The URL can be used to link to this page

04020141 CITY OF CUPERTINOCO �� BUILDING DIVISION PERMIT r TOR INFOR ION BUILDING ADDRESS: AC CONSTRUCTION PERMITNo04020141 OWrf NER'S NAME: PERMISSUE DATE NE: SANITARY O. CONTROL NO. (408) -174-1497 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 +amOp LICENSED CONTRACTORS DECLARATION Job Descri tion u I Wreby grim that I am licensed antler Provisions of Chapter 9(commuxing p with Section 7IXNq of Division 3 ofine Business and Professions Code.and my license is P�?n mfell rorteonaerce01' CHANGE RANGE TO GAS po License Class Tic.0 Z^ Date Convenor ARCHITECTS DECLARATION Yya I undcnund my plans shall he used as public records 7 4G LncnttI Professional Oat I am exempt from DECLARATION <F I hreaso .(Sero that 1 1. exempt from me Commuctor'sCod License taw for the i O O following rinse..(Saito 7(131.3,Business and improve. de ons Calc:Any oily of county a�$ which requires a permit to,ui.the alter.improve.demolish,fi repair any svucntm prior m its eemed pursuant also require IW applicant for such permit to filo se Lad aatemem matnciebcemedtion7 epmvmaronfoxc,Busin reucenachw(Chapter 9 Sq.Ft. Floor Area Valuation �O teat he Is xempt Scnfon70ndth Divisionr n(Neeged cumptand Prof Any vi Code)or that he Is exempt therefrom and the bssu for the alleged eumption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of 3 4V4T9*04Rter0 0 Occupancy Type not more titan five hundred dolurs($500} ❑I,as owner of the property,a my cmployas with wages u their sele comperomma, will dome ubms and the he C-- s Wf-Licded ense Law timesttl -1 a Sec.70 44.Easiness Re U'red Inspect' I005 end Professions Cak:The slum is tots Uttnae Law docs mot apply man ower of q property who builds der ireproves thereon,and who does such work himsel f a through his own employrs,provided that such impraemenu am not latma.d woRered furaak.If. howanI,the building or improvement is said within ane gess ofrompletion.the owa T- j builder will have me burden of proving met he did not Wild or improve for purpose of cons.as owder of the property,.B mess and convening with:)Theed eaneanrora i- Z/ constructLa the project(Sec.7044,wner or and Property who Wion$lds Cale:)Theves demon, td- O�/ who Law dao not apply loan owner of property wce Wilda or Improves Banton,and /Y wheLace for such Drojecu with a canvsemr(s)IianxO puanam m the contractors 0Licence.Law. ❑1 am e�emp�t Amer So.. .B&P C for/thu season Owny'—lam/ /�— Dak WORKER'S COMPENSATION DECLARATION 1 hemby aairm under penalty of perjury me of me fa to dalerxfmu: I have and will maintain•CcrtlOcare of Cament to self-insure for Wm1mesCompcn- sW on,as Provided for by Section 37M of the labor Cade,for the performance of the were for which this permit fs issued. ❑1 have and will re.b urn Wurkcr's Compensation Insurance.as retained by Section 37W of ON Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insumna carrier and Policy number art: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This=Iran decd not W completed time Permit Is for one hundred dollars(SIM) loss.) I certify that in me performance of to work for which this Permit is ivucd,I shall not employ any person in any marmerm u in become subject o the Workcrs Compensation Laws of Ca ifomia.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Fsemption,you mould become subject to the Worker's Compcnution previsions of the UMF Cade,you mom Z forthwith comply with such provisions or this Permit shall be decreed revoked. Z O CONSTRUCTION LENDING AGENCY v (�. 1 Wreby aRum that mem is a construction lending agency for the,perrarmana of (L' > the work for which this permit is issued(Sec.3097.Civ.C.) W Q Lender's Name C Lenr's Address V C) de1 certify that 1 have read this application and sun that the above information Is U.Pcwmct.I agree to comply with all city and county ordinances and sun lawn relating to U Wilding convection,and hereby authorim epresenwiscs of this city In enter upasthe l r W shove-mentivaA Property for inspection Purposes F O. (We)agree to save.indemnify and kap hannlm the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way attic against aid City U Z in eonsequmea of the granting of this permit. .w APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCERE TIONS t^0C Re-roofs "of ApplicanUConbaclaf Data HAZARDOUS MATERIALS DISCLOSURRO Type of Roof Will de,applicant or future Wilding Occupant am or handlc hazardous material as defined by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety cede.Section 26532409 All roofs shall be inspected prior to any roofing material being installed. ❑Ye ON. Will the applicant or future Wilding Occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants u defmcd by me Bay Area Air duality Management all new materials for inspection. Diauia7 ❑Yes No 1 have read me hazardous materials requirements under Chapter 6.95 of the Califor- niaHcalth&Safny Cadc,Stttimun%5,35533am125534.IundcuundthuiflM Wilding �mquimnrcww Chmu itumyresponsibilityuoddlymeacuPWLorthe `nissuaomof.ccruOcaaofoccu Signature of Applicant Date Dan All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue {4E� � Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO Bull De artment JOB ADDR �. SPC ) �/ C G //?o PE T #b O nO r � / OWNER'S NAME: Q e h (U'cx/ 2 h rl PHON)u"# c�v-G2-` —I S 3 GENERAL CONTRA n ✓ FAX # I am not using any subcontractor Signature Date Please check applicable subcontract rs and corn lete the follow 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 Date owner/Contractor Signature 10/28/03 CITY OF CUPERTINO 54J/CITY°F PERMIT APPLICATION FORM CUPEkTINO qWPN# 3 �,1a N q 0, Date: I IId / Building Address: /,/ Nel7 e �`e� /I,, pia lingC dd% if different from building address): (O l� d %h v Owner's Name: Phone #: /)O _ C r Q^ 5'f 6 Contractor: /1 C COnpsF �r�VuC��I�i t\ License#:O Contact: I �1 Pho�nelfp$. 3741 Cupertino Business License#: And re. Ct'R� Fax: Building Permit Info: Bldg ❑ Elect E& Plumb R� Mech ❑ Job Description: C anlj el/lc Ir0 e Oa.5 Residential 6 Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project://��O Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1 M 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 Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC I Comm. Housing Mit. Fee BUILDING I of 37 CITY OF CUPERTINO CUPEYOF PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 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 EaBREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BgEMNgAPP 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 liance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL 2of3 CITY OF CUPERTINO CIT'OF PERMIT APPLICATION FORM CUPERTINO Quanti Fee ID Fee Description Fee Group BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREWOUAN 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 Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem ora R1dQ Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electricals foot ELECTRICAL -77t EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical s . foot MECHANICAL MPERNHTFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbin Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chan e BUILDING • 3 of 3