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05090131 CITY OF CUPERTINO �' sf a�� .a ary 3 '✓cu{t' i "'''" " "' ` BUILDING DIVISION PERMIT aCONTRACTQRINFORMATION �z, BUILDING ADDRESS: PERMIT NO.0 5090131 OWNER'S NAME: PERMIT ISSUE DATE AM MARGARET RICH 09/20/2005 NE: SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO FILM ELECT PLUMB MECH 0 0 0 0 :00 LICENSED CONTRACTOR'S DECLARATION Job Description rd U F I krtby affirm Nal I am licenced under pmWaions of Chapter 9(mmmcneing p with Section 7M0).f Division 3°f Ne Basin.and Pmfessione Code,md my license is rain lnm0lbme an rel. TERMITE REPAIR(DECK / �� 'q_ Li«nm ass Lle.« ((�^.7�o_a�r /BEAMS' JOIST) Dig Dala—���Ccmoxctor_j da%4zT_.,,.;eco CONTRACTOR: FRANZ TERMITB`�CONTROL© ppmmy ARCHITECTS DECLARATION U U ll t i ! ay C< I understand my plans shall W card u public records JaU Licensed Pmfcuiantl 1/�T OOWNER-BUILDER DECLARATION "• JS <I 2005 I hereby arm Nal 1 am exempt from duese Contractors LicenLaw for the CII JJ Ct O following mason.(SecOm 703 L5.Business and Pmfeulmu Cods:Any city m county `❑❑l r�P�__ �> 3: which mquims•permit to construct,alter,improve.demolish.Or repair any swttum that the ersedprsantto the tW applicant for Contrarmiva Law stakmcm t E�Qthommat enccensed pursuant toO)provision of the CO usimpmsnd Pmlaw(Chapmr9 Sq. Ft. Floor Area t `L � {` JI 1'�l} 'sj"V�8[L`•�FD400 z $ Oaths ncingwiNgereirom and Dnuisfion ro(NCaSed euandon.Anynvi GWr)or L2G�'' L V, '` Nn k H attempt therefrom and We bssu for the alleged exemption.My violation of W `•✓ Section 7031.5 by any ap,lic.,for a permit subjew the Applicant o a civil penalty of APN Number Occu ane e ml mom than five hundred dollars(SsOUh 31637053 . 00 p yTyp ❑1,u owner of Ne property,or my employees with wages u their mle compensation, will do tk work and the structure is notimma ed proffered fors le(Sec.70U,Business and Professions Code:The Contractors Lt..Law does.1 apply to an owner of Required Inspections property who buildsorimprows thereon,andwho doessuch work himself or through his awn employers,provided Nat such improvements art not intended or offered forsole,If, however,the building or improvement is sold within one year of completion,the owner. builder,will have the burcim Of pruning Nu he did not build or improve for purpose of salc.l. ❑I.u Owner of the Property,am exclusively contracting with licensed convucon to convect the project(Sec.7Oa4,Business and Professions Code:)The Contractor's Li. cense law does not apply to an owner of property who Wilds or improves thereon.and, who contracts for such projects with a comma or(s)licensed pursuant to the Contractors LKGRY Lan ❑Ismesemptunder Sec. ,B&PCfor Oismasen 10310rr� ner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of pedury one of Ne following declarations: 1 have and will maintain a Certificate of Crescent m self-iuum far Workers Compere I az provided for by Section 37M of be Labor Code,far Ne performance of the for which this permit is issued. Mere and will maintain Worker's Compensation Insurance,u required by Section of Ne Labor Code,far the performance Of tW woh for which Nis permit is issued. Work r2 Compensation Inmmnce carrierandPolicynngtarmeier. Policy No.: f�5_�S' y C IFlCATEPE COMPENSATION N WORKERS' COMPENSATION INSURANCE (This section need not W completed if the Permit Is for°ne hundred dollars(SIM) ca leu.) 1 cenifv Nat in the performance of the work for which Nis Permit is issued.I shall not employ any person in any mannerso u to become subject to the Workers'Compensation Laws of California.Data Applicant NODE TO APPLICANT:If,after making this Certificate or Exemption,you should become subject w the Worker's Campenution Provisions Of the Labor Cock,you muss .JO forthwith comply with men pro,mmut or Nie ramnit shall be deemed rovaked. Z h CONSTRUCTION LENDING AGENCY [+ l hereby affirm Nat them is a Construction landing agency,for the performance of a Use work for which this permit u issued(Sec.3M,Civ.C.) aQ Lenders Name z Landers Address V Q I candy that I have read this application and state Nat the show:information H I2. Contact I agree to comply with W city and county ordinances and state laws relating to OV building convection.and hereby authorim representatives of this city m enter upon the U •Wve.mcnuom'd property for iupecuon purposes. („r a. (We)agree to save,indemnify and keep harmless Ne City of CupeninO against ;;Aliabilities.judgmcnu,cents and eapensu which may in my way accre uagaiost said City IJ Z In consequence Of the Starting of this Permit. r—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �_G f SOL; �AULI ATtON,S� Signature of AppbcanutCOnuacmr l`adC�]Yl— �' Df Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will ted applicant tar future Wilding occupant nom or handle Mnardous material az defined by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safely ode.Scrdan sss3z(a>T All roofs shall be inspected prior to any roofing material being installed. Yes Nu Will tete, licam Or °tam Wildin =u ant ase, If a roof is installed without first obtainingan inspection,I agree to remove PP g p yuipment or denim which p it hzvardous air contaminants az defined by the Bay Area Air Quality Management iscictT all new materials for inspection. \/moo QYos ON. 1 have mad the hvanfoua mamrials rtyuimments under Chapter 6.95 or the Califor all Health&SafmyCodc,Seetiupa SM.15533 and 25534.1 understand Out if the Wilding does.1 Correctly have a tame Out it is my ruponsibiliq m nour,the occupant of Ne mquir=most Wm arwissmaca cerdficamorCe pan . Signature of Applicant Date F t7 Owneraranthoriedag rat D, All roof coverings to be Class "B"or better Community Development 1 10300 Torre Avenue ,. Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: KAG1 r tj'CL PHONE # GENERAL CONTRACTOR ZRr ' FAX#(per LM3-6 I am not using any subcontractors: (G (J� pQk � -ft)( V� 2 nd Signature 7-ermi4- 9— Date Please check applicable subcontractors and complete the following information: 60 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 CITY OF PERMIT APPLICATION FORM CUPEI,TINO N # Date: �(OS Building Address: Mailing Address (if different from building address): l 0 �s31 Nor4Nj;xd Owner's Name: Phon e �g Con ctor: �T License#: Z e M1 f ► U o 3 Contact: Phone: s,0 3 Cupertino Business License#: 71-Was Fax: Qq3-(P{0?' Building Permit Info: eki,IF r�J OK)ocA p cw .cam �u cA cC�- U wA SU-b<<J—z kA- Bldg Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: 1:;J py-r\S qA D f� 7ACt� 6wES,cQe t�2wrrS,pis} Residential S �n Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Project: qr r-7 dDO l Occupancy Grou p: Type of Construction: _I Please check this box if the project is a second-story addition: ❑ ro'ect Size: Standard ❑ Lar e ❑ Ma•or ❑ Quanti Fee ID Fee Descri tion Fee Group BAPPLOTHER Other A liances MECHANICAL BBOILERI 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 Elcc Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Ener Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 3 l 27 —L, 1 of 3 -i? '` CITY OF CUPERTINO S 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 BOVERTIME 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 BPINIERCEP 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTR AP Kitchen Tra 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 fm MECHANICAL BREMAPPLI A liance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lightin 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 A aratus ELECTRICAL BREMNRAPP Rem Non-Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power DeviCe/A aratus ELECTRICAL BREMRECEPT Rc tl, Switcb & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R air/Alter Heating MECHANICAL BREMRESAPP Remode] Res A liance ELECTRICAL 2 of 3 : - CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Mar uee 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 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 MPERMITFEE 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 ZADDCHG Address Change BUILDING 3of3