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06020078 FBU ITY OF CUPERTINO .ts BUILDING DIVISION PERMIT CONTRAC 'UR INF'ORMATIQIa .~ LDING ADDRESS: CUPERTINO PLUMBING PERMIT NO.06020078 1912LINDY LIN OWNER'S NAME: PERMR ISSUE DATE ROBERT RODERT 1300 DELL AVE STE 02/13/2006 NE: SANITARY NO. CONTROL NO. (408) 253-0618 ARCHITEC(ENGINEER: BUILDING PERMIT INFO �gB44LDG �,gELpppECTggg���sss ppp P���LUMB MECH 3d LICENSEDCONnRd under DECLARATION Job DCSCrIp ry� {ry � � O 1 hereby affirm 1 am ONTRA under provisions of Chapter 9(commencing (I�� �f/�yyga� with Section TWO)of Division 3 ofthe Business asM Professiuru Cade,and my license Is rap mmfifineanJ Ica f y REPIPE/WATER HEATER/WATER N P �'g? Licen mcch. LC.* =ssffff......p Dam Cammcer �5 Y, e � ARCHITECT-S DECLkRATlOF7006 1 un hmagr d my plena Mail be used u public records l 7 r- swot; Licensed PruressionaI L' p� �¢[� ` 3 OW NEan exe pt from the Com use �p Ii �a P'� ON CO O hinny affirm that I am excmpl from he Cssions c L cense Law for Ile k7t1 Jf, ID 6 i,p p following reason. ermit t ]ID IA Business and ve.dem ns Code:Any eiy m count' J _ Z S`n which requires•permit also re uinswcL simr.hnprove,h Permts t or repair any suunum 5(] 0 EZA that Ireor itsissuance,pursuant tins visions of for smhpctor'smie a nse signedsmartest m< Natmenccensed pumion 7to has 00)of Division oftheBusiness a icenxlsiw(Chapter Sq.Ft.Floor Area Valuation ,ES F$ (co,jus a(CommencingwithSecuanrs and t f Oiub for of al euei exampt Profession vi Chute)laden or that o r exempt therefrom and the aper for the alleged esemant to Any violation of Secout omthan wby aundreddollafs(M).ltsubjectstheeppiranuo•civilpemltyof r .Occupancy Type out mom Nen five hundred dolma(53007. ❑1,as owner of Live properly,or my employees with wages u theh"[a compenation, will do the work.and the structure r not intended or offered for sak(Sec.7044.Ratings Required Inspections and Professions Code:The Contractor'License Law does tet apply m an owner of q p property who bulldsorimprowa themon,and who doessmhwurk Idmselfor Ihmugh his own employees,provided that mh improwments are nal Intended ora0ered for sale.IL however,the building or improvement is sold within one year of completion.the owner. builder will haw the burden of proving that he did cot build or improve for purpose of sale.). 0 I.es owner of the property,am exclusively commuting with licensed contractors to convect the project(Sec.7014,Business end Professions Code:)The Contractors Li- ve Law dean not apply b an owner of property.who builds or imprown themon,and, who contracts for such projects with acontrcuu(s)licensed pursuant to use Contracera License law. ❑l am exempt under sec. ,B A PC for this Mason wrcr Dam WORKER'S COMPENSATION DECLARATION 1 hemby afnrm under Penalty of perjury arc of the following declarations: I have and will meinuin a Certificate of Consent m self-insum for WorkersCompen- don.is provided for by Section 3700 of the labor Code,for the performance of the wart for which this permit is issued. . [DI haw and will maintain Workcri Compensation Iasurace,as required by Section 3700 of the labor Code,for the performance of the work for which this Permit Is Issued. My Wmkere qsampensmon Insurance carrier and Policy number am: ! i Caller: r 'f Policy O 0 CERTIFICATE OFCOMPENSATION EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Mi.section need not he complemd if the permit Is furans hundred dollars(SIM) he less) I unify that In the performance of the work for which Nis Permit is based,I Mall not employ any person in any manvrsu as M becomcabjml to live WorkerCompensation Laws of California.Dam Applicant NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you Mould became object W the Worker's Compensation provisions,of the labor Code,you mm .,O forthwith Comply with such provisions or this permit Mall W deemed riveted. 'Z CONSTRUCTION LENDING AGENCY (ti4 I hembyafiirm dot it it a comructiun lending agency far the performance of !Y.>. the work for which this permit is issued(Sec.3097,Civ.C.) W�Q Lender's Name , Z Lender's Address T..1 Q ily 1 Cor that I hew read this application and sum that the above information is Dr I. correct.I agree to comply with all city and county Cainevcea and Mm laws relating to O V building convection,and hereby authorhe representatives of chis city to enter upon Ne D7 abow-mentioned property,for bupecuon purposes. gy (We)agree to ave,indemnify and keep harming,the City of Cupertino against In liabilities,judgments.costs and expenses which may in any way acerae against said City V z in eonsegvnce of the gratlung of is rmil. —�� PPLICANT UNDERSTAND WI COMPLY WITH ALL NON-POINT Issued by: Date URCEREG�L 3— Re-roofs signature of it' Coni am �/ HAUL OU MATERIALS DISCLOSURE Type of Roof Will g(e a"pPlicam or forum WIINng omupsntport mhenslc harsNow material w defined by the Cupeniv Municipal Code.Chapter 9.13,and the Health and Safety Code.Section 256324)7 � All roofs shall be inspected prior to any roofing material being installed. Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It hazardous air conumimnu u J eJ by the Bay Area Air Quality Management all new materials for inspection. ruicrt ❑Yea No I haw mal rhe hu7mdousmamri4lerequirements under Chapter&95 orthe Califor- niaHealth h Safcty Code,Secuons25305,25533 md25534,i understand thaifthe building docs not currently haw n4 Nat iiiamy responsibility he notify the occupant of the gmremcntawniapm mi' hcemrm ora ey. Signature of Applicant Date owner mari,=dasem Date All roof coverings to be Class"B" or better Community Development 10300 Torre Avenue aClOF Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 OUPERTINO Building De artment JOB ADDRESS: PERMIT # 191 2, L 1 Ln , MO 2- OWNER'S OWNER'S NAME: volar PHONE # Z 7— iGo7 GENERAL CONTRACTOR: 'P k,,,b ;, FAX # I am not using any subcontractors: i ature 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 Oyfier/ 'ntractor Signature Date 3_ CITY OF CUPERTINO CUPEIZTINO PERMIT APPLICATION FORM O 6/ N# CQD 0 / 5 Date: uilding Address: Mailing Address (if different from building address): O er's Name: � Phone#: vljs-rJ Z100- �-S7 - "0 Contractor: License#: n D � �q 9U S Contact hone:4 2�3�ordl Cupertino Business License#: G�wv r �— Fax: Building Permit Info: r Bldg ❑ Elect It' Plumb 2--� Mech n Job Description: Residential al� Commercial ❑ Sq.Ft. Floor Area: , q.Ft.: pUc� Cost of Proiectt, ! Occupancy Group: s vvv Type of Construction: Please check this box if the project is a fxsecond-story addition: ❑ ro'ect Size: Standard ❑ Laze ❑ Major ❑ uant ity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL. BBOILER1 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 BBOILERS Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax . BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for B Q 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 9331,17-6'I of 3 J CITY OF CUPERTINO .0 OF PERMIT APPLICATION FORM CUPEkTINO -Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 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 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 InstaWAlter 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 BRENLk KHAN 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> IOK btu MECHANICAL BRFMHRAT 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 13REMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL -OF BREMRESAPP Remodel Res Appliance, ELECTRICAL 2 of 3 CITY OF CUPERTINO CUP TY0 - O PERMIT APPLICATION FORM ' QuantityFee ID Fee Description Fee Group 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 BSEISNUCRE Seismic Fee Res BUILDING BSPECLU Special Inspection BUILDING BSWID4 Swimming Pool BUILDING BTENIT Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPER HTFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMfTFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Commel Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUlI.DING 3 of 3