02100099 CITY OF CUPERTINO
BUILDING DIVISION PERT T CONTRACTOR.INFOR • ION:
BUILp@(9d9Is3tEsBARRANCA DR TINA & SCOTT BREHMER PERMITNO2100099
W9RIsNA1s:& SCOTT BREHMER APPLICATITVYB1D4rsy77 2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLOG ELECT PLUMB MECH
0 0 0 0
�O0p LICENSED CONTRACTOR'S DECLARATION
z1 hereby affirm mai I am heenscd ender provisions of Chapter v anmmcnan C
<�E withSeerkm7doe)of Division3oftheBusinessandProfessionsCode,anemybce s REVISION--IN 8 � �� ONLY
�<�„ imm�ro=andeffect. NO NEW PERMIT ISSUED, ORIG. #02070067
E2? License Class—Lic.M°zFo Damcontractor REVISION 402090192
F�—'—'J` ARCHITECTS DECLARATION
Ege< I undersand my plans shall h,used as public records
D O
FLLOS Licensed Professional
to
OWNER-BUILDER DECLARATION
<4 I hereby affirm mai I
OWNER-BUILDER
from the DECLARATION
License Law for the
w�O o following reason.(Section 7131.5.Business and Professions Code:Any city or county
of
n'm$ which requires a permit to construct,alter,improve,demolish,or repair any mmcwre
y poor to its issuance.also requires the applicant for such permit to rile a signed suMment
€G mathe isliecowd pursuant it)the provisions of the Contractor's License Law(Chopmr 9 Sq. Ft.Floor Area 12 Yig&tlon
e— (commencing with Section 7")ofDivision30fine Businessand Professions Code)or
to $ that he is exempt thcrefrom and thetbasu for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
OCCU
not mom man Eve hundred dollars(5500). Occupancy Type
❑ I,as owner of in,property,or my employees with wages es their sole compensation,
will do be work,and the structure is not intended or offered for sale(Sec.707,BusinessFeb
and Preretsioae Code:The Cortracwra License Law does not apply to an owner of 102 - PIERS
egmred Inspections
property who builds or improves thereon,and whodues such work himm1forthrough his
Own employees,provided ten such improvements art not intended oroRered for We.If. 103 — UFER
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden or proving mat W did not baud or improve for purpose of 104 — REBAR
S1a.). 105 — ANCHOR BOLTS
I,as net of the property,am exclusively contracting with licensed contractors 10 10 6 — SEWER & WATER
construct the perfect(Sec.704,1,Business and Professions Code:)The Convectors Li-
censelawdoesnorapplytoanownerofpropertywhoWildsorimprovesthemon,and 202 — UNDERFLOOR PLUMBING
who contracts for such projects with a conracmr(s)licensed pursuant to the Contractor's
License Law. 203 — UNDERFLOOR MECHANICAL
❑ lam exempt underSec. ,B&PCpmiddsmxMm 204 — UNDERFLOOR FRAME
Data 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
I hereby almm ender penalty of perjury one of the following dcclarariom: 3O2 — TUB & OR SHOWER
❑I have and will maintain a Certificate Consent of Conseno self insure for Worker's Compen-
sation.as provided for by Section 3700 of the Labor Code,for the performance of the 3 03 - ROUGH MECHANICAL
work far which thispmmitisissued. 304 — ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Insumnee.as required by section 305 — FRAME
3]00 of the Ir Wm Code,far the performance of the work for which this permit is issued.
My Worker a Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS
Carrier: Policy No.: 307 — INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK
This section need notal Completed if LW remark is moon,hundred dollars(sln) 309 — EXTERIOR LATH
Ire`s''certify mat ethe Performance of the work — INTERIOR LATH
efor which this permit is issued,l shall not 311 - SCRATCH COAT
employ any Person in any mannersn am become me subject m the Workers'Compensation
Laws.[California.Da1e
Applicant 313 — ROOF NAIL
NOTICE TO APPLICANT.11,after making this Cenilicate of Exemption,you should 501. — FINAL ELECTRICAL ENERGY
WcomC subject to the Worker's Compensation previsions of the Labor Cak,you most
U..X forthwith comply with such provisions or his permit shall be deemed revoked. 502 — FINAL PLUMBING ENERGY
? CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY
F .2 I hereby affirm mat there is a comemetion lending agency Tor the performance or 504 - FINAL BUILDING ENERGY
a > the work for which this Norm t is issued(Set.3097.Civ.C.)
h q Leoder:Name 505 - FINAL ELECTRICAL
Z LeneersAddres 506 - GAS TEST
UO IceNfy thatIhave readoristyad cup and sum that the sumabovelaws information to 507 — FINAL PLUMBING
U cortca,l agree coat I ha with all city application ani county ordinancesm Oat
Bute inf refining to
pU building construction,and hereby authomize representatives ofthis city to enter upon do, 5 FINAL MECHANICAL
Da show,mentionedpropertyforinspectionpurposes. Q9 r`IjQ DE
pL (WC)agree to save,indemnify and keep harmless the City of Cupertino against
to
liabilities,cedgmena,,rasingng Of this expenses which may in any wayaccrue against said City 5 N G
U Z A consequence or DERSTANDS As D WILL
Issued bys l WORKS Date l
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS.
Signature of Appl¢enVConvacwr Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Inc applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Heahh and Safety
ode,Section 35533p)?
❑Yes ❑No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Disrtell
0Yes ON.
1 have read the barometers materials requirements under Cle pter6.93ofine Califor-
houHealth&Safety Code.SCctimu35505,25533 aaW 35534.l understand theliflhe Wilding
does not currently have a tenant,Nat it is MY oureminkly to notify the occupant of the
requirements which must W met prior to issuance of a CCNBCam of Osupancy.
Signature of Applicant Date
Owner unauthorized agent D,te I All roof coverings to be Class "B" or better
I � f
awl � io`
I j
IT
AIN
!p
I� InG C
C
)D t,
CPA
sy
Ij I •Ti ��
G� SCF CITY OF CUPERTE*
CUPE{,TINO PERMIT APPLICATION FORM a Zl spa 9
APN# d. � Date:
oz
Building Address:
Owner's Name: Phone#:
Sc csEf ,��e vr�e�
41)F, -7 -73W
Contractor: License#:
Contact: Phone#:
Ap Contractor: Fax#:
uildi
ml
Info:
Bld Elect Plumb Mech
ob bestial: on:
Residential: Comme
Sq.Ft.Floor Area: $/Sq.F
5
Architect/Engineer: Valuation:
Type of Construction: Occupancy Group:
• r-
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/ u- 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
BMITIGATWhanical
Housin Mit. Fee BUILDING
BMTTIGATsin Mit Fee BUILDING
BMNEWMlti-Famil Res MECHANICAL
BNEWMULlti-fam.1 Res ELECTRICAL
BNUCOMMmm Electric ELECTRICAL
• BNUCOMMm Mechanical MECHANICAL
BNUCOMMmm Plumb PLUMBING
1 of � �
CITE' OF CUPERTINO
• CUPE�INO
PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BNUMULTI New Multi-family Res PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
MIXTURE 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
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 Pipe PLUMBING
BPWHEATER WaterHeater/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 -Ughting-LightingFixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> 10K btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Atmaratus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOW"Remodel
rDBVIce/A azatus ELECTRICAL
BREMRECRe Switch & Outlets ELECTRICAL
BREMRELOation of Hood MECHANICAL i
BREMREPr/Alter Heatin MECHANICAL
BREMRESAdel Res Appliance ELECTRICAL
BREMSIGNSi s Add BELECTRICAL
BREMSIGNSigns, Marquee ELECTRICAL
BREMTHEATR I Theatrical Lighting Fix ELECTRICAL
2of3
f
�r '": CITY OF CiJPERTINO
V.
CITY OF PERMIT APPLICATION FORM
• CUPEI�TINO
Quantity Fee ID Fee Description Fee Group
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSF&2FAM Single&2 Family BUILDING
BSFNA Single Family New Add BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swinmiing 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 Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
BBOILERI 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> 1.75 M Btu MECHANICAL
3 of 3