04020080 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTpRyINFORMATION,
BUILDING ADDRESS: DENNIS VAUGHN ......04020080
GRRRbjWnnn DR
R'S NAME: PERMIT ISSUE DATE
DENNIS
NE: SAND'ARY NO. CON ROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.Oo LICENSED COMRACTOR'SDECLARATION Job Description
i U� 1 Mich,affirm Net 1 am licensed under provisions of Chapter 9(commencing
with Section?")of Division 3 of the Businm and Profrainu Code,and my license is
=N in full forte andcffsoL SHEETROCK GARAGE IS, ADD ELECT OUTLETS
p n z License Class Lie.a
Dam.Contractor
ARCHITECrS DECLARATION
as I undersand my plans shall he used in public menrds
DyV
u.t; Licensed Pmfeuional
g OWNER-BUILDER DECLARATION
+� 1 hereby nlLrm that 1 am exempt from the Contractor's Litems Law for the
x
10 following moon.(Section 1131.3,Business and Promotions Code:Any city or county
2 which require.Permit ,,construct.alae improve,demolish,or repair any structure
HZi prior In its issuance,also requires the applicant for such permit to rile a signed statement
m< the,be is licensed pursuant to0mprevisions ofthe Comment's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
rc€m (commencing with Section 7000)of Division 3 of the Business and Proresssans Codc)or
y
that he is asempt therefrom and the basis for she alleged exemption.Any violation of
Schon 7031.5 by any applicant for a prmii mb)ecu the applicant ro a civil penalty of 3-AT4l3'011*(Zr0 0 Occupancy Type
not m..than five hmNmd della.(5300). .
❑1,u miner of Ne pmpeny,a mY wplaymu with wage as Heir sole compevauon,
wise tae the work..nd theawaamuwtimm�dea mn(ferta mr,ale(ser.loss,eesinw Re uired 111,!R
S�
and ftrus oat Cade:The Convectors License Law does not apply to an owner of q bra
property who Wildsor improve chanson,and whodoessuch work himulfortheough his
awn employcu,prwided dussuchimpMWMMU rtnotinteM MOffaed forside.If. /t'
however.the Wilding or improvement is old within one year afmmPlation.the worries- C 34
Wilder wise have the Wrdcn of proving that he did net Wild or improve for purpose of V 20
04 sale.).
❑L as owner Of the Property,am uelusively...s awing with licevcd ronusemra of
coratmel the project(Sec.7W.Business and Profestiav Code)Tle ConMW$Li-
cove law docs not apply to an owner of psoPeny who Wilds or improves thereon.and.
wbr somracu for sutltpm$cu with. uactm(U Rwvea puawmto Ne Contranpra
se Law.
exemptSc. y
,BkPCf'thi
B es
WORKERS COMPENSAIDON DECLARA ON
R
1 hereby arrn under pen i ty of perjury one of to following decimations:
1 have and will maintain•Ccr Rms,of Covent to self-insure for Workm
Worker's COmpc
cation,u provided for by Section 37M Of la Labor Code.for the performance of the
work for which this permit is issued.
Fl I have and will maintain Worker's Compensation Insurance,u inquired by Section
371 of the Labor Code,for doe performance of Ne work for which this permit is issued.
My We
gmes Compensation Insurance carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EKEM MON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need nolaeompleted if the Permit is Inform hundrtddollars(SIM)
or leu.)
I terrify Nes in Ne performance of Ne woh for which this permit u issued.I shall not
employ any PC.n in any mannerm as to Wcome subject to the Workers'Compensation
Isws of Califami
APPlicanr —
N Tic P CANE. Ccni cam of emption,you Nauld
Wino j s.the s Compensation
proviriors of tW Labor Code,you muse
,� IoM romp y with Barb provisions or
Nis patois shall W dcemcdw
rekcd.
Z O CONSTRUCTION LENDING AGENCY n ,
[-. 1 hereby arnnn that Vert is a construction lending agency for the performance of
lye 7 the work for which his panic is issued(Ste.3097.Co.C.)
[[7 Q Lendcfs Name
d Lender.Add.
VC) 1 ccoify Nn 1 have mad this application and sum that to gave information is
Pcorrect.1 agree to comply with all city and county ordinances and sum laws relating a
0 C.7 buildingce)agree to and hememnify d cepminhammiacse this city enter upon the
>, W ahove-memiuned properly for inspection purposes.
(s.ju same to cove,indemnify and tech hay in m the City of against
against
rh liobilisies,judgmcna,case and eapcves which may in any way accme aCainst said City
U in commqu"Xy this permit.
APPLICAN
TVNBERs ND AND WILL COMPLY WITH ALL ON-POINT Issued by: Dat
S uRCF�ecuLAno IDLoce Re-roofs
Si pplicant6Conuncmr DAM
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future building Occupant gore in handle hatsraus material
fined by the Cupenino Munici Code.Chapter 9.12.and the Healthand Safety
c.Section 255320)? All roofs shall be inspected prior to any roofing material being installed.
❑Ye
'ni occupam esu If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or fuum buil cyvipment or devices which
It h tardnus air canumimmor u recd by Nr.Bay Arta Air Quality Managcmcnt all new materials for inspection.
District?
(D Ye
1 have mal the hay(dydsmamn'el}Ycquimmenu under ChgPmf 6.95 of the CaIItof-
niaficalth&SafeyC ff fffuau 253BBTS 2255537 uW255Jd.l undcnsuM thaifdc Wilding
Joe
Currently anon (at IlLL mY rot asihiliy le maify Nr.¢cup
mnaw ogee Pya ag�r.Cron; �ar mawny SignatureofApplicant Date
All roof coverings to be Class"B"or better
Owner or authomsJ age.,
CITY OF CUPERTINO ° " Tr'�'
BUILDING DIVISION PE �-cc.C. _ONTRAC�TORkINEORM�®N.,
BUILDING ADDRESS: DENNIS VAUGHN PERMIT No04020080
OWNER'S NAME: PERMIT ISSUE DATE
ED SANITARY NO. CONTROL NO.
ARCHITECVENGINEER: BUILDING PERMM INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uO, LICENSED CONrRACTOR'S DECLARATION Job DeSCrIpI1On
U I hereby affirm that I nn tuned under provisions of Chapmr 9(Commencing
with Section 7")of Division 3 of NC Estrum and proreuiom Code,and my liccnx is
'rny
in fall force SHEETROCK GARAGE & ADD ELE`C oLQLiTi�EgT ®
jM" License Class LIc.N
��O Dale Contractor.
ARCHITECTS DECLARATION
yI understand my plain shall M used u public mcnrN JUL 30 2004
�yU
;0G Licensed Pml
fcssiona
3 OWNER-BUILDER DECLARATION
g I hereby affirm Nes I am exempt from thnt
e Coreoars Ucenx Law for LM BUILDING
3 00 following moon.(Section 703 1.5,Business and Prefc ions Code:Any city of county g'�ag
E:
$F which rural.a permit mlm
cnnsn,elmL m
improve.demolish,art repair any It—"'
pdotoilaiuuencc,a1mare, iris the at far such Pcnniuo filo esigned Mutant., Floor Area Valuation
iii thefrWislicensed pursuant to the previsionsofNeContractorsLicense Law(Chapter9 Sq.
asH0 (commencing with Section TIDO)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis far the alleged exemption.Any violation of
Section 7031.5 by any appli..tfor a pennon subjects do,applicant to a civil penalty of 3-a4TJ1Nh crpp Occupancy Type
not more Nan firs hundred dollen($50)).
❑1.u owrm,of IM lampeny,of my employees with wage,as their Into compewdon,
will do the nark,and the structure is no,intended a,Offered for safe(Sec.7014,Business -Re uired Inspections
and pmresdnm Codc The Conmcfors Lienee law dors not apply m an owner of 9
property who Wilda orimpromdmmun,and whodoessuchwork himselfor through his
owncmploycr.L provided thalxch Improssmcnta art nos intended ar offered foraale.IL
however,the building or improvement is sold within one year of camPiedon.on,owner.
builder will have the burden of pmving that M did non Mild or improve for purpose of
ulcJ.
1,as owner of the property.am exclusively contracting with licensed convectors to
consumer the project(Sec.7044,Business and Profusions Code:)The Contractors Li-
ecnse Law docs not apply an.n owner of properly who builds or bottom om Nemon.and,
who contracts for such Pmjecu withe mescmr(o licensed pmsuanf an Lot Contractors
License Law.
❑ism exempts cg Se. .BAPCf N' mswwn
O rte .D 7
WORKERS COMPFNSI ON DECL. R ON
1 hereby aRrse under penalty of perjury ane of the following ciecluations:
❑I have and will maintain a Certificate ofConsemtoself.insure for Worker'sComport.
tzau ,u provided far by Section 3700 of the labor Cade,for Ne performance of the
work for which this permit is issued.
1 have and will meinuin Workers Compcmadon Inuv .Is retuned by Seethm
37M of the labor Code,for the pcdortname of dm work for which this permit is issued.
My Workers Campensauon boos.order and Policy number art:
Cartier. poli,No.:
CERMR:ATE OF E%FM MON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section recd notbccompleled iftM permit is forone M1usWreddnllan(SIaR
or lust
1 certify that in the performance of the work for which this permit u issued,l shall not
employ any person in any maonerx u an become subject to the Workers Compe...door
caws or CeliXPoc�A
Applin. "
NOTIC TO1. a Y Coni eau of cmption,you should
men ) sCOMI =donpmvWomoftheUWr.CM.youmussZ fond capmvidom or this permit shall W domed conked
Z O CONSTRUCTION LENDING AGENCY v
[�w I hereby ahem that then is a construction lending agency for lM performance of
C' > the work for which this parrot is issued(Sec.3097.Civ.C.)
W Q Lenders Name
Lcnderi Address
U 0 1 certify Nat 1 have read this application and sou that dm above information is
IL- corm 1 ag.It,comply with all city and county ordinances and sure laws dating u
p buildingConstruction.
retiI.andhmebyeuNodxrtis loomum of this eifymentuuponthe
W aMve-mentioned property for inspection PurPxxs
P. (Wc)agreeto save.indemnifyand hech hay in
eCity yaseof Cup<niwagainst a
h li.bilitiu,Judgmcnta.costs and expenses whicM1 may in any way xrnse against sold City I/
U.Z in costsequeomc0 this permiL Dat
^� APPLICANT4fNDERSrAND AND WILL COMPLY WITH ALL ON-POINT Issued by:
A�l
s'vac nG �r 'Z�a/fes Re-roofs
Si pplianVContncmr `�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theapplicantorfuturebuildingvaupantsmmo,handlehavardousm.t.aA
Is dere ed by the Cupenim Munici Code,Chapter 9.11,and IM Hcalth and Safety
Code.Secuoo 15531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ys u
Will due applicant or future buil 'ng occupant tax cyuip root or devises which If a roof is installed without first obtaining an inspection,I agree[o remove
emit hamdous air courearnants as rmd by the Bay Arta Air Qualify Management all new materials for inspection.
DiWics7
❑Yes u
I have read the haJII IumochhycyvimmenmunderChapmrG95ofthe Califon
nix Hcalih dr SercVC ,S E. rr257415,25533and15534.Iundmsundlhuifthc Wilding
dues t curt U ¢ranl,�1 t i(is res omibility to nouly oM atopererw111t of
entswY vas,be In 'Wi Carr acerti mar eeaPxm'y— � ' Signature of Applicant Date
Ur p 14 - All roof coverings to be Class"B" or better
Owner or amhorrmd agcm
I
k( -
* CITY OF CUPERTIN#
CUP TYOF O PERMIT APPLICATION FORM 11Pd
D � �
41,
APN # � ( Date:
Building Address: 2 &J O O
Owner's Name: ✓ Phone I
h � r� Llvv� -/ s��
Contractor: _ License #:
Contact: Cupertino Business License#:
B;DescnLion:
Permit Info:
El Plumb C-1Mech C-1/N 6/A/zA6 �o /
Residential ❑ L Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: 2 S-0
U — Occupancy Group: r^
Type of Constructio : el-7-
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M 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 Elec Svcs 600V <=200A ELECTRICAL
BENERGY IEnergy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUI DING
lof3
CC' - * CITY OF CUPERTINO*
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
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
BOVERTWE 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 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
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
BRENINRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
2of3
Sm OITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quti 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 Sips 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 Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
BMISCELL Building Mise Fees BUILDING
•
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