23698 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification - PERMIT NO.
Building Address:
Z
3698
e ante: one:
I/OQ CITY OF CUPERTINaBUILDING DIVISION
c p1)• " Ny Jct�j y7le. APPLICATION / PERMIT CATEGORY
�+ oNTROLL
ArchitectEngineer. Lk.Nm BUILDING-ELECIR/CALPLUMBING-MECHANICAL
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
y Address: PFRMITISSUANCEIW El ❑ ❑
LICENSED CONTRACTOR'S DECLARATION L_.F9'
I hereby 7Othatlamsim3oftheBlicensed rpressandsof Chapter9(commmc- APPLIANCESIffSIDENTIAL JOB DESCRIPTION
Ingwith I.hill 70W)of Di died. fthe Buslnemand Pro(emlonaCode,and my
license is In(u6 force and effect. - PANELSmeLicense Clam Lic,a
Date Contractor UP TO 20GAMPq '
ARCHITECT'S DECLARATION XI]-1000 AMT'S
0❑20 lundertand my plata shall be used se public recrnde. OVER 1000 AMPS �Q.FC.�OOR AREA S/SQ.FT.
UFd Licensed Professional - SIGNSELEC1IUCALA'i�� ''nntltl,,
G Fkg' OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MIST 1
2 p„irA:� I hereby afRrrathat l am exempt from the Contractor's License Law for the
qqq
following reason.(Section 70315,Business and Professions Code:An tl or
Fcountywhlchrequlresapert trocomtrup,alter,impmve,demolish,orrepalr TEMP.METER OR POLE INST. DAT L
nystructom priento its Issuance,al•orequireslhe appliantfur such permit to
TO
file a signed statement that he is licensed pursuant to the provisions of the POWERD-- -
O w Contractor's License Law(Chapter 9(comrrenpng with Setlbn 70001 of Divi-� VALII(ATl 0 sion3ofthe Busineasand Profe.i..Cade)arthathelaexempttherefromaad SWIMMING IDOL ELECTRIC ^
O the basis for the alleged exemption. Any vto acon of Stain elect
mutation,by any OUTLETSSWITCHISFIXTURES L ��•
the bcant fora permited ext scion. Any toitomitpemltyof not.5byany -
live hundred dollars�.` 1$101).3 NEW RESIDENTIAL ELECTR SQ.Fr. STORIES TYPE CONSTRUCTION❑I,as owner of the property,or my employees with wages as their•ole
axle&17 44,will clothe wort,ardithedessim structure to mitracded or offercense Law
'q sale(Sec appy to ahem end f property Code:The C impunwo,tuo's hemon Gw
does B
who does
apply torn urserofthrougywho nempuilds orlmproovidedreatsuch OCC.GROUP RFS.UMTS
whadoementsa net Inttededorwghedownefor .If,hce.,providedilding or
Improvementisold ithindneyeardcompletio.](homer-buildewnvc�the rwdi have TOTAL:
Improvement hi sold within oneyeara(completion,the owner-WBderwlll have
tFo (Fplenof proving that he did not build or improve for purpose ofsale.). QTY. PLUMBING PERMIT FEE FLODDMNE APN
cT1�I�eQra,as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
tractor to construct the project(Sec.70y Business and Professions Cade:
C.Zau is License law does not apply to an owner of property who ALTER-DRAIN kVENT-WATER(EA)
Wilds or improves,thereon,and who contracts for such pkojects with a
��ftTTacter(s)licensed pursuant to the Contractors License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY
LII am exempt under Sec. B k P C for this reason
OUTSIDE FEES
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N
Owner Date RECEIPT It
WORKMAN COMPENSATION DECLARATION
E31ffiSCIiODl TAX Y N
I hereby arm that I have a certificate plXq'(IRES PER TRAPte of consent to self-in
ears,or RECEIPT N
3800,Lab C.)
corttflateo(W.rkeri Comperuati..Insurance ora certified copy thereof(Sec. CAS EA.SYSTEM-1 INC.4OUTLETS PARK FEE Y N
Policy If RECEIPT a
Com an GAS EA.SYSTEM-OVER y BUILDING DIVISION FEES
Ceri led copy t herebyth the cid. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECKFEE
❑Certltled copy is filed with the city inspection division.
CERTIR"TE OF EXEMPTION FROM WORKERS' GREASETRAP PAID
COMPENSATION INSURANCE t
SEWER-SANITARY-STORM EA 7(100F1' Date Remi
(Thlssection need not be completed Ithe permit t forone hundred dollars
(8101)orlem.)
Icertifytat[the performance o(thework forwNch this permit is trued, WATER HEATERW/VENT/ELECTR ENERGYFEE Y N
I shall not employ any person in any manner so as to become nubject to the WATER SYSTEM/TREATING
Worker'Compensation Gwsof Callfomia.Date PAID
-
Z Z Applicant NEW RESIDENTIAL I'LMB. SQFT. Date Recti t#
Z O NOTICE TO APPLICANT; this Certificam.1'Exemption,you
Fshould becomesubject lathe Workers-Compensation provisions of the Labor TOTAL:
CC N Code,you must forthwith comply with such provtiona orlhis permit shall be �..
W >
deemed revoked. BUILDING FEE
CL CONSTRUCTION LENDING AGENCY SEISMIC FEE -
IherebyafOrm thatthereta cdmtmetten lending agency forthe perform TOTAL: ELECTRIC FEE
7 Z anceoftheworkforwMch this permitisissued(Bee.3097,Civ.CJ
U O Lendels Name PLUMBING FEE
LL F Landee.Addre.. QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW Icertify thiel have read thtappliatlon and statethatthe above Information
(1 brorrect.I agreeto complywith all city and countyordinancsand state laws PFRMITISSUANCE FEES PAID:
N relating to building construction,and hereby authorlae representatives of this
F Z city to enter upon thSAbove,rainitionail property for inspection purposes. ALTERORADDTOMECH. Date Recti t#
V — (lit)agree to ,Indemnl(y an d p harmless the City of Cupertino P
againstllabiiltl dg pensee:dr.
AIR HANDLING UNIT(TO 10,"CFM) SUBTOTAL:
.gait ai 1 seque grantingofthlspennit.
AIRFTANDLING UNIT(DYIBT 10,000 CFM) CONSTRUCTION TAX
�f
Signa of Ap cant/ r to EXHAUSTAUST HOOD(W/DUC'q CONSTRUCTION TAX PAID:
HAZARDOUS
MATERIALS DISCLOSURE
Will the applicantdefined
the future ruin Municipan ode, hhand9.hazardous HEATING UMT(T'0100,000 BTU) Date Recei
material as defined by the Cupertino Municipal Cade,Chapter 9.1Z and the
Health and Safety Code Section 75537(a)7 HEATING UNIT(OVER 100,000 BTU) TOTA l
❑ Yes I]No
I1 Will the applicant orsfuture building occupant use equipment ordevicca VENTILATION FAN(SINGLE MID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management District? BOILER-COMP(3I-I'OA 100,000 BTU)
Yzs ❑Na
pI have read the hazaour materials requirement under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU)
the California Health building
Code, et currentlyh ve a tenant,
that it
P A f D
understand that notify
the occupant
of t ¢require encs which
that b met NEW RESIDENTIAL METH. SQ.FT. s,9
responsibility to notify the occupant of the requirement which must be met
prior to issuance of a Certificate of Occupa any.
Owner or authorized agent Date ISSUED BY:
TOTAL:
OFFICE COPY
.. ... LI�.r1
tapiocas iUPS3yboC REDUIRED CALIFORNIA
• PR ,w
ra w.
'I DON'S MAGNESITE REP 0(7ry`"°2 tea "
any �r� ; -, _ n
2994 HUFF AVE. #1 �PqT , Y,.
.I Al
SAN JOSE, CA 95128 . o�cp O taal �N
Proposal Submitted To:
Work To P ormad At:
Name
Street66, _
Street ..- __...__-._.__._-
Cit 7-373 -- FALLENLEAF --LN--------------
Y San Jolse _--__- Clty__--Cupertino,— State
state � 95113' ��-"
Date of Plans
Phone _-- _..__._.._. .......-._-._.,
- 298-8600 - Architect
i
We hereby propose to furnish the materials and perform.the labor necessary for the completion of
CU OUT .AND P U T
Hhts4t�'"s ,eight �q {ft. .�,,
I -__d �_ hen:'two sq
___ ft:µ Then along edge, six sq ft Bx�"stairs, b4 #20�cut "
_
_out eight sq ft, -At,.-,#20.-six-.sq-ft---and-sixs
q--ft agian At #21 12-sq-ft
`At-.At - `spout'eight "sq ft and then ten--sq -f£:-At #22 window ten soft T
_
__..
At. corner
_'--'-- , ...eight sq .f.t, then_,:At_*27 -twent s ft- then--sis---sq---f-t-.__ ON----------WEST _ Y q._. '
--DECK knife cut cracks and"'rep`air Ed RESEAL E14TIRE'DECKING AND`
_ _
IMPERFECTIONS_.AND_TRIM_COV.INGS.,.,_(.not_sun- deck)-using NONSKID--I-N- -
SFALER AA�IE"COLOR ac,T7+H N-TRIM 'RtAL`p mTn R p
All material is guarantee to be as sffecifiedE and the above wor�c.�b bBMPErf3rR pFpaC r1r
pecifications submitted- for above work and completed: in a substantialmworkmanlike mannelrh foyer the' suma of
with paymWROTYe maFcQUfoll DRED * ;� * * - * Dollars ($2400 .00 L
FOURTEEN HUNDRED WIN CMENT IS. TT_N..__BLANC(E PRG _R_R.___
Any alteratien'or deviation from above spec) (cations invo ving ex ra costs, will be 6xecu ed on Y upo itL9Pf FOffT6Srt7 Wlll
become an extra charge over and above the estimate. All Agreements contingent upon strikes, accidents or delays beyond our
control. Owner to carry fire, tornado and other necessary insurance upon above work. Workmen's Compensation and Public
Liability Insurance on above work to be taken out by_ n ' s MardnP ' +
Ranair
" , [Section 7019 Cdhtractora L(cense Lewl "'' ` _ " "'
"Under the Mechanics Lleii�ew any contractor suboohtrec-� "' ` "`""" _'
tor,laborer,materielmeh or other pereoh whp fielps to improve
your•property and Isnot aid fnr his lobar services or material -
"' �.Foal94Qini pq y
x�;t'n e��11�e � o yrot`@GC agree ,a' lnst•.au[i .c ;almer
by hhn rbgfore';corrjmenctnpaeuc� wgrk;drpimprovemenCen -' " "` --'�-""` "`"'`"-" -
'arlylne conCpaa"t Farthawgrk oFlmproyeinehC oraritodification _
-thereof a ii'i Bicaofthacountyrecordarhathecbupt where 4 `
y submitted ._ Per phone qu t
that property.lesitueted end rerjuirvng that'a��contreotar s: - ----
"Payment bond oe recordedin'�such office. 8dld bond shell ha mu '" '
,'a'ncemount notaass Chen'hfty"per•bant (609h]of the contract,.
,.price and shall in�addmlon�to any pantlitidne for the'perfor
mance of tha.contract .ba'cond1Cionea fortthe payment In full _
,.of the claims df;all persona fu�mshin(j lebor,servicea, equip State License NO. ..,,
meet,or_materlels for,tha work described
Note-This proposal may be withdrawn by us if not accepted
within _60.,.....days.
ACCEPTANCE OF PROPOSAL
,. a\x 5- xj C v "n Pr ��^„�,E
The above prices specifications end conditions are satisfactory aid ere hereby accepted You are authorized to do tfie work a p olhed ,
ment will be made"as,duClined above= x; , ' " .0 >
7'e,A"+tj v S d r�H a as a
R `
DBCe'Ia2- t fiy}d iti M . n $
SlgneCurB w i y 1!
Contractors.are ragalred by law Co be licenaedxand;regulated'by the Coetraotor's'State Licanae ;e'
BoefM Any questions concerning'e contractor may be refs"reed to the.Registrar;'Co`nti actiiire$tato 11wa • ` `
License Board, [9835 Goethe poad,] SacremOnto, California.-[Mailing Addreas,'P.o.•Sox 2500a.,". „< "a
Sacramento, California 95827.1 . ;
SARATOGA CAPI.TAL, INC.
Ronald E. Funkhouser
Property Supervisor t
I
66 E.SANTA CLARA STREET,SAN JOSE.CA 95113-1804
408-298-8600