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04020149 CITY OF CUPERTINO � GR BUILDING DIVISION PERMl� rAG NG ADDRESS: PERMIIND 04020149 4020I49 CRW INDUSTRIES PERMIT ISSUE DATE 'S NAME: SANITARY O. CONTROL NO. : BUILDING PERMIT INFO ITECT'/ENGINEER: BDG AES PLUMB O LICENSED CO NTRACQWSDECLARATION Job Descripton mI hereby affirm Nat I ann deemsed under provisions of Chapter 9(CommencingcMu70f90)o(Division3oru Bus dpmfC.MnaCodc,a.duty0ccngaa o�eay. at REPLACE WINDOWS (G) �pR tib 2004 Gl�P Sy�b ong9-46-oy Contractor ARCHITECTEC RATIONO ❑ ❑ r� m1 nk�Smnd my plans shall he used u tic rtenrdsU II In\\\`V'll I\/I\fit`/_—vJ/s Ij VIk. ed Professional0OWNER-BUILDER DECLARATION 1 hemhy affirm Nal I am exempt(rum the Contractors License Law for the '0 following rteson.(Section 7031.5,Business and Psafes wins Cale:Any city nes county $ 99 which acquires a permit m eorowet,niter.improve,Muralist.or repair any structure ricer to its issuance,also requires the applicant for such permit to rile a signed statement Valuation : pdicorsnsedder S Ft. Floor Area ss< (commMet he encingscdpurstion7 )ofDiviansnofMeBConmnessandPiarnewaCode).1 q• F$ (commencing encingept MA.f,.m Kitt ofD Division Aleusin..pi...Any Crde)or 'Net he Is 31.5 b t." Pidi and the bob for be alleged exemption.Any violation n( no,. 7031.5beury reddenars($5crmitsubjccuNcapplicanuo¢civilpenaltyof 3� Qg•pp Occupancy Type not mom Nan Eve hundred dollar(E500). ❑1,as owner of Ne property,or my employee¢with wages As their sok compensation, will do the work cad stagnation,is at intended or offered initial.(Be..IDM,Business Required Inspections and Professions Code:The Conmciort License law does not apply to an owner of property who builds or improves Narcan,and who does such work himself ar through his own employees.provided that such improvements are not intended orolQred forsale.If. however,the building or improvement is sold within one year of completion,the owner' builder will have the burden of proving Nat he did not build a improve for purport of sal..). ❑I.as Owner of the property,am exclusively contracting with licensed contractors m construct the project(Sec.70&4,Business and Professions Cade:)Th.Conmcdr's Li- Case Law docs not apply in an owner of property who Wilds or improves Marcos,and who contracts for such projects with a eontramor(s)licensed p....At to the Contractors License Law. I em ammpt under See B k P C for this andan Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby aRmn under penalty of perjury one of Ne following declarations: 1 he and will Mariann a CeNOeate of Consent to self-insure for Worker's Compen- sOinn,as provided for by Section 3700 of Ne Ube,Code,for Ne perfmmance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section 391 of the labor Code.far Ne performance of the work far which this Permit is issued. My WoJJJ�m,s Compensation Insurance aeries and orq umber am: &,{¢(#1161 Tm$, 460191 policy .: D01 D67K-2001 ✓✓ CERTIEICATE OF EM OM WORKERS' COMPENSATION INSURANCE (Thisscction need not becomple¢d If the Permit is f rronc hundred dollars($100) or less.) al certify that in Ne performance of the work for which Nis permit Is issued,l shall not employ any person Many mann.,.as to become subject tis the Wmkeri Compensation taws of California.Date Applicant NOTICE TO APPLLCANr:If,after making Nis Ceniricao of axcmption,you should became subject to Ne Worker's Compensation provisions of the labor Code,ynu mug ,Z forthwith comply with such provisions or this permit shell he deemed revoked. ti O CONSTRUCTION LENDING AGENCY I hereby M.that there is s ed(S.3 lending agency for Nc performance of .0 .moi tiro work fur which this permit is issued(Sm)099.Civ.C.) y A ner's Name U �z Lendder's Address . J C) 1 certify Nat 1 have rad this application and sole that the above information is S. F Correa I agree to comply with all city antl county oNinantts and sora laws relating to V building consweton.and ga,ereby indemnify repmsenotivu of this city to ammo ago upon the �� abovcmentioned property for inspection purposes. (We)agreer to ave,indemnify and keep harmless the City of Cupertino against fq liebllities.judgments,casts and expenses which may in any way accrue egeinstaaiO City in consequence of Ne granting at this permit. Date (.1 z APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: SOURCE EOUL O - 4 oY Re-roofs Signa o App man Convector We Type of Roof HAZARDOUS MATERIALS DISCLOSURE ill the applicant or future building occupant store or handle haamous material as de tied by Ne Cupertino Municipal Code,Chapter 9.11.and the Health and Safely Code,Section 25532p)? All roofs shall be inspected prior to any roofing material being installed. ElYa )<No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or forum building occupant use equipment or devices which mit hazardous air contaminants as defined by Ne Bay Area Air Quality Management all new materials for inspection. District? ❑Yeses I have mad Ne hmaadneramaterials requirements under Chapter 6.95 o(Nc Califor- maHoaW afety CaM.Sados25505.25533ud8534.1undOsond Motifde budding does not cu soy have a can Nat' is my responsibility to notify Ne occupant of Ne require 0' Ch/mg uneeoreeeN�amdraZgi. 9 Signature of Applicant Date IfAll roof coverings to be Class"B" or better Ow r authorised gem Doc v Q- CITY OF CUPERTINO cuPE riNo PERMIT APPLICATION FORM C1TY OF N# /0 , /S� Date: V .2-113-oy Building Address:I Mailing Address (if different from building address): 19801 to r"Aq DR1J6 Owner's Name: Phone : &OiLLS0.0to OR717 ,Yoe 2-62 -2GSG Contractor: License #: C. A.0, yoagB Contact: Phone:4oa Y"-0e,$ Cupertino Business License#: EAN 2CFTegFax: yog _2goq Building Permit Info: Bldg Sf Elect ❑ Plumb ❑ iMech ❑ 'Job Description: Residential 9 Rvp,^ra 51K of 64wo> Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project:(P)1400, 00 Occupancy Group: Type of Construction: Please check this box if the project is a —second-storyaddition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER OtherAppliances MECHANICAL BBLDGFEE Bldg Permit sq. foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1 M 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING # C-9-'Sl l of3 73. 7S_ aCITY OF CUPERTINO 4 CITY of PERMIT APPLICATION FORM CUPEkTINO Albk WQuantity Fee ID Fee Description Fee Group BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Conon 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 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 BREMAUU-IAN 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 > 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 BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL 2 of 3 ®rwmmpr'r"':: (p: ?ITY OF CUPERTINO • CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMTHEATR eatrical Lighting Fix ELECTRICAL BREMVENFANJEScb nt Fan Sin le Duct MECHANICAL BREMVENSYS entilation Systems MECHANICAL BSCBLVD Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimmin Poo] BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem ora Rldo Permit BUILDING 13TEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERNIITFEE Mech Permit Issuance ME,CHANICAL. PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 SED '�2 $tD 3 LIvIKU ROO W. Fau�Y Al m .. N co G'I ori Ertiay ? tT C o1 na F—F r a '. zi. L (48Ot LA wU+k DR'iOE JPERSt NO GA 95011.1 f� &LALLeAK(O ORi17 - CQ.I.J, 1NDJb IBIAZTER � - - { 8�i - krwau - �A2ACSE LoUcrt sll F4€ierF� io lu�� ' EGRESS RGQJiggy�,gµ�y 14801 LA MAR D(2IOF GJ(�ERTtko GA 950ty 40eal Fol ALi Ls (3 L) LL-ERkto 02CiZ_ $jOT ELE 47-toloNl T&IOom2iG's hro,-bn3l� P!RN �sv9L�C+tJ3f1 SS�Ui7� _3,.�3 LN OJ/ Oh ;K.(6 ��zZ XQ 'nfOU3 �NiN3 39tlY11i3 , �rnb Dal 3,�'nV 3b AyN13$ ,0 i, nnwd Z®9 $aa8 S21L34PQ1'�T 'C7 ?j� . ZI!-dQ otnL3�� ® _ 9ot0 Q *N"m b 1ovbi CITY OF CUPERTINO BUILDING DIVISION PERMIT * CONTRACT,ORINTQ,RMATIQN:'. •sy Nt<d. .n, suia�., BUILDING ADDRESS: CRW INDUSTRIES PERMIT NO 04020149 Ig2ni T,A MAP IDR OWNER'S NAME: PERMIT ISSUE DATE JNE SANITARY 0 ONTROL N0, ARCHITECI'/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH u o o LICENSED CONTRACTOR'S DECLARATION �a I hereby,from Nat I amlimound under provisions of Chapter 9(commencing Job Description with Section A)(107n1'Division 3ufthe Btimpl3rd Profession Colaindmy license is tIin full _ Dt� f REPLACE WINDOWS (6) ? License m.N a'a Date 2-20-04 Cuovelod qq \ , ARCHITECT EC RATION 1 u4ssdnd my plans shall he used irFuhlic records ,yU oG Licensed Professional OW NEOER DECLARATION I I hereby affirm that 1 emrn exempt from the Contractor's License law for the 00 following reaan.(Semlon]831.4 Basin",and Professions Code:Any city or county E$� which mi a permit In construct.alter,improve,demolish.or repair any mmaure �y prior o its issuance,also requires the applicant for such Permit to Blc asigned statement < Nat he is licensed pursmm�othe pmvislonanfbeContmetor'sLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation e�� (commencing with Section FOOD)of Division 3 of am Busimasand Professions Cole)or i $ Nu he is monot therefrom and vice India for Be Alleged exemption.Any i alwitso of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3.A.pAiri.nw..f.� O O not mart than Iva hundred dollen(1500). tp�Y LL U6ft�r WW r Occupancy Type ❑I,asowner of the property,or my employs.with wages As their so is compensation, wilt do the work and the swoon,is not intended or offered for sale(Sec.]044,Busit.a. and Professions Code:The Connemara License,taw do.not apply to an owner or Required Inspections propeny who builds or improm version,and who does such work himself or though his con cmployecr,provided Rm such improvements are not intended ar offered forsale.If, however,the building or improvement is sold within one year of completion,the mener- builder will have the burden of proving vat he did not Wild or improve for purpose of Aide.). 1,as owner of the pmpeny,am exclusively contracting with licensed mnnmors to concoct the pmject(Sec.704x.Business and Professions Code:)The Contractor's Li �� 1 O come law dues not Apply to an owner ofpmpeny who build,or improv.daemon.and 1 La CU Y)IlOy7 who connctsfor such projects with a commercials)licensed pursuant to the Convector's License Law. Of eacmpt under Sec. .B h P C for this..on Owner Date OVu , WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a CeniGesm of Content to self-insure for WorelS Compere nation,az provided for by Section 3700 of the Labor Code,for the performance lithe work for which this pnmit is issued. ❑1 have and will maintain Workers Compensation Insurance,.required by Section 37W of the tabor Code,for the performance of the work for which this permit is issued. My Wo sir's Compensation Insurance carrier and1111-1vum her are: v.61/f4NkQV'(SMi, 46aels( Palirya .: D01087S—10s�S CERTIFICATE OF EXEMVft&4OM WORKERS' COMPENSATION INSURANCE (Thissection need nm hecompleu d if the permit is for one hundred dollara(Slot) or less.) I certify dam in the performance of Be work for which this permit is issued,I shall not employ any person in any manner so az In become subject to the Workers Compensation Laws of Califomia.Date Applicant NOTICE TO APPLICANT:IL after making vis Ccnif'tcate of Exemption,you should become Subject b the Workers Compensation provisions or the tabor Code,you must .JO forthwith comply with such provisions or this permit shall W deemed revoked. Z'` CONSTRUCTION LENDING AGENCY (-+ Ihemhy&firm that them is a construction lending agency for the perfumarm,of D z thmi Bic work for which this pert is issued(S..3097.Civ.C.) W Q Lender's Name 0' Lender's Address V 0 1 unify vet 1 have read vis application and state that the Above information is W F' correct.I agree to comply will all city and county eminences and sum laws relating m O V building construction,and hereby authorise repreumunos of via city to enter upon the W ah.w.memiomed property for inspection purposes. LL (We)agree m save,indemnify end keep harmless the City cf Cupertino against y liabilili.,judgir.oda .ts and experts.which may in any way accrue against said City of the greening o(vis conot. V z APPLIC WNTCUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE EGUL 0 04 Re-roofs Sign a App ican Contactor Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof ill the applicant or future building oceupanumre or handle haamoue material az de seed by the Cupertino Municipal Code.Chapter 9.11,and Be Health and Safety Code,Section 15532(x)1 p Ys �Na All roofs shall be inspected prior to any roofing material being installed. Will the applicant or fumm building occupant ase equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it harsdom air contaminants as defined by ve Bay Arca Air Quality Management all new materials for inspection. Jlstrict? ❑Yes 19rNu 1 new real the les armas materials mquiremenu under Chapur6.95 of the Calif. nix Health efctyCodc.Section 15505.15533 and 15534.1 understand that Italic blinding docs not curt rally haw a tenon vat' v my maperaihiin,m notify the accupant or the require ri h at o m is of a CCMLC 'nf Occupancy. Signature of Applicant Date / 21 24-Ad All roof coverings to be Class "B" or better Ow authorized gent Date