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03080102CITY OF CUPERTINO '= `II .a, '. GONTRACT444,3 'ORMATIQN BUILDING DIVISION PERMIT BUILDING ADDRESS: SAIZ ROOFING PERMITN003080102 OWNER'S NAME: 2951 REMINGTON WY PERMIT ISSUE DATE NE: (408) 275-6566 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION lob Description P I hereby affirm that I am limned under provisions of Chapter 9 (commencing widiSec'aa OM)rfDivision 3o NC Busi Professions Calc, end my�'cen Lice. INSTALL SKYLIGHT (44 1/2 X r�3�d ; Date Crntr r �iA ED TS R H CTS AR ION I understand my plans shell M used as public records JAN 017 2004 Licensed Professional OWNER -BUB -DER DECLARATION 1 hereby ,(Sect I ore exempt from the Contractor's License Law for the following a on 7(131.5, Business and ioli os,: Any city for county BU' permit reconstruct, alter, improve, demolish, or repair any which acquires emit t vs,. de h, is s statement poor re its tensed c, also req. the the applicant for such permit In thea signed statement its n that urnment the provisions License Law (Chapter Sq. Ft. Floor Area Valuation or (commencing Section land Division of ona)or (ret Business and Professon. 35623014.00 r Any vi lation I that he is exempt thcmfrom and Ne basis far the alleged exemption. Any violation of he is the But al eged APN Number. Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner ofthe property, or my employees with wages as their sole compensation, lUi — d Inspections will do the work, and the suuerere is not intended reoffered forsole(Sec. 7044, Business and Professions Code: The Contractor's License, Law does not apply to an owner of 102 PIERS property who builds or improves thereon. and whrdees such work himselfor through his — own employees, provided that such improvements arc not intended oranered for ads, If, 103 — UFER' hmvever, Ne building or improvement is sold within one year of completion, the owner, builder will have the burden of proving that he did not build or improve for purpose of 104 — REBAR sa1c.). 105 — ANCHOR BOLTS ❑ I, as owner of the property, am exclusively contracting with licensed contractors to consumer fire project (sec. 7044. Business and Professions Code:)no Contractor's u. 106 — SEWER & WATER cense taw docs not apply to an owner of property who buins or improves themon,and, 202 — UNDERFLOOR PLUMBING who contracts for such projects with a contruch r(s) licensed pursuant to the Contractor's Lic'Mc Law. 203 - UNDERFLOOR MECHANICAL ❑ l am exempt under See. .B& P C for this mason 204 — UNDERFLOOR FRAME owner Data 205 — UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby aT.utitler penalty of perjury an or the following deearalmoc 301 — ROUGH PLUMBING Jyt have and will maimed. a Ccrtificme of Co..., towlf--insmc for Worker's Cwb cm- 302 — TUB & OR SHOWER Baden, as provided for by Section 37W of the Labor Code, for the performance of the 3 03 — ROUGH MECHANICAL work for which this Permit aisaed. 304 — ROUGH ELECTRICAL ❑ 1 have and will maintain Worker's Compensation Insurance, u teyuimJ by Section bye lection wa 3 0 5 — FRAME pned J7W of the Labor Code, fpr the per rmamec of Ina work for which MMy.W�rkeraCm a i6a1. S�pcec� a y� 306 - HOEDOWNS � CC RR ITCATEOFEXEMPT It FROM WORK R 307 - INSULATION COMPENSATION INSURANCE 308 — SHEETROCK anisseetionread nrtmmmpl�udiohePermit isforma, hundred dollars (SIW) 309 — EXTERIOR LATH mrl.sa.j 310 - INTERIOR LATH ' certify Not in the performance of the work for which this permit is issued, 1 shall Out employ any manner so aswbecome subject athe Wodcrs'Compensation 311 - SCRATCH COAT ffimainany Lawn arEc.mmia. oeb 313 - ROOF NAIL APNi.mm 501 - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: If, after maki ng this Certificate of Exam prion, you should become suhjen to the Worker's Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permB shall be deemed revoker. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that them is a Construction lending agency for the serfurannownnot 504 - FINAL BUILDING ENERGY due work far which thin permifisarmed (Scc3(19'I,Civ. C.) Lend''s Name 505 506 - FINAL ELECTRICAL - GAS TEST /Q� Unites Address 1 certify Nall have cited this applicationandordinances sure that tnd above information is cortect. 1 ertif m comply with all city and county dtothe and state laws relating m 5 0 7 — FINAL PLUMBING U — building construction. and hereby aurhoom representxliv.e Of Nis city to enter upon Ne FIN ME#NW' CL shove-mcntionetl property for inspection purpaus. (Wit) agree to save, ind.mmfy and keep harmless the City of Cupertino against liabilities, judgments. costs and expenses which may in any way seems, against said City O 9 FI 5 m Connecticut. or the gmming rf this permit.APPLIC ERSTANDS AND W LL COMPLY WITH ALL NON -POINT Issued by:5 ORKS Date SOUR ON Re -roofs Typp of Roof ere of ApplicaniccoursoM Data HAZARDOUS MATERIALS—DISCLOSURE O Will the applicant or future building occupant Blore or handle ha mus extend as defined by the Cupertino Mantel Code, Chapter 9.12, and the Health and Safety Code.Section 25532(a)? All roofs shall be inspected prior to an roofing material bei. Installed. P P Y g P [3 Yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or futum build i g occupant use equipment or devices which Iharamous air conmmina 11 as cd by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes r I have mad the handous materials requirements uncer Chapter695 of the Califon nia Hmlth&Safety Cod.,S.cumla255)5.25573and25534. 1 and recto]Nwifthc It Ing does not current have a tartan, that it is my responsibility m no� the ' upent of the - race . ts knn nl c prirrwi eve Trace mestere C .r. ignatuie of Applicant � Da All roof coverings to be Class B' or better Owner rr authmucJ .,cut_ ale CATV OF CUPEkTINO CITY OF CUPERTINO U 3 oS o PERMIT APPLICATION FORM ,y t Quantity Fee ID APN # J Date: BAPPLOTHER Other Appliances ` O BBLDGFEE Building Address: Mailing Address (if dif e ent from building address): BUILDING Owner's amp: Boiler <= 100,000 Btu MECHANICAL f 0 / c[7 MECHANICAL Contractoti License #: MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL Co act: Phone: Cupertino Business License#: MECHANICAL Fax: Construction Tax BUILDING Building Permit Info: Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Bldg Elect ❑ Plumb ❑ Mech ❑ BUILDING Job Description: 7Co�[finercial . Hotel and Motel Residential S BCONSTAXR Sq.Ft. Floor Area: � � I $/S� BELEC1000 t of Project: Occupancy Group: BELEC1001 0 ELECTRICAL BELEC200 Ty e of Construction: Please check this box if th project is a BENERGY Energy second-sto addition: ❑ ,y t Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot 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> 1.75M 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 BINVESTIGA Investigation fee BUILDING i BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of y^4 p% ; ,- CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 2 of 3 Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res 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 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 BREMAIRHAN --. 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 BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 CITY OF CUPEI,TINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmd] Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BT Svcs 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 w A 1