, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractors Li- cense Law docs not apply to an owner of property who builds or improves thereon, and who contacts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ 1 am exempt under Scc. . B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker'sCompen- sation. as provided for by Section 3700 of the labor Code. for the performance of the work for which this permit is issued. ❑ I have and will maintain Workers Compensation Insurance, as required by Section 3700 of the labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thissection need not becompleted if the permit is foronc hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to Ox Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must Z forthwith comply with such provisions or this permit shall be deemed rcvoked. Z O CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of x the work for which this permit is issued (Sec. 3097, Civ. C.) 0Lender's Name 3. Lender's Address Z)z C) I certify that 1 have read this application and state that the above information is Pcorrect. I agree to comply with all city and county ordinances and state laws relating to U building conswction, and hereby authorirc representatives of this city to enter upon the w above-mentioned property for inspecuon purposes. LL (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City ,Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store orhandle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Sccuon 25532(a)? ❑ Yes ❑ No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District? ❑ Yes ❑ No I have read the hazardous materials requimmens under Chapter 6.95 of the Califor- nia Health & Safety Code. Sections 25505.25533 and 25534.1 understand that if the building docs not currently ham a tenmL that it is my responsibility to notify the occupant of the requirements which must be met priorto issuance of a Certificate of Occupancy. PERMIT ISS 0 tD"/18 / 2 0 0 3 SANT IARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description ADD 473 SQ.FT./REALIGN GARAGE/RELOCATE KITCHEN UPGRADE INTERIOR Sq. Ft. Floor Area atlon APN Number Occupancy Type 36910019.00 101 - FOUNDAT ONd Inspections 102 - PIERS 103 - UFER 104 - REBAR 105 - ANCHOR BOLTS 106 - SEWER & WATER 202 - UNDERFLOOR PLUMBING 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION 308 - SHEETROCK 309 - EXTERIOR LATH 310 - INTERIOR LATH 311 - SCRATCH COAT 313 - ROOF NAIL 501 - FINAL ELECTRICAL ENERGY 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGY 505 - FINAL ELECTRICAL 506 - GAS TEST 60 IFINAL PLUMBING - FIN�r, MF( NA�TC1aL iii f'� � n •' of •• All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date Owner or authorized agent Dam All roof coverings to be Class "B" or better CITY OF CUPEK rINO k.-tTY OF CUPERTINO rt PERMIT APPLICATION FORM., APN # Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot Building Addres : BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu Owner's Name: BBOILER3 Pho MECHANICAL 7 /N1,/sC �, Boiler> 1M to 1.75 M Btu zss� BBOILERS Contractor: MECHANICAL Lice #: Construction Tax Contact: BCONSTAX Cupertino Business License#: Building Permit IInfo: BCONSTAXBQ Con. Tax for BQ Zone Bldg C2` Elect El-. Plumb C'- Mech Hotel and Motel Job Description•(� �/ " `'"�driimerIl�/ Constax — Resi/Mobile Residential Lys �"?/ Elec 600V <= 1000A Sq.Ft. Floor Ar�/, / $/Sq.Ft.: ELECTRICAL Cost of Project: Elec Svcs 600V <= 200A Occupancy Group: ' BENERGY 4-7 D ` BENERGYADD Energy Add Multi Type of Construction: , BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING r W 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 BBOILERS Boiler > 1.7SM 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 1 of 3 CITY of CUPEkTINO %,QTY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI 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 BNUIVIULTI 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 W"u"" 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 rinkler/Backflo PLUMBING BPSTORM StormlRain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <=10,000 cfiu MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL V 31 C— . 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 2 of 3 r CITY OF CUPEKrINO CITY OF CUPERTINO PERMIT APPLICATION FORM 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 Signs, Marquee ELECTRICAL . w 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 BSPECLU Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEIVIPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL � EPERMITFEE Elec Permit Issuance ELECTRICAL s 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