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03060082CITY OF CUPERTINO $ .. Q ams CJs Z Q C.3 fEl G N ^� 1.ORINFOTt1VI�I,� BUILDING DIVISION PERMIT` rCONT.RA. BUILDING ADDRESS: PERMIT N'03060082 '0 3DO 0 0 8 2 OWNER'S NAME: $6 PERMIT IE`U b %11 2 0 0 3 NE; SANITARY N0, CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH C] O O O LICENSED CONTRACTOR'S DECLARATION Jab Description 1 hereby affirm that 1 am Iicenacd under provisions of Chapter 9 (commencing with Smtion7IX10)sof Diviaion3of do Business an Pmfcssinns Code, end mylicense B mBanln ane rt �'w, /� aa�® ,Y/Its� .) ( BATHRM REMODEL G LIcenae CI Lk, N ` Dam - capxr)aaCqLar� ARCHITECTS DECOfp, t ION CONTRACTOR: DORADO TILE SEP 0 3 2003 I Yndclsland my plBnb aI1aII M YICd a pbtR(le Beards +L.' BUILDING Lkaused Professional OWNER—BUILDER DECLARATION 1 Wreby affirm that I tum exempt from We Convectors License law far the following reason. (Section 7031.5, Business and Professions Cole: Any city or county which requires a Permit to conumn, alter, improve. demolish, lir repair any alrablure Prior to its issuance, also mquhes the applicant far such Permit to file a signed summand Nat he is licensed pursuant m We provisions of We Comrecmr's Licence law(Ch.two 9 Sq. Ft. Floor Area Valuation (commencing with Section ?0110)of Division 3ofWeBusiness and Professions Code)or Nat he is exempt therefrom end We basis for We alleged assumption. Any violation of SSOO APN Number Occupancy Type teNon 7031.5 by any applicant far° Permit Subjects We applicanuo a civil penalty of not more Nan five hundred dollars ($50D). 35602024.00 0 I, a owner of We pmpsuny, or my employees with wages u their sole compensation, RReei� dins eC1100S will do the work, and We structure is not Intended R.RvW for We (Sec. 70th, Business send Professions Codc The Commences License law does not apply W an owner of 101 1 — FOUNDA'I` a p property who Wilda or improves Lineman, and who doesSuch work himself or through his own employam. provided then such lmprowmenu art not intended orofured for We.If. 102 — PIERS however, the building or improvement is sold within one year of completion. We owner. Wilde'will have the burden of proving War he did not Wild or improve ten purpose of 103 — UFER W.J. 104 — REBAR 0 1, a Owner of We property, am exclusively contracting with licensed convectors m 105 — ANCHOR BOLTS consumer We project (sec.70,14.Business and Professions Code:) The Camnemr'sLi. cauu law doss not apply m an owner or Preachy who Wilds or improves thereon,and, 106 — SEWER & WATER who contracts for sLOW pmjecm with a eontracmr(s) licensed pursuant We Contratoes Lim.Law. 202 ' - UNDERFLOOR PLUMBING ❑lam exempt under Sec. ,BdPCfO this reutun 203 - UNDERFLOOR MECHANICAL Owner Data 204 205 - UNDERFLOOR FRAME — UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury ane of Be following declarsdanc It- 301 — ROUGH PLUMBING haw°ndwillenalmstra CenlOaseof Consent self --insure for Wartar's Compen- tadan, as Provided for by Section 3700 of We labor Cade. for We performance of the 302 - TUB & OR SHOWER .ask farwmchthispermitI.issued. 303 - ROUGH MECHANICAL ❑ 1 haw and will maintain Warkces Compensation Insurance, ss required by Section 304 — ROUGH ELECTRICAL 3700 of We Labor Cock. far We perfoone"m of de wah for him this Pascal, la taxed. My War isfampenodi. Insuance arrier and Policy barare: 305 — FRAME C, --7� iia yKMS' 02 306 - HOLDOWNS CERTIFICATE FEXE ON FROM ORKo FEXE ON COMPENSATION INSURANCE 307 — INSULATION (This amount need notal completed lithe permit a fortune hundraddollsa(SIM) 308 - SHEETROCK lir less.) 309 - EXTERIOR LATH I certify that in the performance of the work far which this POmit is issued, I shall oat employ any person In any manmer o a m become subject to the Workers Compensation 310 - INTERIOR LATH Laws tur caliramla. Data 311 - SCRATCH COAT Applicant 313 — ROOF NAIL, NOTICE To APPLICANT: IL after making this Cenifiam of Exemption, you should become suhjecd to the Worker's Compensation provisions of use UMr Code, you must 501 - FINAL ELECTRICAL ENERGY forthwith comply with such provisions or this Permit be doomed Rewired. 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY Ihereby affirm Wad tRe it a convection lending agency for We performance of 503 - FINAL MECHANICAL ENERGY Uft workder's Nrwhich this permit biaucd(See. 3097, Civ. C.) Name 504 505 - FINAL BUILDING ENERGY — FINAL ELECTRICAL In. der:Address 1 unify that 1 haw read die application and abuse that We above informuiun is 506 - GAS TEST bondingIagrce to comply wiW ill city and county ousiomofand it selaws mimingto come,, building conswctlan,Rod hertbyauthodrsrtPreonutiwsafdiacidymcater upon the FINAL PLUMBING abovc-mentioned pmPcny for lmpeNan purposes. agree m eave, and and heap harmless use City of Cupertino ad 08 FIN L ewes) City liabilitiaqudgmcnts, costs and expenses which may In ay way accmc galiut odd City exp rt I in consequence of We grating of this Permit. APPLICANT UNDERNDS AND WILL COMPLY WITH ALL NON -POINT Issued by: 5 NG Dat SOURCER ULAl70 Re -roofs - IL l a t Ap i anal Iiacmr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will We applicant or future building Occupant store or handle hazardous material as dented by We Cupertino Municipal Code, Chapter 9.13, and the Health and Safety cafe.[3 Yenzss3z(a)7 All roofs shall be inspected to any roofing material being installed. 01Na prior If a roof is installed without first obtaining an inspection, I agree to remove Wm the applicant or future building Occupant use equipment or devices whim it haardous air contammanbu a defined by We Bay Area Air Quality Manegemeni all new materials for inspection. tsdru6 C] Yea ja N° I have mad We hannOw, materials requirements under Chapter 6.95 of de Catifon nia Heald&Safety Code, Sections 25505,35533 and 35534.1 unckamnd then if Wm Wilding does not currently how a haunt, Oat it is my responsibility to noddy the meuPm of We mquimme_n_ts_w,hRmx1�anaaf.Ccrifix.mOf'\'upanby0 Signature of Applicant Date All roof coverings to be Class "B" or better Ox 'To ell tfGGrixcd eggett1� CITY OF CUPERTINO Ah AY OF CUPERTINO PERMIT APPLICATION FORM o-3 >6 N #r �a i Date: Co -II- 03 Building Address: c / Owner's Name- O Phone #: y - Flu - Contractor: - License #: (aIZ Contact: Cupertino Business License#: B 7ding Permit Info: BldgC�> Elec umb ob- cription: Residential B' Commercial ❑ Sq.Ft. Floor Area: Jr $/Sq.Ft.: Cost of Project: ccupancy Group: / 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 > I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75MBtu 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 <= 1O00A 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 BUILDING Z2(Zo 1of3 ,� 6(—I. 7(L CUPEkTINO ATY OF CUPERTINO • 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 BldgPermit Fees BUILDING BPFIXTURE Fixture PLUMBING BPGAS —Pblg 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 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 BRENIAIRHAN A/C Units <=10,000 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM3USWAY 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 BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 CI OF CUPEkTINO 0 CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee 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 Sips, 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 Inection 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 • 3 of 3 DORADO 'TILE • Y P.O. BOX 2013 • HOLLISTER, CA 950242013 TELEPHONE (831) 637-0608 • CONTRACTORS LIC. 0612867 Sime 1980 Date 6-11- 0 t D .O - 1 0 • O An IIVv'ACL�dRDANGE�WI''lY +r- I' !'. •; C. Ufl CK. d u - E lu SIGNEtl_ MUG" � �F g' 'atit mi the' jod' at all'timea andl iC ene Iljm6l tto make any cn l%w ,,.th jttpn permission froth.. S is Bilildin&' Dept., Gity of Cupertino. F 3, 7H� starTrpinA of t is Pic-' 66I a aermit or to be art - __ E dRnrnvai of tllo violation of any P rovrniv '—' 0 M � + 3l boy city urQ ulwa : -= 0.T�ug U CF a -v t CITY OF CUPERTINO % xtx�a;' >s'°t^Y""' ' N€TRACTOR,INFORMATION:<- BUILDING DIVISION PERMIT COO P� BUILDING ADDRESS: ""'03060082 ERMIT NOO3060082 OWNER'S NAME: _ PEEMIT L'S[[BDry18 1/ 2 O O 3 1 E; SANITARY NO, CONTROL NO. ARCHITECWENGINEER: BUILDINO PERMIT INFO BLDG ELECT PLUMB MECH 0 LICENSED CONTRACTOR'S DECLARATION e.SCTIp Job Description at I am ved under pmvinons or Chapter 9 (commencing 1 banditry arfirm NIla with Section 7M)of Divl,lon 3 ofthe BualnessanPmfculov Cole,and my liana is , I ease gand rid ® License CI� Lk. t BATHRM REMODEL Dau Can r CONTRACTOR: DORADO TILE ARCHITECT! D N lundeuundmypi.ns,halihcusedup lensad, SEP 0 3 2003 Licensed Profesalonal OWNER-BUILDER DECLARATION ffnsn that I em exempt from the Contractor's License Lew for the 1 Wroby an �wy.1 BUILDING following mon. (Section 7031.5, Business and Professions Cale: Any city or County , which require' a Perot to comem CL alter, improve, demnlixh, or repair My structure prior to its issuance. also requires the applicant penance permit m Elea signed asuman Net W is licensed pursuant to the provisions of the Contractor's lJceme Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $8500 that he is exempt therefrom and On basis for the alleged exemptlon. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of not more than 11. hundred dollen ($500). 35602024'00 01,uownerofthepmpeny,ormyemploycuwiNwpsuNeiraolecoMnution, R�� dins actions P will do the work and Abasuucurt1, not Intended melfened f0... k(Sec.7B44,BualnCas and PrefeVieN Code: The Connector's Licenm Law does not apply u an owner of property who Wilds orimprows Moment, and whodeesauch wait himself orNrough his 101 - FOUNDATYY ownempleycea, provided that inch lmprosemanu ane not intended eroRered forsau.If. 102 — PIERS however, to building or improvement is old within arc year of cempleumn. the oan,T- build., will lose the Wrdan of proving Nat W did not Wild or improve fee purpose of 103 - . UFER nal.')' 104 - REBAR ❑ 1, as owner of the pmpeny, am exclusively connecting with licensed conhuton to 105 — ANCHOR BOLTS construct the Fmjmt (Sec. 7014, Business and Professions Cade:) The Covncuri LI- avelawdrumnotapplytoanownerofpmpenywhoWlidsorimpmvestheteon,and 106 - SEWER & WATER LicenseLawu for each projects wit econtramr(s)Ilaved punuam to du Cantnnoh' 202 — UNDERFLOOR PLUMBING Cl lamuemptunder See ,B&PCfmthlawon 203 - UNDERFLOOR MECHANICAL owner Dau 204 - UNDERFLOOR FRAME DECLARATION WORKERS COty 205 - UNDERFLOOR INSULATION of peury on 1 hereby Kinn under Penalty o(perjury aro of the following dalan0om: 301 — - ROUGH PLUMBING ave eadwill meinteia•CmillemewrOventtoulNomonfor Walml.C.M n- , As provided for by Sarson 3700 of the ubor Cade for the perrmm.nae of the 302 — TUB & OR SHOWER workfor which this Permit owned. - 303- ROUGH MECHANICAL 1 have W will en. mein Worker's Compensation Imurance, u required by Section 304 — ROUGH ELECTRICAL 3100,1 Oc labor Codc. forthe perfarmanaof the wort Ter hick Nupermiriairmed. My Wo Ys oro veno IamreaaatfiGad Policy W,.m: 305 — FRAME C0 �n°ry /y�2 306 - HOEDOWNS CERTIFICATE FEXEk ON FROM ORKERS' COMPENSATION INSURANCE 307 - INSULATION (Thu section need noted completed ifthe Permit Is for one hundred dellan($100) 308 - SHEETROCK tori"`) 309 - EXTERIOR LATH I artily that in the Performance of the work for which this permit is issued.I shall not 310 INTERIOR LATH Caction employ any person in any manner ten u to l eceme subject to t ewerken'mpva - Iawaafcalifinnox is 311 - 313 - SCRATCH COAT ROOF NAIL, Applicant NOTICE TO APPLICANT,If, after making this Cenifncea or Exemption, you should Wcome subject to the Workces Compensation previsions of the labor Code. you must 501 - FINAL ELECTRICAL ENERGY RrOwith comply with such prons visioor this permit that[ bat deemed revoked. 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm than them is a construction lending gency for the performance of 503 - FINAL MECHANICAL ENERGY the for which than permit is issued (Sm. 3097, Civ. C.) 504 - FINAL BUILDING ENERGY Undoes Iandct. Name 505 - FINAL ELECTRICAL Lender's Address 1 certify Nat 1 have rod this Application and suss Net Abe slow information is 506 - GAS TEST m butrt0. 1 agree to comply with all city and county ordinances and sou lens r upon building covwction, and hereby eulsodm representatives of Nie city to enter upon the FINAL PLUMBING forinspectionAn keep ha: above- (We) Aged ree to onysave, against- (Wc) agree ts. ave. indemnify and heap harmless the City .. V FI L gadrusts ensu and nspe•ion which may In any way acme against aid City VO8 Iin consequence of the granting of this permit. APPLICANT UNOE0. NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: ��/�Ilebllitieajudgmcats, NG Dat SOURCE R ULAn S _ Re-roofs nli.-�O6d1-63 B+ tad p n HAZARDOUS MATERIALS DISCLOSURE Dau Type of Roof Will the applicant or future building occupentatore at handle haurdous material as deflned by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety au, section zss3z(aj7 All roofs shall be inspected prior to any roofing material being installed. (]Yu Nu If a roof is installed without first obtaining an inspection, I agree to remove wd1 tiuePplicant or mmre Wilding occupant us: equipment or devices Which vardeu air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. C17 / ❑Yes fjJN. I have mad the haumeus namerlaumquiremcnts under Chepur G95 of the Calif., IAN&SilmyCo lc, Sections 25505.15533 and 25534.1 understand thatills. Wilding Jas not currently hero a unanL that it u my responsibility to notify the occupant of the reyuireme w ch must prior to is}aarmc of a Ceninau or ¢Panty. Signature of Applicant Date _ All roof coverings to be Class "B" or better 0ars