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05090067 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTQRINFORMATION t BUILDING ADDRESS: PERMIT"05090067 OO5090067 O W NER'S NAME: PERMIT ISSUE DATE CAROL EISNER 19/09/2005 ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LOo LICENSED CONTRACTOR'S DECORATION t7:a";% W F I hereby form Thai I am licensed under s of Chapter 9(commencing Job Descriptio nM `ht j, F) 11 �v U tu y a Provision p B a� ar ti.Y+�)t. with Senior 7000)of Division 3 of NC Business and Professions Code,and my license is v1.1 iy way_ off imrail ft.aney5�u —2 .3�S'.Fil REPAIR CHINMEY j�? License I -Sr �Lic.I �,._ ;:n Damef Contract^ CONTRACTOR: MP3 MASONRY 'SEP /9 ARCHITECTS DECLARATION 2005 a< I undcrmnd my plans shall be used ss puhlie menrds �nU y 3 a. Licensed Psufcssianal {�� tt{ tM�LD{I. QS OWNER BUILDER DECLARATION yr (k �,,df tllq/ .1tdlC�Y1b/ 3<q 1 hereby affirm that 1 am exempt from tie Cononefor's License Law for the SULD' 'C following mown.(Suction 7031.5.Business and Profession Cade:Any city m courtly x m which requires a permit to enwrvm,altar.improve,demolish,or repair any structure prorio its issuana,also re,niat Wapplicamforerth permittu flea signcdontemem �E< the,he is rapursuant licensed pursuano themm prisioof the is Cmumult License Law 9 Sq.Ft. Floor Area Valuati$i2 6 8 0 ceFG (commencing with Section 7000)of Division Sof the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a pernit subjects the applicant to a civil penalty of APN Number Occupancy Type not mom than five hundred dollars(S!5M). 32613105 . 00 p y yp I,as Owner of the propeny,a my employees with wages a their sole compensation, will do the work.and theswcture is not intended or offered for sale IS".7064.Business and Professions cede:The Comeactors License Law does not apply to an owner of Required Inspections property who builds orimproves Nercon,and who doeaauchwod himself or through his Own employees,provided that such improvements are,not intended or offered for sale.If. however.Ne building or impmwmmt is sold within are year of completion,the Owrer- builder will base the burden of proving Nat M did not build or improve for purpose of sale.!. ❑I,as Owner of the property,am eaclusivcly contracting with licensed comuanors to construct the project(Sec.7044,Business and Professions Code:)The Contracwls Li. cense law docs not apply to an owner of property who Wilda or improve,Merton.and who concocts for such projects with a comrscter(s)licensed pursuant o the Conoacmre Limme Law. ❑1 am exempt under Sec. .B It P C far this¢awn Owner Data WORKER'S COMPENSATION DECORATION I hereby a(firn under penalty of perjury,arc of the fallowing dedaratiamf: I have and will maintain a Certificate of Consent to self-insum for Warker'sCompen- sation,as provided for by Saturn 3700 of Ne Labor Code,for the performance of the work for which this permit is issued. Yy1 baand will maintain Worker's Compensation lrummce,as detained by Second 00se of he labor Code,for the performarme of the work for which Nis permit is issued. Workers Compensation Insurance airier and Policy number am: Canier.�JT.�1.7��C�✓I/J Policy No.�W - C 0.TIFICATEO E%EMPTIOHFftOMWORK ft5' COMPENSATION INSURANCE (Thu seaiaa need not be complemd if the Permit is fm one hundred dollars(SIM) or less.) I cantly Out in the perfurmenec of the..,it far which this permit is issued.I shall not employ any person in any manner at so to become subject o one WOmeraCompensation Laws of California.Data Applicant NOTICE TO APPLICANT:IL after making this Cenifeate of Exemption,you should become subject m the Worker's Confession.provisions of the Labor Code,you must .J O fol with comply with such provisions or his permit shall W named evoked. Z'Vy CONSTRUCTION LENDING AGENCY F. I hereby aRren that them is a construction lending agency for the performance of C> the work for which this N.11 us heated(Sac.3097.Civ.C.) [f7 Lender's Namc CL finder's Address Zz U Q I certify that 1 have read his application end sum On rbc above information is LL F correct,I agree to comply with all city and county ordinances and state laws minting m Q C.7 building conswction,and hereby aurhodeepresattaises of this city to cnmr upon to ond r[ll above-memidgmentopeny for despenses which ms gy (We)agree tu save,indemnify and keep hornless the City of Cupcnine again, F" Liabilities. seats indemnify ad keep meyinsnye,way City ( Against mid City t.)Z in eo col the grand permit. ^ APP CA U D D WILL COMPLY WITH ALL NONPOINT Issued by: Date SO CE G N . ® Re-roofs /S S attire of Applicant/ n err Data M RDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding oaupmutore or handle haameous material az defined by the CupeninO Municipal Code.Chapter 9.13,and the Health and Safety code,ocean 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. Yo, If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building Gaup in use equipment Or devices which g .mit hazardous air contaminants ass dcuned by the Bay Area Air Quality Management all new materials for inspection. Own"? \�, ❑Ycs )&a Ihavemadthe Wig i)usmaterialsmyuiremenuunder Chapmr6.95ofthe Califoc rias not ASafmyCodc.Seetimu35XI5.3my and35536.1 indarsundthmifthe Wilding Jag not c lly batt a mnanL N y responsibility m notilY rlrc occupant of the need�' ^° must o �ssuancco�a comficato fa a�a. Signature of Applicant Date 46 4 c//%� 5 `i��'— � All roof coverings to be Class"B"or better mer m out mired agent One r Community Development .. ' 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT# c;�aa71 �evp/e 5— o s-o X006 OWNER' PHONE GENERAL CONTRACTOR: FAX # 3/- I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation 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 N= CITY OF CUPERTINO , y' CUP TYOF O PERMIT APPLICATION FORM 6S--b � ry 6�r Ask APN# d6 /3 ,D� Date: Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: 03/-&37- Contractor: License #: pp Contact" / Phone: �3/-63.7 GGG3 Cupertino Business License#: A Fax: G37-J '7 31 Building Permit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Job Description:/ Residential ❑ Commercial ❑ Sq.Ft. Floor Area: q.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 ❑ Lar e ❑ Ma or ❑ Quantity Fee 1D Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL BBOILER3. Boiler> 500K to 1M Btu MECHANICAL BBOILER4, Boiler> IM 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 91h -T BINVESTIGA Investigation fee BUILDING Ju 1 of 3 J CITY OF CUPERTINO c CITY OF PERMIT APPLICATION FORM CUPERTINO -Quantity Fee 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 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 Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING 19 iw BPWATER InstalUAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 clip MECHANICAL BREIvIAIRHAN A/C Units r— 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREIV R P 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 Re air/Alter Heating MECHANICAL BREMRESAPP Remode] Res A liance ELECTRICAL 2of3 at' CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Si Add Branch ELECTRICAL BREMSIGNS Remodel Si s, 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 Insection BUILDING BSVaM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electfical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERN FEE 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 3of3