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03070117 CI TY OF CUPERTINO s r ' w �•z.�,r:" x»a-+'* �'`��� '�' BUILDING DIVISION PERMIT . CONTRACTOR, INFQRMATION, Bue1DING ADDRESS: L AND D CONSTRUCTION PERMIT NO 03070117 OWNER' 9 1_1­44PUS -AV SNAME: _ 1555 YOSEMITE AVE. #17 PERMIT Iesuc DATE NE: SANITARY NO. 15'/ CONTROL NO. (415) 822-8383 CHITELT(ENGINEER: BUILDING PERMff INFO BLDG ELECr PLUMB MECH u00 LICENSED CONRACI'OR'SDECLARATION Job Description C I hereby affirm Net 1 am licensed under provisions of Chapter 9(commencing b with Satlon] pnf Division Sof NC Bu nu ofcuinm Code rad mylicen¢ie LjiR inmOm a tlerreet. REVISION--IN HOUSE USE ONLY . Sr: License a CI In contror NO NEW PERMIT ISSUED, ORIG. #02120090/03070117 qqq .� under ARCHITECT'S QORATION �YI'undc. my plena:hall .A u Public records o Licensed Professional OWNER-BUILDER D:CLARATION y I hereby affirm that I em exempt from tW Chntramu'l License Law for the C o following moon.(Section 703 1.5,Business and Profession,Code:Any city or county s}$ which requires a Permit to consumer,alter,improve,demolish,or repair any s nsctum poor in its issuance..150 requiru the applicant for such Permit to If In signed statement qq mm On that he is lic uurm cd puant to Ne pren,visioof the Contractor's Laurie Law(Chapter 9 Sq.Ft. Floor Area Valuation Cs'� (commencing with Section 7000)of Division 3 of the Business and Professions Cods)or 0 ERR Net he Is exempt therefrom and Ne basis fir the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil Penally of 3.A.H1d r1.tw l.er O O Occupancy Type nm mom Nan five hundred dollars(S5o0). CPG V.SlY G ❑L as he wor elthe property,or my empleyw or waeu u(bask, (Sec. 044.Business will do Prfework.end the h.Con Isnotintendedor offered font:(Sec.70th,"net • mtl Prhfeasiou Codc:The Conumror'a License Law does not apply to an owner of Required Inspections progeny who builds or burrows Moment,and who doessuch work himselforthrough his 101 - FOUNDATION Own employees.provided that such improsements am not intended oroRcmd forsale.If. 10.2 — PIERS however,Ne building or improvement is sold within oro year of wmpletion,Ne owner builder will baro the burden of proving that he did nu Wild or improve for purpose of 103 — UFER talc.). ❑1.as owner of the property,am exclusively contracting with licensed contractors to 104 — REBAR coni the pejeu(Sec.7044,Business and Profusions Code:)The Conmcirt U. 105 — ANCHOR BOLTS', come Law does not apply to an Manor of property who Wilds orimprorosthemon.ad, 106 - SEWER & WATER who contracts for such projects with a contractor(&)licensed pursuant to Ne Contranofa License Lou. 202 - UNDERFLOOR PLUMBING O 1 am exempt under Sec. B k P C for this notion 203 - UNDERFLOOR MECHANICAL Owner ate WORKER'S COMPENSATIONDECLARATION204 - UNDERFLOOR FRAME I berebya0irm under penalty of perjury one of the following dularmions: 205 — UNDERFLOOR INSULATION ave and will maintain Cenificarc u o(Cnncno ml(-insure for Wmhee.Cmnpcn. 301 — ROUGH PLUMBING Is provided for by Senium 37W of the Labor Code,for the affim once of the 302 — TUB & OR SHOWER for which Nis pumice is issued. ❑1 have and will maintain Whistles Compensation Insurance.as required by Section 303 - ROUGH MECHANICAL 3100of the labor Code,for 0.performance of the work for which this pumice is issued. 304 — ROUGH ELECTRICAL I' My Worker'&Cnm. aaalio Inaunntt certi and P/9qlicy num a G cr. P,.� d Po4djNo.: 2¢3 305 - FRAME CERTIFlCATE FFXFN ON FlIOM WORKERS' 306) — HOLDOWNS COMPENSATION INSURANCE 307 - INSULATION (This section wed not W completed if the Permit is for one hundred dnllars(SII)(I) 308 - SHEETROCK or lots.) I unify that in the performance of the work for which this Permit is issued,l shall not 309 - EXTERIOR LATH employ any Nixon In any mannet an as to become subject to the Workeri Compen,ation 310 INTERIOR LATH Lowe of California.DateAppl311 - SCRATCH COAT NOTICE rat NOTICE TO APT:If, pr Certificate of Exemption, should become object .the Worker's Compensation prevision,of the labor Cost.you Mott 313 - ROOF NAIL .JO hnhwithComply With such provision orthis Permitahal:Wdeemed mvnkeQ 501 — FINAL ELECTRICAL ENERGY Z CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY (=.4 IhambyalfirmMo.themInconstructionludins.sucyfollow perfmmanttof 503 - FINAL MECHANICAL ENERGY C> Ne work fee which this permit Is issued(Sec.3097.Civ.C.) tg3Q Unita 504 FINAL BUILDING ENERGY = Londe Address z 505 - FINAL ELECTRICAL Up 1unity that Ihave.4Mr.application and Marc that 0.that.infmmatiunia 506 - GAS TEST ly (~ correct 1 agree to comply with all city and county ordinances and Marc laws meeting to C)U building convection,and hereby auction mpruensuivet of this city to enter upon the — FIN PLUMB G W ahnve•mendomed property for inspection purposes. G (We):gree m save,indemnify and keep hornless the City of Cupertino agelnst O 8 F I AL W liablliriu,judgments,costs and expcases which may in my way aceroc against mid City 5 Q s U Z, in consequence of the granting of this Permit. J\ ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: ING Date souacl:R ULA710NS. 4 NAL PUBLIC WORKS Re-roofs Signamr1c Pit c HAZARDOUS actor Date HAZARDOUS MA ERIALS DISCLOSURE - Type Of ROOF Will the applicant or future building acupanl score or ban No herudous materiel as defined by the CupertinKffi 'pal Code.Chapter 9.12.and the Health and Safety COM. edea sssu(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes NO Will the applicant obuilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove I hnnrdnus air can ounneru u fined by the Bay Arca Air Quality Management all new materials for inspection. ict7 Yes I have rcW the haaaious materials mquimmcnu under Chapter 6.95 of the Califon his Hal"Se etyCode,Seeuum 25505.25533 and 25534.1 understand that if the Wilding docs our currently hose•moms 0.11.is my responsibility in noufy tW occuPmt of the mquimmcnu which must MZL prior iissuance of a C emofo. pmeyy. Signature of Applicant Date All roof coverings to be Class "B"or better j!M,or amhomod agent Date C) CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM o o / -7 CUPEkTINO b3 7 1qFPN# iC) Date: —7_ I S —03 Building Address: Mailing Address (if different from building address): o (,o(N,vn ti Ve 1n,7 Sbl Owner's Name: Phone#: T l OCAtq 60p-2,93 C7 S'3 Contractor: L4 License#: Opul-7/ Contact: Phone: Cupertino Business Licen se#:To^ -/ UA Fax: 193q�2— ding a it Info: BldgED Elect El Plumb ❑ Mech El Job Des ' tion: esi ential c"°� Y2��S on Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a 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 IM 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 <= IOOOA 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 * zz4R `f 1 of CITY OF CUPERTINO ClW OF PERMIT APPLICATION FORM CUPEP.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 Conon Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmos beric 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 Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING 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 Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREIvIAIRHAN A/C Units <= 10,000 cfin 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 BRENMAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 �( CITY OF CUPERTINO CITY P PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 I Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection 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