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03070191w CITY OF CUPERTINO'?"s+ Bun.mNc mvlsloNPERMIT CONTRACTQR INFURMA 10N.Y: - ..�m."`M�n'v.*i BUILDING ADDRESS: I NOBLE CONST PERMITN'03070191 _021 OWNER'S NAME: 259 N CAPITOL AVE #152 PERMIT ISSUE DAIS ONE: (408)205-3692 O. CONNO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION nsed unr provisions of Chafer 9 (commencing 1 hereby from shat 1 am licede ,lilt Description with Section Will of Division 3 of NC Businue and Pg* i� �a�d ylicenmb in full force and c s�J uan=ec ` �-9 REBUILD CHIMNEY Data 43.A s A____CTBDEC AR AUG 4 2003 1 unde.land my plana=hall be used As public records - BUILDING Licensed Pr.. feast nnal OWNER -BUILDER DECLARATION V L 1 hrrcby Affirm 1 oro exempt from the Contractor's License Law for the On n Cade: Any city aunty following season. leatiun III3L5, Business endow. which i sir any structure slur. impmsc, demolish, • Penni. de cure; its ilea ho the fi ea tateme that(m its issuance,alsomquircs the ProvisionsLicense law(ChodInL that ision of foasuch Law (Chapter Sq. Ft. Floor Area Valuat on (commencing Division? of the and Professions Cole) or (commencingwith Section 7B ad O egeBusiness Nal he Is amorph therefrom antl Ne beau for the Alleged Cxemptiun. Any violation of APN Number Occupancy Type Section 7031.5 by any applicator for • Permit subjects We applicant a civil pemby of net mom than five hundred della. (5500). 0 Las oven,, of the pmPcny or my employees with wage As Ncir sale compensation, 101 — FOUNDAITAGKd will do lnewmk, sad theatmcwm is not intended or offered fouale(See 70,14. Baine:s And Professions Code: The Convector's License Law docs not apply In on owner of Inspections property who builds or improves nhercon, and who does such work himmlfor through his 312 - CHIMNEY REBAR & STRAPS own cmployces,provided mnsuch improvernarti n^timended orolRrcd fortale. IL 514 — FINAL PUBLIC WORKS howevm, the harbinger improvement is sold within oro year of completion, the owner. builder will have the human of proving that he did not build or improve for purpose of ❑ 1, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 70W«, Business and professions Code:)The Contractor's Li. can= law does not apply to an owner of property who builds or improves Neeson, and who contracts for such pmjeeu with a eom ucmr(s) liuved pursuant to the Contractors License law. ❑ 1 set exempt undo Sec. . B k P C far this ..an Owner Due WORKER'S COMPENSATION DECLARATION 1 hearty affirm under Penalty of perjury one of she following declualionc 1 hale and will maintain a CenRIULC of Consent to self-imum for Worker's Compan- ion, As provided for by Section 37M of the labor Code. for she Performance of the ork for which Of. Permit is issued. ❑ I ban and will maintain Workers compensation Insurance, u required by Section 3700 of the labor Coda. (or she performance of the work for which this Permit is issued. My Workers Cam pensasion Insurance carrier and Policy number art: Cartier; Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need nor Is, completed if she Permit is fm one hundred dollars (Slily) or less.) 1 certify AltoIrk p rfnrmanec of IhC work far which Nis Pcrmin i• issued, 1 shell nm employ•ray Perso any manner um Mromef 'ualM\6rl is r"hon Laws of Celifo - a. Dau Applicant NOTICE I c ak t text, of -rho on, you shoulJ become s n to she We :ere contpcnatio pmvisio r Cndc, you muse fmthwuh comply with sat pmvisam, OrAld ,mil •hall he deemed rtvn d. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a convection lending agency Or the Performance of be work for which this parotin is issued (Sec. 3097, Civ. C.) Lander': Name Lender's Address 1 certify Nat 1 have read this application and sure that the above information is cording 1 agree to comply With all city and county ordinances and sole laws relating in building cotiored pro and hereby a ed.. p rposeunutivss of this city to anon upon the e ahnvn ertysave for inspection purposes. (We) are to (We) agree m cove, Indemnify and kith harmless the City Cupcnsts isea,ju •nu,coax and to id City expenses which may in any way eccmc against said City Of in APPLIC UNOERSTAN AND WILL COMPLY WITH A L NON.P NT APLIC C of the gr TAN of A D WILL Issued by: Date SOUR EGULATIONS. S G Re -roofs Type of Roof S murc of APPIic ra Innor ale HAZARDOUS T IALS DISCLOSURE WIII NC licenl ser luwrtb di mcupant nand or handle hoodoos meuriel a def nc0 by c Cupcnino Munici •1 otic, C h r 9.12, and the HoslO end Safety Code, SCcliom 25532(a)? / All roofs shall be inspected to any roofing material being installed. ❑Yes �++� prior If a roof is installed without first obtaining an inspection, I agree to remove Will the apprantarmu"ding « a,e4mpmeatordevices which Il hazardous air cor mminants as def the Bay Arca Air Quality Management all new materials for inspection. wrict7 ❑Yc: I hear ad the ramous ials uyuimmcnu senor, Chapter 6.95 of the Califon ria HC 1 SmctyC e, Sccti s 505, 25577 mJ25530.1 unJcraunJ Nal if the FailJing Jas net rcnnly have a un t, 0 u is my m1lasihiliny u, or my the, recq mq mm�oras at nnCcmrememraeuP Signature of Applicant Date All roof coverings to be Class "B" or better er ser amount, agent CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM o 3 o 7 0 ( i / Quantity Fee IDFee APN # ,J r Date: Z D 3 MECHANICAL Building Address: /O I o Mailing Address (if afferent building address): BBOILERI Owner's Name: MECHANICAL BBOILER2 Phone #: T MECHANICAL Contractor;>> vvzk- Boiler> 500K to 1M Btu MECHANICAL License #: rD Boiler> 1M to 1.75 M Btu Contact: BBOIUM Phone: �pS ,�bf26 Fax: Cupertino Business License#: BCONSTAX Construction Tax Elect ❑ -I Plumb ❑ Mech ❑ Ind/Off/COmm/ uasi J'Cescription: Residential BCONSTAXBQ Commercial El BUILDING Sq.Ft. Floor Area: Hotel and Motel BUILDING $/Sq.Ft.: Constax — Resi/Mobile Cost of Proje v Elec 600V <= l 000A Occupancy Group: BELEC1001 Type of Construction: ELECTRICAL Please check this bo ect is a second -story addition: ❑ Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING Quantity Fee IDFee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > l OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOIUM Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/COmm/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= l 000A ELECTRICAL BELEC1001 Elec 600V > 1 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 I L. �a�6n I of mut cm o CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM uanti 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 BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 rinklerBackflo PLUMBING BPSTORM Stonn/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 BREMAIRHAN 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 BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL We*1 Sam, CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee 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 Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM BSEISMICRE Seismic Commercial Seismic Fee Res BUILDING 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 PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING I^1 � I LJ 3 of 3