03020111CITY OF CUPERTINO�'+'.'�
^
BUILDING DIVISION PERMIT,CdNTTte1',
CTOR INFMATIOIVI
LD
BUIING ADDRESS:
uEuAR ROOFING
PERMIT NO.
10684 RANDY LN
03020111
WNER'S NAME:
12510 FOOTHILL AVE
PERMIT ISSUE DATE
MANNY MACIAS (AGENT)
02/26/2003
NE:
-
SANITARY NO. CONTROL NO.
ARCHITECDENGINSER:
BUILDING PERMIT INFO
BLDG EIPLT PLUMB MECH
0
LICENSED CONTRACTOR'S DECLARATION
]Ob Description -
I hereby arlhm that 1 am licvncd umkr pro lona of Chapter 9 (commencing
with Section,] 001)f Division 3 ofthe Eminesa ofculam Cade.andenyllmamis
.
In fullfarce nRydffecL
REROOF
Lice. R Clua✓✓/`�_� d - 3 Lk. x
De Conv
ION
.�s Q A
' N A
1 understand my plan Ntllillm cd u public records
O ®E
APR 17 2003
Limmed Profes,lonal -
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
Following Ruon. (Seed.. 1031.5, Busluou end Professions Code; Any city or county
-
which requiaea a Permit to construct, altar. Improve, demolish. or repair my strocture
'
prior to its run=. also requires the applicant for math permit to Ills a signed statement
- Sq. Ft. Floor Area
011
that he is lluruW punumt to the provision of do ComrmRfa LameW Low (CnPm9
(commencing with Seen.. 7000).( Division 3 of the 11ninessand Prafessimu Code) as
_
But he Is exempt therefrom and the basis for the alleged exemption. Any violation of
Occupancy Type
Section 7031.5 by my appliant fm a permit subjects the applicant to a civil penalty of
not mom Nan live hundred dollars (5500),'
❑ 1, u owner of the property, or my employees with wages u their solo compensation,
will do to work• and theswauR is not intended or offend for sale 7Dµ Business
and Pmressinns Cade: The Commune, Lu mase law does not apply is an owner of
�p�,�NN11[8d Inspections
307 � - INSULFY7'II V 1V p .
property who buildior Improves theaem, and who dmssmhwmk himself or through his
601 ROOF .OFF .. o
awn employees, provided that such Improvements me notim ended orolfemd forsole. If.
- .TEAR
however. the building or improvement is said within one Sem of completion, the mrsr•.
602 r ROOF PLYWOOD NAIL '
Wilde' will have the burden of proving that M did not build or Improve for purpose of
-
"]a.).'
603 - ROOF BATTENS
❑ 1, as owner of the property, am exclusively contracting with licensed cmuacmn to
604 - ROOF IN-PROGRESS
contract the projen (Sea. 7014. Business and Profusion Code:) The Conuacas LI-
CCC Law does not apply le an owMf of property who builds or Imprnwa NGRon. and.
N
who cautious for such pmjuts with a eonuactor(s111ttnsed Panum, in the Contractor's
License Law.
,
❑ I an exempt under Sec, .B&PCforthIoreuon
water Dau
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of the following declarations:
I have and will maintain• CenlfrcusafConsent (a eelbbnu , fm Workers Compcu-
-
"lien, u provided for by Section 3700 of the labor Cade, for the performance of the
work for which this permit is luted.
❑ I haw and will maintain Worker's Compensation insurance. u required by Section
3700 of Ne labor Code, far the performance of dR work for which this Permit is Issued.
W�My pcwdon Iw rex nr'i\m end Paliry num sac y � �
Cajdv u�!/POIIry No.•
U3
v CERTIFICATE OF EKFMPf10N FROM WORKERS'
COMPENSATION INSURANCE
1
(Th esedilon need not he completed if the permit is foram hundred dailm(SIM)
,
- .
sok")
1 unify that in that permamane of the work for which this Permit is traded, l shall not
employ any parer, in my manner m as he become subject to the Wurken' Compenatlon
Law, of Celifomia. Date
Applicant
NOTICE TO APPLICANT; IL after making ink Certificate or Exemption. you should
become subject to the Worker's Compensation provisions of the Labor Code, you mum
foMwith comply with such prevision or this Permit shallha deemed revoked.
CONSTRUCTION LENDING AGENCY
. Ihareby alErm(hot theve is a coautructimm lending agency for the poolumara eat
the .,it far which this permit It blued (Sec, 3M, Civ. C.)
Landes Name
- -
Lender's Add..
. 1 certify Nat I haw and NIs applindan and sub that the above information is
Corea 1 agree to comply with sit city and county ordinances and mule Iowa relating to
'-
building convection, and hereby mthodac mposema iwo of this city to enter upon the
slave-menionol property for harowdon per)waes.
,
IIobllltl(We) Almento cavo i had ape y and k eh hathe Cityalai,
of Cu atan "id Cly
(We) agRe to saw, indemnify and techmay
inhandled, the CITY of against
In consequence of the granting of this pc h.
APPLICANT UNDERSTAND 'WILL COMPLY WITH ALL NON-POI T
Issued by:. Date
SOURCE LATIONS.
Re-roofs
Type of Roof
S' um Applican at tan te
A2ARDOUS MATE IS DISCLOSURE
rll Ne app cam or fuwR building arupnumm or handle hmurdaus material
_
u de0ned by the Cupertino Mu mdpal Codc, ChaPrer 9.11, and da Health and Safety
-
uo.seaienzss3l(M7
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 "
Wits the mPlicmt amt budding occupant nm equipment m demes winch
II haumaus air contaminants in d by f Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes ❑No-
I have mad the WwAblus matarlalamyuiremcnts under Chapter 6.95 ordm Califon
nix HculN&Safety Coda Seedon25505, 2553 end 15531. IundcRmnd Nat lithe Wilding
j
- 03
dna not currently haw a ummi, me s reaponib0ity m notify occupant of the
1
mquimmenu hmuRbsompd ant u e aCCNRcsta or cupan
a re Of ppl iC t e
o
�. All roof coverings to be ClassB or better
merman mirnda c Dom
CITY OF CUPERTINO
auILDINC DIVISION PERMIT
C( Nim ' `G'T��Ra�®N-
.tsx'STW3«^Ci'1:..•:f.
BUILDING ADDRESS:
UEDAR ROOFING
PERMIT NO,
10684 RANDY LN
03020111
WNEWSNAME:
12510 FOOTHILL AVE
t n'MUEDATE
.MANNY MACIAS (AGENT)
02/26/2003
me
SANrrARY NO. CONE OL NO.
ARCHMECTIENOINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMS MErHS
LICENSP9 CONTRACTOR'S DECLARATION
I harchy affirm that l am licerucd ander of Ctupkr9 (wmmeaeint
withSeelian rIIlvislan3ordtoautluaa fesxlwucode.andmyliccnsois
Job Description
In full roeee JLWMZ _ 3 � '
REROO F '
-
LSccfta Clu Lk. q
DamCan
f7Etedi RATION
�!
FINALE®
f unden:aed my planaabill hatauad n public c
rarda
•
'
. AP 1 LUU�
Ltceeaed Proreulonal
OWNER -BUILDER DECLARATION
• f hercby affirm that 1 am exempt frmn the Caarraciora Uccnae Law for ft-
rallowing tcaaon, (Seedan IMI -S, Ruximu and Pr adona Code, Any city or eoumy
which require a permlt to canis, aha , hapfon, dcmollth• or repair any Mature
Prior 10 its Iuuariec. Lila rcqulrrs the oPPlieaat for lush permit to Me a Signed lmemcnl
11,11heia(icon¢W�:rswnfratheproWslm�scitlraCanlncwtaLl�snuE�r(CMprcr9
•,�
Sq. Ft. Floor Area on
(rbatmendn�t.3df Section 7otlo)ar Olvtslaa ] nr fF.e Sasieeaa and Pratuslana Cade) ar
.
■Rat he It exempt therefrom and dra baric for dz alksed esemplon. Any vfolatron or
'
•
eT Occupancy Type
section 7031.5 by airy applicant for it permit subjetu the oppltcauto a civil penthy or
net mare that Tlve hundred doMum (S500),'
❑ 1, as orraer of the property. or my emplopeea with wstea u their Wo eompeawtltta
will dothe wok and the strvnam U not Intended oroffurd far talc (Sec, 7041, Bualrt ss
and Prvrejeons Code: Tao Commiaeo Llanes Law dou nal apply to in owner Of
307 — INSULAIk SI j%d Inspections
property whnhatldiorimpromthereon, ■ dwho doetw:hwark:Nmaclrarth=2bblt
own empleyxes,Provldedtlatatshlmprovemmuare eatfrucadcdorelremdforE&If,
601 - ROOF .TEAR -'OFF
bowever, rht building or lmpmvemeat (■ LoW within oat year of compirtion, theaw=- -
602 - ROOF PLYWOOD NAIL'
Wider will have the burden arprovin4 this Inc did frac bultd or (mprame forporpare of
603 � ROOF BATT$NS
❑ 1, u owner of the propesry, am excladvely eontracrins With Iletn" em:vterot■ m
604 — ROOF IN—PROGRESS
eaaaaua the project (Ser. 7044. Huainea and Prof=dmu Code:) The Caouaetoel L.]•
ane Law dant car apply to to owncr of property wlm ballda or Impravrs thereon. and ,
who cantrtcu for such projects with a eontnrror(t) licensed punuanr ta the Contraaats
r
Lken¢ Law.
a 1 am exempt under See H dr p C fm ibla teams
wner Dae
WORKERS COMPENSATION DECLARATION'
I hereby afllrm wderpemhy orperiwyone omt fonew(nji &&,railanc
f hmand will maiaufn a Certiricotaof Concent fo salf4 uure for WarkdsCampea•
tn, u provided for by Sectlmt 3700 of the Labor Code• for rho perfomunee or dee
,
rk for which thir parmltia irsaK
❑ 1 have and will mOntaln Workm's Campenastloo lrurvamce, u rsquhed by Sccdon
1=.
3700 erdw Laha farthc perfarmancc orthework for which Udo permit Is tuued,
,
My mrter'a Compensation L=O= Major and Palsy
Copier, Paltry Na: 7`
' CERrIpICATEOFP.7CEMPr(ONFROMWORKERS
COMPENSA31ON INSURANCE
.
(Wil ellonneed nothewmpleUtflhopermhisforenchandr0dallat(SIGM
arlea�)
I artliry flur In dre perfnrmL= Lithe work for which tlds permit is InirA l Hall not
emp1ayanypersaninsnymannarmntobecamerubjrctto1h:Wo4b:WCompm"don
'
Laws of California, Data
Applicant
NOTICE TO APPLICANT, It. Mu mating tido Cenirsate at Exemption. you thoabl
bccoree aabject to the Worker's Compeaudon pmvlsioat or k LaharCodc, you muu
;
fonhwithcomply whh sucb pmvWons or rldspermit %W bo decrnorl moked.
,
CONSTRUCTION LFNDING ACENCY
. lbuebyJOrmthatdxrals■carer:acdanlcndlnsttcftryforthepeafurmaneeaf
'
LU wart for %ktkh Ihla permlt la tutrd (See• 3097, Civ. C.)
Lcnddt Name
-
Lcnduj Add,ess
. I unify Zhu I have read rids applicatlan and rmto Thu the above Information It
LM='L 1 agree ro tromply whir all city and rnaury ordim=4 and nate Lw retallat to
1:04ilas eannrtrction, and horeby uahod=np:ucnutivp arthlaeity to encu upon me
■MVe•maatiatred property for Inrpecdon purpares.
de xpcn and keep hartakan the City or acaniaa ■valva■
(We) apse to sate, ad
liabilldm,jodsmtxaa.ewuaadrlpenretwhlehmay lnanywyaettueapltufwidCly
In coracquenee of the =ranting ar thfx pMnIL
APPLICANT UNOF,RSTANQ 'WILL COMPLY WITH ALL NON -P01
Issued by:. Date
SOURCELATIONS.
Re -roofs .
Type of Roof
. to
ftD0USMA IS DISCLOSURH
S ssrQ Appi(�ca
1110capfummballdintoccupant Sim orinrtdlcharardausmterlt]
as dented by the Cupcnina Ma lclpal Cada Chtprer 4.12 and the Health and SJety
section 255324)?
❑Yew No
All roofs shall be inspected prior to an roofing material being installer!. '
P P Y g g
-If a roof is installed without first obtaining an inspection, I agree to remove "
v19i1 the.Pplleam rat ballalnt accnp■nrtue eq:lpmcnl or devtcca vl,ieh
Ihazardoustirconumialau R by rhe gay AM Air QualityMrastemcat
all new materials for inspection.
Dlatria7
❑Yca ONO
Ihavcrc■dihthuardnasmaterlelsn'7prlrrmenaundcrCRaptarA45ofrheGlrfor.
olsHealdt&SJuyCode, S=tloet255052553 and 25534.1 unIcni"1hetlfthe hdIrbnl
,
�` • �� 03
don not eafrnntiy baja L tcr=4 run respanfibhity to n"flr the occupant or'l+c
r
nquiremcros hrnLwbemelpat y e aCenfr>cucar
a re of pplic t e
a
Al] roof coverings to be Class "B' or better
tit
orav pate
. .... . .--x
BUILDING DIVISION PERMIT
OWNERS NAME.
ARCHrfEMENG]NEER:
o LICENSED COMTRACTOR'S DECLARATION
I hereby Ofum that 1 am Bartsc411 of provisions of Chapter 9 (comm=dng
will so It arDivisioA3arlhu'us "at IP reWanaCodt.aadmy1;cat=Ls
ax in roll re nal c
z Clean] Asa lit. t
?�" Qom Cdatraela
licurrECCSDF IL,�,�A TION
.1 undersand my pfsntahall he used u puhild rccnnit
a-
+o� Lltzrhtedliareafanal
GWMER-IIUILD R DECLARATION
0312, 1 heteby.arfirm rho 1 am exempt ftum tho Contranos's U=Ld Law for the
a D kNowring reaaan. (Saalan 7031.7, ecsiness and Pmf=*m Code, Any city Of county
$ which requires a pertit to canrntet. alter, improve, demolish. or repair any smseture
pdnr4o its IsauanMAW [equina the Wpitcanl fartuch permit wftlea alQned aatmM
x� 1IMbeIallcensedputsusnitothe ptavtsinroartkConhsmorYUtxhm11w(Chap=9
(comm 4rawlL4Sccion7000horDivis;"3ofdhc0ui4rmaahvdProrcuiomCodc)w
Lha bt Ls exempt tL efmm and the basis fa Ce aaMA exemption. Any vioiarm or
SeWon 7031.3 by any applicant for ■ permit WbjC= the &MUant w • civil prraahy of
sot mono thin rive humdreddollan (55001.
❑ 1, as owner of the property, ar my, employees with wage u their sole compensation,
will do Lhe work and the stntctu,e is not intended ar offemd fork (Sec. 7014, Businns
and Pronasions Coda The Camncra ft I '— , Law docs not apply to an oras or
properly who builds arim(xas–.s thctean.aadwhorlms ateh work himself or thmegh his
own employees, provided that such impfomaam art rotlntauled Breland forme. If.
however, the Imildieg of improvempnls sold withincne yeudta mpleioe, tha everter
buddar will hoc the burden of pmving Lbathe did not. build m Improve fa putpore of
We.).
❑ 1. as owner or she property. am exclusively contrasting with liernsed contractors to
rchsr= Lhe pm)ea 15= 70K B ain=and Imfrasimn Code:)The ConvActwi 1J-
ceme Law does runt apply to in matt of property woo buoda or improvts thereon. and
who eoatects forsuch ptoj= with a cutTsvo4q limina pursvaM w she Conmemfs
Liuose Ler•
E] 1 an exempt under 5a. B R PC far this rcuon
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby artttm uaL-r pwlty of perjury ane of the fallawjng dcduoLio=
l
I have and will marpaln a Cerdficate of Consent to selr•rnwre for WorltcesCompea-
<+,4 WIN, u provided for by Strdon 3700 of the Labor Code. for the perfatmaricc of the
work r which Ihis permit is [sued.
I love and will msimain WOrket's Compem doo rmurusa., as scqulred by Section
3700 orLbe L abar code. for the performaaxaf ire wort for which chis permit is iasaed
Myth+=icomrramulm'truurancaarricrawpallgmm�5crz=
� Pol4.11 ?CV -3
ity Na;
EIMFICATE OF rSMPT70NTR WORKERS'
COMPENSATION 1NSHRANCS
CThia acotien peed sot hccompt" If rheejrtmil is foronc bundred dollata (S1an)
or les[-)
1 Gerrity the In Ibe puformer:co of 0C work for which this permit 4 fasted. ];hail nor
employ any person In any mannerso u in beeoma sobject to the Wcri :re Compeasadon
Laws of California. Dam
Appnant
NOTICE TO APPLICANT. If, after soaking this Certificate or Faempdon, you should
bso.•ne auhjcct to the WorWa Compertulion provlaioas of the 4ltor Code, you man
.� Z forthMLb comply with rues pmvitlons or Lhis permit than bed=mcd sero d
z 2 CQMMUCTION LENDING AGENCY
Lhesehy aifirm &hu 0tefeLf a eonstructlnn lradingageery forthc perrarmance of
the work for which this perrnit Is Isaued IS= 3M. Cir. GI
Q Leaders Namo
Z, Lcadet'AAddteat
U 0 1 ccnlfy due I have read Wr application and state that the abort information la
IL ► CO-I epee Lo comply with all city and county OniInaecea and slate laws relating to
0 building conslmetion,and berebyaudtari=mpretcnusvcsorails city tocninupon the
i>i lLbave-menuoncdpmpertyforiaspCCUDnPuose
ps
0. (We) swce to save. Indemdiry and keep harmless the City of Cupeniao against
.. rn IlabIIid=Jud:mcrtt24ML!1IndcspenseswhirhmayInanywayawncagainstWdCity
U incamequcttttarshc1t1:ulna0f1Ihi1pMrdL.
APPLICANT UNDERSTANDS AND WILL jCOMPLY WITH ALL NON -POINT
sV
` 5r urcofAppl:cara/Contracmr Data
HA2.ARcOUS; MATERIALS DISCLOSifAl.-t--
Will rho appljoact or ruuat birilding Occupant nam cr hatdic haurioct matciial
as defied by ate Cupudno Municipal Code, Chip= 9.11, and rim Hralth sod Safety
Codc, Section 1.7532(a)7 J
[3 YEN ED41,
Wirl the sppl(caol of future buildmg occupanL ase equipment or devices which
mit harardow alt corumminanu u dermad by Yon Bay Area Air Quality Management
Iktrtict7
❑ Yes o
L hove read the hasatdousmatdalsscquistntenu rmderQtaptcr L93 of the Cali for•
rim Health & SetlyCode. Sextima 25305, 75513 and 25334.1 unMrsmnd thu if the hdldiag
aces nor carrtnsl haus ■ trnarhr, that It 4 my responsihility to nodry the occupant or ate
rer(urt�enu�Ortniss •;�r•renificstcorOmpacy. .
PFRMrrN904090076
PERWr EMM DATE
i��7�2�
SANITARY No.
CONTROL NO.
BUILDING PERMMXFO
ELM ELI= PLUMB
Job Description
ELECT SERVICE UPGRADE (200 SJNALED
CONTRACTOR: MOLCSAN ELECT.
SEP 16_ 2004
FL FlocrArea
31.602059.00
Issued by:
Re -roofs
Type of Roof
BUILDIN
Required Inspections
M
Type
Date 716�.Id� �_/
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
ail new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better
is
CITY OF
UPEkTINO
I ,
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
a: i4t
SUBCONTRACTOR
• •M NEI �, .If �i�
, i 1� _ Ar� 4 IN
NI
Cabinets & Millwork
I am not using any subcontractors:
Signature Date
PIease check avvlicable subcontractors and com-plete the following information:
�f
Contractor Signature Date
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 / Walipaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
�f
Contractor Signature Date
*C10
CUPERTINO
r
CITY OF CUPERTINO o
PERMIT APPLICATION FORM
# 1 / Z
Date:
Fee- Group
7Building Address: Mailing Address (if different from building address):
��$; �:. R,-,
Other Appliances
_
Owner.'s Name:
Phone #:
Boiler c=100,000 Btu
MECHANICAL
51
Boiler > 100K to 500K Btu
Contractor:
License #:
Boiler > 500K to 1M Btu
MECHANICAL
B130ILER4
Boiler > 1M to 1.75 M Btu
Contact: 1 Phone:OS-Szq-)-6�e
Cupertino Business License#:
Boiler > 1.75M Btu
Fax:
BCONSTAX
Construction Tax
Building Permit Info:
BCONSTAX
Bldg ❑ Elect Plumb ❑ Mech ❑
BUILDING
Job Descripti;��Zc?!>
Con. Tax for BQ Zone
Residential se -y v? Commercial ❑
BCONSTAXH
Sq.Ft. Floor Area:
S/Sq.Ft.: 1
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC1000
Cost of Project: ed
1
Occupancy Gr
BELEC1001
Type of Construction:
Please check this box if the project is a
BELEC200
Elec Svcs 600V <= 200A
second -story addition: ❑
rnir�rt �i�e� Rbndard R T,aruP rl Mginr F1
Energy
Quantity Fee ID
Fee Description
Fee- Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBOILERI
Boiler c=100,000 Btu
MECHANICAL
BBOILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler > 500K to 1M Btu
MECHANICAL
B130ILER4
Boiler > 1M to 1.75 M Btu
MECHANICAL
13130ILER5
Boiler > 1.75M Btu
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC1000
Elm 600V <--1000A
ELECTRICAL.
BELEC1001
Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BIlWE$TIGA
Investi on fee
BUILDING
�7J�z7
1of3 .��
*Tya
evP��irvo
CITY OF CUPERTINO
PERMIT APPLICATION FORM
uantity
Fee ID
Fee Descri tion
Fee Grou
BMISCELL
Miscellaneous Fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
BNUCOM M
New Comm Electric
ELECTRICAL
BNUCOWAM
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PLUMBING
BOVERTWE
Inspection Overtime
BUMMING
BP13ACIKFLOW
Atmospheric Vacuum
PLUMBING
BPCESSPOOL
Cesspool
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPFMURE
Pblg Fixture
PLUMBING
BPGAS
eras Piping Sy stem Fee
PLUMBING
PRgTERCEP
Ind Waste Interceptor
PLUMBING
BPLANCHK
Plan Check Fee
BU LDING
BPLANCKADD
Plan Check Add Multi
BUII I}ING
BPLANCKREP
Plan Check Repeat Fee
BUILDING
BPREPIPE
Re i e Of Fixtures
PLVAMI VG
BPSEWAGE
Sewage Disposal
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSPR]NK
Lawn S rinkler/Backflo
PLUMBING
13PSTORM
Storm/Rain Water
PLUMBING
BPTRAP
Kitchen Trap
PLUMBING
BPVENT
Alt of Drain & Vent
PLUMBING
BPWATER
instuWAiter Water Pie
PLUMBING
BPWHEATER
Water Heater/Vent
PLUAISING
13PWSVCS
Main Water Service
PLUMBING
BREINSPECT
Reinspection Fee
BUILDING
BREMACOVER
AIC Unit > 10,000 cfin
MECHANICAL
BREMAIRHAN
AIC Units <=10,000 cfm
MECHANICAL
13REMAPPLI
Appliance Install
MECHANICAL
BREMBUSWAY
Remodel Busways
ELECTRICAL
BUN=
Lighting Fixtures
ELECTRICAL
BREMFURN .
Relocation of Furnace
MECHANICAL
BREMFMOV '
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
BREMYOWER I
Power Device/Apparatus
ELECTRICAL
BREMRECEPT
Rc tl Switch & Outlets
ELECTRICAL
BREMRELOCA
Relocation of Hood
MECHANICAL
BREMREPALT
Repair/Ater Heating
MECHANICAL '
BREMRESAPP
Remodel Res Appliance
ELECTRICAL
2 of 3
• I
CITY OF CUPERTINO
CUPEfZTINO PENT APPLICATION FORM
Quantity— Fee ID Fee Description Fee Group.
3 of 3
BREMSIGNAD
RSi Add Branch
ELECTRICAL
BREMSIGNS
Remodel Signs, Marquee
ELECTRICAL
BREMTHEATR
Theatrical Li tin Fix
ELECTRICAL
BREMVENFAN
Vent Fan Sin le Duct
MECHANICAL
BREMVENSYS
Ventilation Systems
MECE AAIICAL
BSCBLVD
Scb Specific Plan
BUILDING
BSEISAUCOM
Seismic Commercial
BUILDING
BSEISAUCRE
Seismic Fee Res
BUII.DING
BSPECIA.L
Special In'ection
13UILDING
BSWIM
SwimmingPool
BUILDING-'
BTEMP
Temporary Power
ELECTRICAL
BTEMPPERM
Temporary BldgPermit
BUILDING
BTEMPSVCS
Tem Dist Svcs
ELECTRICALS
BUSLIC
Business License
BUILDING
ELECTRIC
Electrical foot
ELECTRICAL
EPERNIITFEE
Elec Permit Issuance
ELECTRICAL
MPERMFEE
Mechanical -s . foot
MECHANICAL
MPERMITFEE
Mech Permit Issuance
MECHANICAL
PPERA ITFEE
numbingPermit Issue
PLUMBING
PPLBG
PlumbingFees foot
PLUMBING
ZADDCHG
Address Chane
BUELDING -----*
3 of 3
w
• r
LOT NO
APPLICATION FOR BUILDING PERMIT
OF CUPERTINO
191!;FPermit No. .
permit to „ 9A4-e� _
a story, T e Building
atJWj -
W.
to be occupied only as
in accordance with Plan , Specifications and PI -Plan filed herewith.
Estimated Value of Improvements, Fee $ ,=�- 41.0
It is hereby agreed that the requirements,of the Cupertino Building and Zoning Ordinances and
.M all other laws applicable to the construction, Jocai)Addrm
, and we of buildings within the City of
a Cupertino, i11 be complied with. ig
Owner /
[I] it 1 / L A -Of _ O Ia A —AA - _ — --
App
7-�(
BUILDING INSPECTOR
RECORD OF INSPECTION APPROVALS
FOUNDATION
DA'Z'E INSPECTOR
FRAME _
DATE INSPECTOR
LATH and PLASTER I
DATE
FINAL BLDG. �-
DATi
FINAL ELEC.
FINAL PLBG.
FINAL GAS
DATE
INSPECTOR
DATE INSPECTOR
HATE INSPECTOR
M
ro LOT NO.
NO.
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Building
at Aft IM NIP -WA LU U
to b c pie only as—, 3 M��
in accordance with Plans, Specifications nd Plot -Plan filed herewith. o
Estimated Value of Improvements, $__ Da �'' Fee
v
C It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
u all dther laws applicable to the construction, location, and use of buildings within the City of
Cupertino will be complied with.
,,_, QwneAddress
By. Address
ONTMC'rOR, AGENT
Pi7ane �,. Approve z.�C
BUILDING INSPECTOR
RECORD OF INSP CTION I;kPPROVALS
FOUNDATION
DA'I'S �j INSPECTOR
FRAME
DA'fCi � INSPECTOR
LATH and PLASTER _ _— � �
DATE INSPECTOR
FINAL BLDG.
` DTE INSPECTOR- '
FINAL ELEC. j
DA'T'E INSPECTOR
FINAL PLBG. j
DATE INSPECTOR ,
FINAL GAS -
DATE INSPECTOR
/.2