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03020026 (4) CITY OF CUPERTINO "•v,�,.,'•,•? i a r a. l BUILDING DIVISION ",uONT"o"OR INF'QR tON BUILDING ADDRESS: ADF CONSTRUCTION PERMIT NO, 10873 WILKINSON AV n102002r OWNER'S NAME: 6201 SHADELANDS DR APPLICATION SUB DATE PANNELL DONALD R AND CHARLO TE 02/07/2003 ONE: 4082819177 SANITARY NO, CONTROL NO. ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Otte, I �ia00 LICENSED CONTRACTOR'S DECLARATION I hereby affimn that 1 am licensed under provisions of Chapter 9(commencing Job Description ��Zwith Section 7W0)of D'vision 3 of the Buasine�e and Profession Code,antl my liwnse is ®'��® in fullforcc and of REPLACE SHAVER & VANITY r Licenm Claus JJJ��/// Lic.N � � . fy F Da Cu�na��tt//r = %og� ARCHITELTS OffiLARATI N E �-20U3 o nderstantl my plans shall be used as public records FEB 2 L J mLLo Licensed Pndemnnl OWNER-BUILDER DECLARATION BUILDING u�a 0 I hereby affirm thm 1 1 exempt from the Contractor's License Lew for the t X Se whichfollow uires a permit t Aonstr t,alter,imp Profession Code:Any city or county so m or which requires a permit re construct,alter,is for h formilt t m repair any statement r Z y,prior m its issuance,also requires the applicant for such permiuo lila a signed natemem £ G that he is licensed pursuant to the pmvioonsofOcContractor's License Law(Chapter 9 Sq.Ft.Floor Area $11WOjotion y $ (commencing with Section 7")of Division 3 of the B usiness and Professions Code)or Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penal) of Occupancy Type not more than fin hundred dollars(SSW). y B r ❑L as owner of the property.or my employees with wages As their sole compensation, will do the work,and the sweture is not intended or offered for We(Sec.7044,Business and Professions Code:The Contrecmrs License Law does not apply to an owner of 10 2 - PIERS equired Inspections p rperty who build.or improves Hereon, Ad who does such work himself.,through his own employees,provided Nat such improvements me not intended or.Hered for sale.If, 1O3 — UFER however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving Nat he did not Wild or improve for purpose of 104 - REBAR We.). 105 - ANCHOR BOLTS ❑I.uct as Onerolthe Profanity.Am(See.704,1, Business contracting COdeth:)Theedconmactors to 106 - SEWER & WATER construct the project(Seco ad w ,o and Professions ds or fi dire ri themon, nd cease Lawdceor such Prs net roan ith aofpropeny who sedporimproves themon,and 202 - UNDERFLOOR PLUMBING who conoecu for such Projects with a convactor(s)licensed pursuant to the Conuecmri Liee".0 Law. 203 - UNDERFLOOR MECHANICAL ❑I And exempt under Seo. ,B&P C for this ,on 204 - UNDERFLOOR FRAME ow°" Date 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declaretlons: 301 — ROUGH PLUMBING I have and will maintain ACenmeateofconaemt"seli-insum fm Workers Cuni 302 — TUB & OR SHOWER sation,as provided for by Section 3700 of the Labor Code,for the performance of the 3 03 - ROUGH MECHANICAL work forall lhav and this maintain lured. 304 - ROUGH ELECTRICAL (�1 have and will maintain Workers Compensation Insurance,h required by Section d. — 9700of NC Labor Code,for Ne performance of Ne work for which this permit is issued. 305 FRAME My Workers Comp naa�tion'I`summnoccanimrand Policy umWram: 306 - HOLDOWNS Carrie S}zL ✓ K(P Pore 2,3:Z- o0 3307 - INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK (this seoften need Act W completed if the permit is fotonc hundred Odims(51IX0 309 - EXTERIOR LATH Iticn.)certify that in the performance of the work for which this permit is issued,I shall not 310 - INTERIOR LATH em become - SCRATCH COAT employ any person in any mannerso as come subject to to Workeri Compensation Applicant wsca California.Dam313 - ROOF NAIL NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject to the Worker's Compensation previsions of the Labor Code,you must On forthwith comply with such Provisions or this Permit shall W deemed mocked. 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY F' 1herehyaffirmOatthen,isaconswctionleadingAgency(ofthePerformanceof 504 - FINAL BUILDING ENERGY the x L,rderklofwhichNisp mitisi ucd(Scc.309],Civ.CJ 505 - FINAL ELECTRICAL OW' Q Isndcr's Namc D z Lendo,'aAdd.. 506 - GAS TEST U O 1 cattily Nat I have read this application and sure Nat the above information is 507 - FINAL PLUMBING L4 F cortecs I agree to comply with all city and county ordinances and state laws relating to �U building construction.and hereby authorin representatives of this city to enter upon the FINAL MECHAN CAL W above-mentioned property for inspection purposes. O9 FIN 6c (We)agree t0 save,indemnify and keep harmss lethe City of Cupertino against y liabilities,judgments,costs and expenses which may in any way accrue against said City C, G U 7�. in consequence of the grand ng of this perm it APPLICANT UNDERSTANDS AND WILL COMPLY WITH A NON-POINT Issued by:5 WORKS Date SOURCER LATION_S. r f m u " a Re-roofs HAZARDOUS MATERIALS DISCLOSURE Doc Type of Roof Will the applicant or future building occupant store or handle havaudous material as defied by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety Code,Section 25532(a)? ❑Yes � All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building oocupantuse equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit baradnus air contaminants as deunctl by the Bay Area Air Quality Management District] all new materials for inspection. ❑Yes Wo I have read the M1nmardusmaterialsrequiremenlsunderchapler 6.95 of the Califor- niaHealth&safety Curio,Scd..s25505,25533and25534.1 dcrsundthztifthc building dcesnotcuruc M1avc a tenant Nat it is my resp.nsibilitym fyN cupant of the rc mre els mil must bene rmissuanceofa Cdrdri, n �r ��«A 2/7/d 3 Signature of Applicant Date Owner alhori.d.agent D=8 All roof coverings to be Class"B"or better i; F'X ISS. TeArp, g1455 gedrooM £�closNre ` NALL c u Ifare4 I,d 9a� ,`PAN Flesh gti� � 1,1NpLegM ER floor 10 y� gree v 4oArod Peckef poo/ At .Skor er W/f/ls TYPO 'id O vaD G F/2 1N ACCOF aAI VITkCUPFRTIN( Cf CITY Of DANCES >AT SIGNEDchis sef /De kept on tyles PeiLilpst!vl'S lawful to 1 at all times • make n and rra n \ D, 1l on ;lamp Make Y changescO1x1' at�n� 3 he yL\'din w'itten permission from rhe ; , rn K �'pmg of Y tis t ty °f Cupertino. -FB tl,c DD M "C' OT be h�Id plan and spec , e permit 1" �of the V.lati m y PW'r to orars ` ._ _ 2403 Y Ordina•ca o of an - Y W �l t Statg,(W7'e 11 SUBMITTAL A4J Smo k#1906c-fOk-, . re &I Qeclr0014S All Fik fmreS 70 de tep/i9ced �jilAs7'� 12 /�A7�i ReMode jN c )(18fil'o y GOclgloolls- Charlots<,e .,oar. e// JD '/KiNso.v �,. CNPerr� �vQ.�.CA•, uU� _y AO-F- G .....__ Zai — `1177 • CITY OF CUPERTINO LUPE T aCITYOFPERMIT APPLICATION FORM • APN# 0 Date: a 03 Building Address:. 16 73 1AJ el s0 Owner's Name: Phone0,60 4n fit #: Contractor: License#: 0 n S"81o30S- Contact: Lb (Z-( Cupertino Business License#: Building Permit Info: -Bldg Elect Plumb 81 Mech ❑ Job Description: Residential 111' - C S d Comm cial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 000 . 0 Occupancy Group: Type of ConstrucL113P. • uanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits .foot BUILDING BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to SOOK 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/ uasi 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 Ener BUILDING BENERGYADD Ener Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. HousingMit. Fee BUILD NG • .4 olS1O Z� I of 3 CITY OF CUPERTINO CUPE TFINO PERMIT APPLICATION FORM • uanti Fee ID Fee Descri tion Fee Group BMITIGATR Res. Housin Mit Fee : BUILDING BMNEWMULTI New Multi-Famil Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bld s MECHANICAL 13NEWMULTI Multifamil 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 Ins --tion Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bld Permit Fees . BUILDING BPFIXTURE Pb1g Fixture PLUMBING. BPGAS Gas Piping Sys tem Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Re eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trav 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 clip MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL BREMFD:T Li tin 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 A aratus ELECTRICAL BREMNRAPP Rem Non-Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTINO 010V COPE TINO PERMIT APPLICATION FORM • Quantity Fee ID Fee Description Fee Group BREMPOWER Power Devic e/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch&Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL I 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 Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING I • 3 of 3