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05080210 CITY OF CUPERTINO ''as vv. �'_ .cx,� ,�rn 1 11 BUILDING DIVISION PERMIT CONTRACTOR INFORMATION -i BUILDING ADDRESS: PERMIT NO.O 5 0 8 0 210 11573 MORNING SPRING CT 01 NER'S NAME: PERMIT ISSUE DATE GORDON PERRY 23 2005 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 +Op LICENSED CONTAACm0.'S DECLARATION Job Description Fu❑ 1 tcmby))Bele that 1 am limned i under provisions of s Code, 9(Commencingsis p �W with Section]gKs)of Division 3.f Me BusincasaM Professions Code,and mylicense is in full force and eif c REPLACE SIDING yyvj? Lieevc Cl l.k.N Conv mr CONTRA. : HOME IMPROVEMENT BUILDING MAINT. ££ ARCHITECTS DECORATION C 9dpraund y plans ah W used as public records a k Lice cesinn OWNER-BUILDER DECLARATION f I he"',affirm Nal 1 am eacmpt form the Camramars License Law far the O o following lesson.(Section H01.5,Business and Professions Code:My city or county 3$ which requires a Permit to construct.alter,impmw,demolish,or repair any Stmemor prior it)its issuanc,also mquirca the applicant forsuch permit to file aligned statement x< that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 Sq.Ft.Floor Area Valuat 8 0 0 0 y{<$ (commencing with Seetion 7")of Division 3 of the Business and Profevsium COO)or Mat he u exempt Marefrom and Ma basis for me alleged exemption.Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to•civil penalty of APN Number Occas nut mom than eve hundred dollars(sew). 36652034 . 00 panty Type ❑I,as owner of me properlY.or my employees with wages as limit sole compensation, aill do Ne work and the awctuse u not intended or oRetod forule(Sec.]014,Buri. nd Professions cede:The Committees License law does not apply w an owner of Required Inspections Property who builds or improves themon,and who docs such work himself or through his however,Onu,provi or improvement vis improvementsartnot ear of completion. lletod for sale.If. must, � own Croaoy basildingortsucsuch r vementsrono year of completion.Ne owner. aas°]W%�i`s fff��C builder will haw the Nodes of proving Oat he did not build or improve for purlose of sale.). v� 'hn.i Q 1,as owner of IN Property,am exclodwly co rrac6ng with licensed ronuaebrs in .3 Sea construct Ne project(Sec.7061.Business and Professions Code:)The Contracwls Li- cerise taw does not apply w an owner of property,who builds or improve Neneon,and who contracts for such projects with a contomem(s)licensed pursuant to the Conwctots Rg�gTjylly%s] /Il'I License taw. ❑lam exemptunder Sec. ,B k PCfarthiawan wncr Data WORKER'S COMPENSATION DECLARATION Y tpfveth I hereby affirm under penalty of perjury ane of the following dmlvations: k� I base and will maintain v Cenificam of Consent to mdrinsum for Workers Compen- sation,as provided for by Section 37w of the labor Code,for the performance of the woh for which Nis Permit is tested. ❑1 have and will maintain Wod er's Compensation Insurance,u required by Section l]w of the labor Code,for the performume of the work for which Nis permit is issued. Carneorke� p pe n PsmPol ry No.:and Ocy number_ CERTIFICATE OF EXEMPTION FROM RKERS' COMPENSATION INSURANCE (This section nod ver W Completed if me permit is for me bundred&it.(5 100) or less.) 1 ccnify Not in the Performance of the work for which this Permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of Califamia.Dam Applir , NOTICE TO APPLICANT:If,after making this Cerifieam of Exemption,you should become subject m me Workers Compensation previsions of the Labor Codc,you muse .J O fonhwirh comply with such provisions of this Permit shall W deemed revoked. '�y CONSTRUCTION LENDING AGENCY (~� I hmeby alrnm On inert iso cmwmctinn lending a;envy for the perfmmanmaf !Yi tiro were for which this permit u issued(Sec.3091,Civ,C.) 1 Lenders Name D z Lender's Addle.. , U Q 1 certify that 1 have read this application and sum that me above information is L E' Comm I agrm to comply with ill city arta county ordinances and sum laws totaling to O U Wilding Construction,soul hereby mimnne mpresenutivrs of this city re cum,upon tic - rty �a ahovcmcnudgm nrop Cori for inspectionexpenses pturpowhich ms. (We)agree,10 save,indemnify and keep ham less the City of Cupertino againe Fh incoidu,JuceorO,cmtsantlOf OiSwamit, may in any waya<crm against said City U z in eovequenm of the granting Of oris permit. " APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 2�&a Date SOURCE REGULATIONS 0 Re-roofs SignatureSignatureo A icant/Contonctor DateHAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Or future Wilding..Pa.,a.or handle handicus mammal u defined by the Cupertino Municipal Code.Chapter 9.I2,and the Health and Safety cWe.Beckon 25532(a)7 lT ❑Yea All roofs shall be inspected prior to any roofing material being installed. Will the, ficaut or future Wilding Occupant quip If a roof is installed without first obtainingan inspection,I agree to remove Pp g pant sew equipment or device Management it harudnus air contaminants u defiled by Vm Bay Area Air Quality Management all new materials for inspection. tonin? ❑Yes , I have read dre h oaMous numnalsrcquilemcns under Chapter A.95 of tiro Califor- his Heath kSafetyCade.Se d.15505.25533vW 25531.1 unmemolmat ifthe Wilding docs twt currently have•tenant that it u my mspmountity to notify me=want of me rebored n s eem h pt prior to a of a Ccrufmam of Oce envy. Signature of Applicant Date Gwnerm thmdagent Dam 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 Department JOB ADDRESS: PERMIT # O .rO fG a ( b OWNER'S NAME: PHONE # _ GENERAL CONTRACTOFAX# u 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 Ah Linoleum/ Wood Ir Glass / Glazing Heating Insulation Landscaping Lathing Af Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO -v g a 2-110 CITYOF PERMIT APPLICATION FORM CUPEkTINO APN# Date: IS-a 03 Building Address: Mailing Address (if different from building address): M -r n c Owner's Name: Phone#: Contractor: License#: Contact: Phon 3ist�3 Cupertino Business License#: Fax: Buildin Permit Info: Bldg 115,, Elect ❑ Plumb ❑ Mech ❑ Job Description.- Residential escription:Residential 9, ( � Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ qp—Project Size: StandardZ, Laze ❑ Major ❑ Quantity Fee ID Fee Descri tion Fee Group BAPPLOTHER Other A liances MECHANICAL 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 BBOILERS Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Com/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> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 4 1 of 3 ` z ° 3 7 ° i CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO 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 BOVERTME 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 Interce for 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL BREMFIXT Li tin Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise Ap2aratus ELECTRICAL BREMNRAPP Rem Non-Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rept' Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R air/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 r�- s CITY OF CUPERTINO CITY of PERMIT APPLICATION FORM CUPEkTINO Adilk 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 BSV1IM 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 Mecb 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 Change BUILDING 3of3