The URL can be used to link to this page

04100185 -CITY OF CUPERTINO '. BUILDING DIVISION PERMIT � R[Ii Q INk tMATTU ` BUILDING ADDRESS: PERMIT NO. - ALPINE RESIDENTIAL CONSTRU TIO 04100185 WNER'S NAME: - .. - FERMITISSUE DATE... . On ONE: - _ _. _.. SANITARY - --- OLNO. ` ARCHITECP/ENGINEER: BUILDING PERMIT INFO BLDG ELECT. PLUMB" 0 MECH 0 0 0 LICENSED CONTRACTORS DECLARATION - I hereby Affirm that l am licensed under provisions of Chapter 9(commencing .6IOb DesCTlphOn - `M Cclic,iontrayficcareta y u full force and cfreet. t 5�z ueenxelasa_ Lie,l $l 45 UPGRADE ELECT. .-SERV� �g . . Zt D"te�-G°""a°°r REPLACE FURNACE. & AIBD ACED j HIIECI'S DECLARATION 1 understand my plans shall he used u public menrds DEC 2 2004-11 Licensed Pm(ceaionel.. pO Oat lam exempt DECLARATION - 4 in hereby nlfi.A. I sic exempt s m the de nt.Co :Any C law for the O O following rcamn.Permit t 703 construct. B.ainoas and m.de ivas Cade:Any city rs roomy $ which lis is a a peml o to rnnAvucl,site"improsuch fa mill fi repair any rtmclme ' prior m its issuerMc.alau requires the applicant for permit m file a algned cummenl a that he to licensed pursuant t"the provisions of Ne Contractor.License law(Chapter 9 Sq.Ft.FIOOr Area luatl,On500 a (commencing with Section 7030)of Division 3 of the Business and Professions Code)or -- - .. �1 that he is exempt therefrom and Ne basis for the alleged exemption.Any violadon of Section 7031.5 by any applicant for a para t subjects the applicant to A Civil penalty ar APN Number Occupancy Type not mom than five hundred dollen(9500), Ql,as owner ofthe phapeny,or my employees with wages as their Aria compensation, - 36215002 (](] will dr the work and thestructure is not intended orofrered forsale(Sec.7044,Business and Professions Code:The Cnntnetor's License Law class out apply in an Mame,of Required Inspections - propenywhoWlldcarimpmvas thamon,and who doeasuch woklimselforNmugh his - s Man emr,the building or i prevehimprowmwithin one year of ompletrccl Is Own `M builder,Nebuilding order ofpmenlissand withinone year or completion,theowner- , builder will have Be,burden of proving than,he did not build or Improve for purpose of sale.). - 1,as owner of the nova rIX am exclusively crnaacling with licensed conuachars to - - Construct the pmjeci(Sec.7044,Business and Proftessiou Cede:)The Contractor's Li. cense Law does not apply in an owner at property,who builds or improves thereon,and .. _ ... ,..,..-.,...._J._._...�._....... - "" �.�..__..r_....... who contracts for such projecu with acontracloKs)licensed pursuant hathe Contractor's License Law. -__.�..�.._. - .. .., ....._.__..:_.'... .... . ❑I am exempt under Sec ,B&P C for this Mason wee, Data WORKER'S COMPENSATION DECLARATION I hereby edam under Penally of perjury one of lie following declarations: I have and will maintain a Certificate of Consent to xlGinsure for Worker's Compen- sation, ..as provided for by Section 37M of the labor Code.for the performance of the rk for which Nia permit is ismed. 1 have and will maintain Workers Compensation Insurance,m required by Section of Ne labor Code,for the performance of the work for which Nis permit is issued. y Worker's Compensation Insurance carie and Policy number am:rtier. Policy No.: - - CERTIFICATE OFEXEMPTION FROM WORKERS'COMPENSATION INSURANCE - Thk section need not he completed if Ne permit is for one hundieddollars(SIM) , nr less.) 1 certify that in the performance of the work for which this Permit is headed.l shall nut employ an ypersoni.mymanncrsirgsuyhcco aub)cc 0ihewo,UWCMmpensadrn - Law sorCalirmnia.Dale„`/n/ %Y- n r� Applicant s __ _ _ NOTICE TO APPLICANT.If,after m ling this Certificate of 113temption.you should - ^ - - r --• -- " WfOme subject W the Worker's Compensation previsions of the Labor Code,,you must Z forthwith comply with such provisions or Nia Permit shall he deemed revoked. Z O CONSTRUCTION LENDING AGENCY HIhereby.M.thnNem isoconnruction lendingagency for No perfurmanee of fl r� the wurk for which Nia permit is tuned(Sec.3097,Co.C.) QLCAdn,s Name z Lender's Add. U O I certify that 1 have mad this application and sum that the above information is IL .Mw- T agree a comply with city and courtly ordinances and sick laws relating u C V Wilding construction,and hereby authodm repomenutims of this city to enter upon the -. W shave (Wtiuned to saw, inspectionnifaM,omkeepha. FL eWe,)egmeto caw,indemnifyandkeep harmless way Accrue Cupertino against Uro in Consequence of ue granting of this expenseswhichmay in any WayaCCNC agalnaliald City U,'�' inconsequence of Ne granting of this permit. ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date .jo—2 i SOURCE REGULATIONS. )2e-soofs Signature a(AppiicanUConuacmr Data ht' " HAZARDOUS MATERIA DISCLOSURE y of Roof Will the applicant or future building Occupant share,or handle hmandouc material IniaMet defined by the Cupenine Municipal Code.Chapter 9.13,and the Health and Safety ane,Sectirn 25535(a)? All roofs shall be inspected prior to any roofing material being installed. QYU VN. Will the applicant or future building Occupant use equipment rr dcvicrs which If a roof is installed without first obtaining an inspection,I agree to remove mit W.u1WA air c"ruminants as defined by Ne Bay Arca Air Quality Management all new materials for inspection. istrict? ,,,,..,,,/// Q Yes ON. 1 hew real the W.MMOA maurialsrequitcmcnu under Chapter 6.95 of the Califnry &SafelyCodc,Sccdom25505,2533md5534.1unJcrsund NwifNc building ars ntcummly haw A tenant Net it 4 my Msprmibility m redly the occupant of Nequiremenu which must tc metprortu imusnac ofaCeniftcate o(Occupency. Signature Of Applicant Date wner orauthorixed aFcns Date, . All roof coverings to be Class nBo or better Community Development " a 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 � CITY OF Fax(408)777-3333 UPEI�TINO Building. Department JOB ADDRESS: PERMIT# O I gS 10 SVoue-v—\, 4r ��_ OWNER'S NAME: Y\A/ PHONE # 20 g- o o GENERAL CONTRACTOR: M1Nr-e Cavls „GJf� FAX# 24q- 6 22S I am not using any subcontractors:. " �� /O /zao / �T Signature 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 /O Q Q O Owner/Contractor Signature Date WCT CITY OF CUPERTINOCUP I�TINO PERMIT APPLICATION FORM APN# _.� /,Z �. S� Z— Date: Building Address: Mailing Address (if different from building address): 1040 AUouewtb<- br) V-e— Owner's Name: Phone#: Mr Mgrs 2 0 S 0 0 4q Contractor: C Alpine C©n g�uUt', � License#: ¢ I �f 5 )3 Contact:G (en ��\ Phone: g-f-,g-t.E.r� +6 Cupertino Business License#: Fax: Building Permit Info: UPgitnlo" CM2 (Irnae.Z -yn , Bldg ❑ Elect 19� Plumb ❑ Mech 8L Job Description: Uyo8COCAin4 Elec te.pOweJ' fog loo -V- Zoo Av-Apec-S Residential K Commercial ❑ Sq.Ft. Floor Area: Z� 0 $/Sq.Ft.: Cost of Project: I �p fl4 Occupancy Group: Type of Construction: Please check this box if the project is a second-sto addition: ❑ Pro'ect Size: Standard ❑ Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances ' MECHANICAL 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<= IOOOA ELECTRICAL " BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY. Energy BUILDING BENERGYADD Energy Add Multi BUILDING. BINVESTIGA Investigation fee BUILDING I of 3 WYOF CITY OF CUPERTINO CUPEkT PERMIT APPLICATION FORM 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 BOVERTHAE 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 Cbeck 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 cfm . MECHANICAL BREN AIRHAN 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 BRENMAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tiSwitch & Outlets ELECTRICAL . BREMRELOCA Relocation of Hood MECHANICAL ' BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance .ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Maz 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 Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING, BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING i ELECTRIC Electrical sq foot ELECTRICAL J EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicalsq. ot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG. Address Chane _ _ BUILDING i ; 3of3