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06020080 F ITY OF CUPERTINO ;: w �' + »' f -'^ • + `�' BUILDING DIVISION PERMIT C,ONTRACTQR�INFOPMAT40N ,,,, LDING ADDRESS: BAY AREA REPIPES PERMITNo.06020080 0103 MERRITT DR OWNER'S NAME: FERMITISURDATS MATT DESALAZAR 1861 ORANGE GROVE DR 02/13/2006 NE: SANITARY NO. CONTROLNO. (408) 371-5763 ARCHMIC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 Q LICENSED CONTRACTOR'S DECLARATION U 1 knotty affirm Wt I am licensed under provisions of Chapmr 9(Commencing Job Description �U with Section 7")of Division 3 of do,Business and Profusions Coate.and my license,is D„ mmBmmeandcrct 36 ��3� REPIPE/WATER HEATER/WATER MAIN j fa� Liana Class J tO LkN . 3F DemT 1111 ..•+rf_ Con Dr CI_ A HN �t rJ 1 'p T ARCHf1EC1'S DE,ugh 0 g1 IA 'O }u.3 I undcreund my Plans shell k used as public mcnr{le [IOI G: IgIET®N/ s k C Licensed Pmfcssi...I OWNER-BUILDER DECLARATION g2 I hereby affirm that l am exempt from the Comiwwrs License,Law for the . ZQ�� 0 o following mason.(Section 7031.5,Business and ProfessiuFE m Code:Any city at county L g Z S� which requires a Permit to cnmlrucL after.morrow,demolish,at repair any swcturn $5000 pnnrmiuiuunce.aisurequims Omgppiieamforsuehpermitm fkasignedmomem �< Nat M is licensed pumunuo the previsions of the Contractor's license law(CMpuer 9 Sq. Ft. Floor Area '�ys.) dluatl0 E (commencing with Sctkm7000)of Division 3oftk But!.and Pm"Uhms Cede)ur D / Ulm q S — Out be la exempt therefrom and the basis for dm alleged esemption.Any violation of P*�/ ll tl "`++.�J// Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of r Occupancy Type not more than five hundred dollars(5XD). ❑I,as owner of the property,or my employees with wages u their in Compensation, will do the work.and the structure is not intended or offered Ima i.(S.C.IDN,Business Required Inspections and Professions Cade:The Conuactofs License Law does but apply to an owner of q p propertywho bulldsorimpraves whercon,and whodoesaueh workhimselfor Waugh his ._ ownemployecs,provided Natsuch Improvements arc not intended oro@red for sale.It, however.the building or improvement is sold within one year of completion,the owner- bullder wi0 have Om burden of proving that he did not build or improve for purpose of male.). ❑I.as awmr of the property,am ecluively contracting with limned conuacters w construct the project(Sec.7044,Business and Professions Code:)The Conuecmfa V- ane law dors not pply In an owner of property who builds or improves Ihenmn,and who contracts for such projects with a contractor(s)licensed pursuant on the Communes License Law. ❑I.m exempt under Sec. ,B h P C for wi.mason 1371M eer Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under twenty of perjury one of the following deemmom: I hem and will maintain.Certificate of Consent to ulf-imus for WorkcraCompen- ion,u provided for by Section 3700 of Om labor Code,for Ore performance,of the k for which this permit is limed. 1 have and will mtintsm Worker's Compensation Imuran¢,as required by Section of the lakr Cade,for dm performance of the work forwhich this permit u Issued.Wocarrier and Policy number art: (y�rtier. .ter 4l� Polity No.:72°b7.V/Vr G CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (TTlasec has need not k completed If the permit is fortune hundred dollars(SIM) to,kis.) I cenify thm in the performance of the work for which Is.permit is issued.I shall not employ any person in any manner an as to became subject to the Wurkem'Compemadon Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should become subject to to Worker's Compensation pmvhwns of the tabor Code,you mum O O forthwith comply with such prnvisiom or this Permit shall W counted revoked. „E,t 5~ CONSTRUCTION LENDING AGENCY EI hereby affirm that them I...costmetics lending agency for we performance of fYi the work for which this permit 1.issued(Sec.3097,Civ,C.) CQ Lender's Name D z (ander'.Address U0 1 cenify that I haw read this application and sum Nn the above information u D. (✓ correct.I agree to comply with all city and county ordimnces and state laws relating to OV building construction,and hereby authorim repreunmises of this city in enter upon the [k1 above-mentioned property for inspection purpams a (We)-:me In saw,indemnify and keep harmless we City of Cupertino gtimt tq liabilities.judgments,costs.no expenses which may in any wry¢enre against mid City fJ7 in consequence of the Suntin fth3 permit r1- APPLIC UN ND WILL COMPLY WIT ALL NON-POINT Issued by: Date '� / �C SOUR AT 6 � --- �3 4 Re-roofs SI E—ai ApplIcanu Conowner Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applimnt w futum building=upant atom arbendle hUmlous material as defined by the Cupertino Municipal Code,Cbapmr 9.13,and the Health and Safety cede,section Iss3x(a71 All roofs shall be inspected prior to any roofing material being installed. ❑Yes o Witt the applicant ar to building wcupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove II Wit Cair Contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strin1 ❑Yes Nu I he.rfet thed,hazand Seen.235 materials requirements under CMpmrd.95 it the Wilding deHcatcto,atcry Cade,Sectiom33X1 577snd23334.1 in nodry that Occup Miring Jou not curtan an, my rcapomibilirytonotify, the eccuPenwf the "'Clmmc ash me to of aCenifimmofOccupancy. Signature of Applicant Date Owner or mash and agent Dam All roof coverings to be Class"B"or better Community Development 0 Torre Avenue CuOpertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building De artment JOB ADDRESS: Inn r�;'J �r PERMIT# 0 2��ip OWNER'S NAME::"({MK- M� r PHONE # g"6 i (c9, St GENERAL CONTRACTOR: 1 FAX # I am not using any subcontractors: - _ '> u` / 3 -2. C. 6 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile X714 2-et)A Owner/Contractor Signature Date . ,, CITY OF CUPERTINO CUPEIZTINO PERMIT APPLICATION FORM N# 3 ��( D ?s Date: /, / S 2Cx/ uildh3 Address: J Mailing Address (i/f different from building address): /d3 �r� /Dr Owner's Name: Phone#: ,4 SGL12� � Coni actor: � n _ License#: 73 C l3 0� Kt D/ C ntac : V Phone: Cupertino Business License#: q0 St xrl Sv-n Fax: 7,3 -77-.3 Building Permit Info: �1buSa� Cl1ff ookti r a�°r wr.�r ^�'�;� ge(ipa. c r0 / lin c. Bldg ❑ Elect ❑ Plumb Mech ❑ Job Descnpt?op: Residential,; Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Proi Occupancy Grou u00.Gtb Type of Construction: ✓ Please check this box if the project is a to In second-story addition: ❑ ro'ect Size: Standard ❑ Laze ❑ Major ❑ Quant Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERl Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1,75741 Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ nasi 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 1of3 31 CITY OF CUPERTINO WDF PERMIT APPLICATION FORM CUPEfZTINO Quanti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMIviE New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTDvIE 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 BPREP11PE 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 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 BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BRE2`g'URNOV Relo Furnace> l OK btu MECHANICAL BREMBEAT Heater Installation MECHANICAL BRElYIINHOOD 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 13RENIRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM uantity 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 Sob S wific Plan BUILDING BSEISNUCOM 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 MPERMTTFEE 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 ZADDCH I Address Chane BUEDING 3of3