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03060166 CITYOFCUPERTINO + -' ' � - � "'• �* *" '�"% BUILDING DIVISION PERMITCQNTRACTQRIINFORMATIN s}., Ave' ..c#?i^�."'.3: BUILDING ADDRESS: PERMIT NO.03 0 6 016 6 2,44rZ C11PRRTING RD #26 O W NER'S NAME: PERMIT ISSUE DATE NE: SANITARY NO. CONTROL NO. 1U... CrIBNGINEER: BUILDING PERMIT INBLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 herebyeffrm that I we licensed under provisions of Chapter 9(commencing Job Description Section7")ofDivision]of tho Bosina end Pmfcssluns Cole.mdmylicaaals l force and arket. REMOVE TUB/ADD SHOWER � Char Lk.as DatConlowtor ee$ ARCHITECTS DECLARATION ss i C l understand my plans shall be used u public records FUNa Aw �6 t Licensed Porous oml g OWNER-BUILDER DECLARATION JUN n 7ry/A�yy i y I Wmso affirm the 11. exempt(rum the CanlnQCo License Law for the H LUUJ <O pOH which followire recon. orals I 703 1.5,Business and inform,mrnsinm h,orde:Any city S county �mLL Whielt itsissanpmmlt to coresthe pplicr. forsudemaEih,rare a siganyed tatement prior its issuance,palms requires for mchparmnit inrileW(Cha mem pp < (commeche is ing wit purmmtto the 7")of Division of theeBusiness Lkcnalsons Code)or Sq.Ft.Floor Area 111 llgft2 d�e that M is (commencing with Sectionrem and the but, 3 of the Baines and Proon.Any Cade)or y�$ thn h O exempt therefrom and the bust for the allcye0 exemption.Any violation of 32615130 . 00 Section 7031.5 by any applicant for permit mbjecu the applicant o a civil penalty of APN Number Occupancy Type not more Nan five hundred dollen(5500). ❑1,as owner of the property,or my employees with wages as their tole compensation, will do the walk.and daauucrose is nos intended or attend formula(Sac.7044,Busiews Md Inspections and Protest..Cade:The Convactorl U...Law docs not apply to an comer of 10 2 - PIERS p property who builds or impartment thereon,and who doessuch work himself or through his own tmploycet,provided that turn improvements art not intended or named(a,ale.If. 103 — UFER howewr.the building or improvement is mid within ane year of completion.the owner. builder will haw the human of proving that W did not Wild or improv for purpose of 104 - REBAR Sale.). 105 - ANCHOR BOLTS ,as come a Ne property,am exclusively contracting with licensed canuecton to ;whoconva tmcithe ro a(Sec.Hide.Business and Promotions Code:)The Condition's LL 106 — SEWER & WATER e�Aw s tapplyt an owner o(propcny who Wilde.,improve dKmon.rod, 202 — UNDERFLOOR PLUMBING for uehprotswithaeo io,(OlirenwdpuesumttotheConvectors nse . 203 - UNDERFLOOR MECHANICAL ame empt dose .B B P C for this lesson 204 - UNDERFLOOR FRAME nerION 205 - UNDERFLOOR INSULATION Iherebyafrmenderpenaltyofperjuryamorthefollowingdecla.dons: 301 - ROUGH PLUMBING naw and will mainWn a cenlneas,of cannot to elf-Osune lW Worker,compen. 302 - TUB & OR SHOWER n,a provided for by section 3700 of the Labor Cade,for the performance of the 303 — ROUGH MECHANICAL work for which this permit is Wood. ❑I have and will maintain Worker's Compensation Insurance.a required by Section 304 - ROUGH ELECTRICAL 5700 of the Labor Code.fm the perforramcc of the work for which this pmol,la issued. 305 — FRAME My Workers Confirmation Insurance carrier and Policy number are: 306 — HOLDOWNS Caenen Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE 308 — SHEETROCK or it.)(This suction need not W completed if the rcemit is for one hundred dollm(11 Her) 309 - EXTERIOR LATH I ceniry that in the performance of the work for which this permit is Issued,l shall not 3 10 — INTERIOR LATH employ any person in any manner an in to assume mbject to the Woekers'Cmnpensadon 311 — SCRATCH COAT Laws iCNC. lifomla.DataA,I313 - ROOF NAIL NOTICE TO APPLICANT:IL after making this Cenifica¢of Exemption,you shouW 501 — FINAL ELECTRICAL ENERGY become abject in the Worker,Compawtion provisions of the Labor Code.you mum ,JO mnhwithcomply with such provisions orthis PermittE haWdecmedrevoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY t—m mN. IWreby alfnm that them i,a construction lending agency for the performance ofthe work far which this permit is issued(sac.3097,Civ.C.) 504 _ FINAL BUILDING ENERGY m p Lattice's Name 505 - FINAL ELECTRICAL jz LendinsAddrea 506 - GAS TEST VO really thetlMwmad this"PlicsimnmdSam that heSWwinfoorahmis 507 - FINAL PLUMBING !". coerce agree to comply with all city and county ordinances and a We Owe retailing to p Crit^ Wndi g nswion,andherebyauthodrtrepmaentationofthis citytoenter uponthe FIN MEC CAL P .hove me rinnedip.perty for inspection purpose. ( )asrte ave,inticnyri(v and keep hmmlev Ne city of Cupertino against 0 9 F I NI limb li es.J dymen caauandt pe eswhichm Yin.nywayaccrueagaimtuidCity 5 NG V P Inert tie ear ting of rs rmLL s`4 AP LICA UN R NDs WILL COMPLY WITH ALL NON-POINT Issued by:5 C WORKS Date s RCER CUL 1 Signatrtuof ApPlicumVConDate ./ U3 HAZARDOUS Re-roofs US MATERIALS DISCLOSURE Type of Roof TY) IIIJJJ Will ydicC,immrfmuni Municipal o occupe,Chapter uortor ad health material ( �fL a defined by the Cupertino Municipal Cale,Chapkr 9.13,end the Health and Satiny Code.Section 3593(.)? All roofs shall be inspected prior to an roofing material beingInstalled.❑Yea Will the apphaantorL( buildial ore Wm vacyvipment ordcvi es which If a roof is installed without first obtaining an inspection,I agree to remove it haamn.,air afined by the Bay Area Air Quality Management all new materials for Inspection. W610 11%3 ON. ev WWl�wzrd,.smasmqui cntsunderChepkr6.95o(thcCalifonanH & cry35374,I underwvW thin i(the Wilding dace come tly rmal ity m nodfy tbe occupant critic miler m ts hkhfaCerdoekofOccupancy. Signature of Applicant Date Owner or authomcJ ase Data All roof coverings to be Class "B"or better ' G � CITY OF CUPERTINO 3 60 / ( b CUP TYOF O PERMIT APPLICATION FORM APN# 3 Z 3 D Date: 6Z2. 0 3 Building Address: 22 YYS^ C�PTiti a �� a� uv 2S Owner's Name: Phone#: 5 -,v v / 4 0 A 1416<g 2 5 3 5e 7 c> Contractor: License#: Contact: Cupertino Business License#: Building Permit Info: —/ Bld El Elect El Plumb 2 Mech ❑ Job Description: Residential 2rE`7't 6v6- 7L /1 1490 /qvW(---X- Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: �Co of Project: Occupancy Group: / SCJ Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V> I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING 13INVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING lof3 0W- CITY OF CUPERTINO °no PERMIT APPLICATION FORM CUPERTINO 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 BNUCOMNM New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING MUM= New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTRAE 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 WDUERCEP 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 rirMerBackflo 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 cfrn MECHANICAL BREMAHMAN 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> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BRENR,4 PP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 SO CITY OF CUPERTINO CUP TYOFFINp 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 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 EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEumbin Permit Issuance PLUMBING PPL13G Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3