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03030154 CITY OF CUPEB'I'INO �. e � BUILDING DIVISION PERMIT 4CQNTRACTOR INFOR ATI'O�1.:. BUILDING ADDRESS: _BOB GERE MASONRY PERMIT NO. MTRAMONT-9 RP OWNER'S NAME: 480 CROSSLEES DR �rsMrLs .9E: SANITARY 146:' tOWMOL NO. (408) 972-1285 ARCHITECDENGINEER: BUILDING PERMIT INFO RLDO - ELECT PLUMB MECH Oo LICENSED CONTRACIOR'S DECLARATION ly I hemby affirm that I am fucnscd under provisions fir Chapter 9(commencing Job Description wish Seed 1")Of DI Itoo3 f do Business and Profeaslons Code,and my license is t� mrmlmmpax, rba� k�Leg REPAIR CHIMNEY FROM SHOULDERS-0A burse 5e. ��®. te mranor AR 1LARATIOH APR' 1 6.2003 S 1I uMman 11 cuhlic records Licensed Professianat OWNER-BUILDER DECLARATION . I I hereby apron that I em exempt form the Contractors License Law for the - BUILDING E00 following reason.(Section 70713,Business And Proraslom Code:Any city m county B E which rcqulra A Permit to construct,alter.improve,demnllsh,or repair,any structure F �+ prior to its issuance.also mquloa the Applicant for such permit he rile asigned statement Zy'C that he is licensed punuantln the provisions of the Contractors License Law(Chapter 9 Sq.FL FloorArea $. 13l §ion 7g (commencing with Section TOGO)of Division S or the Business and Profession.Codc)or 775, ' 33 that be It esempt therefrom and the basis for the eltcgcd esemptlon,Any vloladon of Section 7031.5 by aro applicant for A permit subjects the applicant b A cin penalty or 3 � 7T�f 0 0 Occupancy Type not more Nen five hundred dollen(SSW). ❑1,As owner of the property,or my employees with wages as their sets compensation, will do the work and thamomum is out intended or offered for sale(Sm.70".Business 101 - FOUNDP.*$ @Rd Inspections and Profession Cade:no Commourr's License Law dors not Apply to an owner of property who buildsorimproms thereon,and who daasuchworkhimaelforNmugh his 312 — CHIMNEY REBAR & STRAPS own employees,provided that uch Improvements as turbanded orortercd fursete.11, 'S 14 — FINAL PUBLIC WORKS however,the building or improvement is told within one you of completion,the owner- builder .will have tit burden of proving that a did not build or improve for purpose of - sateJ. ❑I,as miner of On property,am exclusively contracting with licensed centracbra to constroct the project(Sec.7044,Business and Prefeuiov Code:)The Contractors Li- eeme law does not apply to an owner of property who build,a,Improv thereon.and, who contracts for such projects with a eortuanor(s)licensed pursuant to the Contreelnrt ' License Law. ❑Ism eumpt under See. .B&P C for this(coon owner Data WORKER'S COMPENSA710N DECLARATION 1 hereby aprner under penalty of pedury can of NC following deLlaationF ' @. have and will maintain A Cmiifreneof Consent to se151nsim four Worker.Conten etlnn,as provided for by Semien 5700 of the labor Code.for the performance of Ne work for which this Permit Is Issued. - - - ❑I have and will maintain Worker's Cance of dic work as requited t i Section 57W of Nr.labor Code.far the pcnarmmce of the work forwhich this permit is Wued. My Wohera Campewllonl moans nrticr and Polity number Gn{ff' EO PoI c .: R' ERTIFI ATE OF COMPENSATION WORKERS' ' COMPENSATION INSURANCE ' .(Thissectlenaed nm becompleted if the patron Is forone hundred dollars($160) n , orlms) . 1 certify Wt in the performance or the work for which this permit is issued,I tall am - - employ any person in any manner an as in become object o the Workers Compevnion , Laws of California.Dam Applicant " NOTICE TO APPLICANT:If.after making thh Compote of Exemption,you should - become subject to the Workers Compensation provisions of the labor Code,you most - vJz forthwith comply with such provision or this permit shell the deemed invoked. , OCONSTRUCTION LENDING AGENCY 1—, I hereby affrm that Nem I.a mmtnctlen lending egcwy for the perfwmmce of [Yi 7 the work for which thls permit I.issued(Sm.3097.Civ.Q - W Q Len der'.Name D,z Lenders Address / V Q I anify that I have read this application and suse that the Above informs thm is W F~ bending l agree to comply with reg city and county ordinances and allele teacup.t e - - - .�U movongconsuuctiroen0 hmeby inspection nprporesentativrsof this city laenterupon the W .have-mentioned progeny for indme ify on purpose.. G (WA)aju agree m an.indemnify and keep hay in m the City of Cupertino against ULo)Z Ihconsogjnce,ofhecosts and expmucs which may In Anywyaoaue against said City yq C.)z In;AP consequertee oNOER STANDIthisDWE U7 LICA NDERSTANDS AND WILL COMPLY�V1111 ALL N N-PO NT Issued by: . Date R EG LA 5, �J� ,ZR �/ Re-roofs umofApplkan on for DebH DOES MATERIALS DISCLOSURE Type of Roof Will Ne applleam or future building occupant norc rehandle hanod0us material fined by the Cumn in Mu pal Code.Chapter 9.11,anti the Health and Safety e.Secdonsssll(.)7 o All roofs shall be inspected prior to any roofing material being installed. ❑Yds NoWill the applicant Or mbmbuildingoccupantuse equipment re devices which If a roof is installed without first obtaining an inspection,I agree to remove hvmdous air contain esu es defined by the Bay Arc,Air Quality Management all new materials for Inspection. lcl1 ❑Yea u I have mad the hus ns materiels roquiremenu under Chapter 6.95orthe Caliror- nbHcalN&Smcty Calc, dun 155115,25577 And 75534.I umlcnuM has if the building dins not currently haw a tonna Net it u my mapomihility 0 netiry Ne mcupml of be require ts I of elpd it armoracenifieateprOcc, r. Signature of Applicant - Date ' Owner unulhorizcd m All roof coverings to be Class"B"or better ci . t CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO qF'APN# ©� / ©0 Date: Building Address: Owner's Name: ' Phone#: y7 Q /So � • Contractor: License#: ` 14(� Contact: Cupertino Business License#: ��_ Building Permit Info: Bld . Elect ❑ Plumb ❑ Mech ❑ Job/Description " Residential Commercial ❑ Sq.Ft. Flo Area: $/Sq.Ft.: Cost ofProjec . Occupancy.Grou a9� - ---- Type of Const on: Y,{ // ^2 Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other,Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERl Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL -- — �— —BBOILER3- -'--- --- BoileT> 500K to lM 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 Ah BINVESTIGA I Investigation fee BUILDING BMITIGATC Comm. Housing Mit:Fee BUILDING MF 1of3 77. 717 r � CITY OF CUPERTINO cuPEr�TINo 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 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 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BRENLUUiAN 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 Fumace> 1 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 i i 1 (i CITY OF CUPERTINO myoF 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, 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 Swinirrdng 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 F e sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3