The URL can be used to link to this page

04030171 • CITY OF CUPERTINO ' � "� '^" � '^ ' ' "�'xr`. BUILDING DIVISION PERMIT �CONTRACTOWINFORMATIOIV euILDING ADDRESS: STEPHEN LEE PERMrTN0.04f0301.7J. ' •OWNER'S NAME: PEItMrTLSUEDATB ONE:'qTF1PT4FN T.F.F. AA SANITARY oL NO. ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t� 0 L o o LICENSED CONTRACTOR'S DECLARATION Job Description i j 1 Mosby Nml that 1 am licensed under provisions of Chapter 9(commencing a� with Section 7")ofDivioon 3 oBusinesse Business and Profwknu Cade,and my licerse is .fail hundcaea License ChouIJc.N REPLACE L-6T-T-9N--FACJ_AL 5� cnm Dale Gr ARCHRECIsDECLARATION ARATION �^I understand my plans MVI he used as public nxnN �e�y7 /"; C4 0� 3 u. Licensed Pmfcrsimnal 50 OWNER-BUILDER DECLARATION I hereby affirm that I son aaempl from tlm ConuacmYs License Law for the O O following moon.(Section LO 1.5,Busioss and Perfessiom Cole:Any city or county which requires a permit to eonstme4 alter,impmw,demolim,or repair any structure prior m its Wuance,aiso requires the applicant for such Permit to rile a signed moncentthat he -— �.�--� I _ - � Valuation (comm acing ed pursuanttotheof Division of Nc Co Business (Chapter Sq. F[. Floor Area `t or mus, acing Section and ft Wars for of the eusinw endon.Any Code)of /7 r7 I' 3 that he u comsat therefrom and de basis for dm mlegrd exemption.Any violation of '(f�� '/ '� Section 7031.5 by airy,applicant for a permit subjects the applicant m a civil penalty of ` 30 Imo, ccupancy Type .at come than five hundred dollars(5500). ❑1,u owner of the property,army employees with wages u their mle compensation, will do the work and the suudum 0 not intended oralfem l for We(Sec.70",Business and Professors Cada:The Comoscor's License Law does not apply to an owner err stirI ap s property who buildam improves thereo ,and who doeasuch wart himm3f arUuuu lb his --I--- ownemployeu.pmvidcd that stmh improvemants ase nolimtemded oro@retl farsal.Ir, however,the building or improvement is sold within one yeasof completion.the owner. builder will have the burden of proving that ha did not build or improve for purpose of pie.), ❑I.u owner of tie property am exclwively contracting with licensed conummm b construct the project(Sec.7014.Business and Pmfassiou Code:)M Contractor's LI- ttme law does not apply to an owner of property who builds or improves themon.and, who contracts for such projects width eormclor(s)licensed pursuant to the Conlnctor's License Law. ❑I on exempt under See ,B&PC far this reran net DECURA au —O 1 hereby affl m under penalty of perjury ane of the following declarations: I have and will msinuln a Cerlicam afCovent to xif-Wure far Wmlme-Caralm- sation,u Provided far by Section 3700 of the labor Code,for de performarce or the wok for which Nis permit is issued I have and will maintain Worker's Compensation Insurance,a required by Section 3700 of the LAW,Code,far the performance of the work for which this parent is Issued. My Workar's Compensation Insurance carrier and Policy number art: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Thusectiom need mal,ceomplem l If the permit is fm one hundmddollan($100) or Icp) 1«reify that' the pvI rmsece or the work for which this permit u issued,l shall not emPloydny pe mannersoasmbecome subjectla the Wariten'Compemadan laws of Call rola am �J Applicaaa++JJPPp��t i� i NOl'I A aftertesting u incate of Labor Codyoushould bccolge jot y the Worker's Compcwtion provisions of the labor Code,you must .,2 foMwiNmmply with such provisions or this pennitthall be damW mntrd. z O CONSTRUCTION LENDING AGENCY [ti IwrebydOrm tho them ua construction lendingagcncy far the performance.( Q:> the work for which this permit is issued(See.3097.Civ.C.) 0 Lender's Name 0.z U Leader's Addrests U 1 certify Nn I have mad this application and sura this Ne about infomtnion is ,I, cancel.I agree In comply with ail city and county onlimovesand Mute lam miming to C) Wildingcrossuection,and hamby authadm mpmxntsaw,of this city menteruPon tha W show-mcnuoned property for inspection Purposes G (We)agree in save,indemnify and keep h ostein the City of Cupertino against cn Iiabiliuu,judgmcnu,cosu and expenses which may in my wayeccrue&Diao said City / U 7 in consequence of the granting of this pormll. (/ d F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOLLRCE REGULATIONS. 7V 2 Re-roofs Si mum of Applic a net Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building=owl Dam or handle has r ous mammal as donned by the Cupenam Municipal Code.Chapterd the 9.1],snHealth and Safety Code.Section a5537(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑res WIII the applicant or forum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit amsadma air mitmadnanr u defined by the Bay Area Air Quality Management all new materials for inspection. Diauict7 ❑yes eNo I have mad the IupNnusmamruisrequiremenu under Chapter6.95of the Celifor. nialicalth&SamyCodc,Sect om 25505.35533 and 75534.1 understand thatif the building does not currently haw a mnan,that it is my responsibility to notify the occupant of the mquimmcnu which moo be me priorwissuaecm oh Ce 'skate of Lksupumy. Signature Of Applicant Date r d agent Date All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 cl 0 Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDRE • PERMIT# Q r� 00- A7 r U' J OWNER'S N PHONE i 6 -eP-? GENERAL CONTRACTOR' FAX# I am not using any subcontractors: __\%�i// --n , 1.11 gnature Date Please check applicable subcontractors and complete the following information 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 Am Tile Owner/ , ieaturt Date I ; G aF CITY OF CUPERTINO CUPITYOFO PERMIT APPLICATION FORMEkTIN APN# �/�' Date: j G 6 r Building Address: Mailing Address (if di erent frdm build' g address): Owner's Name: Phone#: Contractor: License#: (,!✓NFjt Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: �J �� / r' , o Residential .� /� f— Lu7� r�� L Commercial ❑ Sq.Ft. FloorAr $/Sq.Ft.: Cost of Prlect: Occupancy cup: k 11 vt)lJ Type of csqstructi n: Please chec this box i project is a second a tion: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING 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 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. HousingMit. Fee Q BUILDING 1 of 3 * ERR CITY OF CUPERTINO c,TMO PERMIT APPLICATION FORM CUPEkTINO Quantjtv Fee ID Fee Description Fee Group BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING i 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 rinklerBackflo 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 MECHANICAL BREMAIRHAN 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 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 BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL mw 2 of 3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM ` QuantityFee 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