05080030 CITY OF CUPERTINO �* *�- E *^�x-^�r �' " r�"� `� � ;;
BUILDINC DIVISION PERMIT °"CUNTR�i.C'�TOR INFOl2MATION �
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BUILDINGADDRESS: TRIPLE A PLLTMBING PERMITND.OSOE003O
10
OWNER'S NAME: PEM9TL'SUEDAlB
ERIC TANG 1230 PEAR
ONE: SANfMRYNO. CON7ROLN0.
(650) 964-4935
ARCHI'IER/ENGINEER: BUILDING PERMR INFO
BLDO HLECf PLUMB MECH
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3�o LICENSEOCONTRACfOR'SDECLARATION JobDescription
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W ORKERS COMPCNSATION DECLA0.ATION
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CBRTIFICATE OF PJ(EMP170N FltOM WORKERS'
COMPENSATIONINSURANCE .
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'� A� P CANT UNDERSTANDS ND WILL COMPLY WITH ALL NON�POINT Issued by: Date
S U IILATIONS. �^ O/
� � Re-roofs
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HAZARDO MA'fER1AL5 DISCLOSURE Type of Roof ,
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n CeOivA Ey Ne CupeNiro Munidp ah.CTapmr 9.11.�nJ�he HnIN�nd Safcty
aGc,Secuon23532(a)1 All roofs shalt be inspected prior to any roofing ma[eriat being installed.
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Will Nc a�llcnnt ar fulurc buildiny acupem um cyuipmem or devla�wlJch If a ro0f is ins[alled without first obtaining an inspection,I agree to remove ,
y It�si�Nnus ur conuminmu u Jcfincd hy Ne Bay M�Ai�QuW�y Mmqemcnl all new materials for inspection.
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yw � u kn �:�xm« ao� ' r c�Nn�,�oroen . G Signat�reofApplicant Date
o ��,o„�mo�.=a,�m „� AII roof coverings to be Class"B"or better
' Community Development
10300 Torn Avenue
1 � , Cupertino CA 95014
� Telephone(408)777-3228
C F Fax(408)777-3333
�UPEI�TINO
Buildin De artment
JOBADDRESS: l�al �r�� _ � � � PE�����030
�
OWNER'S NAME: G /1 PHONE # (p - �3
GENERAL CONTRACTOR �yytf�irL FAX# - 2
I am not using any subcontractors: U lx��J � 0
Signa e a
Please check a licable subcontractors and com lete the followin information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Fuvshing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
✓ P�,�,b�g r �9 �oi
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
� � � v �
Owner/Contractor Signature ate
,. ' � CITY OF CUPERTINO
� PERMIT APPLICATION FORM Q�� � ° v� v
' cin o
CUPE TINO
N# � Zf� 3 2-- d �o Date�I�I�S
Building Addr • � � Mailing Address (if different from building address):
cs-v'� C�re,l '� I —
Owner's Name: Phone#:
« 4 3- ial
Contractor: License #: _
�j`�31D I �
Co t: Phone:�-q 10 •�(`�'j Cupertino Business License#:
F
Building Permit Info:
Bld ❑ Elect Plumb Mec -
Job Description:� � �y�-# 1 � =ristctCl o��}OC n.N.uJ wz.-1-e r � � u'� `� e^'kr�,
Residential ❑ Y�e W � �,.� unz��"� Commercial � � �
Sq.Ft. Floor Area: �{�g ' 7a-� $/Sq.Ft.:
Cost of Project: „ ,i�� � 6� Q1� Occupancy Group: �
�`1- �
Type of Constructiory , Please check this box if the project is a
`�Ium b � ✓L second-sto additioa: �
Pro'ect Size: Standazd ❑ Laz e ❑ Ma'or ❑
;
uanti Fee ID Fee Descri tion Fee Grou
BAPPLOTHER Other A liances MECH?.DIICAL
BBOILERl Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to SOOK Btu MECHANICAL
BBOILER3 Boiler> SOOK to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHAAIICAL
BBOILERS Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BLIILDING
BCONSTAX Ind/Off/Comm/ uasi BUILDING
BCONSTAXB Con. Tax for BQ Zone BIJILDING
BCONSTAXH Hotel and Motel BUII,DING
BCONSTAXR Constax—Resi/Mobile BiJILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Ener BLJILDING
BENERGYADD Ener Add Multi BiJTLDING
BINVESTIGA Investi ation fee BLJILDING
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� . . CITY OF CUPERTINO
� CUPEt�TINO PERMIT APPLICATION FORM ,
uanti Fee ID Fee Descri tion Fee Grou
BMISCELL Miscellaneous Fee BiJII,DING
BMITIGATC Comm. Housin Mit. Fee BUII.DING
BNUCOD�IIvIE New Comm Electric ELECTRICAL
BNLJCOMI�Rv1 New Comm Mechanical MECHANICAL
BNUCOMA�IP New Comm Plumb PLUMBING
BOVERTIME Ins ection Overtime BiJII.DING
BPBACKFLOW Atmos heric Vacuum PLUMBING
BPCESSPOOL Cess ool PLUMBING
BPERMFEE Bld Permit Fees BUILDING
BPFIXTURE Pbl Fixture PLUMBING
BPGAS Gas Pi in S stem Fee PLUMBING
BPINTERCEP Ind Waste Interce tor PLiJMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Muld BUII.,DING
BPLANCKREP Plan Check Re eat Fee BiJILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewa e Dis osal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUIvIBING
BPTR.AP Kitchen Tra PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER InstaWAlter Water Pi e PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLiJMBING
BREINSPECT Rein ection Fee BUII.DING
BREMACOVER A/C Unit> 10,000 cfin MECH.4NICAL
BREMAIItHAN A/C Units<= 10,000 cfrn MECHANICAL
BREMAPPLI A liance Install MECHANICAL
BREMBUSWAY Remodel Buswa s ELECTRICAL
BREMFIXT Li tin Fixtures ELECTRICAL
BREMFCJRN Relocation ofFumace MECHANICAL
BREMFiJRNOV Relo Fumace> l OK btu MECHANICAL
BREIviHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc A aratus ELECTRICAL '
BREMNRAPP Rem Non-Res A liance ELECT'RICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/A aratus ELECTRICAL
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT R air/Alter Heating MECHANICAL
BREMRESAPP Remodel Res A liance ELECTRICAL
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�j. CITY OF CUPERTINO '� � . �
cuPE�,riNo � PERMIT APPLICATION FORM ,' '
uanti Fee ID Fee Descri tion Fee Grou
BREMSIGNAD Rmdl Si Add Branch ELECTRICAL
BREMSIGNS Remodel Si s, Maz uee ELECTRICAL
BREMTHEATR Theatrical Li tin Fix ELECTRICAL
BREMVENFAN Vent Fan Sin le Duct MECHAPIICAL
BREMVENSYS Ventilation S stems MECHANICAL
BSCBLVD Scb S ecific Plan BUII,DING
BSEISMICOM Seismic Commercial BUILDING
BSEISNIICRE Seismic Fee Res BUILDING
BSPECIAL S ecialIns ecdon BiJILDING
BSWIM Swimmin Pool BUII..DING
BTEMP Tem ora Power ELECTRICAL
BTEMPPERM Tem ora Bld Permit BUILDING
BTEMPSVCS Tem Dist Svcs ELECTRICAL
BUSLIC Busiuess License BUILDING
ELECTRIC Electrical s foot ELECTRICAL
L EPERNIITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical s . foot MECHANICAL
/ MPERNIITFEE Mech Permit Issuance MECFIANICAL
- �—— PPERNIITFEE— —Plumbin"-PeTmit-Issue PLUMBING —""-
PPLBG Plumbin Fee s foot PLLTMBING ,
PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING /J
PLLONGRNGR Plannin Lon Ran e Residential PLANNING
ZADDCHG Address Chan e BUII.DING
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