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04010074 CITY Or CUPERTINO ' '� ➢UILDING DIVISION pERM Co ��-^T iN�,• hAAI RU ILDINGADDRESS: HIGHLAND CONSTRUCTION AND TD04010074 -1niii PT-TAR T.Ai2 DR NER'S NAME:OF PERMIT ISSUE DATE PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L� l� (� 0 u p p LICENSED CONTRAC'TOR'S DECLARATION 1 hereby affirm that I am licensed and r toovisones or chapter 9(commencing Job Description with Seuion]t)tfo)Uf Division J of the Busined Prufcssiunx Code,and my license ix 9 nmhp, anderrect. �> WATER DAMAGE REPAIR (REMOVE STUCCO 250 SQ. FT . ) L z Liccngiaa Me p n f: Date fa•` Contractor L !/ !R. ARCHITECTS DECLA 'fa Ky o I untl end my plansshall he used as pu ,cons ON Licensed Professional OWNER-BUILDER DECLARATION a8 I hereby affirm that I am exempt from the Contractor's License Law I'or the ,D rm•.nwing mason,(Section 7101.5,Business and Prufessinns Code:Any city or county K m� which requires a permit to construct,alter,improve,demolish,or repair any stratum, yZi prions is issuance,also requires the applicant for such permit to file a signed statement zz< thot he is licensed pursnnotI.mepmvisinnsof the Contractor's Licem.Low(Chapter 9 Sq.Ft. Floor Area Valuation xx•� (commencing with Section of Division 3 of the Business and Professions Code)or y, shat he is exempt therefrom and the bask for the alleged exemption.Any vinlati,on of Section 7031.5 by any applicant fur a permit arbiters the applicant to a civil penalty of 32RN9`bl1n1IQr00 Occupancy Type not more than Five hundred dollars($500). 0 1,as owner of the property,or my employees with wages M their sole compensation, will do the work,and the swess ctme is nut intended car offered for sale(See.70,1,BusinRequired Inspections and Professions Code:The Contractor. e's License Law does not apply to an owner of q h property who builds or improves thereon,and who does such work himself m through his own mployces,provided thatsuch improvements are not intended oroRered for sale.if, however,the buildhil or improvement is sold within ane year of completion,the owner builder will have the burden of proving that he did not build or improve for purpose of sale). 0 1,as owner of me Property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's U. cense law does not apply to an owner of property who builds or improves rhemon,and who contracts far such projects with a enntrarbods)licensed pursuant to the Contractor's License nm Law. ❑ exempt unticr See ,B&PCfar this mason T veer Data WORKER'S COMPENSATION DECLARATION I hereby eff rm under pdralty of perjury no of the following dcdarmions: . 0 1 have and will maintain a Cer ificam of Consent m self-insu,for Workers Compere .anon,re provided for by Settles 3Lw of me Labor Code,for me performance of the - work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of me Labor Code,for that performance of the work for which this Permit is issued, My rkers Coope satiin sa unto r/esndJy Iicy number am: 23 3 `� ERTIFICATE OF b%Eh PTION FROM WORKERS', - ..J✓✓ COMPENSATION INSURANCE (Thisseclion need not he completed if be permit is fnronc hundred dollars($I(Ilp or less.) I trinity that in the performance.(R.work for which this permit is be..d,1 shall net employ any person in any manner so as m become subject to the Workers'Compensation Laws of California,Dam _. Applicant NOTICE TO APPLICANT:If,after making this Conifcate of Exemption,you should Seemed subject to the Worker's Compensation provisions of the Lester Code,you must Oforthwith comply with such provisions or this permit shall he deemed revoked. 'Z CONSTRUCTION LENDING AGENCY F^ ',Z" Ihereby affirm that mere is a construction lendingagency for the permrmanccof C�.ei the work for which this permit is issued(Sec.3097,Civ,C.) Wes Q Lender's Nam. z Under's Address V Q 1 cenify that I have read this application and send that me above information Is lLt E-t comect.1 agree to comply with all city and county ordinances and sera laws miming to 0 U building construction,and hereby euthorim rcpresentatives of his city to come Upon the W ahuve-memioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against fail Roil lilies,judgments,costs and expenses which may in any way Seems,against said City / I) th emsequcnce,(me granting ohhis permit. APPLICANT UNDERSTANDS ANS WILL COMPLY WITH ALL N N-POINT Issued by: Date SOURCE RE ATIONS. ,/J �� I t _ ua�<< lJJc� — 2 (i OT Re-roofs Signature of Applicant/Contracter oil. HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will the applicant or future building occupant tore or handle hmsNous material defined by the Cupenim Municipal Code,Chapter 9.11,and the Heahh and Safety - atle,spur,zss3z(an �No All roofs shall be inspected prior to any roofing material being installed, Will and applicant pant.,Heading occupant use equipment oeatmtda which If a roof is installed without first obtaining an inspection,I agree to remove emit haiamous air eonmmimants as dc0ncd by the Bay Arca Air Quality Managcmem all new materials for inspection. Dinricl? ❑Yes PIINm I have mad the hamodtms materials eequimmena under Chapter 6.95 of the Callrm- ria Health&Sefcty Code,Sections 25505,25533 and 15534.1 undersand that if the building does not carently have a tenant met it is my responsibility to noGly the a: ant of the ours txwh;thmrsthe I rtaiaw td EeNfi.amoraeap r. Signature of Applicant Date 9 r_r '�' aG All roof coverings to be Class "B" or better Owner or amhoii, agent V pat v OCITY OF CUPERTINA CITY OF PERMIT APPLICATION FORM • CUPEkTINO APN# Date: Building Address: Owner's Name: Phone#: Contractor: ��, �/fj'�/ �' f���'�yC License#:« Contact: Cupertino Business License#: Bding Permit Info: BI E4 Plumb ElMech ElJob escription:xe,*n ,od 02 G dcc Residential Z 7-r Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: :Z3� Cost of *t: v Occupancy Group: Type of Construction: ,STve c O' � 9Ar2 Quantity 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 1 M 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. Housing Mit. Fee BUILDING j� 2 Z� 3 1of3 0 q s APPROVED IN ACCORDAN WITH THE CITY Of, CUPERTINO E OINANCES DATE SICNEU� This set of.p and specifications ns MUS Do kept on lob at all times and it is un lawful to make any changes or alterations on same without written permission from the building Dept., City of Cupertino. The stamping of this plan and specifications SHALL NOT be held to permit or r, t� approval of the violation of any pr be aprovisionr of any Chy Ordinance o[ State Law. f° RECEIVE JAN 16 2004 fv • � j A SPARK ARRESTERS• RECEIVED JAN 1 6' 2004 Cupertino Municipal CodeA�-__ _0K fres the installation of a chimney spark arrester, with a mesh not larger than one-half inch, in all new construction projects and in all repair or addition projects which require a building permit and have a valuation over $1,000. SMOKE ALARMS: afficE copy California Building Code states that when the valuation of an addition, alteration or repair to a Group R Occupancy is over $1,000 and a building permit is required, or when one or more bedrooms are added or created in an existing Group R occupancy, smoke alarms must be installed in each bedroom and in a centrally located point in the hallway leading to each bedroom. If the dwelling unit has more than one story and/or a basement, smoke alarms must be installed on each story and in the basement. (Exception: Repairs to the exterior surfaces of a Group R Occupancy are exempt from these smoke alarm requirements) aa ' �ITY OF CUPERTINO* CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWI U TI New Multi-Fami] Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME 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 MBPLANCKREP RCEP Ind Waste Interceptor PLUMBING CHK Plan Check Fee BUILDING KADD Plan Check Add Multi BUILDING Plan Cbeck Re eat Fee BUILDING IPE Re i e Of Fixtures PLUMBING AGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo, PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tra PLUMBING BPVENT Alt of Drain & Vent PLUMBING g.IBREMBUSWAY ATER Install/Alter Water Pi e PLUMBING HEATER Water Heater/Vent PLUMBING SVCS Main Water Service PLUMBING SPECT Reinspection Fee BUILDING ACOVER A/C Unit> 10,000 cfin MECHANICAL A]I2HAN A/C Units<= 10,000 cfm MECHANICAL APPLI Appliance Install MECHANICAL BUSWAY Remodel Buswa s ELECTRICAL MFIXT Li htin Fixtures ELECTRICAL FURN Relocation of Furnace MECHANICAL FURNOV Relo Furnace> l OK btu MECHANICALHEAT Heater Installation MECHANICALINHOOD Installation of Hood MECHANICALMISC Misc A aratus ELECTRICALNRAPP Rem Non-Res A liance ELECTRICALPOLE Pole/Platform Fixture ELECTRICALPOWER Power Device/A aratus ELECTRICAL 2 of 3 OCITY OF CUPERTING9 CITY OF PERMIT APPLICATION FORM CUPE NO • uant Fee ID Fee Description Fee Grou BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Re air/Alter Heatin MECHANICAL BREMRESAPP Remodel Res A liance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Sin le 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 SwinuninE Pool BUILDING BTEMP Tem or Power ELECTRICAL BTEMPPERM Tem or Bid Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical s foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbin Fees foot PLUMBING ZADDCHG Address Chan e BUILDING BMISCELL Building Misc Fees BUILDING 3 of 3 CITY OF CUPERTINO e, BUILDING DIVISION PERMIT CONTt2ACTbR IMI IRMATIOIV ` ' �. �.. ou1LDINGADDRESS: HIGHLAND CONSTRUCTION AND f 0040100 44 111 PT-TAIR TAP IDR ER'S NAME: - - PERMITMUEDATE HE SANITARY NO. CONTROL NO. ARCHITECIENGINEER: BUILDING PERMIT INFO BLDG ' ELECT PLUMB MECH YOp LICENSED CONTRACTOR'S DECLARATION ap 1 hereby affirm that I am licensedand$"Brovations of Chapter 9(commencing Job Description �ZW with Settlors 7IXYJ)uf0ivisian 39f NC Busin�dPmfesaims Code.antl mylicense is _ ^ in fu(Mp and effect. x <�' As Lic.M WATER DAMAGE REPAI �gEMOVE STUCCO 250 SQ. FT. ) o Dam M' Canwcar / ®�� ee .u-�l ARCHITECTS DECLA 1 Y U 1 and rand my plans shall M used as lase records LL LicensedProremioaal MAR 1 8 2004 OWNER-BUILDER DECLARATION <2 1 hereby affirm that 1 am exempt[rum the Connaors License Law for the 02 following reason.(Section 7031.5.Business and Professions Code:Any city or county 42 which requires a Permit to construct,alter,improve,demolish,or repair any structure Lz� prior in its issuance.also requires the applicant for such permit to Glc a signed statement RM DING ctIarnn H£ < malheiaGmnaodpursuant mmepmviamnannhecmtmemraumnscLaw(cnapmr9 Sq.F[.Floor Area Valuation re (commencing with Serion7")of Division 3 of the Business and Professions Code)or y Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of �A�..DDAAiirr##TT�a��.�,,,,.�sI�a Section 7031.5byany applicant for a Permit subjects the applicant to a civil penalty of 3601LOWil9'eer00 - Occupancy Type notmore Nen Gw hundred dollars(M). P Y yP ❑La sownerof the Be, smacar is emntendea with wagesrtheinolc co ,B.AfimAA will dothework,ands: he Cmrtisnaeamended orofferednalc(Seato a4,Business And Professions Cade:The Comemors License law rims not apply lf an owner of Required Inspections Impurity who s,pro vi improvesch hap,and who Areasuch work himselfor through his own employees,provided that v such improvements are not intended m 9Rercd for owner. however,the building 9r improvement Is sold within one year of completion,purpose, owe,of builder will have the burden of proving that he did not Wild or Improve for puryose of vlc.). ❑1,as owner of the Ampeny,am exclusively contracting with licensed convectors At coazsoct the project(Sec.701 Business and Professions Code:)The Comracmrs Li- . cense law does not apply to an owner of property who Wilds or improves Merton,and. who contracts for such prejecis with a contractor(s)licensed pursuant to the Contractors License Law. ❑1 Am exempt under Sec B k P C for this wazon Data WORKER'S COMPENSATION DECLARATION Ir Ihereby affirm under Penalty of erjury au:of the following declarations: aw antl will maintain A Cenificare of Consent to self-insure for Worker's Compen-,az provided for by Section 37W of the Labor Code,for the performance of the for which this Permit is issued. ave and will maintain Workers Compensation Insurance,As required by Scclion of the Labor Code,for the performance of Ne work for which this permit is issued. or kers CmpM sat'on America ter¢sp�policy number am:ty No.:/6. 66, 3 3 ERTIFICATEOF (Eb PI'IONFROM WORKERS' COMPENSATION INSURANCE This weirs;need noehecomplemd Bthe permit is forone hundred dollars(Voir or less.) 1 cenlfy that in the fablumsancc of the work fa which this Permit is issued.1 shall not employ any person in any manner so az Or become subject to the Workers''CurbabOathat Laws of Calif aria.Data Applicant . . NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to One Worker's Compensation provisions of the Lehr Code,you must .J 0 fonhwi th comply with such provisions or this permit shall be deemed mvoked. Z ""t CONSTRUCTION LENDING AGENCY 4F Ithereby Affirm Nat Neo is a castoction lending agency for the Performance of �i > the dud fur which mit permit is issued(Sec.2097,Civ.C.7 I8 A' Lender's Name - � z Lenders Address U 0 I canary that 1 have read this application and sum that our above infomm;on is - I,, F correct.I agree to comply with all city and county ordinances and state laws relating to OV building convection,and hereby authorise representatives of this city to enter upon the W above-memimad properly for inspection purpse os. (We)agree Io save.indemnify and keep ha mlew the City of Cupcnino against / IH—t h liabinfiea,judgmen6,costs and expenses which may in any way accrue against said City U Z in consequence of the posting of this Permit. APPLICANT UNDERSTANDS AN SOUR_CERE _TIONS. WILL CO PLY WITH ALL N N-POINT Issuer!by: Date Re-roofs Signature ofApplica UComracor D c, HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will me applicant or fmurc builJing mcupan4mre or handle hazardous mamrial Is defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety A. OY.25533(4)? �No All roofs shall be inspected prior to any roofing material being installed. Will the appncane or future building o mpam a equipment or devices winch If a roof is installed without first obtaining an inspection,I agree to remove 7nia hasardmus air contaminants As donned by the Bay Area Air Quality Management all new materials for inspection.Yes 17NuI have mad the bmardovs materials requirements omkr Chapter 6.95 of the Calif., ealth de Safety Codc,Seedom 25505,25533 and 25534.1 understand this ifBc Wilding not comply haw a mnans mm it is my responsibility to notify the m ant of the irtmpp1,which mus the met ' rni ce cniGcam of Occup Signature of Applicant Date /}� oG Owner tar nahe' agent D, All roof coverings to be Class "B" or better