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05120025 CITY OF CUPERTINOe BUILDING DIVISION PERMIT C(ANTRA ROR INFORMA�QN ' '€c+Aw- _ BUILDING ADDRESS: PERMIT NO.05120025 20002 NORTHCRE T S OWNER'S NAME: PERMIT ISSUE DATE ADAM ZETTER 12/05/2005 NE: SANITARY NO. CONTROL NO. ARCHIIEC(ENGINEER: BUILDING PERMIT INFO BLDG ELF.Cr PO MECH O 30p LICENSED CONTRACfOR'SDECLARATION Job Description i� 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing wish gallon 7=)of Division 3 of the Business W Profuse Cade.and my Reeme is n inmBfareeande m 9 CHANGE VANITY/ADD LITS . & CIRU � Z Licenm Class Lic.Y 3 r' 7 p sf -- Dam Canlrsnar CIRCUIT FOR MICROWAVE S As shat TS DECLARATION CONTRACTOR: FIATO & ASSOCIATES I understand my plans shall W useJ a public records Licensed Pnrecuional 3 OWNER-BUILDER DECLARATION JA ZOO(/ I hcrehy.(Stem that 11. exempt from the Contractors License Law for the p O which following a permit 1 703 LS,Business olid improve, dennN Code:Any elly Mmcounty which reyulrcs n permit a construct,plan hnpmw,demolish,car rtp.ir any omcure �f.^ prior oiu issuance.also requires she applicant for such Permit to Bb a.igncd suhmcm �< that he is licensed pursnanuo the provisions of the Contractor's Lkomm Law(Chapur 9 Sq.FL Fl OOr Area alt G kommcncingwMSation7")of Division3of Oe BusinasandP r=iom CM)or $ .ha is ammpt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any Applicant fora permit subjects the applicant at a civil penalty of APN Number Occupancy Type trot mom than nw hundred dollars(M). ❑1,as owner of the property,or my employers wish wages as their win wmpewtion, will do the work and the.uuctun is hat funded or offered for ule(Sec.70/1,Business Required Inspections and Profesdoes Cade:The Contravenes License law does amt apply u ownere ns an of q P property who build.orimproves Ihemon.and whodoessmh work himself or Waugh his - Own employcm.provided dousuch Improvement,tie has Intended araffered for tela If. however,the building or Improvement Is sold within ane year of completion,the Owner. builder will have the burden of Moving that M did not build or Improve for purpose of sale,). ❑1,as Owner of the property,am exclusively contrscting with licensed contractors to caarmet the projam(Ser.7044.Business and Pro(esdous Code:)The Cotrantue,W. came Law does not apply to an owner of property who build.or improws Wmon,and, who contracts for such projects with acontracurtU licensed pursuant u the Cantractora License Law. ❑lam.scmptunda See ,BkPCfarthi.won Owner /hf+-,/r c� �fI+1-- Dau�7"s_'pb WORKER'S C6RPENSATION DECLARATION I hereby AB7tm under penally of perjury one of the following dalwuone 1 hsw end will mNnuin a COriOcate of Consent to ulf-lasom for Worker.Compcn- adon,a provided fee by Section 3700 Of the labor Cade.far W Md...of the work for which this permits.lumd. ❑1 have and will maintain Workers Compensation Immune,a acquired by Section 37W of she labor Code,far the performance of the work far which this permit is issued. My Worker,Compensation Insurance eerier and Policy number m: Cartier: Policy No.: CERTIFICATE OF EXEMP ION FROM WORKERS' COMPENSATION INSURANCE (This section dead nothe completed lithe Tama Isforone hundred dollars($100) or leas) I curtly that in the performance of the work for which this permit Is Issued.I shall am employ any person in any mmncr an u in becamesubjeOt m W We Compeaadon Laws of California.Da19 3 51 — �P a Applicant1bssK 7%� -a¢s NGTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker.Compensation provisions of the Labor Cale,you must �O forthwith comply what such Musicians or this permit Nall be domed revoked. '� tiCONSTRUCTION LENDING AGENCY [+ Ihereby affirm that then its construction lending agency for the performance of . C,7 site work for which this permit Is issued(Ser.3197,Civ.C.) ALander:Name z lander.Adder.. U O 1 certify that 1 haw read this application and wu that site above information is U.U correct.l agree to comply wish all city and county Ordinances and suss laws milting o C)S`�J building construction,and hereby wNodre mpresenmiwa ofthia dry u enter upon Use W show-memi...d property for inspection purposes. C (We)agme to saw,indemnify and keep harmless W City of Cupertino Aj iat y liabilities.Judgments.costs and expenses which may in my way accrue agalauaid City t.)7 in consequence of the granting of this permit. r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. —--- &r I I –.ate '? '�° Re-roofs Signsturaof Applian ter Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building=opal Mom or handle hvardous material a de0nad by de Cupertino Municipal Code.Chapter 9.12,and W Health and Safety al=,ser inn 25S32(a)7 All roofs shall be inspected prior to any roofing material being installed. 7arii❑Yes ❑No Will the applicant or future building Occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove it h tcunk us air conuminanu u defined by the Bay Area Air Quality Management all new materials for inspection. z ❑Yes ❑No Ihiveread t e hasrdmts materials requirements under Chapter 6.95 of the Califar Hi Safety Code,Sectiorts 25505,25533 and 25334.1 understand that if Ne Wilding es not curmmly haw a hotel.that itis my responsibility u notify the occupant of the usamcnts which man be mel prior to issuance of a CcNricah of Occupancy. Signature of Applicant Date egrl -S^Ol Own�ar~araamadncdisg= Data 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 �UPEkTINO Building Department JOB Q DR )�-ESS: d>/C� r- PERMIT#OS-/z O O 2-_'5— �J� � �/ OWNER'S NAME: PHONE # GENERAL CONTRACTOR FAX # I am not using any subcontractors: 4u./ e z - s- e s Signature Date Please check applicable subcontractors and complete the followin 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 Owner/Contractor Signature Date CITY OF CUPERTINO CRYO PERMIT APPLICATION FORM QS v 2�V CUPERTINO N# 3iG 3 ¢ GS Date: 12 _ 05' — oS 14 wilding Address: Mailing Address (if different from building address): 000 .2 , c Vesr i'- c o Owner's Name: Phone#: AC/a 2- e -Heot Contractor: License#: ne 3338 yq Contact: Phone: 1'•f-3 os 9 vq Cupertino Business License#: Mi CL, ne Ft4 o Fax: I/P3, .2 o3n Building Permit Info: Bldg Elect 0 Plumb R1 Mech ❑ Job Description: c ti •,^ �e • "R " S / Ff n o t GdC/M, r V-A � &t. � c Residential ® tr d„,, 7 e w Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Proiect: Occupancy Grouv: S 0C1 n . DO / Type of Constru tion: Please check this box if the project is a r c d second-story addition: ❑ A16roject Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBQILER3. Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1:75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL !)i BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING CONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELE 11000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING 13ENFRGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING �2M1rc,� CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMTTIGATC Comm. Housing Mit. Fee BUILDING 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 MIXTURE 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 BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ectionFee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> IOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMUMOOD Installation of Hood MECHANICAL BREMIVHSC 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 13REMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEf oo , PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sigas, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS I Ventilation Systems MECHANICAL BSCBLVD Sob Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSVIW Swimming Pool BUUDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary BldgPermit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electricals foot ELECTRICAL EPERT&TFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Commel Multi-Fam PLANNING PLLONGRNGR Planning LDng Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3of3