04050131 CITY OF CUPERTINO #�,r 3® * '
BUILDING DIVISION PERMIT CONTRACTOR INF'RMATIQN
BUILDING ADDRESS: """04050131
ERMIT"04050131
10742 CARVER.
OWNER'S NAME: PERMIT ISSUE DATE
KATHY CAMPO 05/19/2004
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUME MECH
=oo LICENSED CONTRACTOR'S DECLARATION O O O
=u I Wmby air..that Ian ficenesd towerl rovisians nr enavmr v(rnmmeneing Job Description
wiOSccfi n7 fDiviaion3ortheBnslgedkndProfemonaCode, dmyreeds a�mpt1 n 2
� mmrmraww lz O Lie.a Z'yZr� CENTRAL COOLING & HEATING SYSTECL�Y ALEE0
in fullcrcc
^� Data -r — Cantr tori CONTRACTOR: HIGHLAND HEATING
ARC Unna Tg DE ATIO 7 q ,t
iy�s I understand my plans shall W used az public records JUN rl f-0�Y
M;u. Lkecnacd professional
`03 OWNER-BUILDER DECLARATION �lp� p p��±
y F 1 hereby.Wore Nal 1 am exempt from the COnuncmrs License Law for Ibe IGa IIJJ�E�®IOtlG
00 fallowing ma (Section ection 7W 1.5,Business and Profecsioos Code:Any city or county
K m� which requires a permit to construct.alcor,impmve,demolish,or repair any stroctum
prior to its issuance.also rcpidics the applicant for such permit to File a signed statement
—�s that he is licensed the provisions the Contractor's Licenselaw(Chapter9 Sq. Ft. Floor Area Valuat�gg55
YFC (commencing win taction 7")of Division 3 of NC Business and Professions Code)or
i that rte is exempt therefrom and rte basis for the alleged exemption.Any violation of
Sccuon 7031.5 by arty applicant for a permit subjccu the applicant to•civil penalty Of APN Number Occupancy Type
not more Nan five hundred dollars($500).
37532009 . 00
❑I,as owner of the property.m my emplOycu with wages az Heir sole compensation,
will do the work and the suuctore is not intended or offered formic(Sec.7(144,Business Required Inspections
and Professions COO:The Convector'se License Law docs not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided than such improvements art not Tonal oroffercd forsale.If,
however,the building or bnprovement is sold within one year of complcumn,the owner.
builder will have he Widen of proving than he did not Wild or improve for purpose Of
sake.).
Q I,as Owner of rte property,am exclusively convecting with licensed contractors to
convect the project(Sec.7(144,Business and Professions Code:)The Contractor's Li.
cense law docs not apply to an owner of property who Wilds or improves uncouth,and
who contracts for such projects with a canuacmgs)lianud pursuant o the Conuactoes
License law.
❑l am exempt ander Sec. ,B&PC for this reeson
1037�M
n Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one Of the fallowing declarations:
1 has and will maintain a Certificate of Consent to self-insure for WOrker'sConapm-
ion,as provided for by Senian 37M of dm labor Code,for On ped rrom.of Inc
rk for which this permit is issued. -
1 has and will maintain Workers Compensation buurana,az requirod by Section
of the UWr Code.for the performance of the work:for which this permit is issued.
Wor""ker�isCoo�mpensation Insunna carie and Policy number me
rpe rreN'�'r_CERTIFICATE OF%EMPf10N FROM WQR, g'9Z3
COMPENSATION INSURANCE
(Thu sectio,need not he complemd if IW permit is formic hundred dnllars(SIM)
nr lea)
I Modify Out in the Performance of the work for which this permit is issued,1 shall not
employ any prowmymanner sO az to mc subject Wcosubjeco tie Wmrkami Compensation
Laws of California.
Applicant
NOTICE TO APPLICANT:IL after making this Cenirate of Exemption,you should
become subject to the Worker's Cmmpenwti°n previsions of the Labor Code,you mus
0 O fOMwith comply with such provisions or this permit snail be deemed revoked.
Z '-- CONSTRUCTION LENDING AGENCY
'[•+� IWmby afromoat mere is.construction lending agency for rte performance of
cd > the work for which this Perin,is uaaed(Sea.3097,civ.C.)
W Q Lenders Name
Z Under.Add.,
U O 1 certify that I have read this application and sato Out Oc chow irdimmauun is
W P comm.I agree to comply with all city and county ordinances and state laws relating to
�UWconstruction.
ilding se and hereby suborn mprewmatiss Of this city to cnmr upon the
�W aWve-mentionW property for inspection PaTaws. inn
f••'C (WO)agree to save,indemnify and kap harmless the City Of Cupertino against
h
Liabilities, and experrscs which may in any way accrue against said City I/ I/
U Z in consequence of the granting Of Nis permit.
^+ APPLICANT UNDERSTANDS AND WILL COMPLY TH ALL NON-POINT Issued by: Date
SOURCE CATIONS.
S O Re-roofs
S' curt of Ap,l T-VConuacmr Dam
L HAZARDOUS MATERIALS D CLOSURE Type of Roof
Will the applicant or fumm Wilding atecupm store or handle hvaduus mmerial
az defined by the CupeNno Manic' el Code.Chapter 9.12.and IW Health and Safety
oUc,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes N°
Will the applicant or future building Occupant use equipment art dcvicas which If a roof is installed without first obtaining an inspection,I agree to remove
it hs sums air conuminanu as defined by um Bay Arca Air Quality Management all new materials for inspection.
7z,;_-�?
strict?
❑Ycs cw
It veread Oe handnus materials mquimmenu under Chapmr6.95 mf thc Califor
Health&Safety Codc,Sccuotu 25N15,25537 and255Jq.1 undersand nee if nc building
cs not currently hos a u nano Oat it is my responsibility to notify the t supant of the
m"atWma'y e,pntotoi„” mo"' ow Signature of Applicant Date
ncr or authorimd agent Dam All roof coverings to be Class "B" or better
Community Development
awie
10300 Tone Avenue
Cupertino CA 95014
Telephone(408)777-3228
SCITY OF Fax(408)777-3333
CUPEkTINO
Building De rtMent
JOB ADD xl:l0 e4iev,eX RMIT #O
OWNER'S NA 7 PH #��p7-1G7-19 3
GENERAL CONTRACT-OR: FAX # 9f P-
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
'O7, er/Contractor ire ' ate
y�' 10/28/03
'1 affl---
CITY OF CUPERTINO /
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
APN # 3 � 3 2 Date:
Building Address: O7� Mailing Address (if different from building address):
i
Owner's Name: � Phone #: �8 727_ Z3 _f
I� iI%h
Contractor: License #:
Contact / �A one:&1.SV-J&17-, 9'YW Cupertino Business License#:
ax:6to-Sl�f- 71-1
Building Permit Info: /
Bldg ❑ Elect ElPlumb ElMech Q
Job Descriptio Cel, wo _
Residential LJ sV Coo .' ,4 /.v S finCommercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: r O Occupancy Group:
Type of Construction: Please check this box oect is a
second-story addition: ❑
Project Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> IM 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 <= IOOOA ELECTRICAL
BELEC1001 Elee 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigatio(nn fee BUILDING
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CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCONC M New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE 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 rinkler/Backflo PLUMBING
BPSTORM Stom]/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
BREMARUiAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFlXT Lighting Fixtures ELECTRICAL
BREMFURN 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
BREMRECEPT Rc tl, Switeb & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
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ir1 CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmd] Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Sips, 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
BSVv M Swinuning 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 Change BUILDING
•
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