The URL can be used to link to this page

04070066I i CITY OF CUPERTINO7d "7 BUILDING DIVISION PERMIT W-6NTRACTORINF�ORMATIQN: BUILDING ADDRESS: PERMIT NO,04070066 OWNER'S NAME: PERMITL$UEDATE STEVE & CONNIE CHAD 12 ONE: SANITARY O. C OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSEDCONIRACIOR'S DECLARATION Job Description P I Mmby affirm that I am licensed under provisions Of Chapter 9 (mmmcncing with Section 901Mnof Division Sof the Busimaland ofcasions Code, and my license is in fullforceand If -li iZ RUN 1 1/2" ELECT. CONDUIT Liccns lass Lk. N Date o ca^tractor ' CONTRACTOR: TAMURA DESIGNS INC AR HI'IEC I S DECLA AT ON I understand my plans adult W used a public records Licensed Professional OWNER -BUILDER DECLARATION 1 hcrthy M. Net I am exempt from IM Conacmts License Law for she following mason. (Section 7131.5, Business and Pmfesamns Code: Any city or county - which requires a permit to contact alter, improve, demolish, or repair any &fracture prior In its issuaum, also mget. the applienn forsuch permit m file & signed sammenl Sq. Ft. Floor Area Valuati(,1200 than he is licensed puwenl to the prevnitsmof 0. Conraamr's Lhenre Law(Chap¢r 9 (commencing with Section 7000) of Division 3 of Ne Business and ProfcuiOM Cale) Or and he is exempt therefrom and the thesis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a Permit subjects the applicant of a civil Penalty of .at more Nen lave hundred dollars (5500). 32655023.00 ' ❑ 1, as owner of dm property, or my employees with wages ar their sole compensation. Required Inspections will do the work. and the swaure is not intended of offered for sale (Sec. 7044, Business and Profusions Code: The Contractor's License law does Out apply to an Owner of prepersy who buildshrimpmvu thereon, and who dousuch work himselfor through his Own employees, provided that such improvements am not intended at offered for sale. IL bovoc er, the building or improvement is sold within one yeti of completion, the owner. builder will have the burden of proving Nse at he did not mild or improve far purpoof de sale ❑ 1. as owner of the properly. an exclusively convecting with licensed contractors to construct the project (Sec. 7044, Business and Profusions Cade:) The Convacmr's Li cense Law does not apply to an owner of property who builds or improve demon, and who channels for such projects with a eonuacmr(s) licensed pursuant no the Convachat / License law. 1 am uempwnderSec. . B & P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ane of she fallowing declarations: V� 1 have and will maintain a Certificate Of Content to self -insure for Workout'. Conown- arm, as provided far by Section 3700 of the tabor Code. far the pedamance of Ne W,for which this permit is issued. 1 have and will maintain Woker's Compensation daturas, u required by Section Ic- 00 of the Labor Code. far Ne perrormanceof the work for which this permit is issued. y Worker's Compeuration Insurrance carrier and policynu/�ptb//ar aa��yy�. ]]rtier, st �[<— Polity No.:J��3� CERTIFICATE OF EXEMPTION FROM WORKERS' , COMPENSATION INSURANCE (Thu section need not be completed if the permit is for one hundred dollars ($IW) or less.) 1 certify that in the performance of the work for which this permit is issued, l shall not employ any sewn in any manners^ as to become subject to the WorkersCompensation Laws of California. Date Applicant NOTICE TO APPLICANT. If, after making this Ccnifcam of Eaemption, you should become subject to the Worker's Compensation previsions of the Labor Crum. you mum ' forthwith comply with such provisions or this permit shall be deemed revoked. 1 CONSTRUCTION LENDING AGENCY 1 hereby aththi that is a lending agency for de perfortnana of Se . 3 mit i cci (Sec. ' the work for which this permit u issued (Sec.1097, Civ. C.) Lender's Name Irndcr's Address 1 certify, thal I have mad this application and sum that the above information is - ' correct 1 agree on comply with all city and county endurances and sum laws relating to building construction. and hereby Mamma, mpsuentadws of Nis city to cater upon ft ahave-mentioned pmperty for inspection purposes (We) agree to save, indemnify and keep harmlem the City of Cupenino against liabilities, Judgments. costs and expenses which may in any way amuse against said City acof Ne gaming of Nis permit. in corm"Ora, ' APPLI UN08XNAND�/�fJD WILL COMPLY WITH ALL NON -POINT Issued by: Date SOU GULONS./f Re -roofs Type of Roof ��o S namrc ofA licaHAZAR m HAZARDOUS pp DOO US MATERIALS DISCLOSURE Will theapplicant or future buildings. as defined by the Cupertino Municipal Code. Chapter 9. 12. and dm Health and Safny ni chanumrcorand h Healdous th and Code, 25532(&)7 All roofs shall be inspected prior to an roofing material being Installed. P P� Y g p Yca ❑Na Dyes $ If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building 0ccupant vu equipment Of devices which mit hanrdous air contaminants as defined by the Bay Ama Air Quality Management all new materials for Inspection. District? ❑Yes ON. 1 have read the han dousmamrials requirements under Chapmr6.95 of Jct Califon nice Hui SafItyCode. Sections 25505.15533 and 75534.1 um1ensuM Nairthe Wilding Jos not unreally hast a enacts that it isy responsibility m ratify ft occupant of the re ret nichmyar;2met &ism ttaacetdreacofsea er. Signature of Applicant Date All roof coverings to be Class "B" or better wncr ser au unifed aaaggent— ate Community Development 10300 Torte Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 16-615' ANN gee- AV- PERMIT # D o-7CX: OWNER'S NAME: 57We � Cib"m G C NA -c6 PHONE # ua 7'74- 3 y3 GENERAL CONTRACTOR: Q ()*% LCpNS FAX # qoSr -7-7S-- -7%S `/ I am not using any subcontractors:±rsand Signature Date Please check applicable subcon omplete the followinz information: Owner/ Contractor Signature )y D to SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature )y D to r r CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM o�0 76-066 APN # .3 Z , �-� z 3 Fee Description Date: 1 BAPPLOTHER Other Appliances MECHANICAL Building Address: Mailing Address (if different from building address): I D --316 A a tJ IQ_ e o CA Owner's Name: BBOILER3 Phone #: Sincile G CoN Nth. C NAS BBOILER4 Boiler> 1M to 1.75 M Btu Contractor: BBOILER5 License #: wtusLA, BCONSTAX t� IS 12/ Contact: Phone: 4u8 -19 ' yy Cupertino Business License#: J U9Y hMSor� Fax: BCONSTAXBQ Con. Tax for BQ Zone Building Permit Info: -gum t Kt,t Fq_43.— 2tcAt_ c-ey )LAtr 'tom- PL%mgv SPA Bldg ❑ Elect a Plumb ❑ Mech ❑ Job Description: BUILDING BELEC1000 Residential a ELECTRICAL Commercial ❑ Sq.Ft. Floor Area: ELECTRICAL $/Sq.Ft.: Cost of Project: c P ELECTRICAL Occupancy Group: Z BUILDING BENERGYADD Type of Construction: BUILDING Please check this box if the project is a tJ SCA E REwti/A nFJ BUILDING second -story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BB01LERI 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 1 of 3 b C �, Clp, CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM 2 of 3 QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb 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 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 BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > l 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 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 2 of 3 CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORINT Quantity Fee ID Fee Description Fee Group 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 BSWINI 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 1 •