05080270 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT -ON'TR:di�G"I'OR TNF�4'LtMA.7.?I`UN.f
2' R, n a.
BUILDING ADDRESS: MARTY ZIMMERMAN PERMITNO.0 5 0 8 0 2 7 0
10165 MC LAREN 2L
-OWNER'S NAME: PERMIT ISSUE DATE
Alk MARTY ZIMMERMAN 08/31/2005
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT O O PLO O
moo MECH
LICENSED CONTRACTOR'S DECLARATION lob Description
y� 1 hereby Sfflrm that 1 sum licensed under Provisions of Chapter 9(commencing
with Secular,70110)of DMmm Bar the Business end Profusinro Code.and my licence is
in full force andgffen. 2 GFI CIRCUITS/1 LINE FOR EXTER. SUBPANEL
jNZ Licmucaw
�fJ Dam Contractor
ARCHITECTS DECLARATION
I understand my plans shall W used u public nemds
Licensed Professional
OWNER-BUILDER DECLARATION
'A I hereby
aRrm that I am exempt from the Crammer License LAw far the
0 o fallowing mason.(Satan7( Business and Profusions Code:Any city or county
$ which mqulru a permit m eautrve015. t,ala.Improv,demolish,or reaper any strwture $100
r^ prior O its issuance.also requires the applicant far such Permit to file a algwdaummem
that he is licensed purmant he the provisions of Nen Contractor's license Law(ChaPmr9 Sq.Ft. Floor Area Valuation
(ewnmawing with Sect1on7000)of Division)of the Busineasml Prafusians Cousin,
Nat be is exempt therefrom and the bub fm the alleged tamp fon.Any violation of
Section 1071.5 by any applicant for a permit subjects the applicant m a civil penalty of AP14 Mffibbr U U Occupancy Type
not mom dun R.hundred dollen($5001
(f�1,u owner ofew prapony.or my employcu u
with wages their tale compensation,
1111do We work and tbeawctua Is wtmtended oraRemd formic(Sue.7044,But=
and Professions Cade:The Contramrs Liame Law does not apply W an owner of Required Inspections
property who builds w impmvs thereon,end who does r ah wort him.If w through his
own employcea,provided that such impmvemem are Inst Intended or offered for ream.if.
however,the building or Improvement is mid within on year of completion,We meet. /
/
builder will here the burden of proving Nu he did rot Wild or Improve for purpose of
um.).
C31,u owner of the propeny am exclusively contracting with licensed cona.ctor.m
construct the project(Sec.7044,Business and Professions Cade*The Contractors U. O
cense Law docs not apply to an owner of property who Wilda or Improves dmreon,and /
who contracts for such packets with a conaacmKO licensed pursuant to the Condemner C7
License Law.
❑ions tae under See. .B k P C forthS mason
Owner Data D Yt
05
KE 'S ATION DECLARATION
1 hereby.111.under f perjury oro of We following declarations:
1 ham and will maintain a CeNficnte ofCnnanua alf-insure for Warkar7 Common-
. 13011M
ton,u provided for by Section 7700 of the laor Code,for the performance of dm
rk for which this permit in Issued.
I have and will maintain workers Compensation Insurance,u acquired by Section
of the Labor Code.for the performperformancemance of Ne wartfor which this permii is issued.
Worker.Compensation Insurancecarrier and Polley number am:
rner. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Glass modest wed not W completed If the permit is fwona hundred dollars(SIM)
carless.)
1 coolly that in then performance of Nen work for which this permit is issued,l shall not
emplay.ay person in any gcrte baome abjalto tiro Worken'ComPensation
Lawn of Califomis.I
Applicant —
NOTICE TOA
APP Mr making this Certificate of Exemption,you shall
become subject te tiro a Compensation provisions of the Iceor Code.you muco
0 0 forthwith comply with two prevision or this permit Nall o dccmed rooked.
Z CONSTRUCTION LENDING AGENCY
F4 Ibereby.M.that there ice.cossrneden lending agency for the performance of
C'> the work for which Oda permit is issued(Sue.7097.Civ.C.)
Lenders Name ,
=z Landers Addreaa
U O 1 certify that 1 have read this application and sum that the.ave information is
Iy F cruMaL I.gra O comply with all city and county ordinanaa and sou laws misting m
OU Wilding couwhod
ction.and hereby suta representatives of this city m the
y cnar upon
0 U move-Mmilowd property for Impassion purposes
O. (Wen)agree to save.Indemnify tad kap harmless the City of Cupertino against
h liabilities,judgments.cam and expenses which may In coy way acnm&gaunt Said City
U 7, in com quewe of the granting of this permit
t-+ APP NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date F6-3/ •—O r
SOU EGt ATIONS.
Mal Re-roofs
Sigeuure of Apgl cant/ n cmr Dam
H OUS MATERIALS DISCLOSURE Type of Roof
Will f.pp t or future building occupant tore or In huardous material
as defined by the Cupenim Municipal Code,Chapter 9.17,and the Health and Safety
I
le. Oyu 25572(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes IWO
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 I mardnus air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
saiet7
❑Yen. We
I have read the hmardws materials requirements under Chapter 6.95 of the Califor.
Health M SafciyCode,Sections 25505,25577 and 25534.l understood that if the Wilding
es not currently have a m usn4 that It b my responsibility to notify`be occupant of the
uirec whthMustWmelpdarutivuumareCertficamofOccu cy. Signature of Applicant Date
Owner or suthari d NV
Data
All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: 1 o 1 (05 m l-fltiC-J�3 PL- PERMIT #
Guem,noo t1A 45o)4 if
OWNER'S NAME: IM 4f-TY PHONE # L{08 S(P u-7 ozY
GENERAL CONTRACTOR: S'SL P FAX # 4 a ? -as;-Zss(o
I am not using any subcontractors: 8)3 N I'D.,9
Si tare Date
Please check applicable subcontractors and complete the following ' o om
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
8I3, 5
r/Contractor Signature Date
CITY OF CUPERTINO DS-?_) io 21;70
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
APN# � Iry 21 0500 , Date: 3 -37-05
Building Address: Mailing Address (if different from building address):
10146 PA A-XEJ -PLI C\-If -TIt3o " 9,901y
Owner's Name: 1Phone#:
�ARTy � I.r.nvv.ERrv�A+J 409 - SGcP^-7a1�
Contractor: License#:
SE-L F
Contact: Phone: Lioe-66%4 9oz9 Cupertino Business License#:
OA"zry Fax: �tca-2s5-23sy
Building Permit Info: 001N6 2 GF ) . e-iRcut'rs FOR IWHoush ,TACUIZI FhWb 1c'f�JL
FOR fPK-tb910R 5lILtt- &L Fe(L AJL + CP1euv21 0v1ti0E
Bldg ❑ Elect ® Plumb ❑ Mech ❑
Job Description:
Residential ® Commercial ❑
Sq.Ft. Floor Area: ZrloSq.Ft.:
o
Cost of Project: Occupancy Group:
Type of Construction: Please check this box if the project is a
tacuvrs second-story addition: ❑
F .,tea
Project Size: Standard ❑ Large ❑ Major ❑
Quantity 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
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 <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELE 200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM
QuantityFee 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
BOVERTIgE Inspection Overtone 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
An lk 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
BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREWIXT 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
BREMPOWER Power Device/Apparatus ELECTRICAL
BRENMCEPT Rc tl Switch & Outlets ELECTRICAL
BRENMLOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
CITY OF CUPERTINO
cITM F PERMIT APPLICATION FORM
CUPEI,TINO
Quantity Fee 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
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection 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
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
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