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04110133 CITY OF CUPERTINO s' ¢ •'E ' +' "^T `"" E - 9 BUILDING DIVISION PERMIT ,C,OR.A.C`T„QT.2Tl "U , Ttft SUILDINDADDRESS: CUPERTINO PLUMBING PERMIT NO.05110133 1155 HUNTERSON 21. ER'S NAME: PERMIT ISSUE DATE OWN AliMICHAEL LAITILA 10297 NE: SANITARY NO. CONTROL NO. (408) 253-0618 ARCHITECT/ENGINEER: IL BUDING PERMIT INFO BLDG EIECr PLUMB MECH 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I bunchy afOm tied 1 am Ilccmed under pavisimm of Chapter 9(mmme as with Section 70110)mf Division 3 ofthe Buxncsaand Profeasiom Code,and my license is u«�1are`,and=N L^3(o LIC-0U7llgps REPIPE/WATER EHATER/WATER SERVICE 31„ Da¢ Contractor Wt 0192 ACX 5D RA ON vn f I Y , tau On recortla� 3 U p cad Lis, d pg�cadonal k OWNER-BUILDER DECLARATION <q I kriby a1Dm that 1 am exempt from the Contrammh Licenm law far tic pO following mawin.(Section 7031.5,Business and Profamiom Cade:Any city or county $2 which requites a permit to cmuuuc4 ala,seismic.demolW,or mpolr my ewcwm $5000 -_zin prior m its Wanes,atm nu)uires the applicant for Such permit mfiu a signed autres., €o that he laResound pursuant tothe provisions ofthe Contrecines Ulecom Law(chumur9 Sq.Ft. Floor Area Valuation Ey $ (commencing with Section 7000)of Division Sof the Bmineas and Profmaiom Cade)or Y Nat he u exempt sem(rom and the basis for the alleged emmpdon.My violation of SeNon]031.1 by any applicant for a permit wibjUll the aP ulteant m•dvil PUSIIY of r Occupancy Type est mom caw five huMmd dollars(SSW} ❑1,a owner of llm pmperty,or my employco with wage u their wile mmpe=Oon, W Pr _ ns will tlm the work,and tie Muc7um a antmteMed or oReted farsate(Scc.7nM,Budnev Profession Cads,The Commamoh I.kenm law dose rot apply m an awncr of file(tuired Inspecti property who bulldaarimproms thereon,andwhodaa,uchwork himselfmduough his t� "30 own employees.provided Nat Such impmvnmmu are not intended croReted OWS11c.If. �00✓ bmvewr,the building or Impmwment is wild withat man year ofe mpldtion,the mance- atf builds will thaw thaat harden of proving dust W did Out build or improve for Purpose Of ask.). co L as owma of the property,.B exclusively escmwith enuamrm cmmm the project(SecBusiness and Pro(csdom Code)The Connoisseurs oLaw does amapply nan owner ofpmPeny+'hubuilds orimproes thrtmn,and. who contractsfor such prro)tmwith aeonvectartO licensed pursuant mthe Cwitoh seLaw. 01IDun exemptueder See .Bl PC for this mason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby ar Irm under penalty of perjury One of the following declanumtc 1 haw and will mmmalo•CaNResm of Com=nt m self-Wort fawcfteseompen- So Ion,u provided far by Section 3700 O(dm LaborCode,for the perform.offt Ion, far which this permit a blued. w and will maintain Woftes Companion Imuran¢,u required by Section 3700 of Ns,labor Cad=.for the performance alum work for which this permit is laamd. My Worker ComPemWon lmuranro carrier and Policynumb=ram: Carver.�/U/�' Y5 Policy No.: CEIrfIFlCATEOFEKEMPTION FROM WORKERS' COMPENSATION INSURANCE (This mialon reed mtbecompleud if tie pence is foram huntheddallua($100) or les3) 1 mn11y that In the Performance of the work for which this Permit u issued,I Mall not employ any person In my me perm u to become abject in tie Worker'Compmuation Laws Of CaliFQMIL Data Applicant NOTICE TO APPLICANT:IL a0er making tida Cenilicate of Exemption.you Umuld become sub]=in the Workecu Compensation provision Of use labor Code•you mux .J ZO forthwith comply with Sch provisions or this permit Mall be deemed mwkcd. z` CONSTRUCTION LENDING AGENCY PThereby aflm this th= im4m I.. nmMoiling ing agency for de performance of CL ^ the nark for which this pemlt is issued(Sec.30171,Civ.C.) [tJ L Ous" Name az L=ndee Addmu U O 1«nify that I haw read this application and SUM use Oe above Inmmusden IS IS, ^ correct.1 airs in empty with all city and county oNimrco and este Ism mlIcUl in 0 lr.•J! building construction,and hereby authodm rcpesmutim of this city in enter upon me W show-rsn Toned pmpcny for Inspection purposes. (We)agree caw•milcnmifY and keep hamkas the City of CYpC=tim against Coll liabilities.judgm ,corm and expenses wltiM maylo anyway acctncagaimtuid Cily U zin comeq nc the i711m o mu permit. APPLI N ERST AND,WILL COM LY WITH ALL NON-POINT Issued by: Date _Z'L�D SOU U TION . //"Z3 O Re-roofs y if urc Applicm err Dau OO US MATERIALS DISCLOSURE Type of Roof Will de sp ontinfunce building occupant store or handle haurdom material as dcRmd by the Cupertino Mu '' 1 Code.Chapter 9.11,and the Health and Safety ANVk-cile,Section 37333(3)? All roofs shall be inspected prior to any roofing material being installed. ❑Yon Will the applicant or future Wilding occupant tic equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air conuminanu as defined by the Bay Amo Air Quality Management all new materials for inspection. Dlsuict? ^ oya I ho.M440c hemmtes materials requirements under Chapter 6.97 of the Callfmn nia Hcolth than 133 and 31734.1 und=mund too,lfde building does not tenorµ y responsibility m tlfy the occasion of tin rqulro beeset in issuancearaccroll o(Oceup 7 �Signatureof Applicant Date Ow r an arissd asemt011-4 Oau All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS: // PERMIT # (/ 1 OWNER'S NAME: /,a -7L I !w. /'Yl G Go PHONE # -. 3299-5 GENERAL CONTRACTOR: FAX # 753 0697� I am not using any subcontractors: 1 J/ D Gr Si a Date Please check applicable subcontractors and complete the following 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 ,O Plumbing hp kjo /h (�/ Roofing Septic Tank Sheet Metal Sheet Rock e Owner/C •actor Signature bate. D-. CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO /� I /� N# Date: Building Address: I/Jas , lun / I ding Address (if different from building address): Own r'sl N e: d�o l Phone #: f Contor �G License #: 1-1 Co tact: Phon 253a(ol Cupertino Business License#: 'Q'I G. Fax: 2S3 0(0")3 / Building Permit Info: Bldg ❑ Elect Cl� Plumb M/� Mech F� Job Description: C,Gf-)9e✓ RiGp+ G , lnX HeAj-ev, W i[- Residential ❑ Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ ro'ect Size: Standard ❑ Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 lof3 � _ CITY OF CUPERTINO CUP Ef�TINO PERMIT APPLICATION FORM QuantityFee 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 Ins ection 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 eOfFixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP I 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 BREMAIRHAN A/C Units <= 10,000 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> 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 Appliance ELECTRICAL 2of3 CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Grou 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 Ensection BUILDING BSWIM Swimmin Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary BldgPermit BUILDIING 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-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3 of 3