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03070146 (2) CITY OF CUPERTINO � ' i " ' BUILDING DIVISION PI RMIT RM NTR COACTOR INFOATION a, BUILDING ADDRESS: """"03 ERMIT N00 3 07 014 6 OWNER'S NAME: PERMTTISSUE DATE NE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EIFCT PLUMB MECH y 0 z LICENSED CONTRACTORS DECLARATION lob Description wF I hereby M.that I am licensed under Provisions of Charter 9(commencing it3 with Section 7M))of Division 3 of the Business and Professions Code,and my liccnsb a« L License ull to= effect. CELLAR UNDER GARAGE (E) Z;o License Cress Lk.tr �,p Oaa: Contractor / - ARCHITECTS sixe DECLARATION /✓J// I undcrsuntl my plana shall be usd as public rcenrN O 3ta0� Licensed Professional S OWNER-BUILDER DECLARATION F.<0 I hereby.(Sac that 11. exempt from the Contractor's License Law for the _tel p O follawwhich inn inex.pSeuan]omar.Business and Professions h.a,re ray city .townscounty 'x m which require issuance.permit re quires t e ahem improve,h Pe r it t nr mash any tatuchm Fi<Mthat hepoor itaensedpalwrquiru the so for mchpctor's mbsee a aw(Chaned mem rcss< Ihatheencing licensed runuanun the pmvivision the ortheB Contractor's Sq. Ft. Floor Area. Valua[Ion y�a-p (cat he (commencing Section IIand of Division or the Businessand on.Any vi CMC)or $ Nn he is exempt the.lrom and the bssu for the allegrA exemption.Any violation of 36223011 . 00 Section 7031.5byany applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type not mare than Eve hundred delta.($500). P y yp ❑I,as owner of the property,or my employee with wage as their tole compensation, win do the..h andtheswche is not intended or offered rma.m(See,70th,BusinessdInspections and Professions Code:The Commtors Liana law data pal apply to an owner of 102 — PIERS property who build.or improves ammon,and who dos ouch wask himself or through hit own employae,provided that such i mprovements are,not intended or offered for ale.If. 103 — UFER however,the building or improvement is sold within a¢year of completion,the owner. builder will have the burden of moving that he did not build or improve for ruminate of 104 — REBAR "le')' 105 — ANCHOR BOLTS ❑1,as owner of the propery,am exclusively contracting with licensed contractors to convect the portion(Sec.7044,Business and Professions Cosi The Contractor's Li. 106 — SEWER & WATER cense law does not apply to an Owner of protan who aims or Improves thneon,and, 202 — UNDERFLOOR PLUMBING who contracts for&On projects with.eonuann o(a)licensed pursuano thentta Caclara li,innat 203 — UNDERFLOOR MECHANICAL I ea funder Sec. .Bk PCfn this mason 4 „ ® 204 — UNDERFLOOR FRAME 0 e WORKER �� N Emf�,imN 205 — UNDERFLOOR INSULATION I hereby affirm under Penalty of perjury ane of the following decorations: 301 — ROUGH PLUMBING have and will maintain a Certificate of Cansenuo sclEinsum rat Warkeri Cothran. 302 — TUB & OR SHOWER n,as provided for by Section 3]11(1 of the labor Code,for the performance of the 303 — ROUGH MECHANICAL work for which this permit i.issued. ❑I have and will maintain Worker's Compensation Insurance,as mquired by Section 304 — ROUGH ELECTRICAL 3700 of the Labor Code,for the performance of the work far which this permit is issued. 305 — FRAME My Worker's Compensation Insurance carie and Policy numher are: 306 — HOLDOWNS Cartier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' 307 INSULATION COMPENSATION INSURANCE 308 — SHEETROCK or less.) (This section need not In completed if the Permit is for one hundred dolla.(S 101) 309 — EXTERIOR LATH 310 — INTERIOR LATH 1 certify that er the performance of the wok for which this them it is issued.l shall not Laws C,liformsmany manner snssmhecomh subject to Woekeri Chmpensetlnn 311 — SCRATCH COAT Laws of California.Data Applicant 313 — ROOF NAIL NOTICE TO APPLICANT:IL after maki ng this Ctrifiewe of Eacmption,you sha.W 501 — FINAL ELECTRICAL ENERGY become subject to the Workers ComPcnaatlen provisions of the labor Code,you must .Jz forthwith comply with such provisions or this Permit shall W deemed revoked. 502 — FINAL PLUMBING ENERGY zC) CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY 'F'4—' I thereby affirm Nat then is a construction lending agency for the performance or 504 — FINAL BUILDING ENERGY ' z> Lmde:kNe(or which this p mithissuctl(Scc.J(9],Civ.C.) 505 — FINAL ELECTRICAL z Lenz W Q the wrmc aAddoos 506 — GAS TEST U p 1 cenify Nat 1 ban reed this application and state that the above information is 507 — FINAL PLUMBING correct.l ague to comply with all city and county oJinances and talc laws relating to pU building construction,and hereby authorim representatives of this city to enter upon the FIN MECHWCAL W above-mentioned properly far inspection purposes. y (WO)agree to save,indemnify and kap harmless the City ni Cutest against %511FIMM" h liebilitieO)agrcnto ensu andmnify es andwhichkeep mayinany wryaccmeagertino ig City NGUz in consequence of the granting of this permit.APPLICANT UNDE NDS ND WILL COMPLY WITH ALL NON-POINT Issued by: WORKS Dale S REGULAT Ns. ? Re-roofs i - fAPPlicanV onuacor u HAZARDOUS MATERIALS DISCLOSUR Type of Roof Will the applicant or future building oceupem norc a Mndle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety Code,Seaton25333(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Ye y4Na 1. Will the applicant or mtum building occupant use equipment of device.which If a roof is installed without first obtaining an inspection,I agree to remove hazardous air contaminants u defined by the Bay Arca Air Quality Management in? all new materials for inspection. ❑Yes %No 1 have read the harardtosmau rialsmquircmenta umkr Chapter 6.95 of the Califm. nia Hcxhhk Safety Code.Senator M%5,35533 and 35534.1 understand duaif the building does not currently ban a tenant.th it i.my responsibility o nouly the oe,upmt of the m mneme swhichmust hem nnissuana nf.cartfic,tF ef9n.W'y. Signature of Applicant - Date O authored. n J(/ D, All roof coverings to be Class"B" or better CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM 02 `�7 @l,�Z PN# _S62 2 0 / 1 Date: 3 JUL Y 2003 Buildin ess Mailing Address (if different from building address): Owngr's Name: Phone# 1Z IAM yog 777-0I Contractor: License#: Cont Phone: l Cupertino Business License#: Fax: Buz g Permit Info: ld Elect ❑ Plumb ❑ Vech ❑ b cription• Residential V Sq.Ft. Floor Area: VSq.Ft.: Cost of Project: Occupancy Group: r Type of Const ct Please check this x if roject is a L'e6 cif 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> 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 lof3 � � � , c� CITY OF CUPERTINO CITY PERMIT APPLICATION FORM CUPEIZTINO .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 Multifamil 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 BOVERTME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING r 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 Stom]/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 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 2of3 CITY OF CUPERTINO CITY Of PERMIT APPLICATION FORM CUPEkTINO 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 actor \Iil - car, e„A�iF� ul�, W T<T MkTr. 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