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05110031i 4 02 Z r V W� a� U UC o t u c U G U'a CITY OF CUPERTINO>x'¢ BUILDING DIVISION PERMIT CQN'.CReLCT °INFQ.tMATiO BUILDING ADDRESS: WM LIPP HYDRONICS PERMIT NO. 05110031 OWNER'S NAME: PERMIT ISSUE DATE JOHN & MARILYN PHILLIPS 745 9ND AVENTIE J1107/2 NE: SANITARY N CONTROL NO. (650)327-1942 ARCHITEC IFNGINEEW 11C BUILDINO PERMIT INFO ELECT PLUMB MECH LICENSED CONTRACTORS DECLARATION lob Description P 1 hereby affirm dW 1 w Ileo used under provision of Chapter 9 (commencing with Section 70110) olohrision 3 of use Business and Profcuiom Coda, and my Neense is in full fe_ �e�7G?$ 3 REPLACE BOILER Ling o.m CAnuA mr CONTRACTOR: DECLARATION ATION CHRbe,mc tj]� �y7y®� t� r+/`fir I undenocanJ my sive shall o used u public �+1p //J� pal 17 19 IIJI tlp]l�Y•�Ctt11 a w1Lbl� Licensed Pmfcsdaoal OWNER -BUILDER DECLARATION I hereby milrm this I am Attempt Trump the Contraclarf Ucenm Law for the following mason. (Section 703 1.5, Business and Professions Cade: My city or county i A CO which raquires a permit an construct, Artery hop n w, demolish, or mpsir my structure prior 0 its issuance. amu requires the applicant forsuch permit m file &signal suument this he is licensed partum to the provisions of due Contractors Licenu Law (Chmur9 Sq. Ft. Floor Area rre�aa�pp ffJJ d aluati$15j 352 1�a NN, (commencing with Section TODD)of Division] of No Business and Professions Code) or 1'�bl R� C ilii 44 ` t� I R h' L Nat he is attempt therefrom and the bull far that alleged easmgias My violation of Number 'ti LJ Is Occupancy Type Session 7031.5 by AM applicant for • permit ubjecu the applicant in A evil penalty ofAPN not mom than five hundred dollam(SM. - 37542022.00 01,uownerofthe property."myemployees with xguuthebmiceompe uta, Required Inspections q p will do the work, and Naswnum m nalimended"offered formula (Sec. 70m. Susircu And Proposal.. Cade: The Coouwaw eemes Lilaw dreg Act apply As an awns of property who builds or improves therms, and who d"s such weak bi maelf m through his awn employes• previded that inch im pmvemert arc not intended "offered forum. IL bery ver, the building or improvement mold within ow, year ofeamplamd. the owns - builder will Mw dw burden of paving that he did mm build "impow fur purpose of sale.). ❑ 1, As owner of the pmperty, And uclusiwly communing with lensed W" sa m c.stro" the prejen (See. 7064. Business ted Profudons Cade:) The Contractors U- ccue Taw does act apply in an owner of propent"Ite build, arbmproves thereme. and, who comraclo for such Projects with a conhansus) licensed pununt m the Cnnuactors Licum Law. ❑ lsmuemptunder_-[ .Bkpefmthil. OwnerDau WORKERS COMPENSATIONDECLARATION I hereby affirm under peulty, of peltary One of that following declatociou: I hue and will maintain 4 Cecifcam of Coolant in elf -Insure fneworkcrs Causes- . rocket, As provided for by Section 3700 of the Labor Cade. for the performance of uses work for which this permit is blued. ❑ 1 haw and will maintain Worker, Compensation Lowrance, As requined by Section 3700 of the labor Code, far the performance of the work far which this permit ta Imed My Warkds Compensation bsuurtee carrier and Policy number art: Carver. (Ll40 ZNS Policy Noayy'�gj-'elv%n i CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE Mks csslon need noW compleml If ft permit mf"ane huntheddohass ($100) or ins) 1 wish that In the perfomasec of the work for which this permit is imused, l dull w employ any penin in my maoncrso As At become subject to the WartrX Computation Laws of California. Dam Applicant NOTICE TO APPLICANT. If. after making this CeruOcam of Exemption• you should become subject mum Worker, Compensation provisions of the tabor Cade- you mute ' (o thwith comply with such Provisions lir this permit shall be domed treated. CONSTRUCTION ictim,LENDINGAOEyaCY 1 or Lou mem m s m"uuc. lending agency for the Ite+famanu of which 30 ' the work for which this petit 4 "sued (Sec. ]097, Or. C.) Lander, Name Lander, Address 1 certify that I have read this application and sate this the above infomadon is ' coma I agree m comply with all city and county ordinances and slow Iowa Rasing m building construction. and hereby aumadm repmenudwa of this city locnmrupon the move-memmmed property for Inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against j liabilities, judgmenu,Cut% and expenses which may In my way seems against said City F incanrequerce of the granting of this pemiL APPLICANT UNDEIlSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE RECU —07— 0 Re-roofs✓.� ,, Type of Roof um o(AppEcourtlCantroctorHAZARDOUS MATERIALS DISCLOSURE Dam Will the applies or future building "cupenttl"e rehandle hundou mamml u defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safely code. Scene. 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Y. 01�0 If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant As future building Occupant vat equipment or dcMw which it husidous air conumktnu u deRned by the Bay Area Alt Quality Management all new materials for inspection. Dium7 ❑Yo mPlo I haw mad the haurdasmamdammquimnww undo Chapmr695 Orme Califon - me WAIIh&Safcty Codc. Srnias25505,27533 and 27]34.1 undcnloM thatifde building docs nal cumently haw "nam, that It m my ma mmihllity m w,dfy, the wupmt of the requimmcw whky mA Tdinrue of a Cenifaeme of Occupancy. Signature of Applicant Date All roof coverings to be Class 'B" or better or autha age. Dow x CITY OF �UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax (408) 777-3333 I am not using any subcontractors: //-07-40s- z"' / - y %' oS ignature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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 Owner/ Contractor Signature Date 11/07/2005 09 45 FAX 408 777 3333 CITY CUPERTINO CITY OF CUPERTINO cuPeR71No PERMIT APPLICATION FORM IQ 001/003 APjgJdre.SE Fee Descrt tion Date:Bui OtherA fiances Will g Address (if difTercnt from building address): Ow11 MECHANICAL BBOILER2 �vI ala; -1050 Contractor: ' BBOILER3. License #: 2��25 MECHANICAL 1 � MECHANICAL Contact: Phoney• d �� i qT_ Cupertino Business License#: Construction Tax Fax: llt� BCONSTAX Jnd/Off/Comni/ uasi Building Pe it Info: (jSu Con. Tax for BQ Zone BUILDING Bldg ❑ Elect 'o f, Plumb FL Mech 1 ells MQ.51?.e Job Descrip : Off)ooe ' ter �QAA Commercial ❑ Residential ELECTRICAL BENERGY Enera Sq.Ft. Floor Area: BENERGYADD Ener y Add BUILDING Cost of Proiect: Cv U BUILDING Occupancy Grouv: Type of Construction: please check this bex If the project is a lj no _ �P second -stn addition: Project -Size: Standard ❑ Laze ❑ a'or is Quantity Fee 10D Fee Descrt tion Fee Group OtherA fiances MECHANICAL _BAPPLOTHER __ BBOILERI Boiler <= 100 000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3. Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> iM to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax _ BUILDING BCONSTAX Jnd/Off/Comni/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR BELEC1000 BELEC1001 Constax— Res't/Mobile Elec 600V <= 1000A Elec 600V > 1000A BUILDING ELECTRICAL ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Enera BUILDING BENERGYADD Ener y Add BUILDING BINVESTIGA -Multi Investi ation fee BUILDING 1 of � 3 ny f CUPERAk TINO i q CITY OF CUPERTINO 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 BNUCONV M New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTRAE Inspection Overtime BUILDING. BPBACKFLOW Atmos beric 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 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 InstalVAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <=10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY .. Remodel Busways ELECTRICAL BREMFIXT Li ting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood DIIECEANICAL 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 2 of 3 CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee 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 BTENO 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 T4ech Permit Issuance MECHANICAL PPERMUFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam I PLANNING PLLONGRNGR Planning LDng Ran a Residential PLANNING ZADDCHG Address Chane BUILDING 3of3 J J Ej