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03120026 CITY OF CUPERI'INO BUILDING DIVISION - PERMIT two NTRt1CTnI2 I�NFORMA�g i0 ' a BUILDING'ADDRESS: PERMIT N003120026 88831 BARNHART 'R'S NAME: PERMIT ISSUE DATE CHARD MARTINEZ 12/05/2003 ONE: SANITARY NO. CONTROL NO. ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Sop LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9(Commencing lob Description W. With Section 90(H))of Division 3 or Ne Business and Professions Code,and my license is in fall force and affect. NEW GAS LINE E p License Clara Lie.a =� Dow Conmucter e ARCHITECTS DECLARATION C < I understand my plans shall be wad as public morals )y e C LiccnuJ Pmreseional OWNER-BUILDER DECLARATION I 1 hereby.(frm on I em exempt from the Cnntns Co e:Any c Law for(be Db followwhich motion.(section 703 L5,Business and improve, Codc:Anycity or county $ which rcyulrce n prem t m�imstconstruct,alter,impnwu,h No it t Or c a sig any structure 0 that he Z 'Priormslcensdpassnnt tothe the applicant of for suchvermis mflca Low(Climber (commencing licensedpursuant70be provisions;vnf or the Btnnessanccnxlaw(C oac)or Sq.Ft. Floor Area Valuation $ (comhe is exg with erefoon and the Division r he alleged ass and Professon.Any Code)or y that he is exempt Nertfrom and Ne bssu for the alleged eump0on.Any violation of Section 9031.5 by airy applicant for a permit subjects Ne applicant to a Civil Penalty of r 0 0 Occupancy Type not mon than five hundred dollars($500). ❑I,u owner or Ne property,m my employees with wages or their rale compensation, will do the work.and the Nwclum is not intended or offered for sale(Sec.9044,Business and Professions Code:The improves tncmrl and Law docs not apply m an owner or Required Inspections property who builds farimproves thereon,and who graSuch work or redthrough his own employers,provided Net such improvements are not arofintended m offered for tile.r. / Wilathowever,the building m improvement Is sold within one year of completion,Ne owners builder will have 0m burden of proving that he did not Wild or Improve for purpose of sale... . ❑I.as owner of ct property,am exclusivelyand confessing with:)The Cbonuamms i. earn.Lo d proles(Sec.9814,weer of and property wh ions Cade:) provesntrumty and O cense law docs atapplym an owner of property who sedice at improves thereon,and whoromLacta for such projects with a conlncmr(s)licensed pursuant to the ContnemM1 Lkenu Law. ❑lune pt under Sm., .B@PGfar NNB��n7on Doe = WORKER'S COMICSATION DECLARA[Ify! 1 hereby aRm wick,penalty of perjury one of the fol mg eeclaaturn: I ban and will maintain a Ccnifialeaf Cowen)to ul6imuu fm Wortice Compere radon,u provided for by Section 37M of the labor Code,for the performance of the work for which Nis permit is issued. ❑I have and will maintain Worker's Compentation Insurance.as required by Section 37W or Ne Labor Code,for Ne performance of the work for which this permit Is Issued. My Workers Compensation Insurance carder and Policy number art: Cartier: Policy Na.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Masticator=it not becomplemd Hite permit is formic hundoeddolleaa(SIf0) or was.) I certify thu in she Performance or the work for which this Permit is Wood,I shall not employ any person in any manner=u an become subject to the Workers'Compensation Laws of California.Dow Applicant , NOTICE TO APPLICANT:It.eller making this Certificate of Exemption,you shoulJ become subject or she Worker's Compensation provisions of she labor Cndc,you must =,Z forthwith comply with such provisions at this permit shall be dcemed ranked. Z O CONSTRUCTION LENDING AGENCY I hereby affirm that Nen is a construction leading agency for the Performance of dre.,it fur which this permit H issued(Sec.3D99,Cih,C.) No A Len de'1 mnif z Len,; Add`%, J Q 1 certify that 1 have fwd this application y o mta that she salve information ng Is 0 F building l agree m comply with all city and county oNittes of mJ sum lawe refiling no 'J O building construction. for inspectionpurposes. atiws of thbcity mcnkr upon Ne W elmvc(W)agree to can for infection Purposes. CL (We)acmet.cove,indemnity and kith permitter in City Of Covent against .,t to incoifxparic mcnhecravand ofpemusrmil. may in any wyeccroc against raid City fJ z A APPLICANT of the RSTAgranting of this 1M,mll. APPLICANT UNDjjjjjjE]]3223RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �SOUR GUO � Keay w Re-roofs I" o(A bean o tractor Dam HAZARDOUS MATERIALS DISCLOSY E Type of Roof Will dwapplicant u,future building occupantstore or handle houardousth and defined by nhc Cupertino Municipal Code.Chapter 9.12.mJ the Health soil Safely ' e.Scbdon zssl$a)? All roofs shall be inspected prior to an roofing material being Installed. ❑Yw G4 No P P � Y g g Will the applicant or mwm building«cvPam use agdpmwf or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hotshot air contaminants ex defined by the Bay Area Air Quality Management all new materials for inspection. District? C]Year No I have mail the hmadous materials requirements under Chapter 6.95 orthc Califon. ala Health A,Safety Coda,Sections 25505,25533 and 25534.1 understand this if the Wilding Joc i not- ly ban a tanmt,Nat It is my rwpowiffolity to nobly the occupant or Ne mqul envwnrevs mkt corn 'ssuence of.Certificate or Occupancy. Signature of Applicant Dale oar v, nataa gaol "co�, .All roof coverings to be Class"B"or better r CITY OF CUPERTINO cuPErZTirvo PERMIT APPLICATION FORM U3/,zoa APN# _ Date: 0 d Cr -- 1.2- Building .zBuilding Address: , J9 A .f O O er's Name: Phone#: 2 D� Contractor: License#: GCJ %>o / Contact: Cupertino Business License#: G!o 5ding! it lyeit Info: L,) 1Y J/) (' - 1d Elect ❑ 1 Mech ❑ escription: Residential A `�// Commercial El Sq.Ft. Floor Area: $/Sq.Ft.: a Co of Project: Occupancy Gro p: r x .3"4. e fi4 ype of Construction: QuantityFee 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 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> 1 OOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING I BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING I of 3 CITY OF CUPERTINO CUPEkfIN0 PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-FamilyRes 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 BOVERTHAE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE 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 Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING 4 BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo 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 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL 1 BREMFURNOV Relo Fumace> I 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 2of3 /iv' CITY OF CUPERTINO j CUP kTCITY OF O PERMIT APPLICATION FORM 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 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 Electrical sq foot ELECTRICAL EPERMITFEE Elec Permft 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