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05050101 - CITY OF CUPERTINO ' n- BUILDINGDIVISION PERMIT TR GONACTORANFORMATION BUILDING ADDRESS: TOM' S PLUMBING PERMIT"05050101 OO S O S O I O 1 29 'OWNER'S NAME: PERMIT ISSUE DATE DON LEONARD ONE: SANITARY O. C 014 NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uoo LICENSED CONTRACTOR'S DECLARATION O O O O w 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description Z0. with Smtion]IXMl)of Division Jof dte Business PrOG«on Code.and myliccnseu 44 glg- Q� ��® ��„ inmumaaoderzn I / REPIPE/WATER HEATER hYFp7V� z License Class _ _ Lic.N ^ Dale O COnYYmr ARCHDIE DEC TION y z I understand my plans shall M used u public¢cords 2005 oy Licensed Professional q S OWNER-BUILDER DECLARATION d<f 1 hereby rM.Nal I am exempt from the Comracmes License Law for the i 0 O following reason.(Section 703[.5,Business and Professions Code:Any city or county $ which mquima a permit to conslmcL after,improve,demolish,or repair any structure F Z y poor N its issuance,also requires Ne applicant for such permit to f lc a signed statement FZO that he is licensed pursuant InMeprevisions ofMeContractors License Law(Chapter 9 Sq. FL Floor Area aluatlon m1- (commencing with Section 7000)of Division 3 of the Burins and Professions Cade)or _ Beat he,u hexempt IMrefmm and she basis for the alleged exemption.Any violation of Section 7031.3 by any applicant for a permit subjects Ne applicant to a civil penalty of 3 40IIr(4eto O Occupancy not more Nan Rve hundred dOOars(5500). P Y Type 0 1,as owner of the property,or my employees with wage u their ack compensation, will do Me wart,and Nesuuclure 4.1 intended Or offered for sat(See 7061.Business and Profession Code:The Contractors License Law does not apply m an Owner of Required Inspections property who builds or improves dvreon,and who does such work himself or 0uough his own employees,provided that such improvements art not intended Or Offered forsale.If. however,the building or improvement is sold within one year of completion.Ne owner- builder will have the burden of proving that he did not build or improve for porynse of saic.). ❑1,as Owner of Me property am uclusively contracting with licensed epntneuss to contract M,pmjcn(Sec.7011.Business and Profession Code:)The COmmcmrs Li- Came law does not apply to an owner of property who builds or improves thereon,and who contracts for such pmiects with a cwuactor(s)licensed pursuant to Ne Con rRun's License Law. -11 am exempt under Sec. ,B k P C for this mason Ovincr Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of Perjury ore of the following declarations: I have and will maintain aCco ificate of Ccnera m relf-insure fur Workers COmpen. 7031,W lon,as provided(or by Secllnn 3700 Of Ne labor Code,for the Performance of the ork for which this Permit is issued. 1 have and will maintain Workers Compensation Insurance,u required by Section of Ne labor Code,for Ne performance of Me work for which this permit is issued. y Workeerrs Compensation I suet a/r/per and Policy nmber am:nner. 1IBf.4� L,�1a'1 Policy No.: t �SoZ1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not he completed i0M Permit is forme hundsnd&Jim($100) or has.) I cenify Nal in Ne performance of the work for which this Permit is issued,I shall or employ any person in any reaonerm as;to become subject to Use Wnker3 Compeasauon Laws of Califomia.Data Applicant NOTICE TO APPLICANT:If.after making this CeniOcam of Exemption,you should become subject to the Workers Compcnition previsions or tiro Labor Ccac,YOU most .,,z fOMwiN comply wish such provisicas car this pe.I,shaft be deemed revoked. .zi O CONSTRUCTION LENDING AGENCY [—� I Mmby alRrm Nat dtert is a construction lending agcney for Ne arfxonsme of a Ne work for which this permit is issued(Sec.3097,Civ.C.) QUndcr's Namc z Lcnder's Addreas U C) 1 certify that 1 have mad this application and sate Nat Ne above information u IL P Corrett 1 agree In comply with all city and county ondinmes and sure Jaws relating to OU building construction,and hereby amhove representatives of this city to enter upon the almvc-mentioned property emu fan inpemipn pugwses F y (We)agree m save.indemnify and keep harmless Ne City of Cupertino ag+inst (q in uunce of the flooding or ibis Permit. APPLICANT may in any way eccmc against acid City U z in consequence of Nc gmndng Of Nis permit. APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued by: Date )OURCE GULATIONS. Re-roofs Signet OfApplicamlComeactoraHAZARDOU Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Wi1bM applicant m future building e.Chapter smm or handle ha�oand Safety Us defined by Ne Cupertino Municipal Code,Chapter 9.1 i.and the Health mJ Safety Cwt.Section 25312(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yea [ n Will the aPPIiCam Or factum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hexamous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes t(Nu 1 have mad theft mdrmsmateoau requirements under Chapter6.95 oftM Califor. riaf(cal"SafcryCOde,$ccuon 25505,25533 and 25530.1 understood thatifthe Wilding does not conOntly have a tenni Net it is my responobitity m nouly the Occupant of Me requirements which most be met prior issu O(a Cenificide of Occupancy. r.., Signature of Applicant Date o*.*tdaedagent Date All roof coverings to be Class "B"or better F Community Development ' 1 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building De artment JOB ADDRESS: PERMIT# 2- Z ,'9.6) oI0 / OWNER'S NAME: A, o w gyro. PHONE # 67 GENERAL CONTRACTOR FAX# I am not using any subcontractors: Signature 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 77— Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 61 Own r/Contractor Signature Date CITY OF CUPERTINO / o CUP CITY or O PERMIT APPLICATION FORM v � ` APN# 3 V2- 3 , Date: p D Building Address: Mailing Address (if different from building address): 9-386fne.d;un LA1 UN;t l4 Owner's Nfine: Phone#: 1`'on/ SL1i 0 v Leos z> (0 Contracto{: License#: okk Cont Phone: Sb-7 (o v(J Cupertino Business License#: 0c— Fax: 13 "I 1 Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: (?0„� 1;� L/ .L=F IN + ..r + 6 1 ni r/��c� (001-11w q Gjeq g Residential Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Oa Occupancy Group: 13 00 Type of Construction: Please check this box if the project is a second-story addition: ❑ Pro'ect Size: Standard ❑ _LarLe ❑ Ma'or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL AW BBOILER1 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 BBOILERS Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX hid/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax —Resi/Mobile BUILDING BELEC1000 Elec 600V<= IOOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Ener y BUILDING BENERGYADD Ener Add Multi BUILDING BINVESTIGA Investi ation Fee BUILDING 1 of 3 /� GGA CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO 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 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 BRENfAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREWIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MFCHANICA 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 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heatin MECHANICAL BREMRESAPP I Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO ITY OF 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 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 MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR PlanningLon Range Residential PLANNING ZADDCHG Address Chane BUILDING 3of3