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06010080Q z P IT] UU Q U CITY OF CUPERTINO BUILDING DIVISION PERT p�.�Y-�r ' "7�+01�?lIM1,0 ,OlU�lA -19N -'O BUILDING ADDRESS: CHRISTIAN JUVAN PB m"0.O601OOHO OW NEWS NAME: PERMIT ISSUE DATE CHRISTIAN JUVAN 10053 JUDY'AVE 006 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o t! o .Z LICENSED CONTRACTOR'S DECLARATION 1 Mreby affirm that 1 sin licensed under provismos of Chapter 9 (commencing Job Description with Section 7(1001) of Division 3 of ihd Business and Profcidims Code.and my license is mmfi fame and effect. Licenm Class Lk. M INSTALL SUBPANEL (100A) Contractor iQDate ARCHITECTS DECLARATION i cy7 1 understand mss plans shall M used as public meorms Licensed Professional OWNER -BUILDER DECLARATION . 0 I hereby affrrn that 1 am exempt from the Contractor's License Law for the following mature, (Section 7031.5. Business and Professions Code: Any city or county which roIIAMS A Foreskin construct, alter, improve, demolish, or repair any stmcmre ' $300 i< ;a . prior to is Issuance. amu requires theapplicant for such perms to Bre a signed statement that he is licensed pursamt to cite provisions of the Connector's lion Law (Chapter 9 (commencing with Section 7000) of Division 3 of dm Busnass and Profasans Code) or dust he is exempt therefrom and the basis for de, alleged assumption. Any violedon of Sq. Ft. Floor Area Valuation AN9 5 Occupancy Type Section 7031.5 by any applicant for a permit objects the applicant to A civil penalty of.3 not mom than five hundred dallies (5500). - ❑ Lis ownes of Ne property, m my cmployca with wages astimb sok compensation, Required Inspections willdo theworle and the aWrame u not intended or offered Eurasia (Sec. 7044. Business and Pmfadam Code: The Ca mactor's License Law dead rot apply to an Owner of is pmpeny.W ,pmvi lmthAl=hermn.a emu mnotin vrk himulforlluou lf. awn sumployces, provided that impmwmata art malfrsW if. an yearMetl the Owner. vena me Own however. the buildingvsea improvement u held did oro year of a inprovtioe, builder will have We burden of proving that M did not Wild ter Improve for puryose of ❑. I, owner m the property, exclusively connecting Cavi licensed coninermt to cemtmn the pronto (Sec. . Bsine Li- a Business and Professmu Code:) Tbo Cmvaeto rop t. mon law does; not apply to an awes of proper(wM Wilda rs Improves theme. and, n an whoseLacontracts for projeN with a cmnsctea(q licerumd pursuant b ur Cmvacmr'a � License / ❑ 1 em exempt under Sec. . B As P C for this mason exempt �O Owma Dam WORKER'SC PENSATION DECLARATION I hereby alums under penalty of perjury oro of the fallowing declarmiona: have and will maintain a CWfiase of Comm bxlf-immen for Worker's Compen- n, as providetl for by Section 37M of the IAbm Code, for 1M performeme of the for which this permit is isrmtl. 7037.00, have and will msnWn Worker's CampensNm Insurance, u myulmd by SeNon of Ne Labor Coca. for the performance of the work for which this permit is lamed. orker's Compewtion insurance arse and Policy number am: er. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE Md, accllon mea not Mcompletea if the permit is form hundred dollaa (SIM) or lees) 1 certify that in the performance of the weak fm which this permit is is ed, I shall not ss manu�aO idII to became Subjat to the orkertr '�Compensation anty perrorolna nDmem , ', Lxwx O .ifTw Applicant "" — NOTICE TO APPLICAN . If. after eking this Certificate of Exemption, you Mould bocome subject to the Workeh Cam taking previsions of the Labor Code, you mus forthwith comply with Such Provisions or this permit shall W deemed revoked. z ? H CONSTRUCTION LENDING AGENCY I Money spire that Wem is a construction lending agency for the perfmrnume of the work for, which this permit is iesaed (Sat. 3097, Ci, C.) , QLemicts z Name Lendels Address Q I cenlfy Wal I have road this application and sum Ws the shove information Is HCOMCL U It7 LL y I agree to comply with all city and county ordinances and state laws misting in Wilding convection, and hereby authorim representatives; of Wia city to enter upon tiro above-mentioned property for inspection purposes (We) agree to sat, indemnify and kap harmless the City of Cupcni o against Ilabilitia,judgeenu.cmu andexpeasea which may in any way aanm against said City in conmgmnee of the granting of Wiapemal APPLICANT UNDERSTA�NDS AID WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCEREOULATIQIgS. �� Re -roofs Signume of Appliesocc. 4e ma HAZARD S MATERIALS DISCLOSURE Type of Roof Will the applies., or future Wilding mtupant sore or Iu ulk harsNous material ' a de0ned by the Cupertino Municipal Code. Chapter 9.11. and the Health and Safety Code, Section s 13533(a)7 El Yes �Na All roofs shall be inspected nor to an roofing material beim Installed. P P Y 8 B Will the applicant or future Wilding occupant use equipment or devices which I hvxdnm air contaminated a de0ned by the Bay Ams Air Quality Management If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. District? ❑Yes )5 jk. I have mad the hvammu mmmiah mquimmcnu under Chapter 6.93 of theCalifor- nia Health & Safety Code, Scetimu 15NI5.15533 and 8534.1 understand Ws ifdm Wilding dues not eurently hoc a mnam, 04VI u my respandbility to notify the occupant of dm requirements which mus met pri rtoin oft Certificate of top _ / O 6 Signature ofApplicant Date B All roof coverings to be Class "B" or better Owner orauthoriced agnot Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRE 0 S 3 3u PERMIT # G/ rJ6 L OWNER'S NAME: n -T - tJ PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: — — O Sign4ure Date Please check avolicable subcontractors and complete the following- information: Owner/Contractor Signature Date 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 Owner/Contractor Signature Date CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 0�, /o5,5 -t) N# 3 �� G, o 5' Date: 1 PLC 17 Z004 12 uilding Address: ' O O, 3 Tu Q �� Mailing Address (if different from building address): Owner's Name: Zv4ti � -f J 7 #-ti/ J Phone #: 4 v6 d V Z CP Contractor: O(UA-A (L 72 [-� I' L J) License #: Contact: S qN g Phone: Cupertino Business License#: Fax: Building Permit Info: ( D4— "'/ AIS rte.. L L C V 2 O O /9 Bldg ❑ Elect © Plumb ❑ Mech ❑ Job Description: Residential 8t Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Proiect:3 O Occupancy GrouD: MECHANICAL BBOILER5 Type of Construction: Please check this box if the project is a BCONSTAX second-sto addition: ❑ o'ect Size: Standard ❑ Large ❑ Major ❑ BCONSTAX L 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 BBOH ER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTA-XBQ Con. Tax fora Q 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 1of3 d/o� l� CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BNOCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERT]ME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE 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 cfm MECHANICAL BREMAIRHAN A/C Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation ofFumace MECHANICAL BREMFURNOV Re] oFumace>IOKbtu 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 PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group 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 BSPECIAL Seismic Fee Res Special Inspection BUILDING BUILDING BSWIM 'SwimmingPool BUILDING P Temporary Power ELECTRICAL ERM Temporary BldgPermit BUILDING SVCS Tem Dist Svcs ELECTRICAL IC Business License BUILDING RIC Electricals foot ELECTRICAL ITFEE Elec Permit Issuance ELECTRICAL IEPERAIaTFEE FEE Mechanicals . foot MECHANICAL ITFEE 114ech Permit Issuance MECHANICAL ITFEE Plambin Permit Issue PLUMBING G Plumbin Fees foot PLUMBING RNGC Plannin LR Commet Multi-Fam PLANNING RNGR Plannin Lon Ran a Residential PLANNING CHG Address ChangeE BUII DING .s 3of3 1 I