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03070138CITY OF CUPERTINOS:an:�^''^'�-" BUILDING DIVISION PERMIT CONTRACTORINFORMATIION l., BUILDING ADDRESS: PAYWOOD QT PERMIT NOO 3 07 0 13 8 =919 OWNER'S NAME: PERMIT ISSUE DATE NE: SANITARY NO. li�CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EIFCT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION lob Description I hereby affirm Nn I am licensed under previsions of Chapter 9 (commencing with Section MHnf 'vkionlefthcB sly neµandlimrcuino, CMe, an"ore . S Llcenso ssdcne Lk.0 MAIN ROOF REPLACEMENT/TRUSS & D con nor FIRE REPAIR (CONTRACTOR: SIS CONSTRUCTION) CTS 0 ARCHITEATION I undertund my plans shall heuuJ shV,records ®�q N!/■.,��® F Licensed Professional OWNER-BUILDER DECLARATION I hereby .from that I am exempt fru. Ne Contractors License Law for the p Q003 DEC O 9 2 following mason. (Section 7031.5. Business and Professions Cnde: Any city or county which myuire a permit to convect, alter. imPmve, demolish, en repair any stmclum prior in its issuance. aim requirca the applicant for such paresis to BIe a signed statement that he Is IIRnsL•d prmant to Jm provisions, of Ne Common{ License LaW(Chapter 9 Sq. Ft. Floor Area npp� 000 010 (commencing with Section 7000) of Division 3 of the Business and Professorter ou Nat he is exempt therefrom and the basis for the alleged exemption. Any=r 3 MS ftjpbeT 0 0 Occupancy Type Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty or not .ort than five hundred dollen ($500). ❑ 1,u owner ofthe property, or my employ= with wagesart their sole compensatien, Required Inspections will do the work and the structure is not Intended croRerW (mule (Sec. IDM, Busimua and Pmfeaimu code: Tk Contractor. Liam. Law does not apply to an owner of property who Wilda., improve themon,erd whodoeuuch work himself., through M. 101 - FOUNDATION own employce, provided that such improvements am not intended or offered for ale. If. 102 - PIERS however, the building or improvement i. sold within one year of completion, the owner. builder will have the burden of proving that be did not Wild or improve for purpose or 103 - UFER 104 - REBAR ❑ 1, a owner of the property. . B exclusively contracting with :) TheeConntnnon to the Cedm1TkCs c.Ns, Businesstedrty 105 - ANCHOR BOLTS. theeton,Li- ttmelawdoe^supply moo owner ofproperty who Wildsorimproves Nano,and La not(See. to an who sol 106 - SEWER & WATER who contracts for such projects with a mmnnor(s) slanted pursuant m the CanuacloY. License Law. 202 - UNDERFLOOR PLUMBING l un exempt under See. ,B&PC for this moon 203 - UNDERFLOOR MECHANICAL Owner Date - WORKER'S COMPENSATIONDECI RA ION 204 - UNDERFLOOR FRAME - I hereby arfmm under penalty of perjury one of We following declarations: 205 - UNDERFLOOR INSULATION and will ..Irwin a Certificate, of Cement t^self-imure for worker's CornMa. 301 - ROUGH PLUMBING u provided for by section 3700 or the Labor Code, for the performer. of the Wfhave 3 02 — TUB & OR SHOWER or which Of, permit 1. Issued. 303 - ROUGH MECHANICAL ❑ 1 haute and will maintain workers Compensation Insurance, as required by section 37Mofshe L.W,Code. for ftperf.rromiofthe w.rkfor which this permit I.raised. 304 - ROUGH ELECTRICAL nm en tern ln¢i oras artier a P my number u9cGSS 3 05 — FRAME �M!•y�W'o�yrter' 306 - HOLDOWNS Y- ERTIFICATEOFEXEMPIISIT OMWORKERS' COMPENSATION INSURANCE 307 - INSULATION (Thus seacdan need not he completed If the rermilk far one hundred colors (51(I(H 308 - SHEETROCK _ nr ksa) 309 EXTERIOR LATH I cenify Net in the performance of the work for which this Permit is issued. I shall not employ any person in any manner an u in become abject to thework=n'Compersanon 310 ,- — INTERIOR LATH Laws of Califomla. Date 311 313 - SCRATCH COAT - ROOF NAIL Applicear NOTICE TO APPLICANT: If, army making this C.RIBeale of Exemption, you shoulJ k=ome abject to the Worker's Compensation previsions of the tabor Code, you must forthwith comply with such provisions orthis permit shall Inc deemedmwked. 501 - FINAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY I hereby affirm that there is a consuo=tirn lending agency in, performanarf 503 - FINAL MECHANICAL ENERGY the work for which this permit is issued (Sec. 30Y7, Ci, C.) LenderN..e 504 505 - FINAL BUILDING ENERGY - FINAL ELECTRICAL 1<raer:s Addmm I minify thal 1 lave read this application and sum Net the show information is 506 - GAS TEST cerrcn. l .gree to comply with all city and county ordinances and sure lows mining a Writing convection, and thereby auth.nm rememnmiva or this city to so upanik — FIN PLUMB G above-menlioned Property for inspection Purposes. (We) agree to save, indemnify and keep harmku the city orCupcnino against 0 8 FI AL liabili'e,judgments, costs and expenses which may in any way accrue against mid City 5 in to ocncc of the gr ling of this pormil. CANT UN D R ANDS AND WILL COMPLY WITH ALL NON -PONT Issued by: - ING Dale CE REGUL 1 s. 4 NAL PUBLIC WORKS s3 Re -roofs Type Roof - gnaturco( pplicanl/Com"cior Daw HAZARDOUENATERIALSDISCLOSURE of Will the applicant or future Wilding occupant store or handle huardous material as coined by the Cupertino Municipal Code, Chapter 9.17, and the Health and Safety Cale. Scnioa 25532(07 All roofs shall be inspected prior to an roofing material being Installed. P P Y $ g ❑veeVN. Will 'Idingoccupanluucyuipmenl devices If a roof is installed without first obtaining an inspection, I agree to remove dre applicaor.Irc or which hasardnos sir eminnomm. -food by the Bay Arca Air Quality Man.gcmcnl all new aI for inspection. let? ❑Yes No 1 eve reed Ne htvaNtmsmawrialsmquim=nuunWrChapwr6.95oftheCali(nT- niaHcr &Safely Code,'.w25N15,25533ard2553a.lundcnwnd Ovdbc Wilding Q J to ,mn I hes sero that It u m .ibilor w no ds rccuput of the m enwwhich a cl pnonni enc abcemrcare = gnature of Applicant Date All roof coverings to be Class "B" or better racy ter aulno'z=d safe^I d. CITY O CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM o3 �7o(3 � PN # �I_ 6 — p 7 Date: Building Address: S1 wo Mailing Address if d fferent building address): OM' Nam Phone #:. 3 yr?jj / Y f7, Ct``r-{{act : rT, V VE C - License #: Contact: Phone: W r a93 /d 9-J Fax: YO f/ 'J Cupertino Business License#: Building Permit In BldgR--'Elect : — / Plumb I��/ Mech Job Description: Residential ❑ QVC Coerci ❑ Sq.Ft. Floor Are $ .Ft.: ost of Pro•ect. h Occupancy Group: ype o Co tion: I Please check this bo oJect is a second-storyaddition: ❑ • QuantityFee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 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 > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING - 2 ZS/ 3 S� lof3 ciTY o CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM imkQuantity 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 BOVERTWE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE 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 Repipe Of Fixtures PLUMBING 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 BREIvIAIRHAN A/C Units <=10,000 cf n MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMF[JRN 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 Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL • 2 of 3 \ Io CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 4V 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 i 3 of 3 D. •