03050078 f, CITY OF CUPERTINO
BUILDING DIVISION PERMIT GTQR N00l7RMA.TIQN :;'_:"
BUILDING ADDRESS: PERMIT NO0 3050078 050078
01 qq RICHWOOD DR
t OWNER'S NAME: PERMIT 1E5ff/16/2003
ONE: SANITARY NO. CONTROL NO.
ARCHITCCT7ENGINEER: BUIIDINO PERMIT INFO
OELECT PLO MECH
O
LOp LICENSED CONTRACTOR'S DECLARATION
I hereby afflm that 1 am licensed under provisions of Chapter 9(commencing Job Description
ffi with Seedon 7000)ofD1vldon Sofdm paid Profctswax Code.and my license is FINALaE®
in full force d ecL
�` o�nmc^rpe codaCN UPGRAE PANEL TO 200 AMP
,;e \\ ,,ARCNITECI-S DEC rl MAY 2 0 2003
y 1 undenunA4m)Q1Ws NJI he used u pts a meorda
LL Licensed Professional ppI�
50 OWNER-BUILDER DECLARATION BUILDIIYG
aI 1 hereby nBim that 1 1. exempt from the Comms ra Licence law co than
O O following rcuoa. e(Section 7 construct,
Business and Improve,
demolish.
e Professions Code:Any tiny or county
s$tai which Its Wo a permit re eoawet,Jwc Impmw,h Permit
t are a sig any structure
prior u@iuumep,Junttorequires Ncappingor for uchpemiuucents,signed statement
that helallccnwit pursuant mlhrif Divisionfthe Conuanestanicaclaw(Chmtar9 Sq.Ft.Floor Area $1V��y18tion
(commenting with Sectionfrond andl the
Division 3 the
the eg dnexempt Pinfiession.Any
Code)or
Natio 7 exempt Nen from and Ne Aper for the alleged exemption.Any viol Won of
not a 703 n five
airy applicantfor•permit ubJeets sive sppllent m a civil Pendry of 3 AM"uptgr0 O Occupancy Type
not mom than Rw hundred tlolrn(fsodk
❑I,as owner of the property,or my employees with"get a their tole compensation,
will do the work,and thetbuclum It Out battered ser oflemA I...k(Sec.701a,Budnpes — UFER.
and ProfesJha aCotle:The C rd utnfs Limpee Law dope Act apply a an owaer of Required Inspections
propertywho buildtorimpraws Nercon,and whodoeanuchwork himulfordroughhlt 304 - ROUGH ELECTRICAL
own employees,provided that tach improvements an,not Intended orp0ered fmul.If. SOS — FINAL ELECTRICAL
however,the building or improvement is old within am year of completion.The Owner-
bullder .will haw Om burden of proving that he did not build or Impmw fee purpose of
sale.).
❑1,as Owner of the property am exclusively contracting with licensed contractors to
construct the project(See.70th.Business and Professions Code:)The Contractor's Li.
Cause,law it=not apply to an owner of property who builds or improves Nemon,and
who Contracts for such projects with a eonmemr(p licensed punpem in Na Contneor's
L seL,
lama ptunder See. J ,B@PCfm smarm
r Dau
OMPENSAnUN TION
1 hereby Arnim under partially of perjury am of the following declannions
I
have and will maintain•CeNRcata ofConsam no self-Insane for WorkeM1Compen- ,
7301'00
0an,u provided for by Section 7]00 n(Ne labor Code,fm Ne pedomahae of the
rk for which this Pemlt Is issued.
I have And will maintain Worker's Compewtion Insurance,u required by Section
of Ne labor Code,for the performance of the work for which Nis permit is iumd.
y Worker's Compensation Insurance carrier and Policy number am:
rtier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' '
COMPENSATION INSURANCE
(Thisaecdon hand not W Completed If the pendln Is forone hundred dollars(SIM)
or loss)
1 unify Net in the pea" of the rk for which thb permit b iumd.I shall net
employ any perwyigSitym '0,.j�t ' rncaubjecllothe Wmken'�nm Arlon
Laws of Califomi k
aw.t
NOT1, ,^ L fwr making this Certificate of Exemption,you should
an Join in the Worker's Compensation provisions Of the Labor Code,you mud
.J,x forthwith comply with such provisions or this permit shall be deemed mwked.
„z„O CONSTRUCTION LENDING AGENCY
F V) Ihenby.fim that UlCm las epMNcdon leading agency far Ne pedomNee Of
ai 7 the work ror which this permit is laved(Sec.3097.Civ,C.)
Wh Q Lender's Name
]z Landw'.Addnes
V tt�7. 1 unify that 1 have read Wb craw Nn
aapplicnion tathe show wromNr
un
it, U correct.1 agree to comply with W city and county ordinances and sou lam mining to
traction.and hemby.uthorise npmrentstiwa or this city to comr upon the
w shove-mentioned property for Inspection Pommes
gy (We)agree no save,indemnify and keep handlers the City or Cupertino against
y liabilitiesJudgments.costs and expenses which may in any way same against said City
U 7 in consequence or the gaining of this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
U REGULATIONS. �yp
I E .' mb� Re-roofs
S m Pplian✓car.em
ata
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will was,applicant or future building Martin nom orhandlc havanwin material
As dented by the CuKnfim Municipal Code.Chapter 9.12,and the Health and Safety
code,section 25632(.)]
)(NoAllroofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
7&6tr-mml
n hmardow air contaminants u defined by the Bey Area Air Quality Management all new materials for inspection.
rict7
❑Yes Nu
I hew mW the hvraNws mueddsrequimmenuunder Chaptard.95of the Caliran
HcalLh&SJctyCnde.Secdom 35515.25533 and2553C.1 undcnond thanlf the building
not eumnfy hew A want.that It Is my respomlhibly m fy the accupm,of du
M
rants whim mon be met pd.,m its.me ora ceamawa Signature of Applicant � Date
�_
64 anra a col D�2 All roof coverings to be Class"B"or better
IS
�M ' CITY OF CUPERTINO 7�
1 CUP TYOF O PERMIT APPLICATION FORM o3 °
14 N# ` � Date:
Buil ing s: (�
( )O0 r
Owner's :(.Ou Phone#: ( off , 5-90 S O t7S—
Contractor: License#: �/� 3
h e I F
Contact: I ke Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description:
Residential-Z Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: "I ZQ 0 Occupancy Gro
Type of Construction:
upGSrac�� Pa ��
Quantity Fee ID Fee Description Fee Grou
BAPPLOTHER Other Appliances MEC= CAL
BBLDGFEE Bldg Permits . foot B LDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> IM 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
EEO BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
1 of
CITY OF CUPERTINO
' CIN OF
CUPERTINO PERMIT APPLICATION FORM
Ask
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Ho6sing 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
BOVERTRvIE 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 Disposal PLUMBING
IMF 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 WaterHeater/Vent 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
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
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CITY OF CUPERTINO
CITY OF
PERMIT APPLICATION FORM
CUPEkTINO
Quandly Fee ID Fee Descri tion 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 Sips, 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 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 Mecb Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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