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03060201 CITY OF CUPERTINO r -a'a `�vr@'s.~➢ 'sM»+"t* �-5v"' '-- ?d BUILDING DIVISION PERMIT CONTRACTOR£4NFORMATION `,: BUILDING ADDRESS: H &^_ H CO PERMIT N003O6O2O1 OWNER'S NAME: 725 PIERCY RD PERMIT ISSUE DATE NE: (408) 224-7777 AIS. CONTROLNO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ±Op LICENSED CONTRltoulaSOECLARAT ON hap Job Description I U 1 Wrehy affirm that 1 em licenud under provision ors Code, 9(commencing P With Section 7(Mkry of Division J of the Business and Professions Code,and my licenseis + � imm�rn eandpfrec 7 7 SEWER LINE �gr4A �4 :cense Clan Cf-36 Lic.N - mF Conlranor _ ARCHITECTS DECLARA N I understand my plans shall WusCd.a public rt,Or ,W JUL 0 8 200 CO.O Licensed Pmfcssional o 1 OWNER-BUILDER DECLARATION Y' 2<F 1 hereby affirm ® that 1 am exempt from the Contractors License law for the BUILDING C Q 0 following reason.(Section 70]13,Business and Professions Code:Any City or county �N 5$ which requires a permit m Construct,offer,Improve,demolinn,or repair any structure prior in its issuance.also requires the applicant for such Permit to rile a signed statement < that he is licensed pursuant In the provisions offile Comacmr'sLicense Law(Chapter 9 Sq.Ft. Floor Area Valuation - e (commencing with Section 7")o(Division 3 of the Business and Professions Coda or y ct3 3 that he is exempt therefrom and the baso for the alleged exemption.Any violation of 37533024 . 00 Section 7071.5 by any Applicant for a pawn subjects the applicant to a civil penalty of ppN Number Occupancy not more than Bw hundred dellan($500). P y Type �1,u owner mf the pnpcny,or my employm with wages u their sole compenatlon, will do dfe work end Ne awaurt is notinfended oroffertd foude(Sec.7844.Businua and Professor.Code;The Contractors Liunu law don not apply or an owner of 2 0 2 - UNDERF 20 PL eCIiof NG progeny who builds or Improves Hereon,and who doessucn work himself or through his tS 1 own employees.pnvidcdthat such improvements ace not Intended oroRered formic.If. 301 — ROUGH PLUMBING however,the building or Improvement is within one year of completion,the owner. builder will have fie burden of proving that he did not Wild or improve for purpose of 507 - FINAL PLUMBING sale.). (]1,a owner of the property,em exclusively convecting withlicenud contractors to construct the project(Sec.7(o00,Business cad Professions Code:)The Contractor.Li- cene law does not apply to an owner of property who Wilds or improves Ramon,and who contracts for such projects with a conuaccor(s)licensed punu ser a to the Contractors License LAW. ❑1 am exempt under Sec. .B k P C for this on Owner Date WORKER'S COMPENSATION DECLARATION 1 hemby affirm under penally of perjury on of the following declaration: "'and will maintain a Cafflarte or Consentto ulf-iaure for Workers Compen. sation,as provided for by Section 3700 of the labor Code.for the performance of Ne work for which this permit is issued. 0 I have and will maintain Worker's Compensation luunnce,as required by Section 7700 of the labor Codc,portion,raform r ce of Ne work for which this 7permit is issued. and Policy number am: C YC`rkersSTAaCom s 'on lnwrscarie Policy o.:I_5 6ATJ4:�we}. rIn... CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This unite need not W completed i(the permit is rte one hundrtddollars(310th) err Mss) 1 certify that in the Performance of the work for which this Permit is issued,1 shall not employ any Person in any manner an In to baCOMC Subject m the Worker:Compensation - Laws of California.Dau Applicant NOTICE TO APPLICANT:IL afar making this Ceni0cate of Exemption,you should become wbjech 10 the Worker's Compensation provisions or the Labor Codc,you must J O forthwith comply with such provisions or this permit shall W deemed revoked. yN CONSTRUCTION LENDING AGENCY [-+ Iheron M.that there iso Construction lending agency for the perfurmamc OF C the Work for Which this permit Is issued(Sec.3M.Civ.C.) W Q Latices Name Lenders AddreaS oz C)Q - . certify Na I have read this application yW sins tan the above Sus relating is to C)U comply and herebyall cirywd coumyoNinanttund star laws Upon the pU building construction,and hereby euthon purposes. niwsuf this City manor upon the W above-mentioned(Waree 1. awerty,for inspection keep ha. W (We)agree m save.indemnify and keep harmless the City of Cupertino against Cr!) incomearrJudgmentsecostsand expennmit. mayin any way accrue egeinslacid Cily V z A APPLICANT or DERST N of this permit. " APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR E�t GULA tBla7� (� Re-roofs Signature of Appli ter Das 1 HAZARDOUS MATERIALS DISCLOSURE Type of Roof �so Will theapplicant ser(municipal ooccupantnomor auntie hazardousd Safe(,u defined by the Cupertino Municipal Coo,Chapter 9.13.and the Health and Safety ,aaLcouqu. ow All roofs shall be inspected prior to any roofing material being installed. Yea Will the applicant or lot 9u WBdlmgaccupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hazardous air contaminants�a�/defined by Inc Bay Arta Air Quality Management all new materials for inspection. 7.H.I"S.f.tyC�.S.,6.M505,25533.d25534.1.n��ifft icl7 �t �Yca I have real the h iaNtws maocouls equiremcnta under Chapar6.95 of the Califon m�dthniHle Wilding ntcurrently how a lensna Nath u mymepOnihility w notifytM occupantn(the nmwMcnmuscmnptiorwissuxeccoraCcmricamoraeupmcy. Signature of Applicant DatC er Or amhOr dagent Das All roof coverings to be Class nBn or better CITY OF CUPERTINO ' CITY OF PERMIT APPLICATION FORM CUPEfi;TINO APN# Q Date: 0� Building Address: S Owner's Nam Phone#: r Contractor: D 5 License#: 75 -5973 Contact: T Cupertino Business License#: rBu' g Permit Info: ld Elect ❑ Plumb Mech ❑ kfi/DeWption: Re ential ❑ 5e`"er Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: a�— Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BB01LERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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 > IOOOA 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 �,zJ3 Lf 1 of 3 lk� z9s. l n r �'LL CITY OF CUPERTINO c'TM° CUPEI�TINO 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 BNUCONEYM 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 BOVERTME Inspection Overtime BUILDING BP13ACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping S stem.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 Stom1/Rain 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 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM 3USWAY Remodel Busways ELECTRICAL BREMFD{T 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