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03090199 ¢ CITY OFCUPRTINOTB11CON:TRACT( R INFORMAIO�N -" DINcDlvls)oN PRRMIT �,ra I ti a BUILDING ADDRESS: BOB GERE MASONRY PERMIT"°03090199 OWNER'S NAME: 480 CROSSLEES DR PERMIT ISSUE DATE HAWN B 2003 "E` (4 0 8) 972-12 85 SANITARY N0, CONTROL NO. IARCHITECTflENGINEER: BUILDING PERMITINFOBLDG PLUMEMECH t�1LICENSEDCONfRACOR'SDECLARATIONJobDescri [ion I hereby affirm that 1 em Iimnxed under previsions of Chapter Y(commencing P e U with Stenion 7(I EofDWWoa 3 of Nc ainx¢and Pronasions Codc,and my lkcnac is ±� nlulll e�mdcl;ct REPAIR CHIMNEY ytlZ Licen¢ / JJ a 'L Cun O/ 1 l understand my plans shill he used u public manes 6 e Licensed Prnfusional. q OWNER-BUILDER DECLARATION COO I hereby.(Sere on 11. exempt from the fContractor'sCoLicense Law for the COO following reason.(Section 7(131.5,Business and improve. demolish, e on&h,or:Any tiny m aunty S$ which)its I su a Pmmit u,core;the alter.impmsu h Permit t car repair any swcturc thatrm1616uedprBant to the pre visions or for such Permit toicensre ae ave Chapteal then he is licensed pursuant the previsions of NC Contractor's License law(Chapter Sq.Ft. Floor Area Valuation rj $ (commencing wi lh Section 7000)ofDivision 3 of the Business and Profession&Code)or y Nat he is exempt nM¢fmm and t e basis for the alleged exemption.Any vinhOno of 32641038 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy T not more then five hundred eaten($500). - - - -- P y YPe ——- ❑I.as owner ofthe property,or my employees with wages an their sale compensation, will the the work,and due¢Wct..is nal intended.,offered roreale(Sec.7W.Business and Prefeuiana Cade:The Contractor's Locate Law dues not apply to an owner or 102 - PIERS ) d Inspections property who builds or improves thereon,and who docssuch work himself or through his own employees,provided that such improvements are not Intended oroffered for ale.If. 103 — UFER however,the building or Improvement Is sold within one year of completion.the Owner. builder will have the burden of proving that be did not Wild or improve for purpae of 104 — REBAR 61n.). 105 - ANCHOR BOLTS ❑l,a Owner or the property,em exclusively c.nuncting with licensed contractors to 106 - SEWER & WATER construct the project(Sec.70".Business and Professions Code:)The Contractor's Li. cense law does net apply to an owner or propeny who Wilda or improves thcmon,and, '202 — UNDERFLOOR PLUMBING who contracts for such projects with a comractor(¢)licensed pursuant o the Contractor's 203 - UNDERFLOOR MECHANICAL Lieenselaw. C3 lamuemptundersee. .BAPCTmthh¢ason 204 - UNDERFLOOR FRAME Owner Data 05 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby alarm under Penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING _ I have and will maintain a CCAMMIeor Consent to selGinsum for worker's Compen, 302 — TUB & OR- SHOWER tion,as provided for by Section 3700 of the labor Cade,for the performance of the 303. - ROUGH MECHANICAL work for which Ed.permit is issued. 304 - ROUGH ELECTRICAL ❑1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of du Ube,Coda,for the perfomlma of she work for which this perm it ie Issued. 305 — FRAME My Worker',Compensation Insurance carrier and Policy number am: 306 — HOEDOWNS Cartier: G ds Polity No: ' 307 - INSULATION 'CERTIFICATE 0 PI70 WORKERS' / COMPENSATIONI I ANCE 308 - SHEETROCK (This nctitm need not W completed if the Permit is rn on hundred dollxn(s I50) 309 - EXTERIOR LATH fit less.) 310 - INTERIOR LATH employ certify than in the n any mance or the work nor which thio the W is issued,I shell nut Law,oanypmnlnany manncrmasmbecomc mbjcn to the Wohen'Cnmpeasatlon 311 - SCRATCH COAT LawlicanCalifornia.°its 313 - ROOF NAIL Applicant NOTICE TO APPLICANT:IL after making Nis Cenificate or Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject to the Workeri Compmurtion previsions of the LnWr Code.you must D forthwith comply with such provisions Ofthis Permit shall Wdeemed mocked, 502 — FINAL PLUMBING ENERGY z C CONSfRUCT10NLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY I hauhy afma that lhcre to convection landing agency I.,the rform... f 504 - FINAL BUILDING ENERGY peo Xlrz > nawakmrwhich this pemhHiaaed(ses.3om,civ.c.) 505 - FINAL ELECTRICAL SLendcrName !. Lenderi Address �z 506 - GAS TEST j 0 1 p 1 rectify that 1 have rod this application sou than show information is 507 - FINAL PLUMBING H COMMCOMMl agree to comply with all city and countyy ordinances andnd auk laws mletin[to 7 V building construction,and hereby authorim upresennatiws Of Nis city to enter upon Ne FIWNWG'� L J+�W above (We) Propene for impaction an purpose 099 F I (endagueto ave,indemnifyand keep es. the City of Cupertino agaiw (A Liabilities.judgmcnu.Costs and ospeneswhich may inmyway ammeagainst asidCity In consequence oflM[Honing o(this permit. APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: RKS Dale SOU REGUL TIONS. Re-roofs rg tore plica Can tion Dale HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupant snore or handle ha a dour material as defined by the Cupertino Municipal Coal Chapter 9.12,and the Health and Safety Code.Sce❑banYes 25532(.)? All roofs shall be inspected prior to any roofing material being installed. �No Will the epplicanl or fuwrc building oecupam sex eyuipmem or dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove it hanrdnas air cantsmin.nu to darincd by the 81,Ana Air Quality Managemenr isnrict? all new materials for inspection. ❑Yes 116Nu Ihave mad the hmaNrus materials requirements undcrChapkr6.95 of the Califon tie Hcehb I S.fmy Codc,Secuoes 2550515533 and5534.1 undcnund Ihmif the building does not curremly hew a unank Nal f 6 m m n&ihilitaf.ccny m nodly 150 occupant of the require uwh' most me 'ortuiss lfeam ar Occupmcy. Signature of Applicant Date - All roof coverings to be Class"B" or better weer ser xuth.d,.d agent Data w IACITY OF CUPERTINO 0j U7 0 ( q CUPEY OF PERMIT APPLICATION FORM N # Date: 3 Building Address: O y// Owner's Name: Phone#: Contractor: License#: S3^8 9 Contact: Cupertino Business License#: Building Permit Info: /2/jz N� lrJl// pl 1/91X 3 I u r/ds3-T�o�J Bld& Elect ❑ Plumb ❑ Mech ❑ Jo escription: esidential ❑ Commercial ❑ Sq.Ft. Floor4Arm.*.iOQ\ $/Sq.Ft.: Cost of ProjOccupancy Gr up:Type of Con uantit Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BB0ILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75MBtu 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 ZG 2Y2S 1 of 3 L S� �� 3�—e' 0 a-"CITY0 CITY OF CUPERTINO CURTINO PERMIT APPLICATION FORM AL 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 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER InstalVAlter 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 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace 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 01 BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 aClOFCITY OF CUPERTINO CUf� PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL 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 Insection 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