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05060185 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INF,�ORMATION BUILDING ADDRESS: CRWINDUSTRIES PERMIT NO 05060185 P98 T.TT.Y AV OWNER'S NAME: PERMIT ISSUE DATE MARY JANE OLMSTEAD ONE: SANITARY NO. CONTROL NO. (408) 378-2477 ARCHITECTflENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 �Oo LICENSED CONTRACTOR'S DECLARATION Job Description a stoi G 1 hereby affirm Uta 1 am licensed under provisions of Chapter 9(commencing p G with Sccuon 70B11)of Division 3 of NC Businev PrufcssiurLs Code end myliccnro is License Class e .t { PATIO DOOR REPLACEMENT j�Z Lio. Z_mss Cmur —q Dale /_ ��Can DELL 7 ala sshall use DECLARA O Ky I understand my plans shell W recd as politic records JyV o G L¢cnsed Professional 5 OWNER-BUILDER DECLARATION iZ I hereby infirm Nal 1 am exempt from du Contrauors License law for Me 00 following mason.(Section703 L5,Bms ineand professions Code:Any city or county K$ which.,.I.is permit to construct,slur,improw,demolish,or repair any structure prior to its issuance,also mquites the applicant for such permit to File a signed statement -114 ' z< That he is licensed pursuant to the provisions of Ne Cmiractur's License taw(Chap¢,9 Sq. Ft.Floor Area Valuation P: gommeneing with Section 7000)of Division 3 of the Business and Professions Cade)or si .. that W u exsmpt Memfrom and the basis for the allcgcd exemption.Any violation of Secdon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 9Y193QMcr 0 0 Occupancy Type not mart Nan fist,hundred doll.($W. 1,as owner of the prepeny,or my employees with wag.u Nair cele compensation, will do the work,and the Machin:is not intended or offered borate(Sec.7844,Business and Professions Cads:The Comnctota License Law dant not apply m an owner of RequireMnspections property who build,or improves Netcon.mal wbodo.such work himself.through his own employees,provided Nat such improvements.not intended oroRerad fosala.If. however,the Wilding or impmwmem is sold within ane year of eomplation.the owner. builder will havee touched of proving that bo did not improve or imProfor purpose of � sale.). ❑1,as owner of she property,am exclusively contracting with licensed contractors to ` construct Ne project(Sec.7044.Business and Profusions Code:_)The Contractor's Li- /�[� who law dr.not appy w an with 3 of pmpcny who Wilds ra Improv.Conran.and /U1�/ �� ZOo� whonse Lace for such projects with a eontractoKq licensed pursuam m da:Contracmt, I/`/>ls(/(�/J//// License law. ❑l am eamrpt under Sec. ,B A P C for Nis tenon Own" Dau ®Gf,� WORKERATI 'S COMPENSATION DECLARATION /Ct/1`/\Jy 1 hereby aRia under penalty of perjury me of tha following declarations: V I haw and will maintain a Cenifiau of Consent to selFinsvm for WorteraCempcn- 7371W an,.pmvided for by Section 37M of he Iator Crile,for the performance of the rk for which this permit is issued. 1 have and will rematos Worker's Compes.au0n Insurance,.no,ored by Section of the IaWr Code.for d¢peRoaanec of the work for which Nis permit is issued. yWokct``s Co pe ours lnsuance amu and Policy num ase:ricr.'J � �c/ND Policy No.: 0 CERTIFICATE OF EXEMPTION FROM WOR RS' / COMPENSATION INSURANCE (This scent.send not W complewd if the permit Is furl oc hundred doll.(SIM) or less.) I certify that in the perforromme of the work far which Nis permit is issued.I shall not employ any person in any manner an as as ocome subject 0 the Workers Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Com,onsadon previsions of the Labor Cade,you muss .J O foMwith comply with sh such provisions or Nis penin it all bm Ise deeed¢voted. Z " CONSTRUCTION LENDING AGENCY [-. I hereby affirm that there is a construction lending agency for the performance of �i Un.workfar which this permit is issued(Sce.3097,Civ.C.) W A Under's Name C Lender's Address U Q 1 certify Nat I have rad Nis aOdirnimi and suit that the Move information u ' IL r correct.l agree tp comply with all city and county ordinances and suss laws relating w 0 U building consanion,and hereby auhodm repmsarciDws of this city w enter upon thc LS7 shove-mentioned property for inspection purposes. (We)agree to save,indemnify end keep hornless be City of Cuperino against F' y Liabilities,judgments.costs and capers.which may in any way scour agarnst said City U Z in consmucnec of the grading of this permit ^ APPLICANT UNDERSTANJZS AND WILL COMPLY LTH ALL NON-POINT Issued by: Date _2&-J" SOURCE ULATIONS. � " �� Re-roofs Signature of Applican on ver - Dow AZA DOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupant Tom or handle bvuduus caudal as defined by the Cupeninr Municipal Code,Cast.,9.12.and the Health and Safety ,dMiCadc.Sccdan 25532(a)7. All roofs shall be inspected prior to any roofing material being installed. ❑Y. �Nu Will the applicant of future building Occupant use equipment art devic.which If a roof is installed without first obtaining an inspection,I agree to remove it hanodous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. irdcl7 ❑Yes No I have mW the hoallos mau,ials mquimments under Chapter G95 of the Califon ria Health G SafmyCode.Sciatic.25505,25533 and 25534.1 understand thin if the Wilding dols not currently haw a tenant that it is my msponsibility w nobly the occupant of the myvi tvwhichmu clprionoi v ccofaC cuol�ci / Signature of Applicant Date Ownu or authori'r a b Da o.) All roof coverings to be Class"B"or better r Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building De artment JOB DRESS: PERMIT # XU 1z1/Z ! 661 OWNER'S NAME: &ALt4 JZV? ojj% Clfp PHONE # - -� GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following 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 er/Contractor Signature Date 06/27/2005 14:44 4083782909 CRW IND INC PAGES 02 CITY OF CUPERTINO CUPS TING PERMIT APPLICATION FORM S - 0?' � O APN# Date: Building Address: Mailing Address(if different from building address):vexlue�. Owner's Name: E QS�Gp Phone#:�� , r3G1G. 5 Contractor: \/ License#: CaZv�`Nd.>s�r �r« . y�2y Contact:�na��0. Phone:4b3"14� k Cupertino Business License#:.��Z� Fax: V 'Lcleq Building/Permit Info: L�VQ r l_�Y�^2o k�J p�ac2n�c 4 Bld lg Elect ❑ 12 Plumb p Mech ❑ Job Description: UV-9 Vor l �0.�'� �oct �e Q\Uc eYriRd�Jt Residential Ci' Commercial ❑ Sq.Ft. Floor Area: 3/Sq.Ft.: Cost of Project: 'L/ Occupancy Group: Type of Construction: 1 Please check this box if the project Is a second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major El ® uanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances 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 1.75 M Btu MECHANICAL BBOELER5 Boiler> 1,75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING 13CONSTAX 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 Bvei-gy Add Multi BUILDING BITWESTIGA Investigation fee BUILDING lof3 06/27/2005 14:44 4083782909 CRW IND INC PAGE 03 CITY OF CUPERTINO CUPEIii71N0 PERMIT APPLICATION FORM e uauti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING . BMITIGATC Comm-.Tousing Comm-.HousingMit.Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Colum 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 IntercSptor PLUMBING BPLANCHK Plan Cbeck 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 BPSPRI NK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain&Vent PLUMBING BPWATER Instali/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main WaterSchice PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 efin MECHANICAL BREMAIRHAN A/C Units<= 19,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Ughting LightingFixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> 10K btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC NBC A amtus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power DevicetAplearatus ELECTRICAL BREMRECEPT Rc d Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMRE.PALT Repair/Alter HeatinMECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 06/27/2005 14:44 4083782909 CRW IND INC PAGE 04 CITY OF CUPFRTINO CUPEI�TINO PERMIT APPLICATION FORM Fee ID �Fee Deacri tion Fee Groa Iran ELECTRICAL BREMSIGNAD Rmdl Si Add Branch BREMSIGNS Remodel Signs,Marquee ELECTRICAL BREMTHEATR Theatrical Lightina Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS VeiltUation S stems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL S ecial In ection BUILDING BSWIM Swimming Pool BUILDING BTEMP Tem ora Power ELECTRICAL BTEMPPERM T±meorary Bldg Permit BUILDING BTEMPSVCS Ternp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERrMTFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical q. foot MECHANICAL MpERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING • ZADDCHG Address Chane BUILDING 3of3