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03070038LL' OpZ naz eLL�O coo l§4. Y-4.< H0 = OF U CITY OF CUPERTINO BUILDING DIVISION PERMIT G-'ONTRACTOR INFORMATION BUDDING ADDRESS: 202 CANDLEWQ09 PP. RUDD STEPHEN S AND BARBARA PCMIT"*03070038 OWNER'S NAME: PERMIT ISSUE DAM NE: SANITARY NO. CONTROL NO. HITECT/ENGINEER: BUILDING PERMIT INFO lLicanw BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby efum shat I em Rename under provisions of Chapmr 9 (commencing p Section 7000)) of Divhion 7 of dm Business end Prufessiov Code. and my license I. ilftma 5 -ELECT. FIXTURES/MOVE SWITCH Chiantieffect. Lm.a PINALED Dam Contractor ARCHITECTS DECLARATION I understood my plan %hall be recd u public Words AUG 2.8 2003 Licensed Professional OWNER -BUILDER DECLARATION I hereby oMr. that I .m exempt from the Cmuncmr'a Lleenso Law for she following rtam. (SCCYen 7(n1.5,Maine. and PlnlCaUON Code: Any city tor County which reyulres a permit to consumer. alma improve, demolish, or repair any structure pear to its issuance. oleo requires the applicant for such pcamiuo file. signed summem that the 1. licensed pursuant mmeprovisions orthe com etOr'sueenteLow(Chapter9 Sq. Ft. Floor Area Valuation (commencing with Section 70ID) of Division 3 of she Business and Professions Cook) or that he h exempt Ncmfmm and dot basis for the alleged exunption. Any violation of 36919033.00 APN Number Occupancy Type Section 7031.5 by any applicant for a pemdl subjects the applicant to a civil penalty of has mom than rive hundred dollar ($500). ❑ 1, As owner of the property, on my employees with wages M doth, sole compensation, - Required Inspections wit] do the work. sad theswmum is not intended or offend to, ask(S.C. 7044, Buameaa The Conlnn9fs Lou, dace not apply lf an owner of And Professproperty COCbuilds properly sono bmlm o, improv ummoo..na sono doea.uen wort Mmacuor through ma and 3 04 - ROUGH ELECTRICAL own employee, provided that such Improvements ... ol Intended orof¢red for ole. If, 505 — FINAL'ELECTRICAL however, the Wilding or impwmem is sold within enc yen of completion, the owner. Wilder will bow the burden of proving that he did not Wild or improve for puryae of ole,). ❑ L as owner of the property. em exclusively contracting wit licensed Connections in conswn the pjen (Sec. 70aa, Business and Professions Code:) The Convusori Li. cave law does not apply in an owner of property who Wilds or Improves themon. end, who conuxcu for such projects with a conuusor(O Ihcamed pmsuam in the Con rs csoM1 kens law. I am uemptt er Sec. , B At P C for ditto reason G.Do,.- 7 V a/ W*RKER'S COMPENSATION DE ATION 1 hereby Arm under penalty of podury ons of ftfollowing declarations I haw and will maintain a Certificate of Consent m self -insure for Worker's Compere - titian, u provldrA for by Senior 37Wof tbe Ichor Code. for the Performance of the work for which Permit pcit it issued. ❑ 1 have and will maintain Worker',nu Compensation Insunco required by Section 3700 of the Labor Cook. for lM performance of the work for which this permit is issued. My Worlet's Compensation Insurance terrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not becompleted if she Permit la for one hundred dollen (S 100) of IoW I certify that in the performance of the work for which this permit h issued, I shall nm employ any person in any manner so as in hrcomc subject to the Workers' Compensaon Law. of Califo..I,, Dam Applicant NOTICE TO APPLICANT: IL error making this Cendicam of Exemption, you should become subject in she Worker's Compensation provisions of the Labor Code, you mut forthwith comply with such provisions in this permit shall be deemed revoked. ' CONSTRUCTION LENDING AGENCY I hereby affirm that Nem its covtmgina lending agency for the performance of the work for which this permit is issued (Sec. 3M, Co. C.) lander'. Name Lcndees Address 1 modify the have mad this application and rote IMI the chow hf ennatiun is COMCL I agree in comply with all city end county ordinances and state hums ml.ing to building Construction, and hereby authorize representatives of this city to enter upon the %hove-mensiooed Property for inspection purposes. (We) S. Io caw, indemnify and keep harmless the City of Cupertino against llabllirie,judgmcras, costs and expenses which may in any way accrue against aid City in consequence of the granting Of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE R ULATI S._ _ // ,/�/O� r���J Re -roofs Type of Roof , num of ApplicuVCom,O Dem HAZARDOUS MATERIALS DISCLOSURE sd handland Will OnapplicantCuKmor forum Wiidinge. Chaptstemor Health u defined by dm Cupertino Municipal Code, CMPler 9.13, end she Health and Safety the eared Code, Section 35533(.) - ❑Yes )dN9 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building =upon, use equipment or device, which It Inanities air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection. i.ric0 61Yu ❑Ye I hew mad dm harardtms mamrieh requimmenca under Chapter 6.95 of the C.ifor. .is Health@ SafctyCode, Sections25505, 35533 and 25534. l n&.d the, if the Wilding does not currently hew a tenant. Not iI is my rupavibility m notify the accupen, of the mvuire wit It bemm drm.u�yg ar.CenOempfaevan Signature of Applicant Date g .2G �A�7 7 v3 All roof coverings to be Class "B" or better wncr or authorindagent Dam OWNER -BUILDER VERIFICATION 1. (Check one) I or my ' ediate family (parent, spouse or child) will perform: A. All the work authorized by this permit B. _ A portion of the work C. _ None of the work IfBorCis 2or3 2. A state licensed contractor will be hired to do: it A. _ All of the work B. _ A portion of the work (complete section Contractor I Address/City I Phone # �7 License # Type of work to be performed • 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be performed I declare under penalty of perjury that the above is true and correct. Owner -Builder Information (reverse side). Property Owner's Signature:�`— job Address: (4�� Z Department. I have read and understand the Date 0_3 Permit # 6 ��o B V_ r CITY of - CUPERTINO CITY OF CUPERTINO 06 7"3? "3 PERMIT APPLICATION FORM W Quantity Fee ID APN# Fee Group BAPPLOTHER BuildingAddress: 6ga MECHANICAL Owner's Name: Phone #: 08) `} BUILDING v� < Boiler <= 100,000 Btu MECHANICAL Contractor: _ #: MECHANICAL nLicense Contact: 5`14:e ✓e- 2-S,2// (I,,.) Cupertino Business License#: I MECHANICAL B Permit Info: Boiler> 1M to 1.75 M Btu Bld Elect Plumb ❑ Mech ❑ Oescn—p,lion: BBOILER5 Commercial ❑ MECHANICAL Residential 7rro� 1� sem,-f<<, Construction Tax Sq.Ft. Floor Area: $/Sq.Ft.: Ind/Off/Comm/Quasi Cost of Project: �c ©� Occupancy Gro Con. Tax for BQ Zone Type of Construction: BCONSTAXH W Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot 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 > 1.75M 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 I of 3 P - uTr o _ CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 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 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 Re i e Of Fixtures PLUMBING BPSEWAGE • Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM StomVRain Water PLUMBING . BPTRAP Kitchen Trap PLUMBING BPVENT 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 cim MECHANICAL BREMAHZHAN A/C Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 1 O btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMMHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL . BREMPOLE Pole/Platform Fixture ELECTRICAL wr 2of3 alo CUPEII;TINO CITY OF CUPERTINO PERMIT APPLICATION FORM n i Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BRENIRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BRENMSAPP 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 BSPECLU 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 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 3 of 3 y 1 •