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05070064 CITY OF CUPERTINO �`r`;"'' BUILDING DIVISION PERMIT CONTR ETOR F RMATI,Q�' ll �'+. BUILDING ADDRESS: PARKER PLUMBING PERMIT N0SO7OO64 938 FERNGROVE D W NER'S NAME: PERMIT ISSUE DATE ERIC SCHMIDT 24 CHELTENHAM WAY n7/i2 /2oQ5 .,ONE: SANITARY NO. CONTROL NO. (408) 374-1832 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o I� E 0 nee, LICENSED CONTRACTOR'S DECLARATION upI hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description �W with Sactien 70Nf of Division 3 of the Busincssand Professions Code,and my license is an infall force apd uC e Beet. 4- GAS LINE FOR FIREPLACE 7gan LlcenLic.M conlraemr s 7/12/05 PARKER PLUMBING RENEWED BUS LIC e RCHOECT CIA ff3kTION Y a I unit he s p bl' fccnrds ' Dyu 10 Licensed Pm ssmnal ` S OWNER-BUILDER DECLARATION _ <I I hereby affirm that I am exempt from the Contractor's License Law for the a o following reason.(Section 7031.5.Business and Professimts Code:Any city or county x m which requires a permit to construct,alter,improve,demolish,or repair any su acture a—sm prior in its issuance,also mquins the applicant for such permit to rile a signed statement � < that he is licensed pursuant to the provisions of the Contractor.U...Law(Chapter 9 Sq.Ft. Floor Ar Valua$gn000 ¢i— (commencing with Section'l00xfof Division 3 of the B ushoss and Professions Code)or i that he is exempt therefrom and tho basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number 7-f-3 - 2095 Occupancy Type not marc than five hundred dollars($500). ❑1,as Owner orthepropeny.ormyempicyces with wagesas their sole eompensation, 37538026 . 00 will dothewont ands: awcturt is rots License Law it far sale(Sec.7066,Business and Professions Code:The Conuactoh License Law docs not apply m an awrrcr of 3 f6g property who ballets or improes Himthrough Important and who doessuch workhselfor rough his Own employees,provided that such improvements are not intended croBemd for sale.If. however,the building or improvement is sold within one year,of completion,the owner- builder will have the burden of proving Nat he did at build or improve for purpose of sale.). ❑1.as owner or the property,am exclusively contracting with licensed eonoacmra to - conswn the project(Sec.9W4,Business and Professions Code:)The Contractor's Li- rase taw does not apply in an owner of property who builds or improves thereon,and who contracts for such projects with a contractionfo licensed pursuant to the Contractor's License Law. 1 am exempt under Sec. .B&P C for this reason Pill Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Cenifrcam of Consenuo salf--insum for Workers Compere scion,as provided for by Section 37W of to labor Codc,for the arfarman¢of the work for which this permit is issued. ❑1 ban and will maintain Workers Compensation Insurance,as required by Section 37W of the Labor Code,for the performance or the work for which this permit is issued. My Workers Compensation In ursnce carticr and Policynumber art: came, <<%wap_ Policy No.: Jh?44/9 CERTIFlCA OF M MON FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is formes hundred dollars(9100) or less.) I ccnify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner m as to become subjectto the WorkersCompenntion Laws of California.Dam Applicam NOTICE TO APPLICANT:if,after making this Certificate of Exemption,you should . become subject to the Worker's Compensation pmvisions of Ne labor Code,you must .,O forthwith comply with such prnvisiom or Nis permit shall be deemed revoked. 'ZP" CONSTRUCTION LENDING AGENCY - Ihereby affirm that there is construction lending agency for the performance of 0i ? Ne work for which this permit is issued(Sec.3097,Civ.C.) D.)Q Lender's Name a Q lenders Address O Q 1 ccnify,Nat)have read this application and sure that the above information is W F correct.l agree to comply with all city and county ordinances and state laws relating in 0 building Construction,and hereby authodm mpresenutims of this city to enter upon the W above mentioned property for inspection purposes. H 6. (We)agree to save,indemnify and keep harmless the City of Cuperem.against D,) liabilities.judgments,costs and expenses which may in any way aceme against said City U in consequence or the gmming of this Permit. '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date 7 _ 2_s SOURCE LATIONS.Q +� "I`I h-63� Re-roofs ign ne of pplicanVCo Irxcrr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building nccupam store orhandle havardous martial as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety de..ceedno25532(a)+' All roofs shall be inspected prior to any roofing material being installed. ,YCSl - Cr -If a roof is installed without first obtaining an inspection,I agree to remove mil the applicant or future building occupant use equipment or Devices which g emit havanious air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ((�� ❑Yes /CIhNU I have mad the hairaNnuuss materials requirements under Chapter 6.95 of the Califor- maHealth&SafetyCods.SCNons 25505.25533 and 25534.1 undersand thin ifthe building docs not cure dy hme a moot.d t it is my respomihility to notify the occur.,of the mquiremc chmust W �Ur; rtop�aneorICemfiearoraapancy. Signature of Applicant Date 0wn mamhome0 ase, oar All roof coverings to be Class"B" or better Community Development 10300 Torre Avenue f ` `✓ Cupertino CA 95014 ,. Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS- PERMIT# S q2.,4 (!�,aave, S`v-7oo6 `-( OWNER'S NAME: T PHONE #(32'C1-1cPd 2, GENERAL CONTRACTOR: FAX # I am not using any subcontractors: 4zd9=Rf100-JA 2,� z'O5 Signature Date Please check applicable subcontractors and complete the followin information 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 Owner Contractor Signature Date CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO asa�o6�y APN # O 7 - /d - OS Building Address: 7 Mailing Address (if different from building address): Owner's Name: Phone#: lL/G /arv�+>V Contractor: License #: /1 C�rL L I eo O� Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb ® Mech ❑ Job Description: 103 LAA-C, o 2 c/ Residential ' 0 1,t 0 0 a 10 �S 10'P Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: QO Type of Constructio : Please check this box if the project is a second-story addition: ❑ Project Size: Standard Large ❑ Major ❑ -- Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 1 OOK 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 <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elee Svcs 600V <=200A ELECTRICAL / BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 CITY OF CUPERTINO Cl OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME 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 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 rinkler/Backflo PLUMBING BPSTORM Storm/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 cfrn MECHANICAL BRENLkMiAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace 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 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Ap Hance ELECTRICAL 2 of 3 , CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO 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 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 PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Faro PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3of3