04040113 CITY OF CUPERTINO
BUILDING DIVISION PRRM15__. aC®N 7.{I2ACT<''112'INFOL2NTAI.N,` '
BUILDING ADDRESS: MOCELIN CONSTRUCTION PERMITNO04040113
D,866 LINDA VISTA DR
ER'S NAME: PERMIT ISSUE DATE
IDIT S, BARNCH DEUTSCH 1537 ORILLIA CT 04/19/2004
'ONE: SANITARY NO. CONTROL NO.
(408) 732-6655
ARCIIITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELE PLUMB MECH
trop LICENSED COm'R ACTOR'S DECLARATION
U G 1 he shy affirm thm 1 am licensed mum,pe inions M Chapter 9(commencing .IOrD DCSC
s<i won Seqqqti 7'''")of Division 3 orthe Busi�kssSnd Professions Code,and my license is
_�„
in to "` /wY � 7� FIRE DAMAGE REPAIR
t Liccn Lim,prJ /�'�/
Date G.na DEC 1— 200
££ AR ffl Ef S ISA
wK� dcrssion yplamshaIlk umJ as puM1lic rc Js BUIL
�
JyU
t u.
Licensed Pmfcssi.nal
`ms OWNER-BUILDER DECLARATION
NG
S I hereby affirm Net 1 am exempt from the Contractor's License Law for the
❑o following reason.(Section 70315,Business and Professions Code:Any city or county
5 m which requires a permit to construct,alcor.improve,demolish.11,mpair any struaur^ $11300
_ice priore its issoance..h.mouneslheapplicant forsuch permit to File a signed statement
u
EEo that he is licensed pursuannthe pmvisidnsorthe Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
yr `
(comm ncing with Section 7000)of Division 3 of the Business and Professions Code)or
i� Nat heis exempt therefrom and the basis for the alleged oaempdon.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty or g&AI )$er0 0 Occupancy Type
not more Nan Eve hundred dollars($500).
❑I.as owner from property,or my employees with wages as their sole compensation,
will do thm work,and the structure is not intended of offered for sale(Sec.70,M,Business Required Inspections
and Prufessiofo Code:The Contractors Limme e law does not apply to an owner of q P
property who builds or improves thereon,and who doessuch work himself orthrough his
Own employees,provided that such improvements are not intended or offered for tele.If.
however,Ne building or improvement is sold within one year Of completion,Ne owner
er w
um dill have the burden of proving than he did not build ar improve for purpose of
sale.).
D I,as owner of the property,am exclusively contacting with licensed contractors 10
construct the project(Sec.)BM,Business and professions Code:)The Conoactor's U.
rtse Law does not apply to in owner of property who Wilds or improves thueen,and
who contracts for such projects with a canton or(e)licensed pursuant to the Contractor'a
L
aw
empt un r .B&P C for Nis reason
Date C)�
R' OMPENSATION DECLARATION'
air penalty of perjury one of Ne following declarations:
ndwill ma min a Certificate of Consent to self-insure for Warker'sCompeterovided for by Section 37W of the labor Code,for fie pe Aorromee of the
work rot which this permit is issued.
❑1 have and will maintain Worker's Compensation Insuanme,as required by Section
37W of NC Labor Code.for the pcdormance of the work for which this permit is issued,
My Workers Compensation Insuance sande,and Policy number art:
Cartier: Policy No.:
CERTIFICATE OF E%EM PTION FROM WORKERS'
COMPENSATION INSURANCE
cols section need notbe mmplced Bthm permit is for one hundred dollars($100)
or lois.)
I anis~
flair n the perfarmancc of th w k G richapetTil is issued,I shall not
employ: person It anncr.m t c �su617r no11 Nohcri ed.I hall
Out
Laws ofC
APPlimant ria.
N IC TO APPLICAhtr: of r eking niricaW of Exemption,you should
Wm Object to the Wolh a Comp ation provisions of the Labor Cote,you must
.J O f n 0comply with such provisions of this Permit shall be deemed invoked.
'Z CONSTRUCTION LENDING AGENCY
I hemby affirm Nat there iso construction lending agency for performance of -
C the work fur which this permit 6 issued(Sec.3W4.Civ.C.)
W Under's Name
�+ Lender's Address
az
V Q 1 coldly that 1 have read this application and sue that the above information is
1L F corn.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hobby soubt int representatives or tris city to enter upon the
W above-mentioned property for inspection point
H4. (We)agate m save,indemnify and kith harmless Ne City of Cupanst against
Iiacoisetjudgmcnhe costsand expenses which may in anyway acemc against mid City.
U in eonuquN of the granting of this permit.
r' APPI. ANT UNDER T NDS AND WILL COMPLY WITH ALL NON- DINT Issued by: Dale
SOUR EG .ATI
i D Re-roofs
Si rc I PI an — m
BAZ DOUS MATEftI LS DISCLOSURE �f' Type of Roof
Will applicant ur lure building occupant store or handl yard.smaterial
as def ed by the Cupeni no Muropal,Code.Chapter 9.12.and the Ileal th and Safety
de.Simian zss3z(a)p All roofs shall be inspected prior to an roofing material being installed.
❑sea 6am� P P � Y g g
Will the applicant or fwurc bvilJing occupant use cyuipmenlorJcvices which If a roof is installed without first obtaining an inspection,I agree to remove
emit heramous air conmarmanu u defined by the Day Area Air Quality Management all new materials for inspection.
District'
❑ycs �Mr
I have mad the hanNous materials requirements under Chapter 6.95 of Or Cali for
&Safety Code,Section,25S05.25533 and 25534.1 uoomand Nat if did Wilding
acs not v call~have a mount.thm it is my responsibility m ratify the occuRant of the
uimmcm wh'hm tW ct 'ormissuanccofaCcniFiamof eupan SI ❑ U e 0 ❑t Date
fl All roof coverings to be Class "B" or better
Own t r c Oam
(C - C I'Y OF CUPERTINO
WCITY OF PERMIT APPLICATION FORM
UPERTINO
N # Date:
1Q0
Building Address: rr Mailing Address (if different from building address):
Lit H�QP4 Ul%rA
Owner's Name: Phone #:
732-(G5.S—
Contractor: License #:
ee-L"J B 30tqo
Contact: Phone: Cupertino Business License#:
Z Fax:
Building Permit Info:
Bld Elect/5ZL-- Plumb rff\. Mech
Job Description: .
Residential ❑ — I�,6 'PAtQ1• Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost o Project: Occupancy Group:
/ I L JC�C>
e of Construction: lea a eck this box i tO project is a
'FlRlcz- =PA+2. ZFZSL;— Gqa-/aGc s , o 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> I OOK 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 <= l OOOA 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
0 zs- z v6
1 of rJ—Zrz% Z/
aam
mvw-
PITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
UPERTINO
Quantity Fee ID Fee Description Fee Group
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm 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 Interce for PLUMBING
BPLANCHK Plan Check Fee. BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Re eat 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 Fumace 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
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 Sips, Marquee ELECTRICAL
2of3
4PITY OF CUPERTINO i
CITY OF PERMIT APPLICATION FORM
CUPEkTINO •
Quantity Fee ID Fee Description Fee Grou •
BREMTHEATR Theatrical Lightin 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 Inspection BUILDING
BSWIM Swimmin 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 ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbin Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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