04020138 CITY OF CUPERTINO
BUILDING DIVISION PERMITCC1NT-RXCT0RINF'URMA,TION. /
BUILDING ADDRESS: S P WALLS MAS INC PERMITNO04020I38 '
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY NO. NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
ee BLDG ELECT' PLUMB MECH
YY00p LICENSED CONTRACR3R'S DECLARATION O O O
< y 1 hereby.Burn that 1 am licensed under previsions of Chapter 9(commencing Job Desc ti
'nE withs on] )o(Divialon Sof the Bueipgyand Professions Code.and my license is
. =w m full
In
def@rap ✓
Sp a«nm a C ^ Lle.« CHIMNEY REPAIR
Date Sj FEB 2 7 2004
q \ �y As Mail CTSD RATION
22 1 TYfrluW my plans shall he used itirpublic records
DyU
pH3 Licensed Pnsfcsaionel BUILDING
Oat I A.aUILDER DECLARATION
d a f I hereby.(Siem that 11. exempt from tee Contractor's License Law for 1ty
S:0 0 whfallich requires a penrit t ]rnsinu Business and are.Professions demolish.ora ray city or county
$ whichnquisaaemail recnres the,alter.intforsuermittperrepair signed
F Z y prior In its issuance,aim nt to the tite applicant for such rermiuo File s signed atatemem 400
(commencing
he escingwiit pursuant to the ofprevisions visionf the eBusinurWccmctaw(Chodttt9 Sq.Ft, Floor Area Valuation
$ (cat he Is acnapth Section]ad the
Division r the
the agcd eta and Profeson.Any
Code)of
R.. that he U 31.5 b therefrom and or beau for the alleged eamant in Any l pens of
Section than five
any applicant s(.Permit subjects the applicantaacivil penally of
racer mare than five nanama dollars(g500). 3 AWMI1364N 0 Occupancy Type
❑1,n ownu of Ne pmperty,or my cmploycu with verges u theuaote compenudon, -
will do the work,and the structure u notim ended or offered formic(See.7044,Business
And Pm(asalona Cod.:The C.mrmtoea License Law rias ret apply to an owner of Required Inspections
Property who build.per improves thereon,a nd who das such work himself orthrough his
own employees,provided that such improvements art not intended ora@red fasale.If,
however.the Wilding or improvement is old within one year of compledon,the owner.
builder will have the burden of proving Nat W did not Wild per Improve for purport of
sale.).
❑1,As owner of the property,am exclusively contracting with licemed contractors m
contract Ne pmjmt(Sec.7044,Business and Professions Code:)The Cootracmrs U.
came law docs not apply m an owner of property,who Wilds or improves theme,and
who contracts for such projects with a contractor(s)licensed pursuant in the Contractors
License law.
❑I amexemptunder Set ,B&PCforthlamsson
Owner Date
WORKER'S COMPENSATION DECLARATION
1 Walby affirm under penalty of perjury one of the following declarations:
1 have and will maintsin a CenlBeate of Consent to sel6insure far Workers Compere
inion,As Provided for by Section 3700 of Ne labor Code,far the por(orm.ac of Its
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as mquimd by Section
37W of the Latour Code.for the performance of the work for which this permit is Issued.
My Workers Compensation Insurance artier and Policy number am:
Cartier. Policy Ne:
CERTIFICATE OF E%EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Theacetion acd not W completed iflithe Permit is foronehundred dollen($1IX)
or Ices.)
1 ceni(y Nat in Nc ppcc//(armenc a(the work for which this permit is issued.I shall nut
emPloyMypermAita3W mm 3yJaDmcan+d sLbject to the Workua'Campensalhm
Iowaca Califon 775s(6J �117/n17��a(li�f
Applicant-
N(aTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
b suhjea m Ne Warkerf Compensation proW la
visions of Ibor Code,you must
.JO fo th comply with such prevision or this permirhall W deemed mvnked.
.'E.,1; CONSTRUCTION LENDING AGENCY
[—� I for by which
tur Nat Nero issued(tm.3Wending agency l'or Um perfunnancc of '
rl ti La work for which Nu permit is issued(Sec 309],Civ.Cd
W0. Q Lender's Name
�z Lenders Addmsa
U0 I tardily that I have read this application and state that the above information is
{I. F eartea I agree to comply with all city and county ordinances and state laws relating to
O V building construction,and hereby authariesmproantadvesofthis city toenter upon be
to ahovetmenudgm Property for inspection which may
ow (WA)agree to save,indemnify and kap harmless the City of Cupertino against
fp Iiabilitiesj aor%Acon ling of this permit. mayin anyway accrue Against said City
A Po IWC a of the grating of Nis Permit.
ti APPLIC UND T NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da
SOUR REGUL
ig �y Re-roofs
f C
Data
HAZARDOUS MATERIALS DISCLOSURE /J Type of Roof
Will the applicant or future building occupantaume or tiara us mmcrial
As defined by the Cupertino Municipal cede.Chapter 9.12,and the Ith end Safety
Code.Section 25532(¢)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which P g
alit ha/.ard..A air conianumams as de0ncd by the Bay Arca Air Q.Mly Management all new materials for inspection.
DbuicR /
/ ❑Yr [JNJO
I have mad the havamousmeterelsoequitemcnts under Chapter 6.95 of the Caliror
I nice Hahh&S eiyCo .ScNnns25505,25533md25534.lundcntsndthatifthe Wilding
docs not cu ndy hast a anL that it is my msamihility m nodfy the occupant of the
mquireme whichm a pfi rR i anceofa Ccoiricateofoccupancy.
� Signature of Applicant Date
,r Owne or t a.dagent Date 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
tPEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
02 e_
OWNER'S NAME:
GENERAL CONTRACTOR::� FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
JFlooring: 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
Owner/Contractor Signature Date
10/28/03
(El CITY OF CUPERTINO D
' Cff OF
CUPEkTINO PERMIT APPLICATION FORM
N�L,Z: z
N# _ Date:
Building Address Mailing Address (ifdiffe ent fro buildin address):
Owner's Name: Phone #:
— -23s-
Contractor: License #:
Contact: Phone: Cupertino Business License#:
Fax:
Buil16,r mit 1 o:
d 0� Elect ❑ Plumb ❑ Mech ❑
J b Descripti /
R ❑ Comm ci
Sq.Ft. Floor Area: $/Sq.Ft.:
l ,
Cost of Project: Occupane Gro
Type of Construction Please check thi s a
second-story addition: ❑
Quantit Fee ID Fee Descri tion Fee Grou
BAPPLOTHER Other Annlinnnps MECHANICAL
BBLDGFEE Bld Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 1 OOK 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 inc[/Ott/Comm/("),,as,' BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax –Resi/Mobile BUILDING
BELEC1000 Elec 600V <= IOOOA ELECTRICAL
BELEC 1001 Elec 600V> I OOOA ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD U-- Add Multi BUILDING
BINVESTIGA Lrvesti anon fee BUILDING
BMITIGATC Comm. Housin Mit. Fee BUILDING
CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Descri tion Fee Group
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 Pb1g 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
BPSE
WAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackfio PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Instalt/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
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 Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD I Rmdl Signs Add Branch . ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
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alt CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM 1`1 i
CUPEf�TINO
Quantity Fee ID Fee Descri tion Fee Group
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb S ecific 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 Te�mp 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
ZADDCHG Address Chane BUILDING
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