The URL can be used to link to this page

03090200 CITY OF CUPERTINO •� �+ « �s� <e;zzt•'. BUILDING DIVISION PERMIT <CONTRACTnRINFORMA-TION'� rau�re`ze"4e"ds 1—BUIED-1—NGADD—RES-St PERMIT N00 3 O 9 02 O O OWNER'S NAME: PERMIT ISSUE DATE MARTINEZ JOS 09/24/2003 NE: SANITARY NO. CONTROL NO. ARCHMCT/ENGINEER: BUILDING PERMITINFO BLDG ELEL7 PLUMB MECH t� 0 0 0 i0p LICENSED CONTRACTOR'S DECLARATION CCE1 nereey Erm Net 1 em littnsotl under provisl nrcn.Pl=r 9 e<ammenning Job Description with Section] ))af Divieion3ofN Bnsincme dPysf�iuns Cak.and myliccnseb ' SDI full forte Tec ry ;8= Li=en can NL, L;=« e.. BATHROOM REMODEL Date — core=emr CONTRACTOR: THRASHER TERMITE & PEST CONTROL pp ARCHTfECI'S DECLA ON / ' t k< I undc nand my phns atoll he used u public rteards �y.L_( )yU 'uI Licensed Professional yC5 OWNER-BUILDER DECLARATION !!!! CO p 1 gesso .(Sect on 1 1. exempt from Me Contractor's License Law co the Q� 00 follwhich greaes a r crunit t 8onstrct,&her.sand Improve, emoli Co dc:Any city of county `<$ which requires issuance.permit re construct,efue improve,h Permit or mash any structure nZN prianoitscsedprsuarc to theres reapplicant for sucContrarmitwandon file a Lawned 2Saa (comm is licensedpSecuamtolhcprovisionsofthe Canwness and (Chapter Sq. F[. Floor Area Valuat, )b980- H (cat be I.(commencingwith Section and of Division M the ege Business ProfAny= ny Cwc)ar 3�$ that he ie exempt therefrom mtl dm basis for Ne alleged cxcmption.Any vinlodon of gqrrnn..ii��GGnn Q" Occupancy Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of 3 R'? cr00.- O not more Nan rive hundred dollars 0500). - --- P y `]Pe -—- ❑I,as owner of Ne proWny,or my employe=with wages as their auto compensation• will do the work,and Ne,net..isnot immndcd or offered for sale 7064,Business RR=S�GG d Inspections and Profwm iaCode:The CmusectoYa Liters no Law does s apply to an owner of 101 - FOUNDA p property who builds or improves Merano,and who dam such work himself or through his Own employees,proviwd Nal such improvements are not intended oroRered formic.If, 102 PIERS however,Ne building or improvement is sold within one yam of completion,Ne owner. builder will have Ne Wrtlen of proving Nat he did not build or improv for purpose of 103 - UFER mle.1. 104 - REBAR ❑1,as owner of the property,am exclusively contracting with licensed contractors to - conswcthe project(Sec.70M,Business and Professions Cmi The Contractor's W. 105 — ANCHOR BOLTS come Law does not apply to an owner of property who builds or improve,Ihemon,and 106 — SEWER & WATER who contracts for such projects with a contractor(s)licensed pursuant to the Conmdws License Law. 202 - UNDERFLOOR PLUMBING [31 am exempt under Sec. ,B&P C for this moron 203 - UNDERFLOOR MECHANICAL Owner Dots 204 - UNDERFLOOR FRAME W O0.KER'S COMPENSATION DECLARATION I hereby ail,.under penalty of perjury ow of the following declarations: 205 — UNDERFLOOR INSULATION I ban and will mairain a Cenificau,of Consent to sef'-imure for Worker's Comper. 301 - ROUGH PLUMBING ration,as provided for by Section 3700 of Ne Labor Code,for Ne peRomtance of Ne 3 02 - TUB & OR SHOWER wrekforwhichthisPermitislmaer. 303 - ROUGH MECHANICAL ❑1 ban and will maintain Worker's Compensation Insurance.as acquired by Section 37MofdoLabor Cods.far Mepanic....orthe workfor which this woniraimaed. 304 - ROUGH ELECTRICAL (ray soy er'.Card malign lnsunme emricr end Poli the 305 - FRAME I' '1306 - HOEDOWNS CL TIFICATE OFEXEMP ION FROM WORKERS' COMPENSATION INSURANCE 307 - INSULATION (This section need not he completed if the Permit is for ow hundred dollars IS 100) 308 - SHEETROCK I certify 309 - EXTERIOR LATH employ certify Nat in Inc performance of U to b k for white this perms rl iri'Co 1 shall nm Lawso California.oninanymenncrmmm become subject Workers'Compcnse0on 31O — INTERIOR LATH Laws of CalifoDau Applicata 311 - SCRATCH COAT NOTICE subject APPLICANT:a after making Nis visions Of M Exemption,you should 313 - ROOF NAIL Income womp m the Worked Compensation this provision.of Ina meg Cwe.you must �Z forthwith comply with mehProvuinnsorNisPermit shall Wdeem=drewkcd. 501 - FINAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY I hereby affirm Nal Mere is a com uctinn lending agency for the performance or 503 - FINAL MECHANICAL ENERGY Y.7 the work for which this Permit is issued(Sec.3097.Civ.C.) :Ap Leader's Name 504 - FINAL BUILDING ENERGY Y Lender's Add., Z) 505 - FINAL ELECTRICAL Q 1 cenify Nal I haw mad this application and sum that Me above inforra ion is 506 - GAS TEST correct,l agars to comply with JI city and county Ordinances and soon I.ws relating to building construction.and hereby authorim minemntatim of this city to wmrupmthe - FIN PLUMBI G �L✓a anove-mentiuned property for inspection purposes. x (We)agree to mw,indemnify and keep harmless the City of Cupertino against g08 F IL liabilities.judgments,toad,end expenses which may in any way accrue against mid City min conqcwo of Ne Standing of Ihis permit.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: IMG Date SOU G TIONS. ^� Re-roofs Co.of APPIicmUCanlraclor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII dneapplicant or forum Wilding occupan4mm or luntllc hmWous material as dunned by Ne Concepts. Municipal Cade.Chapter 9.12.and Ne Health and Safoy warScotian 2ss3z(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑YesNo Will the.pp tore(or future banding«=ap.nt rat equipment nr devices wmm� If a roof is installed without first obtaining an inspection,I agree to remove it na emnna ail tdramin.nIS defined by the Bay Area Air Quality Management all new materials for inspection. 'I, ❑Yes Nu 1 have mad the hmaNaws materials requirements under Chapk:r6.95 of the Califon nice Hcalth 6 Safcly Codc.Sections 255115,23533 and 25534.1 uwersNnd that Ifthc Wilding docs al eunendy have a tenant,thn it is my responsibility nodl'y the deupant of the yywnienpust�1.imaanenracmmne Signature of Applicant Date Owner Or.udhorivcd agent Dow Dau Y All roof coverings to be Class "B" or better CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM C) " Z� APN# 2 6s. Date: Building Addres : 6L SE C r Owner's Name: Phone #: Con ctor: License #- sl.� �m,t ` � - � o L � Q. a a vo Contact: Cupertinno Business License#: Building Permit Info: � Bld Elect ZIPlumb -1Grech—LJ— Job De ption: idential - er t Sq.Ft. Floor Area: $/Sq.Ft.. Cost of Project* 'p Occupancy Gr p: v Type of Cons ction: AML r 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> 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 <= 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 J 23 2s3 1 of 4, 20 9 ?.J CITY OF CUPERTINO CUPEI�TINO 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 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 rinkler/Backflo 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 BREMAI RAN 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 OK btu MECHANICAL BREWMAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platfonn Fixture ELECTRICAL 2 of 3 a'D CITY OF CUPERTINO CUP PERMIT APPLICATION FORM ' QuantityFee ID Fee Description FeaGrou BREMPOWER Power Device/A aratus ELEAL EE]l 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 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 TFEE 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 r CITY OF CUPERTINO m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng : Sub: Blk: Lot : APN . . . . . . . . : 36924054 . 00 DATE ISSUED. . . . . . . : 09/24/2003 RECEIPT # . . . . . . . . . : 23253 REFERENCE ID # . . . : 03090200 SITE ADDRESS . . . . . : 6658 CLIFFORD CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER MARTINEZ JOSE AND ELLEN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2347 RECEIVED FROM . . . . : THRASHER TERMITE & CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , 0 TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 1, 980 . 00 77 . 00 0 . 00 77 . 00 0 . 00 BENERGY PERMIT FEE 77 . 00 23 . 10 0 . 00 23 . 10 0 . 00 BPFIXTURE UNITS 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00 PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BPLANCHK PERMIT FEE 77 . 00 65 . 45 0 . 00 65 .45 0 . 00 BSEISMICRE VALUATION 1, 980 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 209 . 90 0 . 00 209 . 90 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 209 . 90 18205 TOTAL RECEIPT 209 . 90