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03070003 CITY OF CUPERTINO BUILDING DIVISION PERMIT S 70N=W-TOR INFQRMATL(• OUILDING ADDRESS: PERMIT NO 03070003 4-4r 7\qTP.P TN OW NESS NAME: PERMIT ISSUE DATE HN N NE: z2EDSANITARY NO. CONTROL NO. n CHITECTIENGINEER: jUN BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uoo LICENSED CONTRACTOR'S DECLARATION r, m I hum by.ffi,m mat IS.Iiansed ondcjjj provixionS or chi,am 9(commencing p Job Description .ZW with Section7IXM))of Division3ofine Busidr�t and Prufesaionx Code.and my license is ^ad in full fotc�aydc(re�'I. �� � f� ,nK License Gds_� L Lm., �i e 9 q �'/ KITCHEN REMODEL �;a am I— Contractor h"or r ad CONTRACTOR: ANCHOR CONSTRUCTION ee ARCHITECTS AR ION Crc� �y rjyyy lanss I.Abq)�ria nli cnr� i>V —fl/ G�iim q/ff 'ta Lis nu �ontl ' os OWNER-BUILDER DECLARATION a y I by affirm thin 1 am exempt foam me Cnntracme,License Law for the m o following reason.(Second 703 1.5,Business and Promesions Code:Any city m county i m which requires a Permit to canmrect,alter,improve,demolish,or mpair any structure prarto its issuance.also uyuires the applicant for such Permit file a signed statement - < that he islimmadpursuant tothe provisions mthe CommmarsUnnseLaw(Chapter 9 Sq. Ft. Floor Area Valu$tipp000 YFG (commencing with Section 7")ol Division 3 of the B usinus and Professions Code)or y m3 S Nat he is exempt theufrom and the basis for he alleged exemption.Any violation of Section 7031.5 by airy applicant for a Permit he applicant to a civil pe..try of 3WN7Offf®er00 Occupancy Type ,notmortmanfivehundreddelta,,(s500). P Y YP ❑1,u owner aide,pmpeny,or my employees with wag.as their sole compensation, will do the work,and Ne structure is not intended or offered for sale(Sec.]844,Business gg and Professions Code:The Conbemos License raw does not apply to an owner of 101 — FOUNDATTOlyd Inspections Property who builds or improves thereon,and who chnsauch work himself or through his Own employers,provided that such improvements am not intended or offered for sam.If, 102 — PIERS however.Ne building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for puryose of 103 — UFER s1S.). 104 — REBAR I,as owner or the property,am exclusively convecting with licensed contractors to convect the PMjuel(Sec.7004,Business and Profusions Code:)The Contractor's Li 1 0 5 — ANCHOR BOLTS .,..Law does not aPPIY to an owner of property who builds or improves dorton.and 106 — SEWER & WATER who contracts for such praXeu with a eadmactods)licensed pursuant to the Contractors License Law. 202 — UNDERFLOOR PLUMBING 0 I am exempt under Sec ,B&PC for this mason 203 — UNDERFLOOR MECHANICAL owner Date 204 — UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION Ihembyaffitmunder pmudLyafperjaryamofdue following deciaratia.: 205 — UNDERFLOOR INSULATION Ihaveandwillmaimmm.Cenifi.mofC.....tlaadf-inaum(mwa,keraCampcn- 301 — ROUGH PLUMBING had.n provided ter by Section 3700 of the labor Code.for the pcArmance of the 302 — TUB & OR SHOWER k for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 303 — ROUGH MECHANICAL raw of me Labarcode.ter the parforn.m.of the walk for which this permit is issuad. 304 — ROUGH ELECTRICAL My warkeraF�m a n mooted:canter add Poi der sm. 305 — FRAME parol(: n 4.w U Policy P u( C a ,�C CERTIFICATE OF EXEMPTION FR OM WORKERS' 3O6 — HOEDOWNS COMPENSATION INSURANCE 307 — INSULATION (This section need not becomplemd if the Permit is future hundmddollars(gIW) 308 — SHEETROCK toric .) 1 unify Road an the Performance of the work for which this Permit is is seed.I shall not 309 — EXTERIOR LATH employ any person in any manncf m as m become Subject to the Overton'Compensation 310 — INTERIOR LATH APPlicwsaam fdoromia.Dam 311 — SCRATCH COAT NOTICE TO APPLICANT:If.after making this Cenilicam of Exemption,you shnuW 313 — ROOF NAIL became$Object to the worker's compensation pmvisiom or the labor Code you must .J z0 tbnhwith comply with Such protl:ions or this Permit shall hcdeemedrawaid. 501 — FINAL ELECTRICAL ENERGY Z o CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY FIhcmbyall atmertisaconstructionlendingagertcyfordePerformamcuf 503 — FINAL MECHANICAL ENERGY a > hu work for ddres,ntmap miosis: d(sea309],civ.c.) 504 — FINAL BUILDING ENERGY W d amm,'x Name � z 4nder'sAdd ss 505 — FINAL ELECTRICAL U O 1 certify that 1 have read his application and stale that the above information i. 506 — GAS TEST um. correct.I agree comply with all city add county andiaanas and state laws putting to O buildidgco.trochim.and hereby aurrorixmprescmativuofthiscity toenterupnnme FIN PLUMBI G .hove.mentional property for im,a ran puTosea O844aitCAPLF (We)agile to save,indemnify and keep herml City of CupertinogainstTA lia&ILASP ment.costs and esp.,- which yway Stamm,against mid City 5V z inOf me grainingofthisKIssued by:5 G Dale C//{ ^ 'A)U U ftSTANDS Ay LY WITH ALL NON-POINTATIONS. f�/ fyV/ Re-roofs nq serepplicanUCOmm<mr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof I the applicant or future building Occupant store or handle ha.Noux mnefial as defined by the Cupertino Municipal otic,Chapter 9.12.and the Health and Safety Code,section 25532(:)? All roofs shall be inspected prior to an roofing material being❑Y. Na p p y g g installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove Oil hanfdnus air commune et u drift d by the Bay Area Air Quality Management all new materials for inspection. ]isrict? ❑Y. I have ry;,r the anamimsnuturialls quire. apter6.95ofthc Califor. nit Heath&SNcry avec,Sections 25585.25 dRJ,2 y4�rstvtd mot oth.building Jona note Em atcn¢nt,mm iii !!s6 6 m dont'the ocxupant of he requiem ^ A t d roEcatearoc any Signature of Applicant Date net or authori agent ` Date All roof coverings to be Class "B" or better p.PPF2OVF-D 46 1 IN 4hftD wl ATF n HANCF,S S � ` � GUAl n� DATE SUB r1 eciThis an 1ob II times and Itis�abe angas or 0"JOTOona 'lawny ormon same wt aC ty of Cupertino. the building Dept., plan and specifications The stamping of thrs p SHALL NOT be held to P f oany proJIsions approval of the violation of a ,)t any City Ordinance ([State Law. © p pC� � Od s 2003 ✓ p J l r 1� A 1200 �aG By \ 7 J O 3 P � V I tl� \( V SUBM] L 1 s I� .n agvsl, AY OF CUPERTINO 3 CITY OF PERMIT APPLICATION FORM LJ CUPEkTINO PN# 0 Date: / i Building Address: n 1q�l�r— tart -Cf Name: X / Phone#: I _ ® hn o GB 660 Contractor: y 'n ©� �r `\ Licens 7 9 % 9 S_ a fl�l G Contact: / E rr / Cupertino Business License#: a GG - B;, ermit Info: lect P m e ption: Rtial ® lel om er al Sq.Ft. Floor Area: $/S .Ft.: / Cost of Project: _ Occupancy Group: Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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 Co BCONSTAXR nstax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V-<=200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Ener y Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1of3 /�/D , Z, RTY OF CUPERTINO • CITY OF PERMIT APPLICATION FORM CUPERTINO 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 BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping S stem 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 Tra PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER WaterHeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection 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 BREMFURNOVaMisc > l OK btu MECHANICAL BREMHEATllation MECHANICAL BREMINHOODf Hood MECHANICAL BREMMISCaratus ELECTRICALBREMNRAPP A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTIA CITY OF 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 41 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 Swinuning Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM -Ternporary 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 3 of 3