The URL can be used to link to this page

03050090CITY OFCUPERTINO �,T"' __ _ ' �' BUILDING DIVISION PERMIT CQk�I,'R1�TOR i1VI+f)1V,r1'�.TOl+'- \ BUILDING ADDRESS: "' PERMIT NO. 03050090 e;AVE PeRMrr ISSUEDATB 05/20/2003 SANITARY NO. - CONTROL NO. ARCHITECT/ENGINEER: - BUILDING PERMIT INFO - BLDO ELECT- PLUMB MECH LICENSED CONTRACTOR'S DECLARATION op Job Description 1 hereby affirm thu I am licensed under provisions or Chapter 9 (commencing with Section 70TH)) ofDivision Sur the Buainess and Profession Codn and my Ikxnm is in full farce and effect. License Claaa 9 uc.a ADD BATHRM/ENCLOSED _ -WALLS & UPGRADE Dam Contractor E TION ARCHITECTS DECLARATION 1 understand my plana shall u wed public ■ INALEO 1pAI gl $ 2004 Licensed Poor ...mal '. OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License law for the. - Jlil's /J following moron. section 7031.5, Business and Pmfcasions Code: Any city or county which requires a permit to comtmct, he,. imprnw, demolish, or repair any structure prior m IIs IUume...len mqulma the applicant for such Penult to rile a algned statement that he is licensed pursuant to the provision, or the Cmarwam'a License Law (Chapter 9 Sq. Ft. Floor Area (commencing with section 7000) of Division 3 of the Business and Professions Cole) or that he isexempt Iheraftom and the basic far the 11cgcd exemplion. Any violation of Q L_ - r Occu ane e P y EYP Section 7D3L5 by any applicant for a permit subjects the applicant to a dvil penalty of not mom than five hundred dollars ($SW). %3 j 3- % = J v2lj 0 0 U L 6 0 1, as owner of the pmpeny, or my employee with wegm As Heir sole compensation, will do the work and the stmtlum Is not Intended oro@mA fonak(See.7044,Businew Inspections - and Profusions Code: The Contractors License Law does not apply to an owner of 101 - FOUNDBPr1100 propertywhobulldsorimprovesthereun. and who doessuchwmk himselfor through his 102. — PIERS ..- ' own employees, provided that such improvements are notintended oroffemd fmale.Tf. however, the building or improvement is sold within one year of completion, the owner- - 103 — UFER builder will have the burden of proving that he did not Wild or improve for purpose of 10 4 - REBAR ` sale.). - �A.s.owner ofthe unparty, am exclusively contracting with licensed contractors to 105 - ANCHOR BOLTS construct he project (Sec. 7044, Business and Professions Code:) no Contractor's Lt. 106 — SEWER & WATER come Law does not apply to an cower of property who Wilds or improves themon, and who contracts for such projects with a comemlor(a) licensed pursuant to date Contractors 202 — UNDERFLOOR PLUMBING. License Law. ❑ I Am exempt under Sec. B&PCT this an 203 - UNDERFLOOR MECHANICAL —/'r o✓ �flo • 204'-- UNDERFLOOR FRAME 1< Q O0.KER' OMP ATIONDECLARATION 205 - UNDERFLOOR INSULATION " I hereby aEien under penalty of perjury am or the following declarations: 301 — ROUGH PLUMBING se and will mslnuin. CeAOcaloof Consent to se161nsure for worker's Compen- 302 — TUB & OR SHOWER m provided for by Section 3700 of the Labor Cade, for Ne performance of the rwhichwsPermitisIssued. l 303 - ROUGH MECHANICAL ve end will maintain Workers Compensation Insurance, as required by Section 304 — ROUGH ELECTRICAL f the Labor Code, for the performance of the work for which this permit le Issued. 305 FRAMErker'& Compensation Insurance carrier and Policy number are:— Cier; . Policy No.: 306 - 307 — HOLDOWNS INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 — SHEETROCK dolla(SIW) Cramsectim mad not W completed lfthe permit is forom hundred!rs or lesa.) .309 — EXTERIOR LATH of 1 ser ify that in the performance of th ork for which thH per �t is issued. I shall not 9 310 — INTERIOR LATH - em to an A menne eel to the Workers'Cam nation or p` 311 SCRATCH Iawa cehQ ate - 313 - COAT ROOF NAIL' Ap gg N TO APty..t -A- If. r mekmg this Certificate of Exemption, you should beeom ubjecllollmWorkersCompenutionpnvismosorlhelahMCnde,you must 501 -FINAL ELECTRICAL ENERGY - foMwith comply with such provisions or this Permit hall Is, dmmcd reversed, 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that ft. is a commotion lending agency for the performance of Bmwork for which this permnisWood (Sm.307,Civ, C.) 504 - FINAL BUILDING ENERGY Lenders Narnc 505 - 506 — FINAL ELECTRICAL GAS TEST Lenders Address I comfy that l have mad this application and sum that the strove infomtaum is cement. I agree to comply with all city and county entrances and sure laws Miming to 507 FINAL PLUMBING ' building convection, and hereby authonm representatives of this city to color upon the shove-mentionedpmpenyrot itnpectionpurposes. 0 — FIL MEC ICAL (We) agree to sawindemnify and keep harmthe City of Cupertino against 0 9 — F I liabilities, judgments. costs and expenses which may In anyway scans against mid Lily In conaequcnce of Ne granting of this pemR 5 NG ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT .Issued by: Date SOURCE RFF�'sULAT10 / �/'_ ✓ +(At.�tf'd V Re-roofs Type Of ROOF - ' nuurtAPPIiesmrau H HAZARDODO US MATERIALSDISCLOSURE Will the ApplicantCuior or handle hazardous mound Wilding occupant tout omen mforum As defined the the Cupertino Municipal Coda Chapter 9. 12, and the Hcelth and Safety io . El en 25532(a)9 El yes "�No All roofs shall be inspected prior to any roofing material being installed. future If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or building occupant use equipment or devices which Amorous air con umonanu as defined by the Bay Area Air Quality Management all new materials for Inspection. a7 ❑Yea allo _ I have mW the havardousm unfidsmqulrements underChapmrd.95 of the Califor. nia Health&Safety Cade, Sections 25%5,23533&mIM534. I understood ft BIN building dram not currently have a meant, that it is my responsibilily to notify dw occupant of the requirements which most W nopdor t.aance nr a Ccrtfic. of Ocen Signature of Applicant - Date C r S � All roof coverings to be Class "B" or better' g thorizcd er or age oar CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS:, PERMIT NO. 03050090 04—NN E: NEWS 01,al "E PERMIT ISSUE DATE 05/20/2003 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT - PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION - Job Description p I hemby affirm Ihat 1 am Ilttnmd under Pmvixiorm of Chepmr 9 (commenting with Section 7008) of Division 3 of Nc Business end Profess(ens Cndc, end my li.to ssis In full farce end .Ilea License Class uc.as ADD BATHRM/ENCLOSED' PGRADE `FIV Oale Contractor ARCHITECTS DECLARATION LEO 1 understand my plane shell be used as public recorda DEC 1 9 2003 Licensed Professional OWNER -BUILDER DECLARATION 1 hereby .inure l exempt from tine Ceni..Cm License Lew for the ..Se mn 7831.5,Buainusand Cm dc: Any city as county j followingmomn. 1. mprve, deism permit time improvq demolish, nr repair any which requires Permit cores R1 III DING Issuance. re the tatemem Mai heior to tscensed pRiserequiresthe provision O for mchpermiuorleesigned Smkmem Nat to the of the hee Sq. PL FloorArea Professions Code) of of Division 3 the usinc ondproelaons Coon) or (commencing of me ccgwith Section $7$IIla�lon U U but&on exempt M alleged Nal he IS exempt therefrom and Ne bssis for Ne alleged exemption. Any violation of that a is pt therefromand Occupancy Type Section 7031.5 by any applicant for a permit Subjects Ne applicant to a civil penally of net a. Nan Bvc hundred delta. (5500). 3�p�Nlr00 ❑ Lasownerofthepropeny, mmyemployces with waguas Nelrsoltcontrami0on. Inspections will do the work. and the Swdure is no emended oroffered fursalc (See. 7044, Business and Professions Code: The Con actorl License Law it= not apply to an owner of 101 - FOUNDM41*0 property who buildsorimproves thereon, and who doessuchwmkhimsellorNmugh his 102 — PIERS own employees, provided that such improvements are nolimmnded or offered fmsale. IL however, the building or improvement is sold within one year ofcompledon, the owner. 103 — UFER builder will have the burden of proving that he did not build or Improve for purpose of - 104 — REBAR sale.). I, as Owner of the property, am exclusively contracting with licensed concracto. to 105 - ANCHOR BOLTS construct he project(See.7844, Business and Prutcsions Code:) The Contractor's Lb 106 — SEWER & WATER ccme Law docs not apply to an owner of property who builds or improves thereon. and who convects for such projects with a emoractor(U licensed pursuant to the Cunvamora 202 — UNDERFLOOR PLUMBING License Law. ❑tare exempt under Ste. the on 203 - UNDERFLOOR MECHANICAL �/Bj&PCT ownl/ -/_',/ r at ✓ Dda L) B 204 - UNDERFLOOR FRAME t✓ ORKER' OMPE ATIONDECLARATION 205 - UNDERFLOOR INSULATION 0 lhereby affmnunder Penalty ofpmjuryone ofetrefollowing declarations: 301 — ROUGH PLUMBING ieveand will mdmeln S Cmdr.cOm of consent to sel6imune for WmIcefs Compen- 0.l, 302 — TUB & OR SHOWER as provided for by Section 3700 of the Labor Code, for Ne performance of the work for which this Permit is issued. 303 — ROUGH MECHANICAL ❑ I have and will maintain Workces Compensation Insurance. u required by Section 304 - ROUGH ELECTRICAL 3700 of the Labor Cod., for the performance of Ne work for which Nis permit is issued. 305 — FRAME . My Worker's Compensation Insurance carrier Policy number art: Carrier. - Policy No.: 306 - HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INS'ULAT'ION COMPENSATION INSURANCE SOB — SHEETROCK mines.) (This scctlrnneed not m emopleted iflhe Ismailia faro.. hundreddilltrs($100) 309 — EXTERIOR LATH I cen)fy that In the perf ernanee of th work for which Ibis permh IS issued, 1 shall not 310 - INTERIOR LATH Lo I an r ni remove t be eel to the Workers'Com enudon otCylPre'aI� ul-f%%E�' P 311 Laws 313 501 - SCRATCH COAT - ROOF NAIL - FINAL ELECTRICAL ENERGY _ N 7Tl AP 1 A . If. r making this Cenificam of Exemption, you Should becom ubjetlmMeWorktleCompensation previsions ofthe Labor Code. you must ' forthwith comply with such provisions at this permit Shall Wdecmcdmvoked. SOZ — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affnm Nal me. is a conswclfon wi ing agimey forte performance of ' the work for whichthis permit Isissued (Sec.3W7,Co. CJ 504 - FINAL BUILDING ENERGY Lender's Name Lender'sormss 505 506 LECTRICAL ' - FINAL ELECTRICAL:'; - GAS TEST 1 certify that I have mad this application and smtt that the above Information is • criumCL lagoon 10 comply with all city and county ordinances and state hovs nalming to 'building construction, and hereby aulhorim represcrllad s nfnliacily, tricolor n per the 5077 FINAL PLUMBING Shave-memliuned properly for inspection purposes. O — FMEC ICAL (We) agree to Save, indemnify and keep harmless the City of Cape rtlne against O 9 — F& I liabilities, judgments, costs and expenses which may in anyway Seems agdn3leaid City in consequence of the of this Cj '^ granting Permit. i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: NG Date SOURCE RE_gULATIONS. I v b — `` ti Re -roofs Type of Roof nseum APpliewil ntraenn ,�aln HAZARDOUS MATERIALS DISCLOSURE Will the applicant Or future building Occupant atom or handle hamdous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safely Cede, Section 25532(e)T ❑Yea ICN. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which hnaerdmusoI,ommunnoants as formed by the Bay Arca Air Quality Management all new materials for inspection. R DYcs MNo I have mail the hazardous materials mqulmmems under Chapter 6.95 of the Califon. lth & SdctyCode, Sectium25585,25533 and 25534.1 understand Nazi(the building Ldnotcurrently hove a ¢nano that II is my responsibility to notify the occupant of the ments which must W mel prior of suance of a Cerofow Of Occu ap Signature of Applicant Date All roof coverings to be Class "B" or better Nmixtd or age a,e CITY OF CUPERTINO (IKY OF CUPERTINO 0 PERMIT APPLICATION FORM �Sro 0 6 C 1 1 of 3 �'s" f S--? Date: r� Building Addres . - W5Y News Owner's Name:Phone ° 16AN 6 A OAk A QLr Ar #: Contractor: -D License #: Contact: fi Cupertino Business License#: Building Permit Info: Bldg Elect Plumbm Mech Job escription: Residential 0 ial Sq.Ft. Floor Area: v$/Sq.Ft.: Cost of Project: Occupancy Gro Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 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 BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING C 1 1 of 3 �'s" f S--? aMgu,�,,L, CUPERTINO CRTY OF CUPERTINO PERMIT APPLICATION FORM 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 BNUCOMME New Comm Electric ELECTRICAL BNUCOAB4M New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING B TI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME BPBAC LOW Inspection Overtime Atmospheric Vacuum BUILDING PLUMBING PCESSPOOL Cesspool PLUMBING BPERMFEE Bid Permit Fees BUILDING BPFIXTUR.E Pbl Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING PINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING JBPLANCKADD Plan Check Add Multi BUILDING PLANCKREP 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 StomVRain 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 BREMAIRHAN A/C Units <=10,000 cfm MECHANICAL Z BREMAPPLI Appliance Install MECHANICAL BREM 3USWAY Remodel Busways ELECTRICAL BREMFIXT 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 2 of 3 :44 CITY OF CUPERTINO CITY of PERMIT APPLICATION FORM CUPEkTINO ,,�uantity Fee ID 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 BREEMRESAPP 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 Insection BUILDING BSWW Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS I 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 Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 •