03060174 (2) CITY OF CUPERTINO
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BUILDING DIVISION PERMIT CONTRACTOR
" -INFO
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BUILDING ADDRESS: CLEAR OAK.DESIGNS 1E1MITN003060174
1 0461 MARY A17T
OWNER'SNAME: 1723 B ROGERS AVE PERMIT ISSUE DATE
IV
NE: SAN
(408) 436-5448 ITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
00 LICENSED CONTRACTOR'S DECLARATION -
I hereby.fRrm that 1 em licensed under provision of Chapter Y(commencing [_ Job Description
with Seetion7 fDivision]o(NC Bu.in rad Profe tions Code.and license is
S� in fullfomeo «n N1 - y J5 KITCHEN REMODEL/ELECTRICA'L FUt . RDE
Dam Cun racier ') '1
ARCHDECI'S RA ION
I understand my plans shall W used! 'hlic record.
)co
cU
goo Licensed Pmfcssionel .y
g OWNER BUILDER DECLARATION Ld
20 2 I hereby affirm that 1 ore exempt from Nc Contractor's Ary C Law for the ill ;tion OO following reama (Section)onstr Business end ve,dei olih.at Anycity or ceunre$ whichrctsissua .also or reuire&te,a@r,imforsudemmit t me a sig anyatrumoreInthatheor its i ensed pursuant to ffis sMvision of for Contrach to i'.1 Ble sicLaw(nemmem(Comme cansrJpmattion7 )ofDiaisiion the oftheBusines andProeuw(chapmrY Sq.F[. Floor Area
that he
ing xemwith therefrom
the
Division]of thee edcmnndon.An vi Code)or
y�$
that he is exempt therefrom antl rise basis(m the alleged exemption.Any violation of 32652073 . 00
Section 7031.5 by any applicant for a permit subjects the Applicant a aaivil penalty of APN Number Occupancy Type
net mare than five hundred dolt..(5500).
❑I,as owner of the property,or my employers with wages ss chair role camper ae0on,
will do the work and he structure,is not intended or offvcd mnale,(Sm.704,1,Borrow — d InS eCUons
and Profesuans Code:The Contractors Liam Law does not apply m an owner of P
ptnpeny who builds orimptesrs themon,and who deessuch work himceBorNteugh his 102 - PIERS
own employrca,provided that inch improvements are not intended oroffered fatale.If. 103 — LIFER
chuArder Ne building or impmvsmvingtsold ewithin one year of completion,theowmr- �
builder will have Ne burden of proving that he did not build or improve for puryou of 104 - REBAR
sale.). 105 - ANCHOR BOLTS
E]1.as owner of the property,am excessively contracting with licenced Commission!;to
ronwn the ptejca(Sec.70aa,Business and Roteuions Code:)The Contncmr's Li. 106 — SEWER & WATER
ane Law does not apply to an owner of property,who wilds or Improves thereon,and 202 — UNDERFLOOR PLUMBING '
who contracts for such pnjecss with o contnetor(s)Iianaed partisans to J¢Coition's
Lima.La1
w' 203 — UNDERFLOOR MECHANICAL
❑I em exempt under Sea ,B J,P C for damn 204 — UNDERFLOOR FRAME
Owner WORRER•SCOMPENSATIONDECLARA ION 205 - UNDERFLOOR INSULATION
Ihereby splints under Penalty ofpejmyone off following duclaratno: 301 — ROUGH PLUMBING e'
Ils. andw0laointaiaaCeniOeamofCa...tluceef-inureforWorker'sCompere 302 — TUB s4 OR SHOWER �.
tion.u provided for by section 37M of the labor code.far N.performance of the 303 — ROUGH MECHANICAL
01harwmehNtpermiin issued. 304 — ROUGH ELECTRICAL
❑I have and will maintain Worker'.Came of dre n Insurance,h required by Section
7700 of the Labor Code.for the performance of Ne work for which this permit is issued. 305 — FRAME
My Worker's Cnmpe cation Imm�nce oiler and Policy number 306 — HOLDOWNS
a CERTIF MPPfION OF�RKERS' 307 — INSULATION ,
COMPENSATION INSURANCE 308 — SHEETROCK
or less.)(This section need not w completed if the permit is for one hundred dollars 1$100) 309 — EXTERIOR LATH
I certify Nat In the performance of the work for which this Permit I.Issad.1 sb.n net 310 — INTERIOR LATH
employ any person in any manner a.alnbrcamesubject tothe Workars'Cnmpenatmn 311 — SCRATCH COAT
Laws af California.Data 313 — ROOF NAIL
LawsApplerr
NOTICE TO APPLICANT:IL after making this Ccnifmam of Exemption,you should 501 — FINAL ELECTRICAL ENERGY
bccemesubject
comply the Worker's Coons or croution
teal ohdemed r Coda you muse 502 — FINAL PLUMBING ENERGY
.J,z fbeMwiN comply with oucher's Ca m, ro Nis permit provisions hall be his LM revoked.Cde.
Z0 CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY
I-d4 Ihorm,. .that them is a contraction lending agency lot dieformance of _
a� ft work for which this `r 504 FINAL BUILDING ENERGY
W- lender's Name permit Is issued(Sec.7097.Civ.C.1
lea l<ndcr'sAddrcu 505 — FINAL ELECTRICAL
DZ 506 — GAS TEST
U O I certify that I have mad Nis application and state that the above information i. 507 —d FINAL PLUMBING
V. cones.l agree to comply with all city and county ordinances and state laws mlating to
pU building construction.and hereby authodn ofessameoves or Lhis City to order upon theF I N MEC CAL
W
.1,ave-mentiuned literary for inspection purposes.
C (We)agree to save,indemnify and keep Wool.the City of Cupertino gainst 09 FI
t]1 liabilities,judgments,costs and espeneswhich may inany w.yacrnmagainstset icy 5 I NG
U7 in consequence of she granting of this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by:5 C WORKS Date
sOU�fC�yR GULATIO S.
Y� 'v^4 LALIQ —1,41 7 Q Re-roofs
Si natum of ApplinnusContrumr Dam
HAZARDOUS MATERIALS DISCLOSURE - Type Of Roof
Will the applicant tar futurt building recupantmre m hendt haartlova ateacrid
as defined by the Cupertino Municipal,Code,Chapter 9.13. ad the Health and Safety
Coda Section 35573(x)7 \, All roofs shall be inspected prior to an roofing material bei.. Installed.
❑rad gHe P P Y g g
d If a roof is installed without first obtaining an inspection,I agree to remove
Will cite applicant or future building occurrent tau equipment or devices which
•mil heva0nus air conmmi ts as it r, d by Nc Bay Arta Air Quality Mandgcmcni all new materials for inspection.
i iwi?
[D ye. Nu
Ihave rcet Cock,he Sections
25505, 553req3 adems 5534,1rChatand the ifthe Calding
die Hn t cur SafetyCock,a wmant,a is,it i my responsibility
to notify
a oectccupant
ht of
Does not currently hese a mien Not it is my rcaponihility m nod(y Ne metapore of Ince
myui cntsw tete mustMreef nm In Comoccofa Co., of cupancy, 5 ( Signature of Applicant ate
xo the , Ca,o a ('177 � ,tr1z�� .
Owner or authorized agent Dmc All roof coverings to be Class "B”Of better
ZffllAY OF CUPERTINO
cuP TYOF o PERMIT APPLICATION FORM 6 3 6
7APN# Date:
Building A dress: 1 ��
Owner's Name: ` Phone#: �� 9
LC 7`-t'
Contractor: C_l_i License#:
Contact: T Cupertino Business LLiceennssee#:
Building Permit Info: 1�
old Elect Plumb Mec
Job Description:
Reside t4dl-- �_ �'^�0 I Commercial El
'Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Z�I bO O Occupancy Group:
Type of Construction:
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/ uasi BUILDING
BCONSTA)MQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V > I OOOA ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
B TIGATC Comm. HousingMit. Fee BUILDING
Y f I�IC
,I
I ora p Qa 0
. R M MTY OF CUPERTINO •
cuP TYOF PERMIT APPLICATION FORM
QuantityFee 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
BNUSFD New Single Family Res BUILDING
BOVERTEV E 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 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 cf n 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
2 of 3
• CITY OF CUPERTIA
alO PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
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 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 ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
'1 MPERMITFEE Mecb Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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