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06010142BUILDING DIVISION PERMIT S NAME: MARY TORREZ 1 thereby of int that I am licensed under provisions of chapter 9 (commencing with Sutton 7"I.17Dirlslon S of Ne IhUmcaa and ProfuSoluns Code, and my license ie in full forte and OGM ,M2 License Class Uc. As Dam Cnrommr ARCHITECTS DECLARATION i' I understand my plans Nail he used AS public mcord, U t� Licensed Professional OWNER -BUILDER axe DER DEthe Contractor's 0 0 1 hereby anion that I I.S.exempt from the Camncmh Licence city o for ne p o following wan. (Built 713 IBusiness and improve, de oli Cade: Any city Structure 912 which requires a permit re straw", alcor, improve, demulbh, ri e a sig any Paeans " LAW issuance,pursuant to the theapplicanto rot Sack p"tor'sU nw Law (Chapter < Nu he b cing wit purwenn 1 the A( Division of the Business n Prof low (C oder r (cam eiis" gwiNSa"ion 7I aro dM basison3n(Neeged exemption. RoAn vi Code) or C a Na io D 31.5 b IMmfrom and Ne bub for the Subjects the ewmPnt to Any it violation of Section 7031.3 by any applicant for a perch anbjats Ne,pplkanl w a civil penally of nal mom than Rw hundred dollars ($500} ❑ 1, AS; matter of the property, or my employees with wages As their Sale compensation. .ill do the work and the mu"um b wt Intended m Armed fee cam (Su. 7044, Budneas and PmfeWons Code: The Contrwwes Llceue Law does not apply to an owner of property who Witcher improves Nermn, and who dauaah workhimselfor through his awn employees. provided Nat such Improwmenuve notin¢nded uoRered for sets. If. however. Ne building or Improvement Is sold within one )ear of completion. the owcer- builder wiB have the burden of proving that M did not build at Improve for purpose of SAM.). AS ower of the propenY• am eSalmively conmanin{ with licensed commmorc to consw" the proje" (Sec. ]010, Business and Pro 21 Cade:) The Contractor's LI- ccose low docs not apply man owner of propenywho build, or improves Ounces, and who concocts for such projects with a eontraewr(s) licensed pursuant m tie, Conmwtors Lie��nw law. fXlatiuemnumdu See .B@PClorthlaruwn 41 I hemhy All under penalty arledury oro of the following dulantimor I have and will maintain aCenifeate of Consent to wif-imam lm Wo 4Compen- ,adon, u provided for by Section 3700 of the Labor Code. for the performance of Ne work for which this Permit Is issued. ❑ i haw and will maintain Worlmes Compensation Iuurutm, As required by Section 37M.f Ne Labor Cork, for Ne performance of the wank for which this permit Is Issued. My Workers Compensation Warn ae euro" and Policy number sm: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This wetiar need Iwlbeeonpleted ifthe permit i,forau hundmd dollen ($100) or len] I cenify ' the Performance of Ne work for which Nb permit b load I Mall nm most any Pc tin anYmutmrwytw�becamGetlbjAct w Ne Workeri Compeosallon La of Calif mea. • 1 L A rte. becomeNICsubject70 APPLICANT`. IL afar m Iecohlo caw of Labor on. you Mould ,J Obiome emp y it Workers Coons or t Son erovWou of de IOMr vode you muss forthwith comply with such previsions or Ni, permit shall be deemed mwked. Z y CONSTRUCTION LENDING AGENCY (~ I hereby affirm Nat Vert is a commitment lending agency for dte performance of lye i we work for which this permit is Issued (Su. 3097, Civ. C.) 0 Lender's Name a Z Lender. Add•••• Q C 1 coolly that 1 have read this application and caw Nu Ne show information Is I,. P correct. I agree in comply with all city and county ordinances and sow laws mlatMS to O U building construction, and hemby maintain representatives of this city to enter upon to ;4 shove -mentioned property for inspection purposes. (We) Smw save, indemnify and keep harmless Ne City of Cupertino against Tory Ibbllides,judgments. costs and expenses which may in any Any same alidat Sold City t.)7 inc neof the granting of Nb permit. F7 p PLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Data ""'nuUb Ul U14Z Job Description REPLACE UNDERGROUND GAS LINE VALUATION WAS ESTIMATED BY LARRY @ 3000.00 Issued by: Iq Re -roofs Type of Roof gg1 Required Inspections 10� f0- DIi ✓�� Will the applicant or future building occupanulow At handle hanardaea msmnai wd by the Cuporthm Municipal Cade. chapter 9.d, and the Hulth and Safmy alae 25532.)? All roofs shall be inspected prior to any roofing material being installed. [3 Yes I(Nm Will the applicant or futum building occupant use equipment or device, whim If a roof is installed without first obtaining an inspection, I agree to remove Cornus air contsminants as deOmM by the Bay Ams Air Quality Management all new materials for inspection. I? C] Yet ONO a encu. that Signature of Applicant Date All roof coverings to be Class "B" or better cc Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # , 1 z— �00 C 2 OWNER'S NAME: a ez PHONE #%1% -- �o GENERAL CONTRACTOR FAX # I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date 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 Date Vitt'}f:; nn o CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Dw101y'01 N # �� 8 \ C Date: uilding Address: Mailing Addr ss (if differentfrom bilding addre s): wner's Name- c� or r c i P ne � gLvo " \b 35-- Contrac o . BBOILER2 License #: Contact: �� Phone:%Ac% Fax: VON lP—\b3S Cupertino Business License#: Building hermit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: Residential a c2 Commercial ❑ Sq.Ft. Floor Area: MECHANICAL q.Ft.: Cost of Proi ect: BUILDING Occupancy Grout): Type of Cc struction: ? Please check this box if the project is a second -story addition: ❑ ro'ect Size: Standard ❑ Laze ❑ Major ❑ BUILDING L Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BB.QILER3. 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 BCONSTA)CBQ 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 I of 3 3 � I CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMMB New Comm Electric ELECTRICAL BNUCOMMM 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 Interc for PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUIJ DING 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 InstaWAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY .. Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREN TURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > I 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 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res A Hance ELECTRICAL 2 of 3 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 Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSC13LVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BS)VIM Swimming Pool BUIL DING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electdcal sq foot ELECTRICAL EPERNIITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE A4ech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plan ing LR Commel Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3of3