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03110051CITY OF CUPERTINO- V b %CON�TRACT0RaINFORMA BUILDING DIVISION PERM* SUILDINGADDRE3S: CAROL & TOM MAKDISSY PERMIT N003110051 OWNER'S NAME: PERMITISSUE DATE CAROL & TOM MAKDISSY--- 11 12 2003 E: SANITANO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDC ELECT PLUMB MECH LICENSED lEh DECLARATION Job Description I hccby afrmtIaCONTRACTORSduderproChapter 9 anmmeneing with Section 70(X)) of Division 3 of Ne Business and Professions Coda. and my license is infnmreeandeffeet. n WINDOW REPLACEMENT License Class Lic. g Date Condonation - ARCHITECTS DECLARATION I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION -, 1 hereby affirm that I am exempt form the Contractors License Law for the Following reason. (Section 7031.5, Business and Professions Code: Any city nr county which requires a permit to conavuu, alter, improve, demolish, or repair' any, structure 3 O O O prior to its issuance, also requires the applicant for such permit m Glc a signed natemenl that he is licensed pursuant n the provisions of the Contractor's License Law (Chapter 9 Sq. FL Floor Area Valuation (commencing with Section 7000)of Division 3 of the B usiouss and Professions Code) or 36933024.00 Nat he is exempt themfrom and the India for the alleged exemption. Any v_iolauon of Sectioo70315 byeny applicant forepemili sub)ccu the applicant to a civil pi- --'--__—-'- APN Number --------- ---- - Occupancy Type not mon the rive hundred dollars (s500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the swaure is not intended or offered for sale (Sec. 70,14, Business and Professions Cade: The Commah 's License Law does not apply to an owner of Required Inspections property who builds or improve thereon, and who does such work himself or though his awn employees, provided that such improvements ars, not intended or offered for sale. If, however, the 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 este.. ❑ 1, as owner of the exclusively contracting licensed convectors 1. Sec. 704, , B COr cense law docs not apply to an owns of property who builds or improves rme al does non apply to an Owner ass and Professions ds or i The Convectors nd and v who eo Lads for such projeeu with a contranar(s) licensed pursuant to the Convectors Commoners Lice Law. ❑ pi under Sec. B & P C for this reason 2 D nor Data `W ER'S C_ LARAData 1 hereby affirm under penalty of perjury o f the following declamsians: - v hive and will maintain aCenifcam of Consenue self -insure forWmkcr's Compen- selion, as provided for by Section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of Ne Labor Code, for me perfrmance of the work for which this permit is issued. My Workers Com pencelan Insumnre earner and Policy number are: Cartier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he camPlued if the permit Is for one hundred dollars (SIM) or loss. 1 ecnify that in the perfurrome, of the work for which Nis Permit is issued, l shall nut employ any Person in any mannerso as in become subject to the WorkersCompensntion Laws of California. Dam Applicant - NOTICE TO APPLICANT: If, after making this Can nonce of Exemption, you should become subject in the Worker's Compensation provisions of the Labor Code, you must forlhwi the comply with such provisions Or this Permit shall he deemed howled. - CONSTRUCTION LENDING AGENCY a I hereby affirm mat fere is a construction lending agency her the performance of the wurk for which this permit is issued (Sec. 3W7, Cr, C. Lender's Name Lorder's Address 1 certify unit 1 have read this application and sum that the above information is ' correct. I agree to comply with all city and county eminences and stale laws relating to building Conswction, and hereby amhorim u pros naladves of this city to enter upon the - abovc-memiuncd popc fan inspection (We) agree to save, indemnify and keep hannleu the City or Cupertino against Purpowhich ms. costa liabilities,Judgf n and expenses which may in any way eccmc against sai0 City ees ince r in con genet of fine granting nhhis permit. .f�a APP C UNDE TANDS AND WILL COMPLY WITH ALL �.v�l-POINT 0 R REGULAT, N Issued by: Date Re -roofs S' natme of Applicanvconvacmr Data HAZARDOUS MATERIALS 015 LOSURE Type of Roof Will the applicant or future building aecupano smoe or handle hazardous material as defined by the Cupertino Municipal, Code, Chapter 9.12. and the Health and Safely ' Code , somYetia2ss3z(a)? / ta All roofs shall be inspected prior to any roofing material being installed. Will the applicant or tura IrBamg rmrpam oda egaipmam on dtmeed which - If a roof is installed without first obtaining an inspection, I agree to remove it hazardous it cmourtaanu es definod by the Be, Arca Air Quality Management all new materials for inspection. isvicR El Yes Nu I have mad the hmartlnus materials requirements under Chapter 6.95 of the Cali mr. eIFl Ith& Safety Code, Scctioro 25505,25533 and 25534. I undcmmnd motif dm huilding docs�c 1 curtendy no a ant. tit is my responsibility m nndl'y the cecupant of the reqs emotswhle ( met ri manroofaccrdficamofOccupancy. Signature of Applicant Date � All roof coverings to be Class "B" or better g Oil cr rr authorized agent pmc L-' This set of &fis and spcdiUm be kept orNhe job at all tlilnaa and lawful to- make any changes 6r al on same without written perprisslo the building Dept.,city of clorti: The stamping of this p an an , a i SHALL NOT be held to par approval OfL the 44"1, of any City Ordinance or 19 LIM Lea WST 6% nth 8406WIk if, I a[TOF CUPERTINO *ITY OF CUPERTINO PERMIT APPLICATION FORM N#3 p Date: Buildin A dr s: / Own Name: -OA Phone #: � as -7,5F— Contractor: Sed License #: Contact: Cupertino Business License#: Building Permit Info: Bldg Elect ❑ P umb ❑ Me ❑ Job escription: Residential ❑ coal Sq.Ft. Floor Area: /Sq.Ft.: Cost of Project: /-occupancy Group: Type of Construction: 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 BMITIGATC Comm. Housing Mit. Fee BUILDING Z 3 rf 1 of anCITY OF CUPERTINO OITY OF CUPERTINO r PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMMI 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 BNUSFD New Single Family Res BUILDING 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 Sprinkler/Bac flo PLUMBING BPSTORM Stom-/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 BREM 3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMEURN Relocation ofFumace 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 0 2 of 3 WITY OF CUPERTINO* cMo PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res A liance ELECTRICAL 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 COM Seismic Commercial BUILDING Seismic Fee Res BUILDING IAL EMBSEISMICRE S ecial Ins ection BUILDING IM Swimmin Pool BUILDING P 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 PlumbingPermit Issuance PLUMBING PPLBG PlumbingFees foot PLUMBING ZADDCHG Address Chane BUILDING CI 3 of 3 ITY OF CUPERT[NO Ice l°�t»M BUILDING DIVISION PERMIT CONTRACTORINFORMATION:` FB10`I`;Nc;-; LDG ADDRESS: CAROL & TOM MAKDISSY PERMIT NO03110051 ,R'S NAME: PERMIT ISSUE DATE CAROL & TOM MAKDISSY 11/12/2003 ONE: SANITARY NO. CONTROL NO. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 i0 F LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing Job Description tW with Section 7000) of Division3 of NC Business and Prufcsxions Code. and my license is in full force and effect. PINALED ii License Class Lic.g WINDOW REPLACEMENT Dose Cumracmr ARCHITECTS DECLARATION '] NOV {� V ZOO] I a U ns I understand my plashall W used as public records {t; License] Professional t� OWNER BUILDER DECLARATION ON : $ Contractors 1 hereby affirm thin 11. exempt from the Ga License Law for the BUILDING ioncla(4 (Section 91onstr Business and Any city or county masares which re a h.Code: which rctsiireso it) construct, improve demolish. any alter,ait me 00 :y ;� a sir ,also gednaumum prior it) issuanre,aisa rcyvires the applicant far such permit to BlcasigneJ smmmem the for such Perlia that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation - ;a (commencing with Section 7000)ofDivision3of the Businesaand Professions CMk)or 36933024.00 — that he u exempt therefrom and the basis for thetio alleged exemption. Any violan of Section TWLS by any applicant for a permit subjects the applicant to a civil penalty of AIN Number ane Occu Occupancy Type not more than five hundred dollars (S500). ❑ I, as owner of Ne property, or my employees with wages= Heir able compenadon, will do the work, and the structure is not intended or offered for sale (See. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon, and who does such work himulfar through his own employees, provided that such improvements are not intended or offered for sale. If. however, the building or improvement is sold within one year of completion. the owner. builder will ban the burden of proving Nal he did not Wild or improve for purpose of sale.). ❑ I, as owner of the property, am exclusively connecting wit licensed contractors to conswct the project (Sec. 7044, Business and Profeesions Cade:) The Contractor. Li. cense law does not apply to an owner of property who Wi Ids or improves thereon, and who contracts for such projects with a coneacmr(s) licensed pursuant to the Contrector's Lmcn Law. ❑ attempt seDa&, Sec.B & P C for this moon r ,X ////�f</%✓f % date/ — 6 W ER'S COMPENSATIOt; S LARAT1oN , I hereby affirm under penity of pe do, f the following declarations: I ban and will maintain a Cmificale of Consent to self-insure for Worker's Compere satom, as provided for by Section 7700 of the Latin, Code, fee the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700of the labor Code, for Ne performance of Ne work for which this permit is issued. My Worker's Compensation Insurance varier and Polity number au: Carver: Policy No.: _ CERTIFICATE OF EK EM PTION FROM WORK ERS' COMPENSATION INSURANCE - (ITh section recd not W completed HIW permit is intone hundreddollars ($100) or less.) 1 certify thus in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner an as to Wcome subject to the Worker: Compensation - Laws of California. Dam Applicant NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you most ,Z forthwith comply with sum h provisions or this permit shall W deemed marked. D CONSTRUCTION LENDING AGENCY jI hereby oRrm that there is a construction lending agency far the performance of the work fur which this permit is issued (Sce. 3197, Civ. C.) Lender's Name Z Under: Address Ci I certify Nall have read this application and sexic dot the show infannauun is —' correct 1 agree to comply with all city and county ordinances and state laws relating to jbuilding convection, and hereby authorim representatives of this city to enter upon the for inspection yehovcmcminneJ A properly purposee (We) agree to save, indemnify and keep harmless the City of Cupertino against tortillajudgmcna casco'"deapcnua which may many wayaccmc againsstt said Cityin / his Permit. of tAND APPn C NT UNDEgroTANDSnLmS WILL COMPLY WITH ALL f)l-POINT 0 R REGULAT N (f/ Issued by: Date f/ Re-roofs t nature oMpplicanv ontnmor - Dam HAZARDOUS MATERIALS DIS LOSURE Type of Roof Will the applicant ser future building mcupantsmre ar handle havamous material defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety . abort 25532 ❑ Yea (a>? All roofs shall be inspected prior to any roofing material being installed. Will the applicant ortore building a cupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove It hazardous air conmminams u defined by the Bay Area Air Quality Management all new materials for inspection. isuict? ❑Yes Nu I haw beet the WnNnus materials requirements under Chapter 695 of the Califor. calth&SafetyCo,&Cuons25505.35533md25534.lunJm=dthalifthe Wilding acs t curtenay ho ant tit is my mepanihility w nouly the oecupant of the retia menu wide met don venae ofa Certifies¢ of occupancy. Signature of Applicant Date w Far aumodmd agent Dam All roof coverings to be Class "B" or better g