03040076 CITY OF C09EBTINO "�`;
BUILDING DIVISION pERMIT.
sitmIDDMRNHART AVE tONTRAGTOR,INFCIRMATION: '.
f.+'3i 4' •2�(f n.4)3.dC F £28Jrv.e , 4..1,
PERMITNO.03040076
Q15�N�tmb BEHER PERMIT`EsdQA)E• 5/2003
E: SANITARY N101.4 1 CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
joo LICENSEDCONTRACnderp DECLARATION
l�m I hereby affirm that 1 am learned under provision of Chapter 9(commencing LOIS Description
< with Sec0c..red riecDivislon3.f Ne Buainesams Profesx.Os Codc.aad myliccnscis
I.Mmsca in full force and effect
elm Lm.a GAS INSPECTION 1NAL EC3
Dale
Dam cmargoar
DELL
AR Mail an
records
ON APR 1�5 2003
I understand my plan[shall h used a pontic records
Licensed Prues imud
3 OWNER-BUILDER DECLARATION NG
f 1 hereby af0rtn that 1 am exempt from da Contractor's License Law for the BUILD
D O following reason.(Section 703 1.3,Business and professions Code:Any city or county
which requires a permit to construct,alcor,improve.demolixh.or rtpsir any atMCNIC
-ti prior in its issuance.also requires the applicant for such Permit to file a Aliwo:mem
p � that he is licensed pursuant to the provision of the Comracturi License Law(Chapmr9 Sq.Ft. Floor Area $S]OidiOn
(commencing with Section 70gar)of Division J of the Business and Profcuinns Cole)of
.. Nat he is exempt merefwm and Oe basis for the elle{cd exemption.Any violation of
Section 7031.5 by any applicant for a Permit sobjects the applicant to a civil penahY of
not mom man son hundred dollars($500). 3*M VgllF�'f 0 0 Occupancy Type
1,as owner of the property,or my employees with wages As their solo compensation, �i i�pAry T7�T
will domework.and th The cient coniuclues intended or offered Law
apply to ad,Business 202 — UNDER( dpIBpeGLItlflY`G
and Prafessiou Code:The Conuuar's LlartM Law dao sat apply a an owner of 1.V!
property who builds or improves thereon,and who doesaahwmk himwlfor through his 301 - ROUGH P UMBI G
own employees,provided mat such Improvements are not Intended programed for sale.If. SOZ - FINAL PLUMBING ENERGY
however,me building or improvement is sold within ora year of completion.de owner.
Wilde'
will have Or burden of proving that he did not build or happen for purpose of
506 - GAS TEST
sale.).
}y�,�I,as owner of the property,am exclusively contracting with licensed contractors to 507 - FINAL PLUMBING
"construct the pmject(Sea 704,1,Business and Professions Code:)The ContractoM1 Li.
cense law does not apply to an owner of promm y who Wilds or improv thereon,and
who contracts for such pmjecu with a concracnr(s)licensed pursuant to the Communes
License Law.
❑I.7arept under Secy .B h P C for ut, aeon
O er / Dame
W RKER'S MPENSATION DECyARgTION
I hereby&Mm under penally of perjury,one o a'[lowing declarations:
ve and will msimain a CeM1aam of Consent a self-insure for Worker's Camper.
,u provided for by Section 5700 of the tabor Cade.far tie performance of the
wok for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,u required by Section
3700 of me tabor Cada for the Performance of me work for which this Permit is traced.
My Worker',Ca.,.don Insurance artier end Policy number am:
camcc Policy No.: _
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(Thu Motion need not beeomplead lithe permit Is fa one hundred dollars($100)
or less.)
1 ecnify mat Von performance of the work for which this Permit is load.I shall not
employs rson in any manner�u�bec0or oche Wortrri Compcnution
Lawlor alifomM.Dam -,;V-120010
1� JJ "
Applica t W gs i Ywv� ..w� .'
N 1 T�APPLI ANT:If.after ter making this Ccnifcnc of Exemption,you should r
e subject a The Woheri COMMUNion provisions of the tabor Code.you mug
�Z oMwim comply with such pmviaiou or this Permit shall be dttmed mvaked.
y'O CONSTRUCTION LENDING AGENCY
1 hereby affirm mat mere its co "clom lending agcay for the performance of
Y'
the wuh fes which this permit is issued(Sec.5097,Co,C.)
Q Undoes Name
�,z Landeh Addross
j C) I certify mu 1 have read this application and sun that the above information is
y F correct.l agree to comply with all city and county ondinanees and sun laws misting to
�U building conswetion,and hereby mthome rcPo,amadver of this city a en4r Open the
N W� above.menliuned Progeny fm inspection Purposes.
(We)agree m save,indemnify and keep harmless the City of Cupertino against
eq liablllties,judgmcnu.costs and eaperucs which may In any way
on,again At cid City 7
:)Z in consequence of the grant in{of this resit /rte
APPLICANT UNDERSTA DS A WILL COMPLY WITH ALL NON- OINT Issued by: Date
SOURCE REG✓ ////j
t O
/, -.
t � � 3 3 - /(
Re-roofs
S ewes of ApPm ✓Contractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fulurc building acupam sere or handle hamrdous material
u dcflmd by the Cupertino Municipal Code.Chapter 9.l t,and the Health and Safely
Calc ❑Yes 23532(x)7 0 N All roofs shall be inspected prior to any roofing material being 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
arardava air contaminants as formed by the Bay Arca Air Quality Management
R all new materials for inspection.
❑Ycs ❑Nu
I have mad the W Miss materials requirements under Chapter 6.95 of the Califor.
nia Health&Safety Codc.Satiots25505.25533 am1ord 25534.1 undcrgthatif Ja Wilding
does n I cum:ntly have a tenant meta u my pomihility In nnJl'y IM aeuPat of me
rcyu rcrecnta which mug _ rtes iasu ceofaccniramafacup Signature of Applicant Date
. ,
oar
or aathariued agent aro All roof coverings to be Class "B"or better • ,a
I
FROM :8LTO5REALTY/RTLHSF[NHNT{HL FAX NO. :4862793659 Oct. 14 2883 09:37RM P2
FROM :ALTASPEALTY/ATLASFINANTIAL FAX NO. :4082793659 Oct. 14 2003 09:36AM P1
r
10300 T:nre..Avmmr
sir.,, C}rpm'rinn, Culj(nrnia 7j1114
70c.phnne (40$) 777-3228
CITY OF rax (4(1,5/777-33.33
CUPEf�TINO
(.'OMMLINTTY L)LVF.LOPMFNT/LIUIT.DINU L)IVTSIDN
October 07, 2003
Homeowner
187.)1 Barnhart Ave
Cupertino, CA 95014
SLJBJEC'l': Permit: >`f03040016, Gas Inspection
(
Dear Owner:
Our records indicate that the above listed permit is due to expire on October 31. 2003.
Tf due to circumstances beyond your control, you have been unable to schedule an
inspection. you ma,., submit a letter to the City of Cupertino Building Official
requesting a one-time extension for his review. Please state in the letter the reasons for
• your request If nn extension is granted and no inspection is called before the expiration
date, this permit will be voided and the permit application discarded. After this point, yot)
will need to submit new plans for plan review and pay permit and plat check Ices to he
issued a new permit.
if your records show that the permit card was signed and released by an inspector as
being complete and final, please notify this office at your earliest convenience. We will
update our computer files and close your permit, and we apologize Ibr any inconvenience
this matter may have caused.
Thank you for your attention to this matter.
Sincerely,
CITY OF Ct.1PERY'INO
Christy Akatiff. Administrative Clerk
• , .._ . .. ,i:r',:,; ,i;:, rte .. .. .�� . .
I'rinled nn R/V:V(:I@n(°9fer
CITY OF CUPERTINO "F s
BUILDING DIVISION PERMIT. '• ,�ONTRAGTOR INFORMATIO�t
Tgwj4JfDMRNHART AVE PERrvlI .93040CY76
TMUff0 BEHER PERMITIss(jEQ4�/A , 5/2003
SANITARY NO. IE1 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
±O0 LICENSED CONIRAC3OR'S DECLARATION O O O
I to lxmby affirm Nu l am named under provisions ofComer 9(commencing Job Description
Nwith Section IM)or Division)of the Businessand Professors Code,and my license is
In roll fume and area
SqI LiccnxClm Lic.# GAS INSPECTION
F 0 Date Contractor
MtoARCHITECTS DECLARATION
1 understand my plans shall be used u public records Q f I
o 1 Licensed Proposal onal
3 OWNER-BUILDER DECLARATION
Conti ON
l20 1 utcby.(f on I am xempt from an the Conmeor License Law for the
L1 O follwhich
moon.Permit
t 703 conduct.
Business and Pmfcetium Code:Any city or roomy
C20
m t which zequims•permit m mmtmd step improve,demolish,t,nr e.sig any sw«uze
�a i tat h n la issomlicensed
a also requite the
ovixo sofant roe Contetich tmiuLicome ave(Cloemcm
C
tathewit pursuant mthe pmvuisionf then B usicerind Proflaw(CharyvY Sq. Ft. Floor Area(comV18ipn
[� bathe MixemiNSceion)Oodth Division Jnfthcegedesandon.Anyrvi Code)or 1JVv
$ that io r exempt thertfmm and les bur for be alleged exemption.Any l N uon of
Section elle S by any applicant fora permit subjects to applicant to a civil pcnalry of
net mem Nan BK htndmd den.n(5500) _ 3*M AIBnPF-E 0 0 Occupancy Type
0 I,as owner of the proper y.m my employees with wage as their to mmpenstion,
will do the work,and be sweum is not intended or offered for aale(Sol.]04d,Business 202 - UNDER TT��TT]]�vT�
and Predua ou Cade:The Contractor Liceue Law does but apply a an owner of d IdWS`G
propeny who bunds or improves thereon.and whod«:such workhimxuor through his 301 - ROUGH PLUMB G
own employeespm.idcd datsuch improvements are naIimmodedoroffemd for mala If. SO2 — FINAL PLUMBING ENERGY
bowever,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did tut wild or improve for purpose of "' . .5.0 6 — GAS TEST
sale).
as owner of the pmpeny,am exclusively contracting with licensed contraeon to 'f 507 — FINAL PLUMBING
^swot be project(Sec.7044,Business and Pro(esiou Cade)The Contractors Li.
come law does not apply so an owner of property who wilds or improves Ucreen.and
who contracts Forsch projects with a contraeor(a)liccued puraumup the Contractor -
Limmetaw.
❑l am exempt under S� ,B&PC for Nis
Ow v Date ,5[L
WORKER'S MPENSATION DEC yA rygT10N
I hereby a(frre under Nutty of perjury oa o aI/lowing dulantio"
ban and will maintain•Certificate of Consent to wir-insum for Worker Comport-
anion,as provided for by Section 3700 of the Labor Cade.for the performance of the
Work for which this permit is isucd.
❑1 bare and will maintain Wcalmes Compensation Insurance,u baptized by Section
3700 or the Mbar Code,for the Performance of the work for which this remit is issued.
My Worker's Compensation insurance carrier and Policy number am: ,
Cartier Policy No.: _
CERTIFICATE OF EKEM MON FROM WORKERS'
COMPENSATION INSURANCE
(Tor Section need not w completed if the .it is for one hundred dollen(5100)
or ksx)
I moify but i the perforro m,of Iw work for which this permit is issued.I mull not
employs non in my mu«rmu b era oNC Wortcn'Camleuation
laws of tlifomia.Dax sl�tL
APPlica t HfrJ
NQTIC� APPLI ANT:IL efmr making Nu Ccnificatc of Exemption.you should
e subject be to Wcrkces Compensation provisions of be La or Crda you mus
�,z oMwthmorply with such pro.iainm or this perm it shall be d«mad revoked.
Z O CONSTRUCTION LENDING AGENCY
I wreby affirm Wt them is•conduction m «
ion lending a,re,for e K,formof \
Z' Ute Work fur which this permit r issued(Sce.111.Civ.C.)
YQ USdcrs Name
Z,z lender's Address
Q 1 certify that 1 have mad this application and cute dust the ewve information is
y coned I agree to comply with all city and county ordinances and sate laws relating 10
5 builyting mns"CLAm.and hereby authome representatives of this city to cow upon the
W
move menuuncdproperty t fan iexpense,mies purpoWhich rex
P. twe)agree m wars,indemnify and keep harmless the City of Cupertino ayainll
Z inmises.jomef,hcc usmind expenses which may in any way accrve gains saidCity
J z in conxq«nec of the gaming u(Nis Trost '
APPLICANT UNDERSTA OSA WILL COMPLY WITH ALL NON- OINT Issued by: Dale
SiULRCE REG
f�p3
�art,e— f� _ Re-roofs
pp c HAZARDOUS MATERIALS DISCLOSURE 0aSe Type of Roof
Will the applicant or future Muni building occupant sero or handle Hold,Rod
as defined io Ne Cupertino Municipal Code.Chapter 9.12 and the Hcatth and Safety
Cade,Section 23532(a)?
❑Yes 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment at devices whim If a roof is installed without first obtaining an inspection,I agree to remove
harardnus air corouromann s dc0ed nby the Bay Area Air Quality Management all new materials for inspection.
P
?
❑Yes ON.
I have read to unrmats materials requizemcnts under Chapter 6.95 of be Califon-
riaHealth&Safety Code,S«tiou M505.25533 and 25534.1 understand that if the wilding
dos not cuncndy have a¢rant the it r my mspomihility to notify the em.pant tf the
req 'rens«ts wbanrote ' rmissu «of,Certificate of 0"" Signature of Applicant Date
/fl.
net urauthorizcdagcnt ,x�/ All roof coverings to be Class 'B" or better
Y
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= ATY OF CUPERTINO * 0 3 0 � ?b
CITY OF PERMIT APPLICATION FORM
• CUPERTINO
APN# J Date: /
Building Address:Mr o y2 ' 6 A MjR �✓g �I/�v
Owner's Name/` O T•l Ph ne#: C-41.
50/
,5f svi o gs-
Contractor: /" r/r r tense #:
Contact: Cupertino Business License#:
71dg
ingPermit Info:
Elect ❑ P Mech
b De ription:
Resi ential ❑ C er i 1 l
Sq.Ft. Floor Area: $/Sq.Ft.: /4
Cost of Project: C i Occupancy Gro u .
Type of Construction:
•
Quantity Fee ID Fee Description Fee Grou
BAPPLOTHER Other Appliancesp
MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 1bOKto 500KBtu 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 <= IOOOA ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elee Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
lof3
SPTY OF CUPERTIN0
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
BPFIXTUR.E Pb1g 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 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 Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
damBREINSPECT 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 UELting 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
BREMNRAPP Rem Non-Res Lkliance ELECTRICAL
-__ BREMPOLE Pole/Platform Fixture ELECTRICAL
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AM CITY OF CUPERTAO
CITY OF PERMIT APPLICATION...F,ORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMPOWER Power Device/A aratus ELECTRICAL
BREMRECEPT Rc t1, 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 Sips, 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
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electricals 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
•
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