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03080118 (2) CITY OF CUPERTINO "' BUILDING DIVISION PERMIT CONTRACTORINFORMATION ; x i�a BUILDINGADDRESS: ANDERSON RADIANT HEATING PERMIT NO 03080118 4r PqTT CT aOWNER'S NAME: 207 S . LEIGH AVE . PERMIT ISSUE DATE ROWFP 7014N TR AND MARTI-T4, (408) 378-3868 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 Op LICENSED CONTRACTOR'S DECLARATION lob Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P Z= with Section 7M)). the Business andessiu� .and my license is in full home and OOff// EPLACE HYDRONIC BOILER �1 A j Licen s Lic.p F _ALE0 �s-� Dam T Contra fff,,, pp ARCHITECTS ARA iC.a l understand my plans shall used as puhli �� oda JAN 0 3 2004 e o Licensed Professional a S OWNER-BUILDER DECLARATION 'vk a q I hereby affirm that I am exempt from Ne Conuanm's License Law for the BUILDING p o following reason.(Section 7031.5,Business and Professions Code:Any city or county `<m f which mill ires a perosis to construct,alter,improve,demolish,Or repair any nmentim Prior n its iuuance,also mep fres the applicant forsuch permit to file a signedslarement s< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft.Floor Area Valuation 4FC (commencing with Section 7")of Division 3 of the Business and Professions Code)or u;§ Nat he is exempt therefrom and the basis for me alleged exemption.Any violation of37542021 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of APN Number Occupancy Type not mora than five bundmd dollars(S500). P Y YP ❑ I.as owner of the property,or my employees with wages as their sole compensation, ��Y rrr iiinnnf�rtrtrtfrrrp��x��rkrrr�� will do the work,and the stmelore is not intended or offered for sale(St .7044,Business — UGH ) tIC99 C[IOn$ and Professions Cade:The Contomdr's License Law does not apply to an owner of ^lV••__ li.. property who builds or improves thereon.and who does such work himself or through his 303 - ROUGH MECHANI AL awn employees,provided that such improvements are not intended or offered for sale.If, ,304 — ROUGH ELECTRICAL however,the building or improvement is sold within one year of completion.me owner builder will have the burden of proving that he did not build or improve for purpose or. 3 05 — FRAME safe.).1, 308 - SHEETROCK ❑1,m owner of the ct(Sec. ,Business exclusively cofessi ns wild licensed convectors to cones et Law oes notapply to an wneroand ProfessionsCoda:)or ipro es tumme.and, SOS — FINAL ELECTRICAL Goose Lasvdwor such pr teen own a rofpmpenywho sedporimpro the Contra.and, 507 — FINAL PLUMBING whonseI c8 for such projects with acdmmetor(s)licensed pursuant to the Contractor's License Law. 508 - FINAL MECHANICAL ❑1 am exempt under Sec. B&P C for this reason 514 - FINAL PUBLIC WORKS Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby afRmt under Penalty of perjury one of the following declarations: J l have and will maintain a Cenifcmo of Cdnaenud ulf-insure for Worker's Compen- sation,asp dad for by Section 37W of le Labor Code,for me perfommnce of hire work for nth Nis permit is mooed. ave and will maintain Workers mpensation Insurance,as required by Section Warta Labor Cedc,for dm arms cc of me work for which this permit is issued. ,.. M raker Compensation ca ter and Policy mormeram: LLc Policy No.0271�i� 03 CERT AE FE MP130N FROM WORKERS' COMPEN ATION INSURANCE (Thissecti needni Plemdif me taforonchundreddoliam(SIW) or less. 1 certify mat' the pc a nc Or this permit is issued.I shall nut employ any an a r t(c dm Workem'Compensnion Laws of C if. a Applican NOTED TO APP ANT:1 after making this Certificate of Exemption,you should becom suhjcct t the Work a Compensation provisions of the Lahnr Cntic,you must ,J z forth ith comp withred provisions or this Permit shall he deemed revoked. z O CONSIR TI N LENDING AGENCY 4 I hereby affirm that Ne ua mmvmion lending agency for the Performance of fk > c work fur which this In t is in ed(Sec.3097,Co.C.) W Qrider's Name Letier's Add.. U 1 certify in. have no this application and sum that the shove information is W (•' correct.l agree,to omply th all city and county ordinances and state laws relating to �U buildineconsw ionan emby awhorin rero t pives drums city(center upon the W ahove-mentio dpm tyformsPectomp S. lY (We) gree save,indcmnif ep harmless the City of Cuperlino against tF—tN liabili' s,j Sm .eosuand scawhichmay in anyway accrue against said City U ,z inc se, n the gran, Of this permit. " AP IC NDE ANDS AND WILL COMPLY WI ALL NON-POINT Issued by: Date SO R ONS. . 5 " Re-roofs Sig tura&fPdi nVCon cur I Date H RDOUS MATERIALS D1SCL SURE Type of Roof W Iue ap i Iorfuture building,Occupant store or handle insertion material dcrine by the Ionian Municipal C de.Chapter 9.12,and the Health and Safety ode,Se scan ❑vas No All roofs shall be inspected prior to any roofing material being installed. Will c applicant or fmur olding occupant yuipmcnl or devices which If a roof is installed without first obtaining an inspection,I agree to remove .nit harar ms air cmdeminan as dcfned by ay Ams Air Quality Management all new materials for inspection. District? Yes, �'fJ0 Ida a radoes mrials reyuircmcnu under Chapmr6.95 of lc Califnr die allof cc' as 5505,25533.d2534.1unde..dmwift holding - doe net curtc t L Net itis my responsihilit nosily the m:eupant of lc reiromenL m tinmrmismadoem'0 r Signature of Applicant Date rorm,mmixed Oam All roof coverings to be Class "B" or better i CITY OF CUPERTINO CUP TYOFFINO PERMIT APPLICATION FORM PN# Date: Building,1ddre�s: /�/ Mailing Add ess (if different from building address): Owner's,�Ia(p yis�t�p� Phone#: Contractor: �2� �Q / � �� License#: 7/ 8 7V`9 Contact: ` ,,/ Phone: Cupertino BussiinesslLiceense#: l tAo Fax. �31f-393F eAsAl Building Permit Info: �� QSDD�1 Bldg ❑ Elect ❑ � � � "Plumb ❑ Mech ET-� Job Description: Residential � fJi(�(C.. �/ Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: ��q,�f 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 Permit 's . 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 Z 2EE-o Iof3 Cg3 . 37 CITY OF CUPERTINO CUP TYOF O 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 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 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 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM13USWAY 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 Apparatus ELECTRICAL BREVE RAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 CITY OF CUPERTINO ,. CUPEYOF PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Grou • 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 BSWIM Swimming Pool BUILDING 1 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 i i 3 of 3