03070033 CITY OF CUPERTINOR"" ':
BUILDING DIVISION PERMIT am°6am R",0s Xs13 NPoR(M� N"II_
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BUILOING ADDRESS: OWENS CORNING PERMITNo03070033
14r7 T.TT\TnY PT,
OWNER'S NAME: 3037 INDEPENDENCE 'PKWY, ST PERR!"S "ATE
BOITANO TRUST
NE: (925) 245-5238 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BGDO ELECT PLUMB MECH
O
+OO LICENSED CONTRACTOR'S DECLARATION Job Description
4U I hereby affirm that I on licensed under provisions lir Chapter 9(commencing P
� with Section]IXgD of Division 3 of NC Basin app Prufcasinns Code.end my license is
;� in full fmccardcffnt. /` L -- BATH REMODEL
? Llcenm Clan
�F,� Dale Comrac
ee ARCHITECTS OEC Af10N
Dieu lundc sand my plans shall hemedia
S D recd es ryslil crccnNa
I
a Licensed Professional
OWNER-BUILDER DECLARATION
X 1 hereby nlRtm that I am exempt from the Contractors License Law for the V n
OO following reason.(Section 7031.5,Business and Prefeasions Code:Any city or County
5O which requires a permit to emnsrua,alter,improve,dcmtdish,or repair any structure _
prior or itsissuance,cels.requimath.mi,icant roomer permiuu file a signed statement
{,2< that he is licensed pursuanuoNepmvisinnsofth.ContractaraLicense Law(Chapter 9 Sq. Pt. Floor Area Valuation
C3� (commencing with Section70li Division)lir Ne Businesnand It Professions Code)or
that he is exempt therefrom and the breis for Ne alleged exemption.Any violation of 35624003 . 00
Section]031.5 by arty applicant fan permituubja.m Ne applicant t.a civil pc..by Of APN Number Occupancy Type
nos some than five hundred dollars(S5W). P Y YP
❑1,as owner of the property,or my employcn with wages as their sole compensation.
will do the work and Reswaure is not intended or offered for mic(Sec.7W,Business iUi —
and Professions Codc:The Conuictors Licnue law ethical not apply to an owner of 102 — PIERS d Inspections
property who builds or improves Neuron,and who does such workhimself or through his
awn amployces,provided that such improvements are not intended proffered for sale.If, 103 — UFER t
however,the building or improvement Is sold within one year of completion,the owner
builder will have Jr,burden of proving Nu he did not baud or improve for purpose of 104 — REBAR
Bale')' 105 - ANCHOR BOLTS
C]1.as owner of lie property am exclusively convecting with Beensed contractors to 106 - SEWER & WATER
consumer the project(Sec.7044.Business and Profes,ions Cade:)Tia:Contractors Li
cense Taw does not apply to an owner of progeny who Wilds or improves thereon,and 202 - UNDERFLOOR PLUMBING
who contracts for such pmjecus with a contracmr(s)licensed purmano Ne Contractor,
Licena<law u 203 - UNDERFLOOR MECHANICAL
❑l am exempt under See. .B&PC for this reason 204 - UNDERFLOOR FRAME
Owner Data
Dat
WORKER'S COMPENSATION OFALA0.A205 - UNDERFLOOR INSULATION
I hereby M.mdcr,penalty of perjury ane of that following declarnimou 301 — ROUGH PLUMBING ,
Iban and will maintain ACenificam of Consent o xlf-boute for Worker's Compere 302 — TUB & OR SHOWER
.all..,as Provided for by Section 37W.1 the labor Code.for Ne perfmmma of the 3 03 — ROUGH MECHANICAL
work for which Nis permit la issued.
❑I have and will maintain Worker's Compensation Insurance,ss required by Seniors 304 - ROUGH ELECTRICAL
37W of the labor Code,for the performance of the work for which this permit is Issued. 305 — FRAME
My Worker?C99mmpye hlion lnsunnce aricn Policy numhcr am: 306 — HOLDOWNS
°" ' 27 ��x "°cs°" 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
lir less.)rlbb section reed not that completed if the Permit U for one hundred d.11an(S IQB 3.09 - EXTERIOR LATH
1 cervi fy that in the perfunnme,of the work for which this Permit is Issued,1 shall mu 3 10 — INTERIOR LATH
employ any Person in my meaner mu Or become subject to the Workers'Compenanim 311 — SCRATCH COAT
IawaorCalifornia.Date
Appfiant 313 - ROOF NAIL
NOTICE TO APPLICANT:It.after making this Ce.incam of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject no the Worker's Compensation provisions of Ne Labor Code,you must
,JO forthwith comply with such pnovisinm lir Nn per mit seal be deemed revoked. 502 — FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 - FINAli MECHANICAL ENERGY
1 hereby affirm that there is a contraction lending&Sony for ffic performance it( 504 - FINAL BUILDING ENERGY
W> the work for which this Permit isiuued(See.301Civ.C.)
a Lender?Name 505 - FINAL ELECTRICAL
V.3
j,z Leader.Address 506 - GAS TEST
U o 1 cenify,that I have read this application and some that Nc above inf.mmiun is 507 - FINAL PLUMBING
correct,I agree to comply with all city and county ordinances and sum laws mining m
0 U building construction.and hereby aohoriae representatives of this city to enter upon the FINMECHANAICAL
W ah.vomen(imed property ror Ins ction purposes. O9 FI J
gy (We)agree to save,indemnify and keep harmless the the City of Cupertino against
y Iiabllllles,judgments.casts and apc.which may in my way..I.again,(said City ,,}G(`i
U7 in consequence of the granting of this Permit 5 N
t� APPLICANT UNDEq�$$TAN 5 A WI L COMP _WITH.ALL NON-PO T Issued by:5 C WORKS Date
SO RCE REGU Tr
%117
Re-roofs
Si namrc ofp(c /Commcmr - c
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willppiiam tar Tamm building occupmta(.m or handle hazardous mamrial
is Il lncd b the Cupertino Municipal Code:Chapter 9.13,and the Health end Safely
Code,section 25532(a)7 All roofs shall be inspected prior to an roofin material bei. installed.
❑Ya B � P P Y g g
Will the applicant or future bplf,ingOccupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
mithemaOrmsaircmImrmams 4d.6.rd by the Day Ami Air Costly Management all new materials for Inspection.
District?
❑Yes UN.
1 have real the harm ous materials requirements under Chapter 6,95 of the Cal iron
Ilia Hcahn&Safety Codc,SccuuosNr6,15577and 155J4.lundcrsmnd thalirNc huilJin
does not euremly h }n n51 is my responsibility 0 notify the..Pan, f
mq.hemmm wn' mast �c a tri .vfee or.C.R. or Dee panap f Signature of Applicant Date
Owm .rmth.r' ,gem 6, All roof coverings to be Class "B" or better
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JUL 0 7 2003
By
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APPROVED
IN ACCORDAOWITH CITY 0"GUP 0 INANCE9Can
)ATESIGNED
chis set of ,.entions MUST
be kept on the job at ail times and it is Uh
awful to make any changes or alterations
m same without written permission From
he building Dept., City of Cupertino.
The stamping of this plan and speclfinations
SHALL NOT be held to permit or to be or,
pproval of the violation of any provisloW
,f nnv City Ordinance or Stato l.nw.
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T� BY I
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APPROVED
•
l�1fi1+�,ftDANCE iNITH rHi: CfTY o9 VUCE CDR
dN IQIC?fRiitv lES ., OINANCES
VWNn ry
1tNmes of P' specifications g UST
Pt on I job at all times and it is urt,
l0>fid to maze any changes or alterations
on same , cut written permission from
Me W.1ding Dept., City of Cupertino.,
l he 5lamP;ng of this plan and specifications
;HALL N0T be held to permit or to be art
IPProval of the violation of any provisions
1f any City Ordinance or State Law,
%i7w A&ZPWo DE�Gs'
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Gv�QT� GA 9s�y
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AWA4 �lyS7 ZIAOY 1'G424-
C AY OF CUPERTINO o� 33
CITY OF PERMIT APPLICATION FORM
CUPERTINO
N # r p� O. Date: 7
V 7 Q
Building Address:
/ 5's7 /WOY /✓L r=
Owner's Name: "— Phone#:
Contra: License #: 7SY023
•dlr. L� o
Contact: Cupertino Business License#:
Gfi�is -y
B din Permit Info:
Bld "Elect lumb ch
-494?15escription:
Residential Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: 7 Occupancy Group:
Type of Constructioq--
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> 1 M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75MBtu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for 13Q 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
Z23
I of3
� 6Y. JD-S
' ~Q�s CITY OF CUPERTINO •
�'TMO PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res, Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New S%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
BOVERTRAE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric 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 Re i e 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 Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFD{T 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
Adlk BREMPOLE Pole/Platform Fixture ELECTRICAL
2 of 3
CITY OF CUPERTINA
TM°F PERMIT APPLICATION FORM
CUPERTINO
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,Mar uee 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
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
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORg'sINFORMATION
BUILDING ADDRESS: OWENS CORNING PERMITNO03070033
OWNER'S NAME: 3037 INDEPENDENCE PKWY, ST RAMrTE"n"ATE
OITANO TRUST
JC. (925) 245-5238 SANITARY n 2 CONTROL NO.
ARCHITECT/ GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
lop LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm in., am licenxd undm
touter pmvisiens of Chapter 9(comencing
with Section 7OXp of Division 3 of On Busir.,apo Pmreashm,Code.end my license is
. � at mean j BATH REMODEL F1'VF1L6®
c to Liccnsc Clan 'Y 6
�= Datc Cammc
ARCHTIECI'SDEC ION
u 1 undo tanJ my plain abet]be uttU u ¢me.",
aLicensed Professional AU6 15 2003
OWNER-BUILDER DECLARATION
I 1 hereby affirm that I am exempt from On Contractor's License Law for the rel`®'��
�Za
$ eta 0 following mann.(Section 711315,Business and Professions Code:Any city.,county
which requires a permit construct,alter,improve,demalixh,or repair any,mmature
prior I.its issuance,also requires the applicant forsuch permit to lileasigned statement
s< that he is licensed pursuant In the provisions;nfthe Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
Fa (cam meeting with Section 7")of Division 3 of the Business and Professions Qsxlej aI
y $ limit he is exempt tMeefmm and the bun for the alleged exemption.Any=of 35624003 . 00
Section 7031,5 by any applicant far a permit subjects On applicant ma civil Penalty of APN Number Occupancy Type
W,more than Join hundred della.(M). _
❑I,as owner of the property,or my employees with wallet w their sole compensation,
will do the work.and OasuucmrcI...intended or offend for sale(See.7044.Business L U i - d Inspections
and Professions Code:The Committees License Law does not apply to an owner of 1 O 2 — PIERS P
property who builds orimprows thereon,and who does suchwark himaelf or Nrcugh his
own employees.provided thauuch improvements are not intended oroRered for Sale.If, 103 — UFER
however,Or building or improvement is sold within one year of completion,the owner.
wilder will have the burden of proving inn he did not wild or Improve for purpose of 104 — REBAR
.1e')' 105 - ANCHOR BOLTS
❑L M owner of the porosity,am exclusively contracting with licenxd conoacmes to
tonnmctthepmject(Sac.7044,BasinessandPrafeasionsCoda:)TheConoxemaLi. 106 - SEWER & WATER
cease law dots not apply to an owner of property who wilds or improves Neuron,and 202 - UNDERFLOOR PLUMBING
enaeL.w. 203 - UNDERFLOOR MECHANICAL
who contracts rot such projects with a contrector(s31icenttpursuant E puContractor'se Contractor's
Lit
❑l ameaemptunder Sec. .B ds P C for this reason 204 - UNDERFLOOR FRAME
Owner Date 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
rT'ly"
Ihereby afRnnunder penalty orperary can oflhefallowingdrearations: 301 — ROUGH PLUMBING
i/ how and will maintains Certificate ofConsenttowt(-insumfor WartebCompen, 3O2 — TUB & OR SHOWER
So
as pmvidnd for by Section 37M of the Labor Code,fm Ne performance of the 303 - ROUGH MECHANICAL
for which this permit is issued.
has antl will maintain Worker's Compensation Insurance,a mquimd by Section 3 04 - ROUGH ELECTRICAL
of the labor Code,forthe performance of the work Jnr which this permit is issued. 305 — FRAME
erter;C ti onlaunncecanieraPolicy number am: - 306 — HOLDOWNS
v� Pa 307 - INSULATION
CERTIFICATE OF E%EMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
aleu.)
(nit Section need notes completed B the permit is for one hundred sonars is lm) 309 — EXTERIOR LATH -
310 - INTERIOR LATH
e cetify that in the any mann of the work for which this permit is issued,1 shall not
employ C.IRparent iDm,mannermuwberomesubjauathe worccriCompensation 311 — SCRATCH COAT
Lawa.rc.Rramia.mm
Applicem 313 - ROOF NAIL
NOTICE TO APPLICANT:If.after making this Cetificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker;Compensation provisions of the labor Code,you must
0z forthwith comply with Such provisions orthis Permit 0allbe deemed Invoked. 502 - FINAL PLUMBING ENERGY
Z O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
1=a .N. Iherebyalrnm that Nem iso construction Itedingagenry for the performmevid 504 - FINAL BUILDING ENERGY
a > the work to,which thuPermit ISRican!(Sec.3o91.Co.C.) 505 - FINAL ELECTRICAL
W 0 Lenders Name
:5 Z Lcnder;Addras 506 - GAS TEST
U O 1 ceniry Nat 1 have read this application and auto that the above information is 507 - FINAL PLUMBING
comet.1 agree to comply with all city and county ordinances and state laws relating to
�U building conswnion,and hereby culmina repmttntateas of this city to enter upon the FIN MECjVNG'
CL
W ahovcmcmiuncd pmpcny far inspection purposes.
gL (We)agree to save,Indemnify and k5p ha ndess les City of Cupenlao against 0 9 F I
N lomilitics.judgmcnWcosts and expenses which may inmyway accrue against midCity 5 I UZin conaequence of Ne gmming orchis permit.APPLICANT UNDE N S A WI L COMP WITHALL NOWPO Issued by:5 WORKS Date
;1.n,,aIura
RCE REGU r Qpf y
;16g Re-roofs It
S
of m Conmicom e
HAZARDOUS MATERIALS DISCLOSURE. Type of Roof
Will pplicentor(mum building occupant store orhendle hamnlous material
finedh theCupeninoMunic alCodc.Chapter9.12,andthcHaltbdSafety.Semon zss3z(a)7y� All roofs shall be inspected prior to any roofing material being installed.
❑Ya B oWill the applicant or futurcb dingoccupantusc"opmcntardevions which If a roof is installed without first obtaining an inspection, I agree to remove
ho ods air retain 'ats d6ncd by Ne Bay Arta Air Quality Management all new materials for inspection.
.]
❑Yes Unit
I have mad the ha a duusmaterials rcquimmenb undcrchaptcr .6.95 of the Califor.
nia Hcalth&SafetyCodo,Secuona ,35533md35534.1unw..dthmifthc huildin
does not cunemly h it o my rox ibility m nodly the occupant f
"ohnmcntawh' m m' ccefaCcoinca .too pansy Signature of Applicant Date
own ojauNa'' agentbad
f All roof coverings to be Class"B" or better