03080162 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION.
BUILDING ADDRESS. NU—DESIGN MANUFACTURED PERMIT N003080162
10520 T TTTRWQRTH £H j'ERhBT ISSUE DAM
OWNER'SNAME 1566 LA PRADERA DR #3
VFiQTVAT AVACAf7AM .—.. —'�- O 7?7-/7003
E' (408) 374-4362 SANITARY o: cONTROLNO
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSE on h A DECLARATION Job Description
C 1 he by afOrm that I am Leenxd uadc 11 vrsmm of Chapter 9(commencing
w,wMS.lmr�70(lo)of Division 3of the BU an. Professions Code.and my license is
j?as 10 full 77G `j `� SOLARIUM GLASS WALL 9/ ~�
Umu'Class Coal
:� Da¢ Cumwyav� t'x''—SiC�iN LC' ,�
RCe SD CCLWAI ON
dcmanJ lonyh II sctl as pit Web ds /
l.Tcemed Profcslmnel
OWNER-BUILDER DECLARATION
�Y 1 hereby from that 1 am exempt from the Convenors License Law for the
10 following mason.(Section 703 1.3,Busnvss and Pmfe am ns Cale:Any city or county I
e E which rcymres a rattail to consumer,alter,improve,demolish,or otpir any svuctum p
-" prior to its issuance.also requires applicant for such permit to flea signed sutemcto G2n�F
20 that 1cislicensedpmmantI.theprovi aonsnrtheContosstor'.taccraceU tCluprer9 Sq.FL Floor Area Valuat ors
(commencing with Section 7O W)of Dlwnon 3 of the Business and Professions Code)or
S$ Nat he is exempt therefrom and the basis for the alleged extortions.Any violation or 3 7)A,4 F 0l 9 (1(1—
an -
section 9031.5 by any applicant for a Permit subjects the applicant to a civil Penalty or APN Number Occupancy Type
not mom Nan f vc hundred dollars(S500).
I.as awocf or the property,m my employees with wages ss their sole compensation, I — - -
wih do the wok and Nesocure is not intended or offered fo...1.(See 7Daa.Busmen j 101 FOUND A
and Professions Code:The Conwcor's Limns Law does not apply N an owner of d Inspections
property oliobuilds or Improves Nemon.and whod«ssuch wort Mmalf.r through his 102 — PIERS
own employees,pmvidcd that uch lmpmwmem are not ntended mortared for sale.If. 103 — UFER
however,%a budding or improvement is sold within one yens of completion due. e owner. -
b ilder will hate the burden of proving Nat he did ram baud m Imprms for purpose of i 104 — REBAR
sale.).
❑I,in owner of the propcny,am exclmlvely comormung with licensed contractors to 105 - ANCHOR BOLTS
common,Nn project sec.7a.Business and Prafcssiom CadeU The Conamoor's Li- : 106 — SEWER & WATER
ceam taw Eons not apply in an owner or property who,muds or improves themon,and
: 202 — UNDERFLOOR PLUMBING '
who convicts for such protects with a comacmr(s)licensed pursuant to the Conh
nw .
01.Lew. 203 — UND ERFLOOR MECHANICAL -_
❑IUn nemp,undar Be,, ,BkPCfm this reason , 204 — UNDERFLOOR FRAME
WORKERS COMPENSATION DECLARATION I 205 — UNDERFLOOR INSULATION
40 1 hereby arm under recently of perjury arc of the rollowmg dcclarationm 3 01 — ROUGH PLUMBING
I hers and will maintain a CemOcom of Consent o ulf-insure for worker's Compen- I 302 — TUB & OR SHOWER
salon,as provided for by Section 37M of the labor Code,for me pcoforiname,of the 303 —work for which ROUGH MECHANICAL
w this permit is....a
❑1 have and will maintain Workers Compensation Insurance,u no,mmd by Section - 304 - ROUGH ELECTRICAL
3700 of me tabor Code.for the perfmm.rice of the wan fm whim Nis Poison is issued. . 305 - FRAME
My WO Compensation lnsursnm carrier end klliryyo ber am:
cyWol�' pmneYeaA�V'111 ' YL — t3 306 — HOLDOWNS
CERTIFICATE EXEMPTION FROM WORKERS _ 307 — INSULATION
- COMPENSATION INSURANCE 308 — SHEETROCK
less.)(Thu section see act bccompleted iftlte lemur u for on hundred dollars(1100)1 309 - EXTERIOR LATH
or
I Cenlfy Ilia,in me ptr(mmance of the work for which Nis permit is Issued.I shall not 310 — INTERIOR LATH
.employ any pc...a any manner an u an become srbj.,,.the W.,lcra Compensaumm t 3I-]- — SCRATCH COAT
Laws of cal,mmia Dal• 313 — ROOF NAIL
APDticam '
'NOTICE TO APPLICANT.If.after making this Cernfcate of Escmption,you should 501 — FINAL ELECTRICAL ENERGY
become mbject to the Workers Compensation previsions of the Labor Code,you must 1 s
IO,forNwlN Co.,],with such provmnitsa Our permnshall be dccmrA mvoktd. 502 — FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY - 503 — FINAL MECHANICAL ENERGY
Ihcrebyafrum Nat Ocrem.construction lcndmgaperny tar the perfuoatse tar 504 — FINAL BUILDING ENERGY
' the won rat which Nis Permit u,ssued(See.3097.Co,C.)
i F) LandcrsName 505 — FINAL ELECTRICAL
jz LCnderfAddm•• 506 — GAS TEST
C) I cenify Nu 1 haw read this application and sole that the above mro atim is
F Contact-l agree N comply with all city and county ordinances and stale laws misting to 507 — FINAL PLUMBING
jU building cmuoction.and hemby eu,horre nprsmnumeaOfNS City tocmu Upon ft 4IN MEC CAL
above-mentioned propeny for Inspection proposes
s 6. (We)agree,o save,mdemndy and facts harmless the City Of Copulate.against 0 9 v
h Iubiludes,judgmenu,costs and expenses which may In my way amo ,against said City I s� q
Z, on consequence of rite grant of this perm'
^' APPLI NT UNDERSTANDS AND LL COMPLY WITH ALL NON-POINT Issued by:5 CNWORKS Date
SO REGULATI
`ni"( � . -- S"/2 7/O,� Re-roofs — /
Signs=of Appllcmvcnnvmlor I Date
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will IM applicant or future building Occupant atom or handle harsrdous material
as defncd by me Crpenow Mumnpal Coda,Chapter 9 13,and the Health and Safety
Code,SecctionZ553z(a)' O All roofs shall be inspected prior to any roofing material being installed.
Yes N.
Will me applicant or rutum Wildmg occupant Um egmpment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
sit hvafdnrn air contaminants as defined by the Bey Area Air Quality Management all new materials for inspection.
District?
Ihavem" code. nos matenals requirements under i,romm6.95oftat Culdmg
niaFlea I him read code.Semau 25anils rquiaryl I tlhmNnd NUrtNe baiting ✓/
Mnot Cu m[ h.w a¢rent.Net rt n my. hili,y m ufy t [opera M me
mym to mhmustt,, n I,�u r. de rar .PDue SfignatureofApplicant Date
o r ra.N.n,mdasent 2 All roof coverings to be Class "B"or better
C*Y OF CUPERTINO
E � PERMIT_ P\ TION FORM
APN #CUPRQF N� ,
/;;Z- 7107
Build in ddress: C /�1 ng Address (if different from building address):
16' TXV1
Owner's Name: Phone#:
Contractor: License#:
Contact Phone: '9 75 yJG ` Cupertino Business License#:
✓' -�SS cS�rr%/'/ _ Fax: .`?r/5' x/0/6
WResidentipapi nfo: lect_ Plumb ❑ Mech ❑
: ,5'UL-sIF/� % / OG �G/lSS GtJ<7� Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
{
Cost o roI Occupancy ct: _ � P Y Grou(bo
—
` T e of Cogs ction: Please check thii ro ject is a
�A 6�— G��✓5i/�u ;�ti second-story addition: El
Quantity Fee ID I Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permit sq. foot BUILDING 1+
BBOILERl Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K_Btu I MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL {I
i BBOILER4 Boiler> 1 M to 1.75 M Btu MECHANICAL 1
BBOILE_R5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax I 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 I
r / \ BELEC200 Elec Svcs 600V <=200A ELECTRICAL l
J BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING I
BMITIGATC Comm. Housing Mit. Fee BUILDING
z
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�Qd- CIDY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEI,TINO
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
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BOVERTIME Inspection Overtime BUILDING
I BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
/ i BPERMFEE Bldg Permit Fees BUILDING
I BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
L/,/ BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
i BPREPIPE Repipe Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal I PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn SprinUerBackflo I PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap I PLUMBING
BPVENT _ Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pipe I PLUMBING
13PWHEATER I Water HeaterNent PLUMBING
BPWSVCS Main Water Service I PLUMBING
BREINSPECT I Reinspection Fee BUILDING
BREMACOVER I A/C Unit> 10,000 cfm I MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm I MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
�L BREMBUSWAY I Remodel Busways I ELECTRICAL I
/ I BREMFIXT Lighting Fixtures I ELECTRICAL
BREMFURN Relocation of Furnace I MECHANICAL I
BREMFURNOV Relo Furnace > I OK btu I MECHANICAL _
I BREMHEAT Heater Installation I MECHANICAL
BREMINHOOD I Installation of Hood I MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance I ELECTRICAL
13RENTOLE Pole/Platform Fixture I ELECTRICAL
BREMPOWER I Power Device/Apparatus I ELECTRICAL
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�(vl CITY OF CUPERTIl4
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group i
BREMRECEPT Rcptl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating I MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmd] Signs Add Branch ELECTRICAL I
BREMSIGNS Remodel Signs, 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
I I / BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING 1
BSWIM Swimming Pool BUILDING j
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING 1
BTEMPSVCS Temo Dist Svcs ELECTRICAL 1
_ BUSLIC Business License BUILDING I
ELECTRIC Electrical sq foot ELECTRICAL 1
EPER11ITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL 1
PPERMITFEE Plumbing Permit Issuance PLUMBING 1
PPLBG Plumbing Fee sq foot PLUMBING i
ZADDCHG Address Change BUILDING 1
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7- N ACCORDANCE WITH THE CITY OQ
CUPERTI v;.C:° nrot) ORDtNARCf.4
DATE_
SIGNED
This set of plans an✓ eificationa MUST
De kept on the jo' .t all times and R is um
lawful to make any changes nr, akerations
on same without v.1tten
the buitling Dept., City of Cupertino.
The stamping of this plan and specifirgt T!;
;HALL NDT be held to permit g4xCer-ar.
inpf ba%f the viol'),�njo!t arty provseos
anw tt Ordananrre or State 4arF,
C?�
PLOT PLANS
CnECKE IfX
TOTS 1 oz
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t 7
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