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05080159 CITY OF CUPERTINO BUILDING DIVISION PERMIT = CONTRACTnR3INFORMATIOO BUILDINGADDRESS: IONICS FIDELITY PUREWATER PERMITNo.05080159 OWNER'SNAME: PERMIT ISSUE DATE AIPA CYPRESS HOTEL 1971 RUTAN D 2005 7ONE: SANITARY NO, CONTROL NO. (925) 456-7000 — Artlroilllxaiull....Ori CHITEMENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u o LICENSED CONTRACTOR'S DECLARATION 0 wI hereby affirm that l am licenced under provisions of Chapter 9(commencing lob Description n ito Section 7")of Droision 3of Ne Business and Profusions Codc.and licevc is s Ill mALED z, ull forteandcffcn' 3 sZ3(ooeyy INSTALL WATER SOFTENER �f �J�� j,� cnu Class L— �" Lic.N nFte f.</Tu`�Contractor O`4 C$P ?4 s�Nf�s 6,444 lA�.�r L 6 u 1 underwnd my plans shall he used as public recmds �s/,C`Mr� 2005 Nod Licensed Professional `f vt S OWNER-BUILDER DECLARATION fpkl n B ry ry e�-a v <5 1 hereby affirm that 1 am exempt from qw Conuactofs License Law for the III JfL'^J��!U I'pI+ftLIIS LDj��Tlsl j1•K\\VF'rl fUl\yS',''.%Vi—/, O o following mass..(Section]varLrr Business and Professions Code:Any city atcounty flll I. which require a permit m emnuuet,alcor,improve,demnlivb,nr repair anY avuemm prior its issuance,also requires the applicant rot such permit to file a signed statement r< that he is licensed pursuant roMeprovisions ofMeCon=wisLicense Law(Chapwr9 Sq.Ft. Floor Area Valuation YFG (commencing with Section 7")of Division 3ofthe Business and ProfeuinalsCode)ser $25B90 y $ Nat he u exon,(therefrom and the basis for Naem Ne micipi d cptioo.Any violation of Seds.7031.5 by any applicant for a permit subjects Ne aplumm,to is civil pc natty of APN Number Occupancy Type not comm Nan Gra hundred dollars($500). P Y YP 1,as owner of the property,army employees with wagee as their sole compensation, will do Ne work,and the structure is not intended.,offemd forsak(Sec.7044,Business 3 698±064 , 00 and Pmressi.ns Com:The Conuaaoh License Law does not apply or an owner or Required Inspections property who buildsor improves thereon,and who deessuch work himself.,through his own employees,provided Nm such improwmcnts are not intended proffered forssle.IL however,the building or improvement is sold within one year of completion.Mc.wner- builder will have Ne handed of proving that he did not build or improve for purpose of sale.). ❑1.as owner of Ne property,am exclusively contracting with licensed convaemrs w contract Ne pmject(Sec.7044.Business and Professions Code:)The Chaumont's Li- cense Law docs not apply to an owner of property who builds or improves thereon,and who contracts for such pmjccu with a contractors)licensed pursuant o the Conuacmrs License law. ❑I am exempt under Scc. ,B&PC for this Mason Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 1 haw and will maintain is Certificate of Consent o self insum for WorkersCompen- 7031.00 on,as provided for by Section 7]00 of the labor Cade,for Ne performance.f the rk for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as muined by Section of Ne labor Code,for Ne performnce of Ne work for which this permit is issued. Workeerrli�Comp nduati.n Insurance artier and Polity number am:ner:A?_1�A—'- Policy No, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thissectioniced not becomplewd itthe permit is Bouric hundred dollars(SIM) Mr less.) 1 unify Nat in the perrmmance of the work for which this permit is issued.l shall not employ any person in any manner ao as on become subject o Me,Worked Compensation ' Laws of California.Dam Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become suhject to the Workers Compensation provisions of the Labor Code,you must .J,Z forthwith comply with such provision or Nis permit shall be deemed invoked. Z O CONSTRUCTION LENDING AGENCY In IhereM1 &Mm Nat them is a construction lending F+^ y gagcney for Nc Performance of a the dework for which lNa permit is issued(Sec.7097,Civ.C.) W Q Lenders Nam. � z lender's Address U Q 1 certify that 1 have read this application and sum:Nn the above ieformniun is n, c.vccL 1 agree to comply with all city and county ordinances and some laws mining to 0U building construction,and hereby au@orise mprnenutives of his city to enter upon the W idmec-mentioned property for inspection purlwes (~ G1 (We)agree to save,indemnify and keep harmless Ne City of Cupertino against N liabilities,judgments,costs and expenses which may in any way memo,against said City U in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �-1-J-0j- SOURCEREGU IONS. g I8"�- Re-roofs Signaturep B Signature ofAnHAZARDate HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne i ppinmu ter future building uccupam amore or handle harallous matenial as dermad by Ne Cupenid.Municipal Comm,Chapter 9.12.and Ne Health and Sadly Codc,Seetion23512(a)] All roofs shall be inspected prior to any roofing material being installed. ❑Yes i /u Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it havzndnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. isoict7 / C]Yes T7TTT 1 have mad Neh,Sr om253O5, 5533aduusunder Chapter Q9LifNe Wilding nia Hher- ca W 6 Safny Codc.Sccdoas 25X15,23577 mJ 25574.1 undcrstmd thatifthc building docs not cunemly haw a nnmL quit it u my mspomihility to notify thc awupant of Ne raquimmen�swliclOrpst lcmetprimtuissuanecorl ccrdrelumar«apancy. Signature of Applicant Date owner m cot .dvnd agent Dow All roof coverings to be Class"B"or better Community Development _ 10300 Torre Avenue l ry�l' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building De artment JOB ADDRESS: PER HT# OWNER'S NAME: IPHONE # GENERAL CONTRACTOR-- I ONTRACTORI am not using any subcontract i Date Please check a licable subcontractors an Vlete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile er Con r Signature Date aCITY OF CUPERTINO CUCITY TYOF O PERMIT APPLICATION FORM 0 , z � 7 APN # _-�09 0 1 O (o Date: Building Address: Mailing Address (if different from building address): oso S , UE A,o,3-aa StQ& Owner's Name: Phone#: ri`SS 'Ftrv-TC(- (_upr3) 00 Contractor: License#: Ctact: Phone:�� o 3'4 Cupertino Business License#: �on Es n P-ZA Fax: goo age $13 l \ 85CP Building Permit Info: O o 75 Bldg ❑ Elect ❑ Plumb 15� Mech ❑ Job Description: Residential ❑ Ar-Q-tC_ SOP-16r�It-r 1» lIA-T0Ai Commercial 19 Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: ,Z<F� 69.0 Type of Construction: Please check this box if the project is a second-story addition: ❑ Proiect Size: Standard ❑ Lar e ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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 Elee 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 # 3 J 1 of 3 he'1' CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIltHAN 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 Apoaratus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel ResAppliance ELECTRICAL 2 of 3 I L- CITY OF CUPERTINO °TMOF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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,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 N PERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Faro PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3of3