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03100059 CITY OF CUPERTINO BUILDING DIVISION PERMIT ". CONTRACTnR INF,ORMATIQN`4, BUILDING ADDRESS: PERMIT NO.03100059 3100059 'ERS NAME: PERMIT ISSUE DATE NE: SANITARY N0. CONTROL NO. ARCHITECfIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Ito LICENSED CONIRACnOR'SDECons of CON I heresy afrrm mm 1 am3.f he plicensed under provisions or Cbzpmr 9(commencing Job DeSCilpI100 ion with Section 9000)ofDivisionlof NC Business and Pmfcssiuns Code,rind my license is i 'n full"tcand cf ,. v 4 3 WINDOWS/PD DOORS/BAY WINDOWS Licenac�Clasx I Lie:x ;t-0 Dam C, o corer CONTRACTOR: THE WINDOW BROKER /O/ ££ `'.� ARCHITECTS DECFJ ION C U `_sfidersunJ my plana shall E used as tootle mcnrd< /,3 o� Licensed Professional `�/ 3 OWNER-BUILDER DECLARATION O� i I I Wish,41'Erm that I am emmpr from she Caronewl's License Law for the 00 following reason.(Section 7031.5,Business and Profession$Code:Any city or county . m which requite a permit to construct,alta UrPmve,demolish,Or repair any.nrueture ale prior as its issuance.also mquimo the applicant for such permit to file a signed statement i that he is licensed pursuant 10 the provisions Of the Contractor a License Law(Chapter 9 Sq. Ft. Floor Area Valuatlg980 21—� (commencing with Section 211f1(O of Division 3 of the B Usines and Professions Cmlq or that he is exempt therefrom add One India for be alleged cacntption.Any violarinn of Section]011.5 by any applicant for a permit subjects one applicant o a civil penalty of 30Pk� Qt�.e100 Occupancy Type not more than five hundred dollars($500). ❑ L the work rend pmpcny, remY cmplended oils wagu as ale(Sec. compcnation. will dothework,endo: senorisnotintendedm offered for aps(See.?014,Business and arty who ns Code:The vise mctdrs License Law dos not apply to an owner of Required Inspections propOwnemywnebinids or,proviidthatsuchimp,arbd who ereem, oenotinwork edmodredfarrgnhi: 101 - FOUNDATION however.the building rimpraat uc ver,is sold Witt in not year fcmdRcrW for owner, 102 — PIERS builder however.the building or improvement is cold within one year of completion,me owner- sal.). sow nano me burden of tmving mel he am not end or improve ser purpose of 103 — UFER axle.). ❑I,as owner of the property,am exclusively contacting with ranged contractors to 104 — REBAR consent the project(Sec.7W.Business and Pro&sslons CdJc:)The Contractor's Li. 105 — ANCHOR BOLTS. ase Law does not apply to an owner of property who builds or improves mereon.and. 106 — SEWER & WATER who commets for such projecu with a contoctm(s)licensed pursuant to he Contractor's License aw. 202 — UNDERFLOOR PLUMBING ❑Ive o aemmason pl under See. ,Bk PCfdr this sn Date 203 — UNDERFLOOR MECHANICAL WORKER'SCOMPENSATION DECLARATION 204 UNDERFLOOR FRAME Ihereby effort under pewsyorperjaryamofthe following de<iasationa: 205 — UNDERFLOOR INSULATION 1C3'10M veand will maintain.CenificatoofCannot tose6.Inmmfor workcrsCamper. 301 — ROUGH PLUMBING as provided for by Section 3200 of the labor Code,for Ohs performance of the 3 02 — TUB & OR SHOWER or which this permit is issued. av and will maintain Worker's Compcnastion Insurance,as required by Section 3 03 — ROUGH MECHANICAL itheLaborCodsrdnccpeedrmanadrtheworkforwhichthispnaitisiame. 304 — ROUGH ELECTRICAL rkch Com nsatinn Imunwc cartpic�r/ap�Policy nunttcr�c: 'rm�FCa �OE1, ';pYYliry o.: 633 305 — FRAME " E 6P zpRiVFfo M ORKERS' 306 — HOLDOWNS COMPENSATION INSLI ANC. 307 — INSULATION or less)91u section wed not he completed Ufa,remor is for one hundred dollars($MM 308 — SHEETROCK 1 cenify mal in the perfnrmance,of me work for which this permit is named,1 shall not - 3 09 — EXTERIOR LATH employ any person in any manner so as m become subject to the Worker"Compensation 31O — INTERIOR LATH Laws of C.Infir n..Dam Applicant 311 — SCRATCH COAT NOTICE TO APPLICANT:If.aper making this Ccnipcam of Eacmptian,you should 313 - ROOF NAIL become subject to the Worker's Compensation previsions of the Latin Code,you mon Z� mrmwimeamplywimdwnprn.iamnsarmiaprmitanalbaamedmanked 501 — FINAL ELECTRICAL ENERGY ` CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY Thor by which affirm Nat themboti isecon(Sol.3 1.lingagcwy for me Performance of 503 - FINAL MECHANICAL ENERGY Z' de work far whiff Ito permit is isa co (Sac.ion le Civ.C.) //>----- S7 F Lender's Name Leodcr'sAddress 504 - FINAL BUILDING ENERGY p I nify mve at 1 haread this application and sum he,me about information is 505 — FINAL ELECTRICAL ce Fconcert agree to comply with all city and county ordinances and stoic laws rclaling Id 506 — GAS TEST U building construction,and hereby athaim uprosentatives of his city to enter upon the FIN PLUMB G N W ahove-mentiuned proiat for inspection purposes. y (We)agree to save,indemnify and keep harmless the City of Cuptnino against 0 8 F I AL rA Liabilities,judgments.costs and extensor which may in any way scenic against said City 5 J Z in consegwnec of to granting of this permit. '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 Date SOURCE REGULATIONS. I NG / �' io��/o Re-roofs 514 NAL PUBLIC WORKS Si fur pplmanVC,nrowfor oto HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will he applicant in future building decorum'am nr handle haanlous material as defined by the Cotenind Municipal Care.Chapter 9.12.and the Heart and Safety Section 25532(a)7 Ely. Srr Yes � No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or ffuuture building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hvardous air contaminants as;dcrncd by the Bay Area Air Quality Management all new materials for Inspection. ncl? ❑Yes 1 have mad the ho>aN/ws`materials requirements under Chapter 6.95 of me Califoo- nixHcdlmgr Sdcty Codc,Swdom25Yd5,25533md25534.lunJ mmndmatifmc Wilding does om cunenJy tee s enant Nat it is my m.pomihlliry m wtif I Owcupant of @c tquiremcnm whi mut sect oissuancc dfa Ccruficam df cupw y. Signature of Applicant Date nor auhoriacdagent areAll roof coverings to be Class "B" or better CITY OF CUPERTINOT ,e "' BUILDING DIVISION PERNA � CONlAv>CT�R�INFOl�1aAA�N °: BUILDING ADDRESS: PERMIT NO.03100059 3100059 NER'S NAME: PERMIT ISSUE DATE HONE: SANITARY NO. n 2 4 9 CONTROL NO. ARCHITEC(ENGINEER: . BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH too LICENSED CONTRACTOR'SDHCLARATION Job Description i U Fj I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing ,Zm with Section 70M.1Division3MbeBusinaaumdProfcssiumCodc.andmylicenseis n,nZ LifanuCasnaFIN WINDOWS/PD DOORS/BAY WINDOWS AL ®cenmum -7 Licl# pie Date - o n ' canlmet CONTRACTOR: THE WINDOW BROKER (1_ iysAATIONI dcrsund my plans shall be used asECLpuhlic cords OCT 13 2003 iaU °0t, Licensed Professional s 3 OWNER BUILDER DECLARATION y 1 hereby affirm that 1 am exempt from the cmilmem's License Law lir the BUILDING :O O 6.IInwing remora.(Secfon 1131.5.Business and Professions Code:Any city or county S$ which requires is permit In maxims,ellen impro e.demolish,or repair any structure ai prior in in issuance,also requires the applicant for such permit 10 file a signed statement tfln ValUHt that he is licensed pursuant to the Provisions of the Contractor's License law(Charnel 9 Sq. Ft. Floor Area YO980' ii- (commenting with Section 7000)of Division 3 of the B usiness and Pmfcssions Coda)Or .that he Is exempt therefrom and the basis for the alleged exemption.Any violation or ,n kx15 crf..wwii��.... Section 7031.5 by any applicant for a pembit subjects the applicant to a civil penalty of 3 62Y1 filer 0 0 Occupancy Type not...Nan fim hundred dollars($500). ❑C u all of the propcny,or my cmplOycu with wages as their.1.compensation, will do due work,and the stracuum is no,intended or offered for late(See.7044.B usincest RequiredInspections and PmrMairm s Codc:The Canmctor's License law docs not apply on a owner of property who builds or improves Nercon,and who docnimch work himself.,through his 101 - FOUNDATION Own employ=,provided thmsuch improacmenu are not muctmed or offered f.rsole.It. 102 — PIERS howeveq the building or improvement is sold within one year,Of completion,the owner- builder will have inc burden of proving flat he did not build or improve for purpose Of 103 - UFER a'1e) 104 - REBAR ❑1,as Owner of do propcny,am exclusively contncting with licensed contractors to construct the project(Sec.7B44.Business and Professions Code:)The Contractor's Li- 105 — ANCHOR BOLTS, close law docs not apply to an owner of propcny who builds or improves thereon.and 106 — SEWER & WATER who contracts for such projects with a eonoaemr(s)licensed pursuant to the Contractor's Llcenselaw. 202 — UNDERFLOOR PLUMBING I am exempt under Sec. .B h P C for this mason 203 — UNDERFLOOR MECHANICAL wnef D. 204 UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty of pnjary oa Of the following declarations: 205 - UNDERFLOOR INSULATION ❑Thos and will maimaina Cenificmeor Comcnll.self-insure for Worker'scumpen- 301 — ROUGH PLUMBING aalion,as provided for by Section 3700 of the Labor Code,fm the performance of the 302 — TUB & OR SHOWER we*for whim this permit is issued. 303 — ROUGH MECHANICAL ❑1 hiss and will maintain Wwkcr's COmpenwtion Insunncc,as required by Section 3700 of the tabor ends.fn the performance club.work for which this permit is issued. 304 — ROUGH ELECTRICAL My Worker's Corriplonation Insurance carrier an andiPolicy num,cflipe:dPo 305 — FRAME nFE `AOcy 33 N Fl. KERS' 306 — HOLDO WNS COMPENSATION INStACE 307 - INSULATION This section need not he completed if the Permit is for one hundred dollars(SIM) 308 — SHEETROCK 111fss) 309 — EXTERIOR LATH I certify that in the performance.of Ne work for which this Permit is issued.I shell not employ any person in any manner so as M become subject to thewmkeol Comperommin 310 — INTERIOR LATH Laws ofCalifornia.Date 311 — SCRATCH COAT Applicant NOTICE TO APPLICANT:If..(to,making this Comficane of Exemption,you should 313 - ROOF NAIL became subject to the Worker's Compensation provisions of the tabor Cmle,you must �z Tonhwithcomplywithsuchpm.isionsorthispermitshallhedccmcdtcvoked. 501 — FINAL ELECTRICAL ENERGY Z O CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY I hereby affirm Wal there is a construction lending agency for the perfutmence of 503 — FINAL MECHANICAL ENERGY X> thework for which this permitisissued(See 3097,Civ-C.) 504 - FINAL BUILDING -ENERGY A Q lender's Namc Dz <nder'sAeams 505 — FINAL ELECTRICAL j p I certify Nat I have read this application and site that the above information is 506 — GAS TEST 3. F coned.I agree to comply with all city and county Ordinances and stn¢laws,elating to �U ideamngconslruclioeena hertbyauthoris«ose¢nutivu of this city to cnmrupnn We FIWPLUMB abovomconstrudireran herimPcccrizagmsaa AL (We).,me to save,indemnify and kap hannlass the City or Caperton against 0 8 FI liabilities,judgments.costs and expenses which may in any way seems against said Cityin consequence of the granting Of this Permit. 5Date GAPPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 5 SOURCE REGULATIONS 514 NAL PUBLIC WORKS Re-roofs Si lir ppl 11AV RDD etc 1{AypRDOUb MATERIALS DISCLOSURE Type of Roof Will un,applicant or furan:building Occupant stem or andhandlethe Hcardousd Salty u defined io the Cupertino Municipal Code.ChaPur 9.11.mJ IM1C HcaIN end Safety code.scalcn 25532(a)1 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ANo Will the eppl"M m future building Occupant use equipment or devices which al a roof is installed without first obtaining an inspection,I agree to remove emit hmardnus oil c.nmminanls as dcfincd by the Bay Arca Air Quality Management all new materials for inspection. Disaia7 ❑Yes >on I have mad the hanrdnus materials requirements under Chapter 6,95 of the Califon. ria Hcalth k Safety Code,Secdmms25505.25533 and 23534.itunkrsuna that ifthe Wilding does not currently hast a wram.Wm it u my¢speresibility w notify the asupant Of Wa rc uimmenuwhi must met ri uivuanccOfaCeniOcaseOf span y. _ Signature of Applicant Date L4 All roof coverings to be Class "B" or better nem authorireJ eFem ane Som-mxm, kITY OF CUPERTINO* CITY OF PERMIT APPLICATION FORM / CUPEkTINO APN # 2, O Date:l® �8/O3 Building Address: 2) 4i5 a2 Owner's Name: Phone#: /_ cfoO_6 2J.LJ _ -9-r-2 7 CGKG— Contractor: License #: Contact: < < sr Cupertino Business License#: r4RiU.e L.1is�1//c�J � Building Permit Info: S�n%"�c�5' .et7�psi/ �� iNsr.,y;7 /�,✓� Bldg 9 Elect ❑ Plumb ❑ Mech ❑ Job Description: �(// r Residential " Y I i ? ❑ Sq.Ft. Floor Area: /Sq.Ft.: Cost of Project: /• / 7a Qp' P 7 Occupancy Group: (o � Type of Construction: 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 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 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of ,r 7s's �Zq 3. WITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO EQuantity 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 BNUSFD New Single Family Res BUILDING 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 rinklerBackflo PLUMBING BPSTORM Stomi/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 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 BRENR RAP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 (d *ITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Si s Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical'Li ting 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 Insection BUILDING BSWIM Swinuning 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 • 3 of 3