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04070198 CIPY OF CUPE1UTNO BUILDING DIVISION PERMIT CONTRACT(?R INFORMATION ` 1. "z ,W"', BUILDING ADDRESS: PERMIT NO 04070198 OW N_R S NAME; PERMIT ISSUE DATG 1,E: SANITARY OL NO. ARCHITECrIENGINEEN: BUILDING PERMIT INFO BIAC ELECT PLUMB MECH Lop LICHNSEDCONTRACI'OR'SDECLARATION u•ttlf ja F I hereby affirm Thal 1 am licensed under provisions of Chapter 9(commencing Job Desenphon' w wiohSecoion]tNxgnfDivisihn3ofaeBusincrosanJPmfessinmCode.and myliacnseis All, 9 � D - err borneClas er@"' ADD 2 CIRCUITS License Class Lie.N nFw Date DEC2004 Contentment- ARCHITECTS DECLARATION ? U l understand my plans shall W used as puhlic records I a+ 3 o,rl'( Licensed Pmfussio od O OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from Ne Centmemr's License Law for the p o following reason.(Section II01.5,Business and Professions Code:Any city or county k m which requires a permit to construct,alter,improve,dcmnlish,or repair any structure prior to mosimem,also requlms the applicant fhrsuch permitm Ile asihmdsummenl that he is licensed pursuant In Chromium the provisions of the Chro 's License Law(Chapter 9 Sq.Ft. Floor Area Valuatl0 isHQ (commencing wi lh Section 7")of Division 3 of the Business and Professions Code)or i�§ that he is exempt therefrom and the basis for the alleged ascription.Any violaUon of Section]031.5 by any applicant for a permit subjcou the applicantto a civil Penalty of 3�y er0 0 Occupancy Type not more than rive hundred dollars(E5W). t 0 1,as owner of the property,or my employees with wages as their sole compensation, will do Ne work and Ne structure is not intended or offered for sale(Sec.7W,Business and Professions Code:Ta Commerce'License Law does not apply to an owner hf Required Inspections property who builds or improves thereon,and who doessuch work himselfor through his own employees,provided that such improvements are not intended oreffered for sale.if, however,the building or improvement is sold within one year of compladon,the owner- builder will have the burden of proving that he did not build or improve for purpose of salej. (K1,as owner of the property,am exclusively contracting with phimead emnmmis to construct the project(Sec.7044,Business and Professions Code:)The Chnmctor's Li. cense law drum not apply to an owner of property who Wilds or improves thereon,and who contracts for such projects with a chmractor(a)licensed pursuant o the Contractor s License Law. 0 1.exe pl antler Sec. .B&P C far this reason Own Daoe WORK R'SC MPF.NSATIONDECLARATION I he Ire under penahy of perjury one of the following duclar�r ns. 1have ono will maintainection 37M of Me abtoCodensure farunommuma.of e smirk,r provided for by Senior 3]1%1 of tee labor Code,far the pemfhmancc of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as repaired by Section 37W hf the Labor Code,for am perfinemnec of the work for which this .it is issued. My Worker's Compensation Norberto carrier and Policy number we' Cartier: Policy Nh.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This Semon need nm W completed if the parmil is f o one hundred dollars(2100) or less.) 1 certify that in the perfoomncc of the work for which this permit is!wood.I shall nut employ any poem any mannersnax m become subject to the Wmimes'Campensaliun Laws of California'Date Applicant NOTICE TO APPLICANT;if,after making this Cet ifano of Excmptim, no should become subject to the Workers Compensation provisions of the labor Code,you most ,J O fudhwi th comply with such provisions at this permit shall he deemed awoken. „Z,t CONSTRUCTION LENDING AGENCY [-r Z, I notchy affirm thm dare is a construction lending agency far tee perfurmmcc of IY. > me work fur wh ieh this ..it is hsuW(Sce.3197,Civ.C.) W Q Lender's Name ❑. Lender's Address U Q 1 certify that 1 have read his aphis,min.and nate that the above infomoutat is U.Fcorrect.I agree to comply with all city and county omin=as and soon laws rclming to V building construction,and hereby authorise repreaemalivus of this city to enter upon the W above-menlimod property for inspection purposes. d (We)agree to save,indemnify and keep harmless the City of Cupertino against DO liabilities.judgments,casts and expenses which may in any way accma against said City C.1 Z in consequence of the granting Of this permit. ^' APPLI NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:3 Dale SOURC REGULATION '30-04 Re-roofs H Applicamom u HAZARDOUS MATERIALS CIRCLOSURE Type of Roof the Cupent orrtino Mure nicipal Code. hanum.12.re and handle h Draft aolous ftand Safety as ocfncJ by the Cupertino Municipal Code.Chapter 9.12,and the Hmhh and Safely Code,Section25532(a)? All roofs shall be inspected prior to any roofing material being installed. O Yes Will the spplimnl or future building occupant use cyvipmenl ar devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants an,defined by the Bay Arca Air Quality Managemcm all new materials for inspection. District? 0 Yes �q_lba I have read the hmallous materials remiumenu under Chapter 6.95 ofmc Califor- nia Heahh&Smcly CWa,Smtions 25505,25533 and 25534.1 endcmoand am if tee building does not currently have a avant that it is my responsibility m Muddy the oompml of am mquhm er ea to meet be melpdar isaumecofaeerdncaaof0c'upency. Signature of Applicant Date „3a-0L( ow aaxea agent rola ter 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 of N-1 TD Building Department JOB ADDRESS: PERMIT -75-3& 5 -f 07 0 1'� OWNER'S NAME: ,jov,� �( PHONE # 6 Sp— GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 30 0 ner a¢t r Signature D to aums, CITY OF CUPERTINO CITY CUPEI�TT INO PERMIT APPLICATION FORM APN # Date: 3 5� -ate -oa- 7- 30 -0 Building Address: Mailing Address (if different from building address): �7 S8 6 w n� 1.-..� Owner's Name: Phone #: X -AVl 6 s -99 6-Ii? V00 Contractor: License #: -7 5`l SOS Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect ® Plumb ❑ Mech ❑ Job Descripti p,a3 \Wo �z Lc RtLwl Ck is Ac St 6N� e h t�4an yk Residential Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy cup: Type of Construction. Please check project is a second-storyaddition: 11Project Size: Standard ❑ Jre ❑ Ma'or El Quantit Fee ID Fee Description Fee Group BAPPLOTHER OtherA fiances 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 1.7.5 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi 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 Energ BUILDING BENERGYADD Ener Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING lof3 �� o . 3 v ` CITY OF CUPERTINO 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 PbIg 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BRENLkUU AN 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> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMIiRAPP 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 WYOV CITY OF CUPERTINO CUPEPERMIT APPLICATION FORM Quantity 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 BSEISNHCRE Seismic Fee Res BUILDING BSPECL L 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 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 ZADDCHG Address Chane BUILDING 3 of 3