03060048 PERTINO
CITY OF CO
BUILDING DIVISION PERMITAI CONTRACT®R INFORMAT
BUILDING ADDRESS: PERMIT NO.
AR CONSTRUCTION & REMODELI G 03060048
11209 AM PERMIT ISSUE DATE
1335 NORMAN DRIVE 06/05/2.003
Eln_71914 MAR SANITARY NO. CONTROL NO.
(408) 732-3663
BUILDING PERMITINFO
ARCHITECT/ENGINEER:
BLDG EPLUMB MECH
0
CE 0 0
!OZp LICENSED CONTRACTOR'S DECLARATION Job Description
On F 1 hereby uffrm that 1 em licensed under provisions of Chap¢r 9(commencing
E4 widlSeellun�OW)9LQivislon3oftheBusinessenJ6p5r��es-s�iniuQCod�e.ardor,Red..I. pp®pp aa�
' 3ose mmn mrce n Q4rcxL/((G see.« G MS BATHRM UPGRADE �'�/ ��G®
p Z Llcenu ClesY� l/ f—
y D Gn bar JUL 'I �]
ARCHITECBD RATION J + O Z003
I understand my pits shell M used u puhlic rccnrdt
'C, Licensed Proration.]
s� .] Oat I A. arum I .DECLARATIONIMCoBUILDING
1 hereby oRnm Nm I R-acmpt from Ne TLicense Lew for the
ia D following rcoson.(Section 703 1.5,Business and protection,Codd:Any city or county
j g� which requires a Permit of construct,also,improve,demolish,or repair any structure
-z iprior In its issuance,also acquires the applicant for such permit to File a signed statement vv CIOn
that he Is licensed pursuant to the provisions of the Contractor'Wcense law(Chapter 9 Sq.Ft. Floor Area $1 in"U
(commencing with Section 7000)e(Divuion 3 of the B usiness and Professions Code)or
that be,B exempt damcfrom and the basso for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil mostly of 3 4"At'81OR 0 Occupancy Type
not sou Nan Five hundred dollar(5500).
❑1,.mvner of Nc property,m my employca wIN wage as Heir vele compen.lion.
will do the SmiSmal Nenrvcsre is not intended or offered tarsal.(Sec.7044,Basin(. 101 - FOUNDA'Ri4iNed Inspections
and Professions Code:The Corran o' License law data not apply to an owner of
p,apeny who builds of improves demon,and who doesmeh work himself orthrough his 102 ,- PIERS
own employees.proviOetl Nat such improvemens uenotimended oronered forest.If, 103 - UFER
however.fie building or improvement is sold within one year of completion.the owner.
Wilds,will have me burden of proving that rte did not Wild or improve for purpose of 104 RE BAR
sale')' 105 - ANCHOR BOLTS
1,as owner of the property,am exclusively connecting with licensed mm
ncton to
Coal the pmjem(Sec.70".Business and Profe.ions Code:)TIC COnuxcter's U- 106 - SEWER & WATER
cease law does not apply Loan ownerof property who haddt or improves thereon,and, 2O2 - UNDERFLOOR 'PLUMBING
who conuams for such pmbm
cB wit a conuaor(s)licensed pursuant to the Conmh
cto
License Law, 203 - UNDERFLOOR MECHANICAL
E3I am Camara under Su. ,B R P C for Nis Mason 204 - UNDERFLOOR FRAME
Owner Dole-
WORKER'SCOMPENSATIONDECLARTION 205 - UNDERFLOOR INSULATION
I hereby affirm under penally or perjury on of the following ded.afimSe 301 - ROUGH PLUMBING
I hese end will maintains Canlficale or Concept to sel61nwre(a,WoAets Compen- 302 - TUB & OR SHOWER
.don..provided fm by Samoa 3700 of one labor Cade,fm the peleareance of the 303 - ROUGH MECHANICAL
work for which this permit is Issued
❑1 have and will maintain Worker's Compensation Insurance,as required by Seetion 304 - ROUGH ELECTRICAL
3700 of the labor Cade,for the Performance of the work fea which Nis Permit is issued. 305 - FRAME
My War s nm nsetIon Insurance Carrier and policy nu core: n 306 - HOLDOWNS
_ • Pandy R5-23 20 7
,T CERTIFICATE OF EXEMPTION FROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(This uctimt need nothecompleted if the Permit is Intend hundred dollxn(SIM) 309 - EXTERIOR LATH
nr laa)
1 certify Net in the perf smi nce of the work for which this permit is Issued,I shall not 310 - INTERIOR LATH
employ any person in any manner..of become subject o the work,ri Compensatlon 311 - SCRATCH COAT
Laws of California.Date
Applicant 313 - ROOF NAIL
NOTICE TO APP LICANT:IL after making thP Coal O ofExemption,youshould
most 501 - FINAL ELECTRICAL ENERGY
bdcome mhjact te it Worker oCompcn,this permit
Provisions t of Ne trailLabor Code,you mull
forthwith comply with ouch provisions or this permit ahau be deemed mvntcd. SO2 - FINAL PLUMBING ENERGY
z0 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
EIhdubyaffirmthwmnn
edit.Uaemctilendingagcrcyfartheferformemeat 504 - FINAL BUILDING ENERGY
> ft fr:for which adl permit 1,batted ISca.3097,Civ.C.) 505 - FINAL ELECTRICAL
w�A landcName
a z Lm er'sAdd.. 506- - GAS TEST'
V I canary Nat 1 have read did,application and sum that Ne above information is
(yam
correct.
l.l agree mComply with all city and county oNiasnttund sou laws(dating to 507 FINAL PLUMBING
�U building convection,and hereby ampoule,Mpusenmtives or his City tr enter upon the FINA MECHAN CAL
W above-mentioned property for inspection purposes.
(We)egrce to mase.Indemnify and sm,hmmle.Ne City of Cupertino against 9 FIN
yIiabilide pcignmrateasts.ad espdnsa which may in any way accrue egatnst said City 51 - G
Uin consequence of the granting of[his permit.
•7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bY5 - WORKS Date
SOURC REGU y3r
Re-roofs
Sig u o pl,m9C ruior am a of Roof
IIAZARDOUS MATERIALS DISCLOSURE Typ
Will Ne applicam or future building mcupant,tore or handle h.ardous material
as defined by the Cupenlno Municipal Code,ceaptcr 9.12,and the Health and Safety
Cadd,Section 25532(ar? All roofs shall be inspected prior to any roofing material being installed.
C]yes 11�No
Will the applicant or future building occupant use equipment car devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conteminans as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ya [ u
I have mad the ha.Nnus materiels requimmeo¢under Chapter 6.95 of the Cali(or.
ria Hculdt A Safety Code,Sections Z!5!505.25533 md25534.I undersand uatif thc Wilding
docs not currently hove a 1,11 t' n my responsibility to may the eccupam sof tie
Mquiremena wnfvn mat be �nm�.mana era CCrdrua¢ef epxt�;/ Signature of Applicant Date
b c All roof coverings to be Class rBr or better
Owneror auN and ag m D,te
e. W OC()W 0
o lin I
v,ev Det,
_l
JE
5 2003
�j
41
r
APPROVED
IN ACCORD N WIT HE CITY of
CMTI N RDINANCES
PER
OAT
SIGNED
This set par, d specifications 41U$i
be kept on
thr job at
lawful to maall times and it is un ►L�{lIJ"
V; any changes or altorotlone
on same without written parmissien from
the building Dept., City or Cupertino.
The stamping of this plan and spt+clhrnNons
SHALL NOT be held to permit of to bo un
-- . approval of the violation of any prnvlefum
If any City Ordinance or Stefe Law
'( - AY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM v.3 o 6 o 0
CUPERTINO
Date:
Buildin ddress: r
t,
Owner's Name: Phone#:
I�evv , cAq
Contractor: 9 (� / /
n License #:
P
Contact: Cupertino Business License#:
Building Permit Info:
Bld Elect Plu Me
Job Description:
Residential ❑ r
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: y Occupancy Group
Type of Construction: U
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot 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
BB0ILER5 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
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
4f- 7 7 3
1 of 3
26 ' ��.
k ATY OF CUPERTINO
CITY PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee 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
BNUCOM M 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
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
VENT 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 efrn MECHANICAL
BREMAPPLI Apphance Install MECHANICAL
BREM 3USWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> 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
.a
alOCITY OF CUPERTT�I PERMIT APPLICATION FORM
CUPEI,TINO
Quantity Fee ED 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 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 Issuance PLUMBING
PPLBG Plumbing F e sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
�.S
CITY OF CUPERTINO n ��° �a �y� T��a, '
BUILDING DIVISION PERMIT GOWAACTORINFORM TIO
BUILDING ADDRESS: PERMIT NO.
AR CONSTRUCTION & REMODELI G 03060048
gf _ PERMIT LEVE DATE
1335 NORMAN DRIVE 06/05/2003
N 71(;14 MAR (408) 732-3663 SANITARY NO. CONTROL NO.
ARCHancrfeNGINEER: BUILDING PERMIT INFD
BLDG ELECT PLUMB MECH
0 0 0 0
i00 LICENSED CONIRACTOWSDECLARATION Job Description
1IuJ 1 hereby affirm that I am lisansed under provitions of Chapter 9(commencing
Tj with Section =1 yL�livialon SoflM Business r cuinns Code.end my license is
'+< in full fo¢c a�6Q�)Br //(l LIc.M
��zpppp
Ras
h! C �S°� MS BATHRM UPGRADE
C DARCHnECi'SD tear RATION
y U I undcuconin
und my Plant dull he used u public mcmda " •v®�
AI
G Licensed Profe"imml
OWNER-BUILDER DECLARATION
2 1 hereby M.Nat I am exempt from the ConOactoft License law for the UL 1 0 2003
-0 O follnwin{reason.(Section 703 IS,Busineu and Profesaiom Code:Any city or county
which".I.a Permit w emtseaL alar.improve,demolish,Or rtPon any structure
prior to its i"uance,elan requires tbeapplicant for such permit m file.signed Suumem
££m< dutheislisancofpurwmuoNeprovisimsnfdmCordracmr'su.nseLaw(Chapmr9 Sq. Ft. Floor Area A�Jtaluation
(eommencin{wiNSeetion7")nfmi ion3oftbe Busineaiand Professiom Cl )ur W
e v$ Nn he Is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to•civil Penalty of3 4pEp�,I3��'@}�e0 0 Occupancy Type
not more than five hundred dollen(SSW).
0 1."meet of the pmpeny,m my employees with wages u their able compensation,
will she the work and the SttLcnm is not intended mothered for sale(Sm.7W,Busiest 101 - FOUNDAR&PEfed Inspections
and Predictions Code:The Contractor's License Law does not apply to an owner of
propenywho builds or improvesthemon,andwhodsam euchworkhlmalrorthmugh his 102 - PIERS
own employees,provided that such improvements are not intended or offered for tale.If. 103 - IJFER
however,Ne budding or improvement is sold within one year of completes,Ne owner-
builder .will have the burden of proving that he did not build or Improve for purpose of
104 - RE BAR
tele.).
❑1,as owner of the properly,am exclusively contracting with licensed contractor,to 105 - ANCHOR BOLTS
construct the project(See 7W.Business;and Profession Code:)77e Combscu's U. 106 - SEWER & WATER
ccem law does not apply in an owner of property who builds or improves thereon,and 202 - UNDERFLOOR PLUMBING
who conmcu for Such projects with a eontraemKO Ranted pursuant to de Conmabtorl
License La- 203 - UNDERFLOOR MECHANICAL
❑1 am exempt under Sec. ,B 6 P C for this buthon
204 - UNDERFLOOR FRAME
Ower WORKERS COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
I hereby afRrm under peraty of perjury on of the following dmlamien: 301 - ROUGH PLUMBING -
t/ IhaveaadMil nOinuinaCeNOutene
of mself-InuRfo,WmketsCompen- 302 — TUB & OR SHOWER
"tion,u provided for by Section 37W of Ne labor Cade,for me performance of the 303 - ROUGH MECHANICAL
work for which on.permit is issued.
I have and will maintain Workers Compensation lnsonnce,as acquired by Section 304 - ROUGH ELECTRICAL
37W ofthe Ube,Code.for see performance of Ne work for whim this Permit 6 issued. 305 - FRAME
My Wor s/C�nm/pe,natlan lnaunnlx/e)nicnnd Polity nu 6a ase: ,306 — HOEDOWNS
Camie�✓f *-e X 6f Policy 5,533 Z� 1
vX CERTIFICATE OF EKEMPION FROM WORKERS' 3O7 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(nth section need ret bo completed if the permit is for one hundred dollars($1W) 309 - EXTERIOR LATH
ear less)
1 unify Net In de Performance of the work for which this permit is Issued,I[hall not 310 - INTERIOR LATH
employ any person in any manner an as m become subject to the workeri Compensation 311 — SCRATCH COAT
PPicant mia.Dau 313 - ROOF NAIL
NOnCE TO APPUCANT.IL after making this Cetificam of Exemption,you thmW 501 - FINAL ELECTRICAL ENERGY
become subject Co the Worker's Compco"tion provision of the labor CMc,you mote
,JZ forthwith comply with such provisions or this permit hallWdecreedrevoked. 502 - FINAL PLUMBING ENERGY
z CONSTRUCnONLENDING AGENCY 503 - FINAL MECHANICAL ENERGY
( .N. 1wrchy.fEmn Nat ft.it.conwmm.lending agency for the leamnumce or
x> ft work for wMmthis permitI.Word fsa.3M,Ch,C.1 504 _ FINAL BUILDING ENERGY
W p Lemko.Name 505 - FINAL ELECTRICAL
]Z C..Ct. AddOdm
,.at 506 - GAS TEST
U0 I sanity Nat 1 have read Nis.,mimaion and mute Net the above Information iS -
cortca.l a{ree to comply with all city and county ordinances and sum lows relating b 507 - FINAL PLUMBING
OU building construction,and hereby authorim mPruenutiws of this city to enter upon the FINA MECHAN CAL
W a11oVG(Wei agree
fInemnifyan keep harmless
.
y
(We)agree a save,indemnify and kap ha ml ss the City of Cup nine egeint 9 FIN
I/y liabllidu,judgmcnu,costs and cap..which may In any wayxccroe against to City 51 - G -
U Z in con"gwnm of the granting or this Permit.
�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bY5 WORKS Date
SOURCFs REGU}h
S 0 e.4. Re-roofs
$1{ Ro l t" Wam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appiinnt m future building pcoupabt mtom or lundk hvsNous material
as,defined by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Code,Sation 15531(x)? t�Ne All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or fumm building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
telt hxnrdnn ob conumimnu"dcfncd by du Bay Asea Air QualityManagement all new materials for inspection.
DistridT
❑Yet Den
I have mW dm hvmdommemdels mquimmcnu under Chapmr6.95 of the C lifor-
nia H"IN K Safely C,*,Secdon25505,25533 md2M34.1 undcuund thm iroC building
does not currently haw e 4 that my maponibility w nattily the Occupant of the
acquirements which eat lrbrm issaanaora Cenincam of a Signature of Applicant Date
owner ear cam , ext mm All roof coverings to be Class "B" or better