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10075jraz 00 qg. �c Eau aa'N Oe �Do SFO Mi CITY OF CUPEWHNOw� �"'" . BUILDING DIVISION PERMITCOlVTY2ACT�nl2INTrYVI, BUILDING ADDRESS: A SADENA AIT TERRY BROWN, GEN CONTRACTO ERMITN0.0309007S 3R'S NAME: 14510 BIG BASIN WY PERMIT ISSUE DATE PHONE: (408)868-1640 SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRd DECLARATION Job Description I hereby affirm that 1 am licensed under provisions ofChapterCmd.. 9(commencing under P with Station of Division 3 of the Business and Pmfcssinns Codc, antl my license is I. red of in mnmreaanderre"'TENANT License ClClassLic. N IMPROVEMENT „�'w7th ap���® Dem Cuntracmr � ARCHITECTS DECLARATION I understand my plans ,hall be used as public records MAR 2 g 2004 Lic)n ed Professional OWNER -BUILDER DECLARATION I hereby Maso . Sect on 7 1 1. exempt from the Co imus, Code: z Licenu Law co thefollo ire reason. (Scion 1onsu Business ens Professions city or county BUILDING which h.orAny which ,equines a Penni,, re cnnswm, eller, improve, Jemolrh. or repair any structure primus its tensed ,elsu inquires the applicant for suchpermiuu rho ssigned stammem Ran heencing wit pursuam 70th) Lsw of NC Canuimar ind Sq. Ft. Floor Area Valuation Cupmr9 of Division 3 of the a Pro CudAI or (commencing with Section sand of D axis cacand Natio r li and aper for ed on. Any f exemption. Any violation of ,,any 35717043.00 be cts the 31.5 b applicant or Sectnot - Occupancy Type moronfivehndredGdanar,(Srata,a:aajeaaNeappGeamm.eivupen.byar oat mom Nannvehanartaamlarafssn). - �- �� .APNNumber P Y--_- I, as owner of the property, or my employees with wages As their Aura compensation, will do Ne work, and she swaure is not intended or offered for sale (Sec. 7W. Business and Prefeuiam Code: The Cornmewr'a Licenz Law does apply to owner d Inspections not An of 102 PIERS pmPerty who builds or emprovu,ancon, and whodues such work himselfor Bari his — own employees,provided that such improvements us not mtandcdmattered for asla.If. 103 — UFER however, the building or improvement is sold within one year of completion, due owner. builder will have be burden of proving Nat he did not Wild or improve for purpose of 104 — REBAR W.J. 105 — ANCHOR BOLTS co 1, pe owner or be pproject ec. 704. Business reclusively contracting with :) Theed a tractoora to cense oct Processions Cade:)pro Canuamon, Li 106 — SEWER & WATER Law oesntapply.ianOwneofprot or Property who Wd pursumPro the Comm,arta, who Lawdoeanotchplyman with who consents for such projccr with a cnntnaar(s7 licensed pursuant to ae Convenor` 202 — UNDERFLOOR PLUMBING License U., 203 — UNDERFLOOR MECHANICAL ami=cou�p,, nde^rSee�. B&PCrorI, anon � J 204 — UNDERFLOOR FRAME . er_ J/yl D.A 7/10 205 — UNDERFLOOR INSULATION WORKER'S OMPEN$ATIDNDEGIARATION 1 1 I hereby AM. underpenalty of perjury ow of on following declanteona: 301 — ROUGH PLUMBING 0IhaseanewBlmainminaCcrricamorCommnlloui6msuinforwuateracumpn- 302 — TUB & OR SHOWER cation, u providca for by Section 3700 or the user Code, for Ne Performance of tam 303 — ROUGH MECHANICAL work for which this permit is issued. 304 — ROUGH ELECTRICAL D I haus and will maintain Workers Compensation Insurance, As required by Section 37W of he Labor Coda, far the performance of the work for which this permit is issued. 305 — FRAME My Worker's Compensation Insurance caner and Policy number am: 306 — HOLDOWNS Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE 308 — SHEETROCK (TMs section need not ecompincd if the permit is foram: hundred dollars (SIM) 309 — EXTERIOR LATH I eeaa.) 1 certify Out I. ac p of the work for which this permit issued, l shall nm 310 — INTERIOR LATH .by insure lc 311 — SCRATCH COAT Law aenyperaoninanymanncrsnminbecomesubjemtotheWDrkcn'Compamallon Laws of California. Dula Applicant 313 501 — ROOF NAIL — FINAL ELECTRICAL ENERGY NOTICEAPPLICANT. ng er aRmpacustenprvisinsOf orE n. subject WoriIL Labor Code. youmus,, become momply the Worker',Compcosshis of theNeemed P forthwith comply with such provisions or this permit shall be ticemetl rtroket. Permit v.kcd. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that Nen 13 a consvuminn lending agent' for Performance of 504 - FINAL BUILDING ENERGY be work fur which this pcnnit is cooed (Sea. 3W7. Ci¢C.) s<ndcrn Name 505 - FINAL ELECTRICAL Lcmde 506 — GAS TEST IAadu,a 1 ttnee that I have read Nis application and slate Na,, red same l information relatiing es careen. I agree m comply with all city and county and ante laws relating to 507 — FINAL PLUMBING ionany hereby nems Of Ferminladves of NesCity menmrupon the FIN MEC CAL .bovemgcadinned parimauthore algvt-mentlan)d properly fO! IKpCCIIOm Fermi (We) agree 70 sere, indemnify end trop harmless the Cin of Cupertino against 9 FI Liabilities, Judgments, costs and narcoses which may in any way ¢erne ageinsl Paid Can in conuqucnca of the granting of this Feemb. 54j� NG �� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL Nreland T Issued by: 5 C WORKS Dale 5 REGULATIO Re -roofs Type of Roof ?A 0173 Signature of APPIMMYComracmr Dam HAZARDOUS MATERIALS DISCLOSURE Will Na applicant per future building occultism share or handle havnrdous material defined by the Cupertino Municipal, Codc, Chapter 9.11, and the Health and Safety de, Section 33531(,)? ❑tion %(,. All roofs shall be inspected prior to any roofing material being installed. Will If a roof is installed without first obtainingan inspection, I agree to remove k P �a the air comm or tumre building by the B tau ea Air Qu or Ma as which emit havaNnus air contaminants ss JCEneJ by she Bay Area Air Quality Mengcmcnt ' all new materials for inspection. Divlrict? Dyes [have mad aehammtmsmaterialsr uimmenuunt rChapter6.95ofae Califon ' mea Heala&SafctyCcdc, SccdotaanSidS.25533and25534. IuntkrsmnJNatifthe Wilding Joel not currently ham a tenant, that is r my responsibility to Amity the axupsmt Of ac mgmnigh maR aay�,, r_nmrwvpeaan)mra c)mG)eta of sea`) Signature of Applicant Dale All roof coverings to be Class "B" or better Owner., authorincJ,goal sDale T- f IG,A•L GoFFFE- ff��K NSW WAt Ls M_s. 1 HO.JK FIF<EWI 12 STAIIJ'_c• ST ` IutC .'C CpP;N Aff-WE �ll (ijQ\ 08j --- rT_— VVV V �� h! _ TH I _ r.flH,THE CITY06_t s • 'n ` R E f-� , `-Rf T I ; I213� ! ` MCORDA NEW - 1 it j 1i G;II StfD fir; ,nd : pecitice on MUS - - - set o P . I and itis un• MEL. ft 1.1E - Tto oh at rkt time l keptr ne t I br. altem1don;s- Do rh;mg to make anY� er nission Ito n m. WithoaeS t wntten P - t VEI--IT FK1'F'1 00.'Ao , CePt olPe ecticatiar6 r--� of th Pla rd sp bo aP 0 1 42" H IvH GUA Rr R I L `� KGF r \ / 214] I ? 6 1,2 0116 heQj to ,rmit or mr_ lal• no 1 TO ` �/ 1 Z aHwd' i" P aPprpval of the violation State JAW, i \ '� CrdinBOP gN I i OPEIJ TO Hr" \ N 'YT 3C, &k-. - L REC V — ' �--•, GUM e �nr�+J -- \a, �2� -�, l T —, I __.....-- - - '-' /'� r+SD !i Ai!Z Kc. M fu --- �`-. WlT SFtPFT© 24° 32" \ - B tC K WIT}+ VEa4T -- ,� -- -- F LAM. CUTK. - +k- @ SC � � I UTPOe N 141T, TOP `, sPLA-N ;' ; _ G 29 ---- j N �2) C i'� - �i� ►v is EQ I EQ F -Q -_a ' 1!I -3i1 _ loo?S PASA DEKA AVE (au V U cam: r -Poo �-�• 2 �F.��i� rio N- �rn�c �v2 �-� ul�,-Ll.. V o � .J NalzTl+ <r A OV 'P�,; ;-, ;-10N-S .j CITY OF • CUPERTINO C*Y OF CUPERTINO 9 PERMIT APPLICATION FORM 0)07607r APN # 3 57- � 7- 0 �3 Description Date: �- /0-03 Building Address: 00-7) F4"DeNA Owner's NazuG1 � � Bldg its .foot XMFCTH4AANIrAATL Phone # Contractor: tLicense BBOILER2 z - Contact: BBOILER3K to 1M Btu Cupertino Business License#: Building Permit Info: Boiler > 1 M to 1.75 M Btu MECHANICAL Bldg E�" ect Plumb ❑ Mech ❑ Job Description: Residential ❑ Construction Tax Commercial �J Sq.Ft. Floor Area: Ind/Off/Comm/ uasi BUILDING $/Sq.Ft.: Con. Tax for Dn Zone BUILDING BCONSTAXH Hotel and Motel Cost of Project: Occupancy roup. Type of Construction: BELEC1000 Elee 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Quanti Fee ID=Boi0l0erth>e500Kt1t10 Description BAPPLOTHERliances BBLDGFEE Bldg its .foot XMFCTH4AANIrAATL BBOILERI00,000 Btu BBOILER2 to 500K Btu BBOILER3K to 1M Btu BBOILER4 Boiler > 1 M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi BUILDING BCONSTAXB Con. Tax for Dn Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elee 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 El Svcs 600V <= 200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Rnprav Add Multi BUILDING BINVESTIGA ..Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING �231�2 1 of 3 COY OF CUPERTINO CUPEI�F PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI I Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMNO New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING PBACKFLOW 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 Repipe 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT ' Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm I MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfrn 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 BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTINO 0 CITY OF CUPERTIlA PERMIT APPLICATION FORM Quantity Fee ID BREMPOWER Fee Description Power Device/Apparatus Fee Group ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marque 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 Ins ection 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 D •