03010198 (2) CITY OF CUPERTINO -.€* ••A, k; '
BUILDING DIVISIONPERMIT , CONTRAGTORIN)E'ORMATI
IF
BUILDING ADDRESS: REED ARTHUR M AND JEANNE K TRUNO.
10990 MARIA ROSA WAY
O xlNER'S NAME: APPLICATION SUB DATE
REED ARTHUR M AND JEANNE K U 01/30/2003
TONE: SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION
G Job DeSCr
1e I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7000)ofDivision 3 of Ne Business and Professions Code,and my license is
Z�= Lierns from and err"'' SHEAR WALL IN FM RM
Data Class Cmdr MAR - 4 2003
0 F Dam T'S DECLARATION ES
ARCHITECT'S DECLARATION _
1 understand my plans'hall be used a9 guhlic records
o. Licensed Professional BUILDING
LLO OWNER-BUILDER DECLARATION
u�<S 1 hereby affirm that 1 am exempt from the Contractors License Law for the
i—p0 following mason.(Section 7031,5,Business and Professions Code:Any city orcouncy
2 which requires a permit to construct,Sher,improve,demolish,err repair any Structure
prior to its issuance,also requires the applicant foramen permiuo File saignedstalement
0 that he is licensed pursuant o the provisions niche Contractor's Limmo Law(Chapter 9 Sq. Ft.Floor Area tion
$ (commencing with Section 7")of Division Sof the Business and Professions Code)or
i Nat he is exempt therefrom and the basis for Be,alleged exemption.Any violation of
Section 7031.5byany applicant for a permit subjects Ne applicant to a civil penalty of �p
not more Nan five hundred dollars($500). ¢ Occupancye
0 1,as owner of the progeny,or my employees with wages u their sole compensation,
will do the work,and the swcmre is not intended or offered for sale(Sec.7044,Business tOt FOUNIDA; 015
—
and Professions Code:The Contractors Lt..Law does not apply to an owner of egwred Inspections
progeny who builds or improves thereon,and who dorthrough s such work himselfor rough his 102 - PIERS
own employees,provided that such improvements arc not intended or offered for sale.If, 103 — UFER
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 104 - REBAR
C]1.
❑ aowner of the property, mm
exclusively contracting with licensed 105 - ANCHOR BOLTS
constructdcontractors to 106 - SEWER & WATER
construct the project(Sec.]044,,Business usineand Professionss Code:)The Contractor's Li.
cenx law does no apply to a a owner of property is Mrilds orimproves theraon.and 202 — UNDERFLOOR PLUMBING
wh,comrac rsuc prpjecrscvs raglm ice sed Pursuant so the Convenor:' 203 — UNDERFLOOR MECHANICAL
ens l
Iam empt n ce B&PCfordai, an 204 - UNDERFLOOR FRAME
°w
WORKER'S COMPENSATIO DECIAI -so 205 - UNDERFLOOR INSULATION
R I
�/I hereby affirm under penalty ofperjury one ofthe following declarations: 301 — ROUGH PLUMBING -
IhaveandwillmaintainaCardBeamofCorsemmelf-insure for worker's camper- 302 — TUB & OR SHOWER
cation,as provided for by Section 37W of the labor Code,for the performance of the 303 - ROUGH MECHANICAL
work err which this permit is issued. 3 04 - ROUGH ELECTRICAL
❑I have and will maintain Worker's Compensation Insurance,as required by Section 3 0 5 — FRAME
3700 of Ne labor Code,far the performance of Ne work for which this permit is luted.
My Workers Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS
Carrier: PolicyFROM
307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COM PENSATION INSURANCE 308 - SHEETROCK
or leas.)
rI'his Section need not ilicraoideted if the Permit is for one hundred dollars 1$IBI) 309 - EXTERIOR LATH
310 - INTERIOR LATH
1 cenify Nel in an ich th' ger it is issued,1 shall not
employ any sane `ry nn w c Workcrs'Compcnsation 311 - SCRATCH COAT
Lawi of mmi 313 - ROOF NAIL
App 501 - FINAL ELECTRICAL ENERGY
NOT 0 o t A :I[Compensation
pr Certificate of of Exemption,you should
Wo,
c hjccl y the Worker's Compensation provisions of the hear vodc,'ynu must
O ,Z mrmwhhenmplywhnstmProvisions nrthis permitsnallbedeemed revaked. 502 - FINAL PLUMBING ENERGY
'z�.'O - CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
H
I hereby affirion that there is 4 construction leading agency for the performance of 504 - FINAL BUILDING ENERGY
x > Lenders far Namewhich Nis permittsissued(Sec.J09],CieC.) 505 - FINAL ELECTRICAL
W0. Lender's Name
Dz
Leader's Address 506 - GAS TEST
U'O 1 certify that I have read this application and sum that the above information is 507 - FINAL PLUMBING
[✓ti correct.I agree to comply with all city and roomy ordinances and Stam laws relating to
building emnswclion.and hereby authorise reproordstives of this cit mcmeru
O U tho FINAL MECHANICAL
above-mentioned progeny,for inspection gurpoxs O9 IM01—
tn
H a (We)agree to save,indemnify and keep harmless the City of Cupertino against
H Bad lilies,judgments,costs and expenses ich may to any way see...gainsl said Ci ty 5 G
U z in can a the a 'n his r t.
E" APP CA ST DS D ILL COMPLY WITH ALL NON POINT Issued by!1 - WORKS Date
S RC U ION .
Re-roofs IF
Si at c of AppReant/Contractor ala
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or future building Occupant store or handle vamrux material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
`vele.Section 25532(a)] All roofs shall be inspected prior to an roofing material beim
❑res '�ofrn P P y g g installed.
Will the applicant orfuturebuilding accupanl sax equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ich haradnus air contaminants as de0ned by the Bay Area Air Quality Management all new materials for inspection.
Oistrin9
❑Ycs
I havcm c thentanus materials requimmmou under Chapter 695oftoo Califor-
nisHealth cry tions 3 534.1 understand Nu if the building
tiros not aread sae 11N it is to Idly to notify the rocuparl of the
rcgtie cataw al melp rto iSa a fa CCNncale of elft
� Signature of Applicant Date
or aathorized ageml D,m All roof coverings to be Class "B"or better
CITY OF CUPERTINO
1� 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35618003 . 00
DATE ISSUED. . . . . . . : 01/30/2003
RECEIPT #. . . . . . . . . : 21013
REFERENCE ID # . . . : 03010198
SITE ADDRESS . . . . . : 10990 MARIA ROSA WAY
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : REED ARTHUR M AND JEANNE K TRU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4720
RECEIVED FROM . . . . : ARTHUR REED
CONTRACTOR . . . . . . . . LIC # *OWNER*
COMPANY . . . . . . . . . . : REED ARTHUR M AND JEANNE K TRU
ADDRESS . . . . . .. . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4720
TELEPHONE . . . . . . . . :
0E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 200 . 00 77 . 00 0 . 00 77 . 00 0 . 00
BPLANCHK PERMIT FEE 1 . 00 62 .25 0 . 00 62 . 25 0 . 00
BSEISMICRE VALUATION 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 139 . 75 0 . 00 139 . 75 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 139 . 75 4683
TOTAL RECEIPT 139 . 75
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S11CITY OF CUPERTINO
03
CITY OF
CUPEkTINO PERMIT APPLICATION FORM
•
APN# �� / J {�✓ �d Dateb
Building Address: . u
Owner' Name: Phone#:
23;1", 1 4nS-2,&-7-. 349
Contractor: License#:
Contact: Phone#:
Applicant/Contractor: Fax #:
DJobD
Permit Info:
Elect Plumb Mech
cripti��on:ial: N1/J iL: t�1 u f Y1now1 WALC /8 S lM' omme c3a1:
Sq.Ft. Floor Area: $/Sq.Ft.:,
Architect/Engineer: Valuation. i
T eyp of Construction: Occupancy Gro
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances 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
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME I New Comm Electric ELECTRICAL
BNUCOMMM I New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
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R ,rte • •
F � CITY OF CUPERTINO
c'Ty PERMIT APPLICATION FORM
•' CUPEf�T1NO
uanti Fee ID Fee Description Fee Group
BNUMULTI New Multi-family Res PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmos heric 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 rinkler/Backflo PLUMBING
BPSTORM Storm/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
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT -LightingFixtures ELECTRICAL
BREMFURN Relocation of Furnace 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 Sips Add Branch ELECTRICAL
• I BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR I Theatrical Li ting Fix ELECTRICAL
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r� CITY OF CUPERTINO
CITYOF PERMIT APPLICATION FORM
.
CU
PEkTINO
Quantity Fee ID Fee Description Fee Group
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSF&2FAM Single &2 Family BUILDING
BSFNA Single Family New Add BUILDING
BSPECIAL Special hisection BUILDING
BSWIM Swinuning 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 Plumbing Permit Issue PLUMBING
• PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane 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> 1.75 M Btu MECHANICAL
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GbX PLSr .�l�t✓�_ 1 ' n _ -
SAN 301003 t
By,
APPROVE[) --
TN ACCQRDA CE WITH THEXY OR I
CUPERTIN� ES AND 0 INANCES
DATE
SIGNED
f Thi, set o plans and "specifications MUST '
be kept on the job at all times and it is un
e, + I r' lawful to make any ehahaes or alterations
L�dJC� `vl At IA- X534 G 4( on same without writNh permission from
_ the building Dept:; WV gf Cupertino.
IOC ° Cl I°�—Cj 7 � The stamping of thig plah and specifications
7_ � SHALL NOT be 4r 4 to permit or to be an
approval of•tttti Wliltion Of any provisions
ant+ taw ^;"4'nance or State Law.