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03010144 CITY OF CUPERTINO - , r ,,+.,,. ••r,.aq.•: BUILDING DIVISION PERMI {CONTRA CTOR`rINFORMATI , N: BUILDINGADDRESS: PERMITNO. 20171 JOHN DR 03010144 orWNER'S NAME: APPLICATION SUB DATE FURUSHO WALTER K TRUSTEE 01/24/2003 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMR INFO 0¢Z BO EPLO MO moa LICENSED CONTRACTOR'S DECLARATION V 1n. from That1 am Ilet. under provisionsof Chapter9(commencing Job Description with Scaio�aII M1)of Division 3 of the Business and Pf rssi°ns Code.and my litterse is /gy pp Ind in full forte c cl. \ MASTER BATHRM REMODEL FINA`E® ne� License Class Lic.M OHF❑ Dam Cunuulor �--£,� ARCHITECTS DEC TION FEB 11 3 W u 1 understand my plans shall rte used as public recorder 2003 t-LLG� Ucenua Prolcssional OWNER-BUILDER DECLARATION BUILDING y 1 hcmby afErm that 1 am exempt from tM COnvaaor's License law for the wfollowing mason.(Section 7031.5,Businessand Pmmxxmds Code:Anycitymcounty ,-5-.00$E which murder a permit to construct,alter,improve,demolish,or repair any struemm FZ< PrientaiB iiSuan[e,815°rCgYire{BM appliWnt for SYCh pCnllit l0111e a5igned sNlCment ppxx that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area $76'a'JUa[ion wa (commencing with Section 7")of Division of the Business and Professions Coax)or y5 that he a exempt merefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollen($500). N'dMbeV U Occupancy Type ❑I,as owner of the property,or my employees with wages as their sole compenudon, Will do the work,and the auuclu.is not intended or offered for We(See.7866,Business and Pmreasiona Code:The Contractors License Law docs not apply m an owner of 102 - PIERS equired Inspections property who builds or improves Worm,and who doessuch walk himself or through his own employees.provided that such improvements are not intended or offered(oracle.If, 103 — UFER however,Inc building or improvement is sold within one year°(completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of 104 — REBAR sale.). T. ❑1,as owner of the property,em exclusively contracting with licensed cmtracronm 105 — ANCHOR BOLTS 106 — SEWER & WATER consumer the project(Sec.7060,Business and Professions Code:)The Contractors Li- emoseLaw does net apply 10 anownerof property Who Wilds Wtopoovaadaemon,add 202 — UNDERFLOOR PLUMBING who contracts for such projects with a conrtaaar(s)licensed pursuant to me Contractor's' cnse Law. 203 _ UNDERFLOOR MECHANICAL me,ermp��tole,_Sec. , BAlPCfor Units a 204 — UNDERFLOOR FRAME Dam r'2, 205 — UNDERFLOOR INSULATION WORKER'S COMPENSATION DMZ R ION 301 — ROUGH PLUMBING Thereby aRrm antler penally of perjury ons oft owing declarations: ❑l have and will maintain a Certificate of Comant to self-imum for Worker's Compel- 302 — TUB & OR SHOWER sarion,as provided for by Section 37W of the labor Code,for the performance of the 303 — ROUGH MECHANICAL work dor which this maintain issued. 304 — ROUGH ELECTRICAL ❑1 have and will maintain Workers Compensation Insurance,as tear .by Sectors 305 — FRAME J1Q1 of me ubor Cotle,for me pertormantt of ds work for wM1ich Nis permir is issued. My Worker'sCoorNmarion Insurance carrier sola Policy number are: 306 — HOLDOWNS Carrie" Policy No, 307 — INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 — S'HE•'E'.TROCK (Thu section need mol rte completed if the permit is for one hundred Bolla,g I W) 309 — EXTERIOR LATH I ocoil.) 310 — INTERIOR LATH e«dory any in the performance mance of ds walk for winch this permit is issmed.l ansa ons 3 11 — SCRATCH COAT employ any person in any manner m a m become subject m the Workcri COmpcnsation a Laws of California,Date Applplicant 313 — ROOF NAIL NOTICE TO APPLICANT:If,after making this Certificate,of Excm prion.you should 501 — FINAL ELECTRICAL ENERGY bttome withcoalywit Workers Comp or this pmviaipns of ftLaborr Cnkc'd.you most 502 — FINAL PLUMBING ENERGY Oz beMwithmmtt with orkers CosedneorlhonprmitshallfftLadr Codetl. Z10 503 — FINAL MECHANICAL ENERGY y CONSTRUCTION LENDING AGENCY F IhembyalErmthathercin.consmuctionlendingagencylottheperformammor 504 — FINAL BUILDING ENERGY a ti Um Work for which this termor is issued(Sec.7097.Civ.CJ LenderName 505 — FINAL ELECTRICAL D z Under'sAddress 506 — GAS TEST U O I unify that I have read this applicationando sum that the above information is 507 — FINAL PLUMBING ty F career.1 agree m comply woe all city and county ordinances dna suns laws relating to U buildingconstruction,andherebyamboammprtsenutivesofthiscitymenteruponthe 5 FINAL MECHANICAL U shove mentioned property for inspection purposes. CL (We)agree Ins save,inderamfy and keep harmless the City of Cupertino against 0 9 — FIN E h liabilities,judgments,costs and expenses which may in any way accmcagainst saillCity 5 N G 1 U Z inconsequence of the granting of this perm i t tJ, APPLICANT U DERSTANDS AND W111{{{,,,L COMPLY WITH ALL NO NPOINT Issued by51 WORKS Dale SOURCER LATIONS. '/ , a mor Apphao—ouracmrRe-roofs HAZARDOUS MATERIALS DISCLOSUR Dam Type of Roof Willythe Clicantor rMurtbuil ng occupant smrc or handle harallovs material as dc.Sec by the Cupertino Manic' Code,Charter 9.12.and the Health and Safety Code,Section 25512(a)? ❑Yin Nm All roofs shall be inspected prior to any roofing material being installed. Will Inc applicant m falser building usecquipmcntordevias which If a roof is installed without first obtaining an inspection,I agree to remove Distict' xair c°ntaminanl/d1 cfncJ by the Bay Arca Air Quality Managcmcnl all new materials for inspection. emit hl? jar( , ❑Yes 1 ban nod the hava dous materials mquirenents underchapter6.95ofdte Califoe ria Health&Sx1ctycode,Sections 25315.25533 and 25576.1 undersand thatifthc building dors not currentl have a tenant,thin b is my resWmibiliry to n0tilydddtttccc neesssQQQ��ant or the requirements IfmuvN el 'or "issumex of a Ccrifcate°f0. . ere , Signature ofApplicant Date owner errs ro°r,sd age.,J• Dam All roof coverings to be Class "B"or better P AP DROVED 4183Y2 IN ACCORDA ArE W}TH THE CITY OF CUPERTIUO o'nNR iNANCES DATE sign SUBMITTAL This set of pla is z d specifications MU:(✓U.• 69 kept 6n th a at all times and it is un IdwINj to moR j any changes or alteration: v8 sarnii wilt out written permission from the Building Upt., City of Cupertino. Th@ mAmpin of this plan and specifications SHALL NOT ie held to permit or to be an appfoval of I', it hnv Olfy r rdinance or State r /\ i �ITY OF CUPERTINO MY OF CUPEkTINO PERMIT APPLICATION FORM I�T APN # r � 6 — Date: Building Address: Owner's Name: Phone#: WRI r,�9 �r Contractor: \ License#: C C Co/V ' T L c ?>.� Contact: Phone#: Do L lftL ' ' - � 6j Applicant/Contractor: =Fay i g e 't Info: 1 g Elect lumb Mech ob Desc ' ion: > S i=ce 9 Resi ential: n/Fty v _ Commercial: Sq,Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuation: Type of Construction: Occupancy oup: Quantity Fee ID Fee Description Fee Group BAPPLOTHER OtherAppliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/COmm/ uasi BUILDING 0CUlNb I Axuy 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 Ener BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housin Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-famil Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUnical COMMM New Comm MechaMECHANICAL BNUCOMMP New Comm Plumb PLUMBING 2o �S' Z 1 of 3 ` � 2- 7 ' d7 q CITY OF CUPERTINO O` PERMIT APPLICATION FORM • CUPE TINO Quantity Fee ID Fee Description Fee Grou BNUMULTI New Multi-family Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE PbIg Fixture PLUMBING tBPLANCKADD Gas Piping System Fee PLUMBING ERCEP Ind Waste Interce for PLUMBING CHK Plan Check Fee BUILDING Plan Check Add Multi BUILDING CKREP Plan Check Re eat Fee BUILDING IPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Stonn/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 cfrn MECHANICAL BREMAIRHAN A/C Units ` 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL BREMFIXT Li htin Fixtures ELECTRICAL M BREFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc A aratus ELECTRICAL BREMNRAPP Rem Non-Res A-1;_. ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BRE.. OWER Power Device/A aratus ELECTRICAL BREMRECEPT Re fl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heatin MECHANICAL BREMRESAPP Remodel Res A liance ELECTRICAL BREMSIGNAD Rmdl Si s Add Branch ELECTRICAL BREMSIGNS Remodel Si s, Mar uee ELECTRICAL BREMTHEATR Theatrical Lightin Fix ELECTRICAL 2 of 3 h._ CITY OF CJPERTINO s CITY k PERMIT APPLICATION FORM INO CUPE��T Quantity Fee ID Fee Description Fee Group BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRF Seismic Fee Res BUILDING BSF&2FAM -Single &2 Family BUILDING BSFNA Single Family New Add 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 S_q 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 ZADDCHG Address Chane 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> 1.75 M Btu MECHANICAL • 3 of 3