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05110027Buaomc DlvlsloN PERMIT WyTRA. QI o lit V °. .ba.f'z's'vfh(;:,7 BUILDING ADDRESS: MICCICHI MASONRY OWNER'S NAME: 1 bmeby affirm that 1 an licensed under provisions of Chapter 9 (mommencin{ with Section 70N0 afDiAxion 3 of the Bucher mw Proletarians Cade. aim my 14cac is in ren name and ane --2 g 14 a "2-5' ... . . I in derdand my plans most W used as public needs Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Cunuacto's Uumet Law for the following mason. (Section 7031.5, Business and Profasdom Code: My City or county which mquim a Permit in conduct, after. Wprow. demnl4h, or repair any structure priorm id issuance, dw requiea the applicant farwch permit in Ole unsigned Raement IMI)m is licensed forwent In the proviso" Of Ne Conummes Lison law (ChaPar 9 (commercing with Section 7000) of Division 3 of tho Business and Profession, Code) m Out he is coapt ihemftan and the but, for the alleged memp0an. Any violation of Section 1031.3 by arty applicant for a permit subjects the applicant w s civil penally of rest mom dun Ow hundred dollars ($500). 0 L a owner Olds, property, or my employcu with wages as their soleeompenssdan, will do the work, and dm suctum is nut intended or offered for ark (Sec. 7044, Business and Profesdam Cade: The COWaewel License law don not apply in an owner of propertywM builds orimpmwadtemon, and wMdaotechwork him effordwugh his own employee, provided thatkah improwmems artatwmMW or -freed (mull If. however. Ne Wilding or Wine a rent is sold within onc)ear ofaamplatia, the owar- builder will have the Wraan of proving that he did al Wlw or improve fn puryosu of ❑ 1. u owner a the property. am exclusively carousing MN licensed Cnnmunors in Ll—construct the project (See. 7044. Business and Profession, Code:) The Communes ansa law dao not apply in an ownn of propemyvho Wilda or(mprova tiwean, and w.-] ho anuaas for amb project with a commu7or(O u 5- andpunnt w rw site Comwes License Law. O l an exempt Cauda See.' , B is P C for this mean Ower Done— WORKER'S au WORKERS COMPENSA71ON DECLARATION I hereby dMo mue, parody W perjury aro of the following dmlarWmu: Ihawand will maintain aCexti0cateofCominntwselFesumforWorteesCampen- sWan, u provided for by Section 3700 of site labor Code, far dm performance of de work for which this permit is load. ❑ 1 have and will maintain Worker's Compensation fmunnm, u required by Section 3700 of the labor Code. for dm performance of ate wont for which this permit is issued. (This seetiam need nut he Completed If me permit 4far one hundred antlers f$ 100) or test) I CCNfy amt in the Performance of the want for which this permit 4 issued. I "I rest employ any person in any manner sun as In humor subject to the Workew Compensation Laws of California. Dam Affluent NOTICE TO APPLICANT: If, after making Nis CemElcate of Exemption. you should became subject b the Workrls Compenudan provWaa of One labor Code, you roue ,JO forthwith comply with such provisions or this permit shall W doemod mended. z .~yrs CONSTRUCTION LENDING AGENCY (—r 1 Mackay afrmn that times 4s mu4ucdnr ending agency far the pedormmxx of fY 7 the wont for which this permit is issued (Sec. 3007. Civ. C.) VJ Q Le makes, Name 7 z Lattices Address U O 1 certify that I haw rad this application and sum that the sbow infammiun 4 eomees l ora to comply with all city and county ordiese eea and sue bass, elWn{ in O SV^ building construction, and hereby authorize epmsermam of this city menteruPnn lbs ir7 above-meni m ed property for inspection purposes. g1 (We) agree to saw, indemnify and keeps harmless the City of Cupertino against a.t rn lubiliti gmen4.cosu and expenses which may In any way aura agdat said City U z in cmof the {mnun{ of Nis permit ^ APP i, U E STANDS AND WILL COMPLY WITH ALL NON -POINT SO REGON !l C Slgnkumo li - nmerwr Pam HAZARDOUS MATERIALS DISCLOSU Will site applicant or future Wilding omupwtmarc orhandm hamdom material as defined by the CupWno Municipal Cade. Chapmr 9.13, and the Health and Safety nae, Section 253310)7 Oyu VNo Will the applicant or future Wilding occupant use equipment or devices which mit hezodnm air eanumi MIA u de0ncd by the Bay Asa Air Quality Mangemem Disc m7 ❑ Yea Ik"O I haw mad the lou materials equlemau under Chapter 6.95 of Ne Califor. n4Hcal"WmyCade,Se/wm25505.25533aim25534.1urdcmundthmifdte Wilding rm"mrl"x'05110027 PERMIT ISSUE DATE 03 nVIWI"V YCMMII I"YV BLDG ELECT PLUMB l� Job Description NAL REPAIR (E) FIREPLACE (BRICK) NOV i g 1005 Required Inspections Issued Date �� , �2- a} Re -roofs t✓ Type of Roof 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 all new materials for inspection. Signature of Applicant Date . All roof coverings to be Class "B" or better CI OF UPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: �j PERMIT # OWNER'S NAME: r ,q, �,, 0 PHONE # a i rf C y GENERAL CONTRACTOR c o FAX # I am not using any subcontractors: Phase rherk annlirahle snhcontractors and complete the following information: Owner/ Contractor Signature Date 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 Owner/ Contractor Signature Date E.,-& CITY O CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM OT 1 27 IV N# f v Date: / -7 )� BAPPLOTHER Building Address;Mailing Addr s if jfferent from build' g address): (r MECHANICAL U S IV tfL pet, Boiler <= 100,000 Btu Owner's Name: one #: Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler '> 500K to 1M Btu Contractor: M t C-4 � fps jo (i License #: Boiler> IM to 1,75 M Btu C 7 C BBOILER5 Boiler> 1.75MBtu Contact�. Phone: Cupertino Business License#: BCONSTAX L Fax: BUILDING Building PeAnit Info:r— (� *�-��V}lY �X\s� Ind/Off/Comm/Quasi BldgElect ❑ Plumb ❑ \ Mech ❑ BCONSTA)MQ Job Description: BUILDING Residential ❑ Commercial ❑ Hotel and Motel Sq.Ft. Floor Area: q.Ft.: Constax — Resi/Mobile Cost of Project: Occupancv Group: - Elec 600V <=1000A Type of Construction: Please check this box if the project is a Elec 600V > 1000A ELECTRICAL second -story addition: ❑ Elec Svcs 600V <= 200A ELECTRICAL ro'ect Size: Standard ❑ Laze ❑ Major ❑ Energy Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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> 1.75MBtu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTA)MQ 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 lof3 ('-1 r CUPEfZTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Ouantitv Fee ID Fee Description Fee Group BIMCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUMEAM 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 Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstalVAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUNIBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BRENLARUTAN 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 AINCHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 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 i] 2 of 3 cin o CUPEKTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity . Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Li ting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Sob Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSW1M Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Pe BUILDING BTEMPSVCS Tem Dist Svcsrmit ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERIv1FEE Mechanicals . foot MECHANICAL MPERMITFEE 114ech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbin .Foe, sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BT=ING 3of3