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03110049CITY OF CUPERTINO -- �a A xh' ` �rT p�k� ♦ ^� "�i CONTRACTOR INFORMATRA - BUILDING DIVISION PERMIT BUILDING ADDRESS: CAROL & TOM MAKDISSY PERMIT N00311O049 OWNER'S NAME: PERMIT ISSUE DATE CAROL & TOM MAKDI SY 2003 NE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing P with Section 7000 of Division 3 of the Business and Profession Code, and my license is in fell to.Andeffect. License Class Lm. M ELECT UPGRADE/LI I Data Ctolrnur ARCHITECI'S DECLARATION 1 understand my plans shall he used as public records APR f R © V 9 L 004 Licensed Professional - OW NER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the ' BUILDING following reason. (Section O031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish. or repair any structure prior to its issuance, also requires the applicant for such Permit o file a signed statement Sq. Ft. Floor Area Valuation that he is licensed pursuanOo the provisions or the Conlracmri Lice esu Law (Chapter 9 (commencing with Section 7")of Division 3 of the Business and Professions Code) or 36933024.00 Nat he is exempt imminent and the basis for Ne alleged exempliun. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of not more than Jr. hundred dollars 0 1, as owner of the property, or my employees with wages as their sale compensation, Required Inspections will do the work, and the swctom is not intended or offered for sale (Sec. 7844, Businesa and Pearessions Code: The Contractors License Law does net apply to an Owner of property who builds or improves thereon, and who deeasuch work himself Or through his own employees, provided that such improvements are not intended or otfered hostile. If, however, the building Or improvement is sold within one you orcomplchom the owner- builder will have the burden of proving that be, did not Wild or improve for purpose Of - sale.). 0 1. as owner of the pfopeny, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Codi The Contractor's Li- _ cense Law do. not appy to en owner of property who builds or improves Hereon, and . who contracts rot such projects with a canuactor(s) licensed pursuant to Or Contractors License Law. Ohne pt under Sec. . R h P C for this reason 0 6 4 DION WORKER'S COSATIO 1 hereby anion under penally of perjury, one Of the following declarations: I have and will maintain a Cardinale of Cement to self-insum for Workers Compon. sation, as provided for by Section 3700 of the Labor Code, for the performance of the - work rot which this permil is issued. 0 I have and will maintain Workers Compensation Insurance, as required by Section 3700 of the tabor Code, for the performance or the work for which this permit is issuN. - My Worker's Compensation Insurance carrier and Policy number am: Carrier: Policy No.: CERTIFICATE OF E%EM MON FROM WORKERS' COMPENSATION INSURANCE (This section need not hecomplmed irthe permit is for one hundred dollars ($100) leas) 1 cenify Nat in the perm onceof the work for which this permit is issued, I shall not employ any on' ae m a//eraheSyul Subject to the Workers'Compensetlon n pers Laws of a APPlicam can94 NOTICE PLICANT: IL after making this Certitude of ptiom you should ehor becomes b t to the Worker's Compensation provisions of Ne Cndc, you must forthwith comply with such provisions or this permit shall W deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affom Nat there is a construction lending agency rot the performance nr On work for which this permit is issued (Sec. 3W7, Cih, C.) Lender's Name ' Lender's Address 1 certify Nat I have read this application and won that the above information is - conecl. 1 agree to comply with all city and county ordinances and Ane laws relating Io building construction, and hereby authorin repreecmadves of this city to enter upon the above-mentioned property for inpection purposes. (Wo) agree to save. indemnify and keep homeless the City or Cupertino against Iiaemses ireenonhecosts and expenses which may in any way sector against said City of the granting or this per mit. �1 Aconseq NT APPL NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SO 7 REGULATIONS. v .Date ! Re-roofs Type of Roof ✓ ig lure ofApPl' HAZARDOUS MATERIALS DISCLOSURE Dam Will the applicant or future building occupant amen or handle harsrdous mammal as defined by the Cupertino Municipal Code, Chapter 9.12, and the Hcallh and Safety ode. Season25532(e)? ❑ Yes 1:INd, 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 Wilding «spam use equipment or devices which it hazardous air contaminan6 e foul by the Bay Area Air Quality Management all new materials for inspection. ialricl? /./I( YCs lT 1 ban real the haraNnusmamrials mquiremenm under Chapmr(.95 of the Califor- niaHoal Safety Calc, Sccdons 255(15, 25533 and 25534.1 undcmmnd thmif de Wilding rota t c rtently bow a mnanl, Nat it is my r.ponsihility m nntil'y rbc a<upant of Ne mqu'em over, h .1bayf�r;7G i rACemncateofOce a a Signature of Applicant Date All roof coverings to be Class "B'.' or better nr wiffimixed agents Date f CITY OF CUPERTINO Ah CITY OF CUPERTINO PERMIT APPLICATION FORM l 7S- z-- 1 of 3 Date: f I Building Address'. /n ,53 1p a C'`jq Owner's Name: /eO1 / f Phone #: Contractor: y S License #: Contact: Cupertino Business License#: Building Permit Info: Bldg ❑ E c ❑ Plumb ❑ Pech Job Description: Residential ❑ 4?�Oial I— Sq.Ft. Floor Area: /Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: 47 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 7S- z-- 1 of 3 ,day CITY OF CUPERTINO CUP TVOF 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 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 Permit Fees BUILDING BPFIXTURE —Bldg 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 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 BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfrn 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 Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 Cm OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM uanti 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 BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimmina Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTM"SVCS Ternp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL IAPERMFEE Mechanicals . foot MECHANICAL I MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 re •