03020056 (2) CITY OF CUPERTINO L n*a ^v:' x; :^.a�^�'tri'.Y
BUILDING DIVISION PERMIT CONTRAC"TORiILVEORMAI�T`t
BUILDING ADDRESS: PERMIT NO.
NER'S NAME: APPLICATIO U A fl
GgG
PHONE: SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO ELECT PLUMB MECH
oo LICENSrmshotEDCONnRACnORS derpDECLARATION Job
fI I Section,700D)
Doom Nn 1 am of
under provisions of Chapter 9(commencingDescription
nt1
with llto=7mp)of Division 3of the Business wM Profession Code,and mylicenseLL -
L full forte and ettett
z� Libman Clea Co.=,., REPLACE WINDOW
p Dete Con DEC
ARCH17EC1e DECLARATION
[understand my plan shallbuusetlu public=ratio
ib G Licensed Professional
OatNEm BUILDER DECLARATION
f I Wrehy.(Sict on 1 em exempt from the Cosec Cee License Law for Ins
p O following mann.(Section 70313,Bminp,and Rofesilnro Code:Any eiry or county
B� which requlru a permit m com bract,alter.Improve,demolish,or repair any structure
F-ZC prior m ILL issuance.aim nquims lM applicant for such Pepit to(Ie&signed statement
gg Gthat WLLliavedpennon ntoU&provisions ofthe ConusctarsU..Uw(Chapter9 Sq. Ft. Floor Area $1!yo® bion
$ (commencing with Section 7000)of Division 3 of the Business and Profesinlu Code)or
that he ts exempt Waefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by airy appliam for a permit subjects the appliaal to a civil penally of p
not mom than five hundred dolnn(5500). 3 M�`IiTher 00 Occupancy -!.ys,pe
D 1,as owner of the pmpeny,army employee,with wges u their sole compersentlon,
will do the work,and the wucnre isnot Intended oroRemel fonale(Sec.7044,Bminw — OUNDP � id lnSpeCt10H5
and Proreaalout Code:The Contractor,License Law does,ado apply to an owner of 101
Property who bulldsor improws thenagand whodoca,ochworkhimselfar through his 102 – PIERS
ownemployeas,provided thusuch improvements art not intended Moffemd for ante.If. 103 — UFER
however,the Wilding or Improvement is sold within ane year of mmpledon,the owner.
guilder will have the burden of provinal he did not Wild or Improve for lem cu of 104 — REBAR
,ale.). g N 105 - ANCHOR BOLTS
co 1,a owner of Ice Sec.? ,m ewers;and contracting with li The oonuunan a
corouum theproject
pplyM n owner
andprofession who
Cade:)The es sooner,LI- - 106 — SEWER & WATER
Genu hwdoasnaupplymaoith. of property veno Wnm orimpmwa Commenced, 202 — UNDERFLOOR PLUMBING
who Contracts for such proJecLL with a eonuanortq Iluroed punwm n the Gnlmnara
LI...seLaw. 203 - UNDERFLOOR MECHANICAL
Dlam Caere du
,B&P C for this mason
AR
y_l�� 204 - UNDERFLOOR FRAME
r RK M ATIONDECLARAate 205 - UNDERFLOOR INSULATION
1 all affirm under pMWtj of perjury one of the following declaralias: 301 — ROUGH PLUMBING
D l Mw and will maintain•cmineate ofGnert mull-houne for Worktra Compen- 302 — TUB & OR SHOWER
nation,as,provided for by Semon 3700 of the labor Code.fa Uta performance of the 303 - ROUGH MECHANICAL
wor01 for vend thnpermit n Worker's
304 - ROUGH ELECTRICAL
❑1 Mw and will milmiln SYMkers Groper the
work
Learn hi as his perm by Sermon
3700 of tho Co Cade,for Uta performance of the work fm which inn permit LL lased. 305 — FRAME .
My Workers Compensation lmunnz carrier and y No.:number ax:
Carrier: 306 — HOLDOWNCarrier: CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or Lew.)This ancient new not beCompletedu[be Introit nfor one hundred dollars(slm) 309 - EXTERIOR LATH
I
cenify Nit In the psfg6boa of the.,it for which this permit is iuurA,l Owl not 310 - INTERIOR LATH
empluyanypemo m raj" - Hothewarkcrf Compeasadmi 311 — SCRATCH COAT
laws of ver I ate
A It 313 - ROOF NAIL;
N TO UCANT:If.any na t IhLLGnificateofasemption,you,bdow 501 - FINAL ELECTRICAL ENERGY
become,ubj m Ne Worker,Ch ptw ion provision,of Ne Islar Code,you most
.JQ rcrihwitnCo Iywith1.1provisionsorIN,Permlu1,11Wdecmedwvokcd. 502 — FINAL PLUMBING ENERGY
CONSTRUCTION LENDINGAGENCY 503 - FINAL MECHANICAL ENERGY
[—I rNi - Iberehy,llum Natlhecrelaam.rolmbllan lending agency for the Performance of
a� the work for which this permit Is Issued(Sec.3M7,Ch.C.) 504 - FINAL BUILDING ENERGY
U0 Lender,Nunm 505 - FINAL ELECTRICAL
�z LenderaAddrew 506 - GAS TEST
U Q I ttnee Nu 1 law read the application and sum that the abuve laws
mating LL
0 buildingiagneCcomply and with mcity and countyordinancesand cute law,nndngC 507 — FINAL PLUMBING
holding sow ori pro and hereby initiation purposes.
eanwiwa of Nu Illy m enter upon Use� alveus-mcntionW property for inspection puryroses. FIN MEC ICAL
�"y (WchI—C saw.indemnify and keep homeless Ce CITY of Cupertino against 09 FI
fag Inbllities,judgments.costs and expenses which may in any way smon against aid City
U In consegpnce of the gating of this permit. S NG .
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 C WORKS Date
S UR GU TIONS. l
Re-roofsIf
gnat of Applin CrIPS S MATERIALS DISCLOSURE Oath Type of Roof
WIII the applicamor future Wilding occupant now or handle hauwJoas material
as defined by done Cupertino Municipal Cade.Chapter 9.11,and the Health and Safety
e, DSection25532(4)7 All roofs shall be inspected prior to any roofing material being installed.
Yess IRNo
Will the applicant or Polure Wilding occupant uta equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it h.vardnu,air cmWninam,as donnW by the Bay Ara Air Quality Management all new materials for inspection.
District?
D Y.,
I hew mad the hanamnus materials requirements underChepter6.95 of the Califor.
No TIVIV&Surety Code.SWUM 25505,25533 md25534,i understand thmifthe building
dce curnnlly haw.tenant,that ll u my responsibility m n Ute Imcup I of the
req. on hk�mnR m tpdormlutranceafa Ce Ur,,.,
7 ^o Signature of Applicant Date
er of ed agcfV All roof coverings to be Class "Br'or better
wife
• No NCtmskgt�
- - ec�- - - - - - - - - - - -
14.0'
FP 7.0' " 14.0'
x
28.0' ft)iVt .0'
[ � � d
Family Room BN�eLagI m4 2003
Kitchen Dining Room ¢�i(t'
B
39.0'
Bath CL
r
F .01
Master
CL Bath
WH Bedroom Bedroom n frwj
��nA�ry Bedroom
Laundry �.51
0.
IN ACC ACE WITH THE CITY W;K
CU 0 AN RDINAI
01 Living Room
AT a
2 Car Garage i�'Alk�_ spa ilicaticns MUs�
(his set of ps as a p is un
Oe kept on the to acnangesaTir a us an ( ntiM FP
lawful to make any _
on same without written permissioi- 5.0'
— the building Dept., City of Cupertino,
The stamping 0111115 plan and spacLK
'.' r
21 5' SHALL f40T be held to permit ar to be an
he violation of any provl®Ian=
of any City Ordinance or smtrsketch Calculations
Location Dimensions Area
,Tum A 2.0' x 14.0' 28.0
i1 1 �C B 3.0' x 36.5' 109.5
C 14.0' % 7.0' 98.0
pp D 15.0' x 19.0' 285.0
10132 91444 Q p� C E 56.0' x 29.0' 1624.0
Gross Living Area 2144.5
E
( 1�0 asa - D
. ....... .....
MecApprelser•" Real Esiais Apprelsal eollwere by aretllotd and Robbins(900)822.9 .
CITY OF CUPERTINO •
• CUPEI�TINO
PERMIT APPLICATION FORM Z
APN# — 6 Date:
"lip
Building Addr
10 /,32
Owner's N e: Phone#:
Contractor: 1. 2.5 Z— 9 g 7
License#:
Contact: Cupertino Business License#:
S
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: / C� Occupancy Gro
I /
Type of Construction:
f—
NOW
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits .foot . BUILDING
BBOILER1 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> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX hid/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. HousingMit. Fee BUILDING
laf3
�" b
CITY OF CUPERTINO
CUPEko PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Grou
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOM M 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 Pbl Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINI'ERCEP 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 rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap" PLUMBING
BPVENI' Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection.Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> 10K 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
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CITY OF CUPERTINO
00F PERMIT APPLICATION FORM
. CUPEI�TINO
Quantity Fee ID Fee Descri tion J Fee Group
BREMPOWER Power Device/A aratus ELECTRICAL
BREMRECEPT RC tl, Switch&Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMgEPALT 'Re air/AlterHeatin MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Si s Add Branch ELECTRICAL
BREMSIGNS Remodel Si az s,Muee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUII DING
BSEISMICOM I Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inection BUILDING
BS WIM Swimmin Pool BUILDING
BT EMP Temporary Power ELECTRICAL
BTEMPPERM Teor Bld Permit BUILDING
m
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUS IC Business License BUILDING
ELECTRIC Electrical s foot ELECTRICAL
EPERNIITFEE Elee Permit Issuance ELECTRICAL
MPERMFEE Mechanical s . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee s foot PLUMBING
ZADDCHG Address Chane BUILDING
•
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