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04030050CITY OF CUPERTINO 77777777jt7l­7,,, " BUILDING DIVISION PERMIT t,(C ONTRACTOU, M, ORN�WQNN, -" , _ � 1 --,T, B BMILDING ADDRESS: U nqg-i TqnPTT_jqKy so WALKER CONSTRUCTION PERMIT "04030050 OWNER'S NAME; EVIA MARA -71 -P F-T. rLMTbTC) RRA.1 PERMIT ISSUE DAM 12004 ONE: (650)961-767R SANITARY NO. CONTROL NO, ARCHITECTIENGINEER: BUILDING PERMIT INFO RLDO ELECT PLUMB MISCH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm than I amiianoweil under previsions of Chapter 9 (commencing wilbsecio 7 )ofDivixior3ofdwBu susandlinficialonsCode.apdriyfice.i. ,, :zal EXTEND GAS LINE & ELECT TO GAS INSERT �� em Ms)Vr1'V'A21. Rx§d 9wdupilicrecords yiptaghC11c, Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the fallowing mason. (Sudan 7031.5, Business and Prafecdons Code: Any city or county which mutation a Permit to construct. alter. improve, demolish. or repair any structure Don prior to its issuance, also acquires the applicant for such permit to rile a signed ausionacra Nmb.isliccn.dp..antt.ftpmvisiomoftheConi=tor'sLimnwUw(Chapim9 Sq. Ft. Floor Area Valuation (commencing with Section 7") of Division 3 of dm Businessand Professions Code) or that he is exempt ftnefecom and the basis far the alleged exemption. Any violation of 3 1VVCft*r.r0 0 Occupancy 71�pe Section 7031.5 by any application for a perail, subjects be applicant in a civil Penalty of not mom than fin hundred dollars (S500). 0 l,umnaofthe pmpenymmyemploycowith wages utheir mlecompenution. will do bewaik and thestructum Is not intended orofficand forsole (Sm. 7044, Business Required Inspections and Professions Code; The Contractor's License Law dran an, apply in an owner of property who buiIda orimproves bercon. and who does such work himself orthrough his own employces, provided thationch improvements are not intended oraffired forsaid. If. however. the building or improvement is sold within one year of completion. be owner, builder will have de, burden of moving that he did not Wild or improve for purpose of sale ). 0 1. as owner of the property, am exclusively contracting with licensed connections in FI HALED contract the project (Sec. 70", Business and professions Cade:) The Commictur's Li- crown Law dims not apply 0 an owner of property who Wilds or improves themon, and who common, for such projects with a connumemar(s) licensed pursuant in thas Contraccum's LicenseLaw, MAR 1 0,2004 K2amearropumseasm. _.B&PCfarthairmism Own,, Data — BUILD rING WORKERS COMPENSATION DECLARATION I hereby ¢Man under penalty of perjury one at the following dmiturations: I have and will emmusti. . Cerafficati: of Cannot to self-inure for Worker's Connium. colum. as provided for by Section 37M of dm Labor Code, for be performance of be Work for which this Permit is Wood. C] I have and will maintain Worker's Compensation Insurance, u required by Section W of Its. Latin, Conn. far be p.,famonsom of be work for which flus permit I. Issued. 3" My Worker's Compensation Insurance carrier and Policy number are; 1(nds - I Carrier: oficy NO, CERTTFICATEOFEXE�1� OM WORKERS' ATE 11 COMPENSATION INSURANCE section mail not Ini completed if IW permit Is foram hundred dollars ($101); or cis.) lcertify Net l.the p.,ftionamen. a cork which Nis permit is issued, I shall im, employ any person in any 507., Wearm Law, of Ctilifionan,&W Applies. 4 IL,�c NOTICE TO APPLICAMT. If. after making biTCEldicatic of Exemption. you should became subject an the Worse's Corripmarefion previsions of be Labor Code, you must forthwith comply with each p ... id.. or this permit mail W deemed ranked. CONSTRUCTION LENDING AGENCY I hereby affirm that thime is a construction lending agency for be performance of Ne work for which this permit is issued (Sm. 3097, ch, C.) Lender's Name larder's Add. I mildly that I have read this application and sum, that ths, sheve information is correct. I agree to comply with all city and county ordinances and sim, taws mladng to building maned pion, and hereby suntame, hiphosenistivas of this city to cam, upon do, above-mendand tropical, for inspection purposes. (We) agree to .., indemnify and keep harmless the City of Catacomb against liabilities, judgments, costs and expenses which may in any way acme against said City in consequence of be timing of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Type of Roof S wo ol'ApplicamVContractor Dole HAZARDOUS MATERIALS DISCLOSURE Will be applicant in future Wilding occupant store or handle Manhattan material as defined by the Capetian Municipal Code. Chapter 9.12, and be Health and Safety ode, Section 25532(a)? n Yes p(M 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 be applicant or future building occupant use equipment or devices which 'nit haxitaftes air Contaminants as defined by be Bay Area Air cosily Management all new materials for inspection. District? [3yes No I have neral the Waindons materials roquannorm ..do, Chapter 6.95 of the Calif., at. c Y ccdora21M105 533and25534.1unmrsuraddsalifthe building that d .11 ally It hai it y responsibility to no ly the C. fba ,a., a at en which 91 prior do, ounce, of. Coal �f Signature of Applicant Date 4, 1 All roof coverings to be Class "B" or better — 1 r thinizedallona +nre and rmmnlete the following information: C i � 4t,,Que NTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing eating l.U'�L12 -Insulation Landscaping LathinMasonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering ,W Plumbing Roofing Septic Tank Sheet Metal Sheet Rock . Date CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM APN # (� q b 2-- Date: 4 -3//0 7 Building Address: Quanti Fee ID Mailing Address (i different from building address): Owner's Name: �IA�A BAPPLOTHER Phone #: IPSO 2 79 2 2 75 Contractor: 6-QNS% , BBLDGFEE License #: 7/-F1Vi Contact: / Phone: !e S'0 Z'7 Cupertino Business License#: MECHANICAL Fax: 2275 �/ju tclLE Building Permit Info: BBOILER3 i Bld ❑ Elec Plumb Mech Job Description: BBOILER4 Boiler> IM to 1.75 M Btu Residential EEG ommercial ❑ Sq.Ft. Floor Area: K 4-7— (off !N sem. $1Sq.Ft.: Cost of Projec BUILDING Occupancy G up: /6a o BUILDING BCONSTAXBQ Type of Con tion: BUILDING J Please check t is ox if the project is a Hotel and Motel BUILDING second-sto addition: ❑ ! ✓ 1 of 3 Quanti 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> IM 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 1 of 3 rGl CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 2of3 -Quantity Fee ID Fee Description 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 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 rinkler/Backflo 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 Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BRENLUU- AN A/C Units <=10,000 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREN MISC 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 BRENMSAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL 2of3 aw o CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 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 ZADDCHG Address Chane BUILDING 3 of 3