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03060146-EXPIREDCITY OF CUPEkTINO Ci 1"Y OF CUPERTINO v .3 `D I � f PERNIIT APPLICATION FORM APN # D Date: Building Address: STEVE NS ..CEFE K VD. Owner's Name: Phone #: Contractor: WEB—`DP- B yu t --D EFR.S License #: Contact: GH�s VAt�.G I�-N - N�u.r�Er�-r Cupertino Business License#: B g Permit Info: 41�g� Clec�k6�1Plumb ❑ N �ec b e ription: Residential ❑ Commercial tK Sq.Ft. Floor Area: $/Sq.Ft Cost of Project: - Occupancy Group: Type of Construction: Boiler > 500K to 1M Btu LIV - - - Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other A liances 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 B130ILER4 Boiler> 1M to 1.75 M Btu MECHANICAL B130ILER5 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 BELEC 1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING 13ENERGYADD Energy Add Multi BUILDING BRgVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING a CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Deseri tion 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 BNUCOM10M New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTEVIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDEl G BPF -I LRE 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 BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo 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 pv^r-; BPWSVCS Main Water Service ;;;.t; 4,i. BLUNV3JNG BREINSPECT Reinspection Fee BUILDING BREMACOVER AIC Unit > 10,000 g-fal BRENLkMHAN AIC units <-10, TO cfhf `'- '11i1EC �I�TICAL BREMAPPLI Appliance Install r iv~NICHANICAL BREMBUSWAY Remodel Busways._,_ T '+' ELECTRICAL BREMFIXT Lighting Fixture `e'e�"'°`� ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL DREN20LE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTIN O ` Cl °F; PERMIT APPLICATION FORM CUPErkTINO Qu oty Fee ID Fee Description Fee Group LJ BREMPOWER Power Devic elA aratus ELECTRICAL BRENMCEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Altar Heating MECHANICAL BRENMSAPP 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 BSC BLVD Scd S ecific Plan BUiLDRgG BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECLAL S ecialInspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC - Business License BUILDING t ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical s . foot MECHANICAL MPERNUTFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 06 z" CITY OF CUPERTINO � % INFOtMrTIL:m. BUILDING DIVISION PERMIT �C�NTRACT4R BUILDING ADDRESS: PERMfT NO 03060146 OWNER'S NAME: PERMIT ISSUE DATE PHONE: SANITARY N0, CONTROL NO. ARCHITECTIP,NGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH E-1 0 0 0 LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter V (commencing ' Job Description with Section 7000) of Division 3 of the Business and Professions Code, and my License is fr1021 icwwalass cfftct License Class Lie, A REVISION--GENERATOR-IN HOUSE USE ONLY Date Contractor NO NEW PERMIT ISSUED/ORIG. 401070021/403010050 ARCHITEusds pnsI understand my plans hall he useas records NO FEES --PER NANCY / VERA Licensed Professional OW NER•BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the Following reason. (Section 703 f.3, Business and Professions Cbdct Any city or county which requires a permit w cnnseruct, otter, improve, demolish, or repair any se viciure prior la its issuance, also requires the applicant Cor such permit to file a signed statement that he isliwnsed pursuant to the previsions of the Contractor's License Law (Chap[cr 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and tie basis for the alleged exemption_ Any violaden of $ 0 APN Number OCCU p y Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundredOccupancy dollars (5500), 3690 1029.00 ❑ I, as owner of the property, or my employees with wages as the it sole compensation, will do the work. and the structure is not intended or offered for We (Sec. 7044, Business Professions Code: The Contractors License Law dots to of Required Inspections and not apply an owner property who builds or improves thereon, and who docssuchworYhimself or through his own employ=, provided den such improvements am not intended or Offered for WaIt, 101 - FOUNDATION however, the building or improvement Is sold within one year of completion, the ownu- builder will have the burden of proving that he did not build or improve for purpose of 102 - PIERS Sale,). 1, as owner of the property, am rxtrusfvely contracting widm licensed contractors (a 103 - UFER Ecissiract the project (Sec. 704A, Business and Professions Code.) The Contractor's Li- 104 REBAR cense law docs not apply to an owner of property who builds or improves thereon, and , 1 O 5 — ANCHOR BOLTS who eontracrs for such projects with a conuznor(s) licensed pursuant to the Contractors Lice= Law. 106 - SEWER & WATER ❑Iamexempt under5 .1s&PC(ortnls reason ' 202 - UNDERFLOOR PLUMBING Owner a` u Da01__S WORKER'S OMPENSATION DECLARATIO 203 - UNDERFLOOR MECHANICAL I hereby struma trader penalty or perjury one of the following declarations: 204 - UNDERFLOOR FRAME ❑Ihave and will maintain accrtireatrnfConsent [aself-insure for Worker's compcn- 205 - UNDERFLOOR INSULATION sation, as provided for by Section 3700 of the Labor Code, for the performance of the 301 - ROUGH PLUMBING work for which this permit is issued. 302 — TUB n T B & OR SHOWER ❑ 1 have and will maintain Worker's Compvusatfon Insurance, as required by Section 3700 orthe LaborCode, For the performanm orthe wart for which this permit is issued. 303 - ROUGH MECHANICAL Myworknrs DmpensaS n ore 7 nn Policy numberaR: 304 - ROUGH ELECTRICAL carrier Policy No.: CERTI CA OP EX ON FROM WORKERS' 305 - FRAME C PENSATION INSURANCE 306 -- HOLDOWNS (Thfsseetionneed not becompleted if[he permit Isfor onchundmddollars(f100) 307 — INSULA'T'ION or ) - 308 _ - SHEETROCK I cefUr certify that in the performance of the work for which this permit is Issued, !hall not employ any person inanymanncesaastobecomesabjeeltoOicWarkers'CDmpcnsatlDn 309 - EXTERIOR LATH LApplicant lifornln,Date 310 311 - INTERIOR LATH - SCRATCH COAT NOTICE TO APPLICANT: If, after making this certificate or Exemption, you should become subject to the Workers Compensation provisions of the Lahr Code, you must forthwith comply with such provisions or this permit Shall be dccmed revoked. 313 -- ROOF NAIL CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY I hereby affirm that them 12 a coftsuruttfinn lending agency for the performaxc or 502 -- FINAL PLUMBING ENERGY the work for which this pcnni[ is issued (Sec. 3097. cry c.) I.endds Name 503 504 - FINAL MECHANICAL ENERGY - FINAL BUILDING ENERGY Lendcr`sAddM4s 1 certify that 1 have read this application and state that the above information is correct 1 agree to comply with all city and county ordinances and state laws relating to 505 -. FINAL ELECTRICAL building construction, and hereby authorize representatives of this city to enter upon the GAS TEST above-mentioned property for inspection purposes. (We) agree m save, indemnify and keep harmless the City or Cupertino against liabifiGes, judgmcnrs, cases and erpcnses which may in any way accrue against said City 0 7 5 F 1 I CAL 1 in cansex(uenco of the granting or this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: 5 Date CE R S EG A ONS. Re -roofs 5�4 INAL PUBLIC WORKS r 0 SignlletmOrApplican onlraclo[ Dale RDOUS MATERIALS DISCLOSURE Type of Roo Will the applic t or future building occupant store or handle hazardous material as defined bythe Cupertino unicipal.Cadc, Chapter 9,f2, and rhe Health and Safety Code,Seetian2ss32(a)7No ❑Yea 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 building Occupant use equipment or devices which emit harardnus air coniarninanu u defined by the Bay Area Air Quality Management all new materials for inspection. Distrfe17 11 Yes o ' ahaveread the harard us materialsrequimmenrsunder Chapter 6.95ofthe Cali (or- nia Health & SafetyCodc, Sections 25505, 75533 and25534.I understand drotif tlrt building , does not currently have a tenant, that it is my responsihility to notify, the occupant of the . requ'trcmentswbic be Me can of dEc3LnofOccUpqnq. I ` Signature of Applicant Date All roof coverings to be Class "B" or better Owner or authorized ageNt Date