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03050085CITY OF CUPERTINO- U1Vfi��IU.:. nmLDlNc otvlsloN PERMIT *l,.adr,irl�.#�1.�04a „gym„ ��o -,I � �, + ,.;�"-• �. .DING ADDRESS: LUND LEONARD H AND MARGAR TR R NO.03050085 0430 PERMIT ISSUE DATTAp OWNER'S NAME: 05/192003 LUND LEONARD H SANITARY NO. CONTROL N0. PHONE: BUILDING PERMIT INFO ARCHITECT]ENGINEER: BLDO ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hominy affirm Nat 1 am licensed under provisions of Chapter 9 (commencing with Section 7")ofDivlxlon 3 of the Business and Professions Code, and my license is Imfell force anderrea DECK UPGRADE Licej o Claus, Lie. tr DamGoa DSCI Data ARCHITECTS DECLARATION O j 1 underhand my plans shall W used as public mcoNx i^ /Q Licensed Prof od..al j OWNER -BUILDER DECLARATION .(firm that 11. exempt from NC Contractor's License Lew for the g 1 herebyMason. Code: Any city or courtly o ID3L5, Business and a o de improve. demolish. a, wM1kM1 requires a pcamit m construct. alter, impmvc, demolish, nr repair any structure, whichOlowinguires a Permit t ^ prior mIts Issuance. also requires the applicant forsuchpermit to file asigned statementSq. 9 Ft. Floor Area that he is nsed pursuant to the provisions of the Contmctur's License Law (Chapter lice $�'al�v6ion (commencing with Section 7000) of Division 3 of the Business and Pmrstions Cod.)or E . that he Ix aacmpl therefrom and Ne basis for the alleged exemption. Any violation of Section 7031.5 by say applicant far a permit subjects Ne applicant a civil penalty of 3AEK NMb�r 00 Occupancy Type not marc Nen Ow hundred delta. 4500). 0 1,. owner of Ne property, army employ., with wages u theirsol. compematlon, will do the work. and Ne souclum is not intended or offered for sale (Sec. 7044, Business — FOUNDI� 'd Inspections and Professions Code: The Canhwtork License Law does not apply m an owner of 10 2 - PIERS property who builds of im prove. Nercon, and who does Such work himsei f or through his ownemployecaprovidcdthauuch imp.vcmanIs are not intended or offered far -is If, 103 — IT however, the building or improvement is sold within a= you of completion. tuner- builder will have the burden If proving that he did not Wild or improve for purpose of 104 — REBAR em.). 105 - ANCHOR BOLTS 1, a owner oI Ne Srw exclusively connecting with licensed convacme m co ,teen Ne project (ec. 7044. Business and Profession, Code:) The Crimactor'. 1:, 10 6 - SEWER & WATER Ce. who seed pearsu0mmt�ile Contncmr i' nodwip.jecia with a coniracmr(i) 202 - UNDERFLOOR PLUMBING m,.w.d. licns mLaw. 203 - UNDERFLOOR MECHANICAL em exempt under See. .0 &PCfor Nis mann 204 - UNDERFLOOR FRAME Own. /"Or' _�l 4n"JD =,p.. lD 205 - 301 — UNDERFLOOR INSULATION ROUGH PLUMBING WORKERS COMPENSATION DEQ TION I hemby effrn under penalty Of pi ora ar the following dathretione O l have and will maintain O CeniOcateofConsent tosif-nsum rorwationsCompen- 302 — TUB & OR SHOWER .mice., se provided far by Seai. 37W of the Labor Code, for the performance Of IW 3 03 — ROUGH MECHANICAL work for which this Permit lsWood. 304 - ROUGH ELECTRICAL 0 I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code. for NC performance of the work for which this permit is issued. 3 0 5 — FRAME My Worker's Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 307 - INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (This section need not W compmmd ifihe permute foranc hundred dollars(E100) 309 - EXTERIOR LATH °'less.) 310 - INTERIOR LATH 1 anify that in the performance of the work for which Nle permit is issued, I shall not employ anypeeon.�'�-A1' mgnne�snlumWcom aubjuuotheWorkeriCnmpensation <--`--'i11---r- 311 — - - SCRATCH COAT Lawsaf Cdirornlaws0afc —n 313 - ROOF NAIL Applin Nor IC APPLICA:IcrmakingNUCcnifiroteofExcmption,ynushnbld 501 - FINAL ELECTRICAL ENERGY become subject to the Woakees Compensation provisions of the Labor Code, you must `j... forthwith comply with such provisions or this permit shall be deemedmvoked. 502 — FINAL PLUMBING ENERGY O 503 - FINAL MECHANICAL ENERGY rte.. GDNSTRUGTIONLENDINGAGENGY Ihcmhy affum Net there, laecnstemmn lending agency for the performance or SO4- — FINAL BUILDING ENERGY the work for which this permit is issued (See, 3097, Civ. C.) - 505 FINAL ELECTRICAL QLender's Name 506 - . GAS TEST cq�lI lendnr.Addr.. z Q 1 certify that 1 have mad this application end into that the be. information Is ounce, 1 agree to comply with ail city and county Ordinances and xmk laws mlaling 10 507 - FINAL PLUMBING building construction, and hereby ailhorim representatives or Nis city to enter upon the FIN MECH CAL W 86aVG1(We) .,= ed 1.rly for ladcooctlanpurposes. of ayruCupertinoid City (WC)ag`MlO NVC, Indexpensendk.p hay in an eccmc against said City y in 09 F1 a way expenses may any way liabilities,consequence 5 NG nce of hegratsand permit. 7 A consequence of the RSTA 6 of this permit. F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by:5 C WORKS Dale SOU_ Rq[ REGULATIONS. r� qq� a �� ..—f�Ccn -� r &✓�� Re -roofs Type of Roof I Sj a afApp¢anVContmcaor Data HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant store or handle hazardous material dented by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Cock, Scclion 25532(x)? All roofs shall be inspected prior to any roofing material being installed. Dyes No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants. dcfncd by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes '54 No I have mad the hu ardouss materials requirements under Chapter 6.95 of the Califon nie Health ac SarmyCode, Socdons V5505,25533 and 25534.1 understood Nm if the building dins note oily have e¢rte4 Net 11 I. my eaponaihiliay 1. 1, the pant of Nc mymremc whichmnatbein pit`r,bsunccor.Cerifu:alL�arano. Signature ofApplicant Date i - sa CB All roof coverings to be Class "B" or better --� Owner or audumimd agent ritt C1 OF CUPEkTINO C%Y OF CUPERTINO 40 PERMITAPPLICATION FORM o -3 , Y�5'- APN # � ,, 2 _ i 0 371Date: Fee Group r Building Address: lel MECHANICAL y I�Phone .#: Owner's Name �� ^ 1 , • BBOILERI c� Contractor: � A�,r I— {�� ,� _ Boiler > I OOK to 500K Btu License #: Contact: MECHANICAL Cupertino Business License#: Buil ing Permit Info: Idg Elect ❑ Plumb M ch ❑ Job e ption: ential Ell?Co�tci Boiler > 1.75M Btu ❑ BCONSTAX Sq.Ft. Floor Area: BUILDING BCONSTAX $/Sq.Ft.: Cost of Project: Q l BCONSTAXBQ Occupancy Group: I,e of Construction: BCONSTAXH Hotel and Motel 1-2- Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <- 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK 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 1 of AY OF CUPERTINO 40 cTMO 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 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 MIXTURE 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 Stonn/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pipe PLUMBING BPWHEATER Water HeaterNent 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 BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise Apparatus ELECTRICAL BREMNRAPP Rem Non -Res App liance ELECTRICAL BREN20LE Pole/Platform Fixture ELECTRICAL 2 of 3 alm., 0CITY OF CUPERTIA CUP TYOF PERMIT APPLICATION FORM QuantityFee 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 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 Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBGPlumbin Fees foot PLUMBING ZADDCH I Address Chane BUILDING 40 3 of 3 1- L_ 0 OWAR-BUILDER VERIFICATIOPP 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. All the work authorized by this permit B. _ A portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. 25, All of the work B. _ A portion of the work (complete section Contractor Address/City Phone # State Lic nse # Type of work to. be performed c hr, e � oV Say � �r a 3. —I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Finn Address/City Phone Number Type of work to be performed I declare under penalty of perjury that the above is true and correct. Owner -Builder Information (reverse side). Property Owner's Signat',-- Job Addressk. I have read and understand the Dat/ Permit # ✓� v Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. wi % MAX 19 2003 IN ACCORDANCE WIT,, PROver) Cup THE Orry Of DES AND RDINA RDINANMs - DATE This S. and spec;fc, De'k t I lcatldns MU eP on the job I at all times F,4)C�y s £o p A; s�viul to Mak as andIt I any changes op -same mthout Writt or alteratlort 6 )6pt an patmission puildine, L City of Cupouni -Itlmping of pie Who U 'NOT P, a hold 't ol�"tlatf 't A 91,31 �Of, the. 1�1010 I of any r. r ofPiny CnY Oirdin�nC6ov fan A." Ef TITF 7 V5, IOLA