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04020064 ,/CITY OF CUPERTINO ""- '-- " -'�- — .:a„ n✓at ^,m � s-1> ate'^4 x _ BUILDING DIVISION PERMIT pCON1Rk1CTORhINIOiAIAIQN BUILDINOADDRESS: ROYAL SERVICES PERMIT NO 71 T,AN��lIATdg Air OWNER'S NAME: PERMIT ISSUE DATE ONE: SANDARYNO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO p LPO ELECT PLUMB MECH j LICENSED CONTRACTOR'S DECLARATION ��® (' 1 herby affirm Thar 1 am licensed under Provisions of Chapter 9(commencing Io ii wishll Co. ato Division 3Ortha Busimasand Profession Code,aM my lice..is ^< in full fore&anti& 51= UcanseCIT 44 Lie.Jr 2Y/&e'f REBUILD CHIMNEY FEB $ 2004 n Date z Y a Conuxter 2u YsIL SG/w c� ARCHITECrS DECLARATION � i 1 understand my plans shall be used an public records 'LLQ Le.udPmfesstanal OWNER-BUILDER DECLARATION BUILDING I hereby.(Sero that 11. exempt Inn the Contractor's Cc License Law for the 6OO followingtenon.Permit ]onsu B.ainurs andw. mans Code:Any city or county $vo which its hand a ,allu re Bores[be ober,hmpmve,demolish, file remit ed structure H y Pat mor is Pursuant to Lim thovislu etnt for auchnermitteea a Law(utement p that he is llc.nxJ PuesuenuO the nmvision of the Comr.wr's lJcen.law(Chapter Sq.Ft. Floor Area Valuation (commencing with Section 7")of Division 3 of the Business and Profession&Cede)or Net he Is exempt therefrom and the baso for the alleged enmptlon.My violation of Sermon 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of not mom than five hundred call.(11500). 3W`191- t4er00 Occupancy Type 0 1,U owmer of the prepeny,as MY employees with wages As their sole compensation, will do the work,and the structure is nm intended ororfend for *In(See.70,14,Business And Pmfesaiocs Code:The Canonical.License,law does ter apply te an owner of Required Inspections plapeny who Wi lds m her prows thereon,and who doesash wank hila W f or tbeough his own employees,provided thar.ch Improvemants—.at intended OroRemd(male.If. however,In.building or Improvement B saldwithin ane yes,of anpleda.,Ne an, builder will have the burden of playingN,i he did not Wild or Improve for purpose of sale.). / 0 I.as Owner of de property,em negluaiwly contracting with Insured comm cters to Wosrmet the pmjm(Sec.7044,Business and Profession Cade:)The Contractor's U. cense law does not apply 0 an owner of property who Wild&or improve themon,and who contracts for such projects with a conuxnr(e)licensed pursuant te the Contractor's License La- 0'...'relaundueScc aw.0lamescmptundueSec ,B&PCtar Nlamase, Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby grim under penalty of perjury arc of the fallowing declaration: I hoe and will rosined.a CertiOnte Of Caesars self-m-me for WOrke'.Compete 7C11 ion.a provided for by Section 3700 of the Labor Cade,for the performance of the rk for which this Permit Is issued. 1 have and will mainWn Worker's Compensation insuranm,as required by Section 00 of the laWr Code.for the performance ofthe work forwhich this permit is usual. workers Compensation Insurance carrier and Policy number are: rrier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE or Iless.)(TMs ucdo.need not W completed it the Permit b faro.hundred dollen($11) 1 certify the in Ne Pcrfmmance of the work for which this Permit is issued.I shall not employ any persan in any mar"A F mFsubjecl to the Wollues Compensation Laws of Celifomin Data T„< / Applicant— GY.- � NOTICE TO APPLICANT.If,aper making this Ceniricate of Esemption,you should Wc....Object to the Worker's C.amans tion provisions of IM Iaosr Cede,you muss Oz fOMwith comply with such provision car this Permit shall be lamed rewked. Z O CONSTRUCTION LENDING AGENCY r [-� T for which the there in courSec.3W . aCency l'or the perfurmma of G' the work for which this permit u Issued(Base J09],Co,Civ.C.) 0 Under',Nam. z Lenclanderi Md. f,Q I terrify that 1 have mad this applicsainn and clow that theabove infonnnion is corrttt 1 epee to comply with all city and county aNlnancea and ante laws elating m 0 Wilding construction,and hereby authorise repmaaftno l of this any te enter Open the CCl aWvetme judgra property fm inpamses propwhich ms C4 (We)agree to save,indemnify and kap harmless fee City or carton,against Z liabilac.itigancc c the granting and of this mayinany way accmc against said City V z in conxgancc of the gnnOnC of this premie. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULA NS. Signature 'Dam Re-roofs StgnuofApplic _HAZARDOUS MATERIALS DISCLOSURE Dan Type of Roof Will the applicanture Wccu or for= occupant sone m handle haessdous Maeriel as termed by tie Cupertino Municipal Code.Chapter 9.13,end the Health and Safely Cole,sc0cYes 25332(a)? 9d-' All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building mupanl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove I hagrdnus air conuminnby rd Ocd by the Bay Area Air Quality Management all new materials for inspection. 7d�- uict7 ❑Yes ON. I have mad the hamdnua materials mquircments under Chapter 6.95 ofthe Califor- nllhametlyCodc,ScctiouhatitimyrearAnd 25534.1undeilythe rtheWifiam not cumcntiy howate Natiti&myenare cilityicmof the acupant of tiw G ire/mctnyu�M'menmaat Ipoor wissnanaanc.o]O.awarOccun ry. Signature of Applicant Date Owner oraathamcda l �)�' Dal — All roof coverings to be Class "B"or better z CITY OF CUPERTINO C5Y O aZ CUP TYOF O PERMIT APPLICATION FORM ISAPN # Dte _! q a : o11 ll Building Address: Mailing Address (if different from building address): i0r7l LW15dkQ Owner's Name: Phone#: Tyle leaen lu/S 6;5 - Contractor: License #: L! aOY& ,SC'CUCe5 Contact: T Phone: g31 y62053J Cupertino Business License#: i oti` m i L Fax: Building Permit Info: Bld D— Elect ❑ Plumb ❑ Mech ❑ Job Description: r Residential JV w a N RJcrr Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: o� Occupancy Group: Type of Construction: Please check this box if the project is a ,,4second-story addition: ❑ 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 Toiler—> 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 500V> 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 1 of 3 If n 6- CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO -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 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 Heater/Vent 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> 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 2of3 Milk it Sam CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM QuantityFee 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 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 BSEISMICRE Seismic Fee Res BUILDING ! BSPECIAL Special Insection 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 ELECTRIC MFAL MPEREE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING BMISCELL Building Misc Fees BUILDING i i 3 of 3