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03090086 (2) CITY OIp.CUPERTINO BUILDING DIVISION PERMIT CO 'TRACTOR INFO�ATI '. wz3�'_' erxr4vn ah 1'^J#£ s_�ffizfi4fa3r4ef BUILDING ADDRESS: IRVING STEPHEN M AND D L PERMIT H%3090086 OWNER'S NAME: PERMITISSUEDATR NITNC, qTRPHRN M ANT) T) T. 09/11 /21303 NE: SANITARY NO. CONTROL NO. ARCHITECI'IENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMBMECH 0 0 0 0 100 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9(commencing £�to owith Section7")of Division 3 of NC Business and Professions Code,end my he...is inmuforce Class ton., KITCHEN REMODEL/WINDOW RADE infullLicense Class Lic.p s t,p Dau Contractor RCNITECrS DECLARATION �z6 I understand my plamewll be used as public records 56D 5oG Licensed Professional G/ 0 S OW NErn a.mOER DECLARATION a O C 1 masa .Sec that 11. exempt from the Common Co License Law for the o O fallowing mama. panic t 7031.5,Business and Professions damns Code:Any city nr roomy 5 m� which requires a pcmtil hs mnswe6 alcor,impmvc,demolish,or repair any structure prior In Tim issuance.also exports the applicant fel Such permit to file a tinned statement that he is licensed pursuant m the pmvicionsof the Contractor's License faw(Chapter 9 Sq. Ft. Floor Area Valuation 2^ (com mounting with Section?OW)of Division 3 of the Business and Professions Code)or Nat he is exempt therefrom and Ne basis ror the alleged exemption,Anpviolmfion of 35620046 . 0 0 Section 7031.5 by am applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy'Type ... " not mom Nan five hundred dollars(S500). " I;ss owner or the property,or my employees with wages m their sole compensation, will do the work,and the swcwrt is not intended or offered for sale(Sec.?BM,Business — d Inspections tend Processions Cade:The Commucmr's License Law does not apply to sn owner or 10 2 — PIERS P property who builds or improves theorem,and who does much work himselror through his own employees.provided that such improvements are not intended interfered for sale.IL 103 — UFER however,the building or improvement is sold within one year of completion,the owner builder will have the burden or proving that he did not build or improve for purpose of 104 - REBAR aa'`')' 105 - ANCHOR BOLTS 1,as owner of Ne property,am exclusively contracting with licensed convectors to 10 6 - SEWER & WATER Construct the pmjen(Sec.IBM,Business and Professions Code:)The Contractor's Li ceme law does not apply to an owner of property who wilds or harrows thereon.and, 202 — UNDERFLOOR PLUMBING Lcenwu for such pm � jecu with, mmrsu tncr(s)IicensedpuanContractor's NeContractor'sseL 203 - UNDERFLOOR MECHANICAL Q I em eapmpl under Sec. ,B h P C fin�this mason Owner C ���' Du !� d 204 - UNDERFLOOR FRAME `' WORKERS MPENSATION �CLARAJT� 205 - UNDERFLOOR INSULATION Thereby affirm under penalty of perjury mrmemlfwing deel.raonn.: 301 - ROUGH PLUMBING I haw and will maintain a Certificate of Consent to self-insure for Worker's Cumpen. 302 — TUB �c OR SHOWER _ workforfans idevihich mu pen,I'a vucd7W of the labor Code,for the performance of the 303 - ROUGH MECHANICAL ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3 04 - ROUGH ELECTRICAL 3700o17the LaborCoda,for the perfmoideacf0m,week mrwhich thispennil is issued. 305 — FRAME My Workers Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS Carrier: Policy No.: 307 - INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' . COMPENSATION INSURANCE 308 - SHEETROCK md,scodmosecd nmbecomplesediftbe permit is fmmm hundmddnll.,suir(B 309 - EXTERIOR LATH irties ) 310 - INTERIOR LATH I e,rtiry Nat in the perrom once of the work for which this Permit a issued,I shall not employ any posed in any manner so mat to become subject o the Workeri Compensation 311 — SCRATCH COAT Laws of California.Data 313 - ROOF NAIL Law,Applam NOTICE TO APPLICANT%If,anter making this Certificate or Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject to Ne Worker's Compensation provisions of be Lawr Code,you must >Z mrthwith comply With such pmeisonso,thbPermit shall Wdestruct mwokcd. 502 — FINAL PLUMBING ENERGY ? � CONSTRUCTION LENDING 503 - FINAL MECHANICAL ENERGY I hereby milrmNm Vert is.construction lending agency for the varrormenc.ser 504 - FINAL BUILDING ENERGY z> NcWork fo which this pcmitbissucd(Scc.3(N?,Civ.C.) 505 - FINAL ELECTRICAL 11 Q I.endirb Name jZLeader's Address 506 - GAS TEST 1 certify Nat 1 have read this application and some that the above information is 507 - FINAL PLUMBING D. F cored,I agree to comply with all city and county ordinances and state laws failing te- �v building consvoction,and hereby submire representatives ofthis city tocnurupon the FIN MECHANICAL N U ahovo-mcmb ned property for inspection puriwus 0 9 F I (We)agree to save,indemnity end keep harmless the City of Catcrtine against r� liabilities,judgments,Costs and expenses which may in any way accrue against said City 55 NG JZ in consequence of Ne granting of this parent. �A/ " APP ANT UNDERSTANDS AND�WILL COMPLY WI'H'ALCNON.POINT Issued by:5 C WORKS Date SOb EGOLATIyyNS. \, ,V— 4mL`�l !� /r�O>' Re-roofs Signjaur�A licanUContract r�mmlicanUContract r am HAZARDOUS MATERI LS DISCLOSURI=' Type of Roof Will the applicant or future building occupant store or handle barardous mamdal as defined by the Cupertino Municipal Code.Chapter 9.12,and the Ilcalm and Safety Code,Section ca ,,m All roofs shall be inspected prior to any roofing material being installed. 7�tndWill the.ppfieanter future bmldlnso,vapant au egmpmenter demes which If a roof is installed without first obtaining an inspection,I agree to remove a�'I'lsh it hazardous air Contaminants as dcOned by the Bay Arca Air Quality Management all new materials for inspection. i ❑YesI have mad Ne hamblousmmcrials reyuirem rum underChapter 6.95 of the CalifonHetiti Safety Codi,Se.filmu 5505.25533 wd25534,I undeuund loathe wilding moy haw a¢mint,Nat it is my responsibility m nosily the �upard m Nc mut wmcl poor SFlj anteole CerdfcofOh Date J "' 1SignalureofApplican[ncreLaw, rcdage-m / m All roof coverings to be Class "B" or better 7tl �9 SEP 1 1 3 i BY s p PROVEDHE Gm UR IN go R AN E WIT It�ANCES GUP.EttTIN G E —---,-- I)ATE� sgIEo specdications A1UST Thls set o 'a at all times and it is,un )a kept o the lo. changes or altemdons Q u. lawful to make ap ermission from _ without Witten p ZZ, n same city of buliertiM he building Dept. _ llcadona of tl is�plan,an'.IsP,to,bae at • ,/ ,r The stamping Id to partglRro4r SHALL t\oT be e 'pCnYlalon9. ° y – I vaI of the vloletion of r tlKv. ?�0 ordnance or,,,St anV�fY \ u qN Cv �J (V o•..J v 0•t.� A - . Jl. • RECETV SE ' !I hPPROV D M ACCOR NCE WI H ME CITY L ICU CODES/i D DINa CES 5 PAT.E,. SIGNED _ ter'. This set 11 Is and speci i:wions MUST be kept of ne job at ail tin s and it is un V lawful to make any changes or alteration: on some without written p .•nssion hon: the building Dept., City of Chpartino• ,The stamping of this p.'en 6ncatiur .� SHALL NOT be herd to pe:r i Yy in N, , approval'of the viclat;ut cf r;,,:i• 1 of any CRY Ordfnance • dF � j �! &UZ r, aclio AY OF CUPERTINO CUPERMIT APPLICATION FORM RTINOA 1k N# Date: /i/ 3 Building Address. r Owner's Name.>4 I Phone #: i.2✓�nlG 2.;;-71. �'6 Contractor: N41;r License#: Contact: lV Y Cupertino Business License#: ildmg Permit Info: 1 E ct� P1 ech Job Description: Residential ❑ "comm is Sq.Ft. Floor Area: $/Sq.Ft.: 4 e7 Cost of Project: D Occupancy Group: Type of Construction/ Quanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I00K to 500K Btu MECHANICAL BBOILER3 Boiler>500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS 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 Elec 600V> IOOOA 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 1 of 3 / 3P, 7/ ' �"' C*Y OF CUPERTINO r °NO PERMIT APPLICATION FORM CUPEkTINO 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 BOVERTME 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 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 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 cfm MECHANICAL BREN AIRIIAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL 13REMBUSWAY 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 BREMPOLE Pole/Platform Fixture ELECTRICAL • 2 of 3 avi CITY OF CUPERTINO PERMIT APPLICATION FORM CUPERTINO uanti Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood -s 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 PlanBUILDING BSEISMICOM Seismic Commercial BUILDING ol BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Ternp 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