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03060193 CITY OF CUPERTINO "m+ , 1yz;i,� BUILDING DIVISION PERMITCO �t RAGTQRINFQRMATIQN: BUILDING ADDRESS: DREAM HOME BUILDERS PERMIT NO 03060193 OWNER'S NAME: 13675 LONG RIDGE RD PERMIT ISSUE DATE ONE: (408) 781-1400 SANITARY 0 CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH CJ O O O 300 LICENSED CONTRACTOR'S DECLARATION Fu I hereby affirm that 1 em licensed under provisions of Chapter v(commencing Job Description w with Section 701MUOr Division 3 of dm Business and Profciminns Code,and my license is /�p �g to furl foae and ctten. F a�B F'°'� Aar l[M License Class Lk.N ELECT UPGRADE 200AMP Irr�— UU RRAA q Data Contractor 7W ARCHITECTS DECLARATION 1 understand my plana shell w used as public records J U L 2 4 2003 )yU 4O� Licensed Prefcssional I OWNER-BUILDER DECLARATION F 1 hereby affirm that 1 am exempt from the Contractor's License Law for the BUILDING E U/gt p`®I pg Q0 following mann.(Section 703 1.5.Business and Predictions,Cade:Any city or county g tl G 5I E which requires a permit to construct,cher,improve,demolish,Or repair any structure nnn prior to is,issuance,also requires the applicant for such permilto file a signed statement < that he is licensed Potential Inthe provisions ofthe Common's LicenseLaw(Chapter 9 Sq.Ft. Floor Area Valuation $ (commencing with Section 7")of Division 3 of the Business and Professions Code)or Net he Is exempt therefrom and the basis for Ne alleged exemption.Any violation of 316 3 010 8 Semon 7031.5 by any applicant for a Permit ubjects the applicant o a civil penalty of APN Number Occupancy Type Out more than five handled della.(SSW). 0 I,u owner of the property,or my employees with wags,as,their sole compensation, will do the work,and the structure is not intended or offered forale(See.704,Baines, — Re UICed Inspections Professions Code:The Can=,.,',License Low does not apply w an owner of 3 04 - ROUGH ELECTRICAL property who buildsor Improves thereon,armwho dnessuch work himselfor Waugh his we employees,provided lhaauch improvements are not inteMed oroffered ler rale.If, SOS — FINAL ELECTRICAL however.the building or improvement Is sold within one year of completion,Ne owner- builder will have the burden of proving Na he did nm wild or improve for purpose of - ale. ..as owner of the property,am acleslvely contracting with licensed contractors to construct the project(Sec.7W,Business and Professions Code:)The Contractors Li- cense Law done nal apply to an owner of property who builds or improves thereon.and who convects for such projeeu with acom.car(O licensed pursuant in the Contractors License Law. an under Sao ,B&P C for this reaon er te WORKER'S COMPENSATION DECLARA7 N 1 hereby affnm under penalty of perjury one of the following dedarmions: 1 have and will maintain•Cenifiata of Cantonal to self-insure for WorkersCompcn- ution,a provided for by Section 3700 of W labor Code,for fee perfarmance of the . . work for which this permit is issued. 0 I love and will maintain Workers Compensation Nsurance,a inquired by Section 3700 of the labor Code.for Ne performance of Ne work for which this permit is issued. My Woher's Compensation Insurance carries antl Policy number are: Canin: Policy NO.: CERTIFICATE OF EYEMP ION FROM WORKERS' COMPENSATION INSURANCE (Dissection need not W completed hills permit Is fosane hundred dollars MIM) or test) I certify Nat in the performance of the work for which Nis permit is bossed.I shall not employ any pcwn in any manner an as in become subject to the Workcri Compensation Uwe of California.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation previsions of the LaMu Code,you must .JO (unhwith comply with such provision or this Permit shall be deemed raveled, Z y CONSTRUCTION LENDING AGENCY 'r I hereby affirm that Nca las construction lending agency lot the performance of 4i da work for which this permit Is issued(Sac.3097.Civ.C.) W�Q Lender's Name Dz Lender1 Address U 0 �. V Q I ttnify that I have read Nis application end rota that Ne above information in 0 f' bonding 1 agar to c comply with all city and county nNlnaces and sue taws tclning m Q V building construction. hereby auNoriareoses. vee o(Niscity center upon dte W shove-mentioned propene for inspection keep the G (We)agrees.ave,indemnify and kap harmlw the City of Cupertino id City 9 f4 inconsequence onsequ Wgmen0.coauad rxpcacsmit. may in any way accrue against said City U 7 In cons CAN caof the granting of UNDERSTANDSthis AND WILL COMPLY WITH ALL NON-P Issued by: Date G7 U GULATIONS o Re-roofs rtnu eof ApplicsuVCom Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tint mrtor Town building anatorc orhaNrdea material a earned by case Calendar,Municipal Code.Chapter 9.12.and the - NesIN and Safety Cole,Section 25532007 // All roofs shall be inspected prior to any roofing material being installed. O Yes 134o Will the applicant or future wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It haardous air contaminaa &nncd by the Bay Area Air Quality Management all new materials for inspection. 4trict7 O Yes Nu I have sad the ba.rNms materials requirements under Chapter 6.95 of the Califor- niaficnith&Safety COM,Sections 25505,25533 and 35534.1 undenund the lfthe building docs not cmrentiy heti•tensuk Nat it u mY reyonsihilltY m mtifY W ac ant of W e Manmaat mctptlorwIts aenaanceNnestearaa cy. Signature of Applicant Dale Ow orauthernndagent ate All roof coverings to be Class "B" or better (�% CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO N# dt Date: Building Address: /0 Ai. B/aL /f jAe . Owner's Name: Phone#: o tf— �{ 7s7 3/1S' Contractor: ,, (1 License #: rCG-w1 t 6m Q. P�v. Contact;.] k Cupertino Business License#: uilding rmit Info: / Bld Elect 21 Plumb ❑ Mech ❑ o e ripti—on/ ential Ly o'�DD hiH rigid 2 Commercial ❑ Sq.Ft. Floor Are $/Sq.Ft.: Cost of o'ect: Occupancy Sa phi Type f Construction: 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 Zz,3 / ' / 1of3 , 126 , ` Z '`- CITY OF CUPERTINO CUPEI0 PERMIT APPLICATION FORM QuantityFee 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 BNUSFD New Single Family Res BUILDING BOVERTIME 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 Interc for PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe 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 PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDCT 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 2 of 3 1alm CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity 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 BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIN4 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 3of3