03070150 CITY OF CUPERTINO 'a• yr r ,a ✓ �,BUILDING DIVISION PERMIT PCONTRA.CTORANFOILMAT,IQN
w ya`dA�h 13xdb»ea�gx xhul.:.*.hv.X
BUILDINGADDRESS: NICE & RIGHT CONSTRUCTION 61ITN003070150
OWNER'S NAME: 166 EUCALYPTUS DR PERMIT ISSUE DATE
NE: (415) 239-2696 SANITARO.YNCONTROLNO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� � t� 0
LOO LICENSED CONTRACTOR'S DECLARATION MM U N
1 hemby affirmat 1 am liaenacd under provisions of Chapter 9(commencing Job Description
with Section 70($0 of Division 3 of the Busincsa and Pro(casions Code,and my license is
m full fume and effect.
]12_ License Class Lie.0 .r REVISION--IN HOUSE USE ONLY
tDate ARCHITECTS DECLARATION REVISION--FOUNDATION #02070032/02110020
I understand my plans shah he used as public records #03040082/
3 0 Licensed Professional
<
3 OWNER-BUILDER DECLARATION
I I hemby affirm that 1 am exempt from the Contractor's License law for the
p O following noon.(Section 1101.5,Business and Professions code:Any city rr county
3 which".I.a permit In construct.elm,,improve,demolish,rr repair,any atomism
prior m its issuance,also requires the applicant for each permit to Ne a signed mucrec set
p�?'< that he is licensed Puruant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 70E of Division 3 of the Business and Professions Cottle)at
— Nn he is exempt themfmm and dm basis for the alleged esemption.Any A.l.unn of $107
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
Evil more Nan five hundred dollen(5500).
❑I,asowner of Bm pmpcny,mmy employee with wagealhe'u sole compenudon, 32611006 . 00
will do the work.and the swcure I. Intended or offernd I.,W. 7044,Business Required Inspections
and Professions Code:The Co ince e,Lt..Law docs nm apply m an dinner of q P
Property who builds or improves do rcon,and who dossuch work himself orthrougb his
own employees,provided that such improvements arc not intended m offered foruk.If. 101 — FOUNDATION
however.Ne building or Improvement is sold within tam year.(completion.the.wmr-
bund.,will have the human of proving that he did not build or improve for purpose or 102 — PIERS
'pie') 103 - UFER
0 1,as Owner of the property,am exclusively Contracting with licensed contractor to
...street the proiect(Sec.7061,Business and Professions Code:)The Contractor's Li- 104 — REBAR
come Law docs not apply to an owner of property who builds or improves themon,and, 105 — ANCHOR BOLTS
who Contracts for such pmjeeu vitt a contramm(U licensed pursuant to the Conmctaa
°ntavw. 106 - SEWER & WATER
( time under See. I B6PC for thBm on
/Yf,Y�MRA J. D.m o 0 202 - UNDERFLOOR PLUMBING
WORKER'S'COMPENSATIO ECLARATIO4 203 - UNDERFLOOR MECHANICAL
I hereby strum under penalty of perjury one of the following declarations: 204 — UNDERFLOOR FRAME
ave and will maintain a Cenlftcam or Consent a self-intim for worker'.Compen. 205 — UNDERFLOOR INSULATION
as provided fm by Section 3700 of the labor Code.for the performance of the 301 - ROUGH PLUMBING
work for which this Permit is issued. 302 - TUB & OR SHOWER
0 1 have and will maintain Workers Compensation Insurance,as required by Section
37W of the Labor Code,for the performance of the work for which this Permit u issued. 303 — ROUGH MECHANICAL
My Worse ,Compensation lnsuranec carrier and Polity number am: 304 — ROUGH ELECTRICAL
Carrier: Policy No.: _
CERTIFICATE OF MEMIETON FROM WORKERS' 305 — FRAME
COMPENSATION INSURANCE 306 — HOLDOWNS+ .
less.) =.reed Wt he completed if the Permit is for..hundred dollars($IW) 307 - INSULATION
lir
1 certify that in the per(nrmence of the work for which this Pcrmh is issued,l.toll nu 308 - SHEETROCK
emPlnyanypera.nmanym.nner nam cenme reel.,troth wnrkerrcnmp natmn 309 EXTERIOR LATH
Laws of Celifomia.Dam
Applicant 310 - INTERIOR LATH
NOTICE TO APPLICANT(rafter making this Ccrtifieae or Eacmplion,you.hnuld 311 — SCRATCH COAT
become subject to the Woher's Compensation previsions of the Labor Crdc,you must
.Jz mrthwiLIE Comply with such provisions orthis Permit$hillISO deemed minded, 313 — ROOF NAIL
Eo CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
F kforwhichtmthatNenissued(wm3097, oe.C.)enryfnrthePerformenceof 502 - FINAL PLUMBING ENERGY
!Yi � the work for which Ibis permit is issued(Sec.309],Civ.Cd
CoQ lenderlName 503 - FINAL MECHANICAL ENERGY
O+ Lender's Address -
7Z 504 — FINAL BUILDING ENERGY
U O 1 certify that 1 have read this application and sum the the about Cos misting is 505 - FINAL ELECTRICAL
jy f, corms I gne to Comply n.and with y city and county outdimmer and sum laws relating e
U blond ingcnnsnetirolend forchyauthoriaerposes. utives of this city to ewer upon the GAS EST
w above-(We)agree to
for emnify nPurposes.
y
(We)agree to Cove,indemnify sed tech hay in a the City n(Cupenino against 0 7 F I
In in
(thegraLLindexpCouswhichmayinenywryeccmcgainnsaidCity 5 ICAI,
U'� in cnnuqucnec of the granting Of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH A NON-POINT Issued by:5 Date
SV5_7_
OURCE REG IONS.
' 27 1Q P Re-roofs NAL PLANNING
Signamrc of Applicant/ .te 5 4 - INAL PUBLIC WORKS
HAZARDO SMATERIALSDISCLOSURE Type of Roo
Will the applicant or future building Occupant store or handle harudous material
as defined by the Cotentin.Municipal Code,Chapmr 9.12,and the Health and Safety
Code,Section 25532(.,)?
❑Yea 1P. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to.remove
harardrus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
et?
❑Ycs CYN'
LOVEAhmoodogto,
ave mad the haaardrus materials requirements under Chapter 6.95 of the Califnr
d:SafayCOde,Secthma 75505,25533 sed 25536.1 undcutood thn iflh huilding
tmon0y hove a lem.m,Nat it is my rcspoasihility u Lordly the rccuPant of the
mwi must le met priorm issuance art ccnincaOccupancy' Signature of Applicant Date
�� All roof coverings to be Class"B"or better
- D e
Son CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
N # Date:
326 - I I - ooh 07 ► E 05 .
Building Address: Mailing Address (if different from building address):
IXL 31 G-asfo„ Los CIF-• ea u .
Owner's Name: Phone#: 65b - 41 2 - 0 2 17.
Tom 1-%m -
Contractor: �qrY Yu . License#:
Contact: Phone: Cupertino Business License#:
Fax:
B '161fing.Permit Info:
Bld /Elect El Plumb ElMech El
sup ❑l ^ �
Residential v V' erci C -
Sq.Ft. Floor Area:
Cost of Project: Occupancy roup:
Type of Construction: Please check this box roject is a
second-story addition: ❑
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 IM 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> I OOOA ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDCING
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_ CITY OF CUPERTINO
CITY0 PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMIJLTI 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
BOVERTDa Inspection Overtime BUILDING
BPBACKFLOW Atmos beric 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 Cbeck 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 Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMARUiAN 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
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Devi ce/A aratus ELECTRICAL
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CITY OF CUPERTINOCUPEfPERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
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
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