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1571 CITY OF C U P E RT11 N Qzawo APPLICATION FOR RESIDENTIAL ¢UJLDING1 IT PERMIT NUMBER 72 . FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: .....:147.8... rimros.e..Way................................ .............................. • • Legal Description: Tra t .............. gJock. ..... ,. Lot ............... Description of Work: ��.5...yr....Wood,land___shingles..appli d Plans Received By--_................_......................._.....Date ......................... over..existing.wood..shingle...roof................................ REQ.: Plans.... Survey.... Cates: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel:Yes.... No... Area of Bldg............... Plans Checked By....................................................Date ......................... Separate Structurg............ or Addition/Alteration to Exist. Bldg..-........ Application Approved BY...c....................................Date ....... .......... No. of Stories................ UsgQ ggf Building .........residezlce................. Validated By...................................._........................Date ........................ Valuation of Protect: $2,,i3.y5•,00_..............................................____ Compensation Certificate Verified B Date ........... .......... ......._... .............__. Phot :.2.53-.7.3. 9 P Y -���������������� Owner: $$ Contractor: ...Zav,ala_-Roo�ing.._Co.....City Bus. ff. /.S./.._. • ' '" • $ Contractor's Address: 740 W....San-Carlos Phone;.28b-2 b5 Permit Fee (plus penalty if applicable) ........................$.24.00......... &XNYX7FSC7£7D{Y4IZy fX ....-San_.Jose.,...Ca ......9512.6-................ Plan Check Fee (less deposit of$.......... Rct. #..........)$....................... City Business License ................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #.........$....................... Plumbing: ........_................ ._..............._...._............................. Strong Motion Fee ................� City Business License #.................... Phone:.................... ....................._........_.......$...... Heating and Cooling Plumbing Permit Fee ......... #.......... ............................... .................... Electrical Permit Fee ..................._......................_.........$.......__............ City Business License .................... Phone::.................... .. Architect/Designer: .................................................. Phone:................ Mach. Htg./Coolg. Permit $............................. $........ ............. .... Engineer: ... . ...... ..... _ ........................ .................. Phone:.................... Residential Construction Tax ._._.`................_._...........$...... .............. Lender: Misc. Fee ............ $.... ... certify that i _.....perfo...ance..of the .........w c C] Unknown -�����"����-����������"'��' � � � � "I certil Thal in the .................... Misc. Fee ................ $, Y y any person of the work for which this penult la ---���--- -�------�-�---�-'----�'- �-��----��------ issued I shall not employ any parson in an manner so as to become subject • • . . ; $ 30•50 to the workman's c p ensation law Cal lomla." SIGNATURE OF 10-31-8 • • APPLICANT/OWNER ... .. ...............�/!/ .. DATE........................ Environmental Status: Exempt ....._.... Other__................................... ... "I certit m as the applicant m licensed unde'the rqqv' '�oppgg pWf the Design Review Approval: Bldg. ............ Site ..._....... Sign .._........ Contractors License w and further that my Llcens. No v.2.loe9F........ t�y39. Use Zone ............ P.D. Conditions ....._............_......................_......._...._ m Classification . ... ..-_.....___ Is in lull force and effect: or Coad. Use Permit #............ Variance ... Parking Spaces............ - I certify that I am exempt from the "Licensed Required" provisions of the Approved B Date ......... C,,,rewe License Law. (State basis o/ exemption.) PP Y........ - ------------ - ---- ---""--""' hereby acknowledge that I have read this application and state that the above Is correct and agree to comply with all City Ordinances and State Laws regulating • ' • building. 1 (We) agree to save, indemnify and keep harmless the City of Cupertino eroachment Permit........................ Grant of Easement..... ........ against liabilities, judgments, costs and expenses which may In any way Orb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... secure against said City in consequence of the granting of this permit." Sewer-........... Conn. Fee $................ Water................ Meter $................ SIGNATURE OF 10 31 80 Agreement for Completion of Public Works Improvements .................. ApvucANT/coNTRAcroR ...............................I......_................ DATE ........-.....--.... Plans Checked By........ Date........ Approved By........ Date.................... NOTE- when properly validated this form constitutes a Building Permit. This , permit expires and becomes null and void should work not be commenced within e e . 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days eller work is commenced. PERMIT INSTALLATION NO. EACH FEE i APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ..... ....... $ .50 - - Gas System with up to 5 outlets .................................$4,00. _.......... Range........ Cooking Unit........ Oven............ ..... 2.00 .............. Each additional outlet ............................................. 1.00............... Dryer........ Garb, Disp......... Dishwasher .........._. ...... 2.00 .............. Water System (Installation, Alt. or Repair) ................. 4.00 .............. MOTORS: 1 HP or less ........................................ ........ 2.00 Water Closet.... Water Heater.... Ld. Tray................... .. 4.00. Greater than 1 HP not more than 5 HP .............. . 3.50 .. ............ Lavatory..-. Shower Pan.... Bathtub.... Sink................... 3.00............... Temporary Power Pole or Service — 100 amp .. ..... ..5.00 ..I...,,,,,.... Wash. Mach.-... Dishwasher.... Garb. Disp..... ............... 3.00............... —200 amp........ . 7.00 ........... Sewer .........................-_-................................................ 8.00............... Time Clock ...................................._........... ..._.... . ....... . 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... ............. Mise (see Ord. current 1... .. . f.gT .......................... Vacuum Breakers ............................................ ..............3.50.. ............ New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ............ 0-500 s it. $22.00 1501-1750 $34.50.............................. Plumbing Piping without fixtures ..............4.00............... q• Misc. (See Ord. Current) .......................................... 501-750 24.60 1751-20000 37.50.............................. Permit Fee ..........................................................................$8.00 751-1000 26.00 2001-2250 39.50.............................. 1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) $ 1261-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if api $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................g 6.00............... INSPECTIONRECORD over 100M ........................ . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 6.00............... Forms / Foundation .......... .... BYDate:. ............. to 15ton/HP................. ...._.. 9.50.............. Plumbing Ground Work ....... (.. .. _.._......... .........__.............. to 30 ton/HP......................... ., 12.00. ............ Rough Electrical .._........................_...... ...... ' to 50 ton/HP................. ..........17.00.............. tme - Plumbing and Heating ..........I........................ ........................... Space Heater........ Wall Heater .................................. 6.00.............. ration 8 Energy.............................. .................................................... Flues - other than above .............................................1.. 3.00.............. asTest ............... ............... ... .. ...... . ...._..........'... ....................... Vent Fan: Kitchen........ Bath ................................_..... .. 3.00............... Temporary Power Gas / Elect. .._............................. ....................._.... Commercial.Range Hood .............._........................:. 6.00... ......_.... Final - Electrical ........_.............._.._...............__..._....... .......................... Mise. (See Ord. Current...................... ... . Final - Building/ Mechanical ......___...................................................... Permit Fee ................... Final - Design Review / Landscaping . ... ........................._...._.......... TOTAL Htg./ Cool Permit Fee (piluspenalty if a............ $ 6.00 Final-Public Works g g (p penalty PP ❑) $ Sheep 2 CITY OF CUPERTINO BUILDING PERI4IT Permit No: 15-71 , JOB Address: 1478 Primrose Way • Date: 11-3-80 BUILDING PROJECT IDENTIFICATION WORKERS' COMPENSATION DECLARATION St l C San Carlos . Applicant's Mailing Address 740 W. I hereby affirm that I have a certificate of consent to self-insure, San loga, lra 95126 or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec 600,Lab.C.'r. Address of Building 1478 Primrose Way Policy No. Company Cupertino Certified copy is hereby furnished. Owner's name Mr. "McCarthy--- Certified copy is filed with the county building inspection Telephone No. —. depar{rpen�orfdunty' epart cn -253=7349 Date 11-3- /ppli"nt a a n Inc. Contractor's Name Zavala Roofing-Co.; Inc. diH sa t/ Contractor's Mailing Address - CERTIFICATE OF EXE. TION FR WORKERS' 7,o. W, Sa3848-9109 St. , San Jose COMPENSATION INSURANCE Lie. _xe. C3 9-3 848 32 (This section need not be completed if the permit is for one Architect or Engineer hundred dollars (5100) or less.) Architect's or Engineer's Address I certify that in the performance of the work for which this permit Lic. No. is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. LICENSED CONTRACTORS DECLARATION Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of I hereby affirm that 1 am licensed under provisions of Chapter 9 Exemption, you should become subject to the Workers' (commencing with Section 7000) of Di%ision 3 of the Business and Compensation provisions of the Lnbor Code, you must forthwith Professions Code,andfjcerise is in full force and effect. _384892 comply with such provisions or this permit shall be deemed revoked. License Class >> Lic Number Date 11 -1-An Contractor Zavala Roofing Co. , Inc. CON'STRUCT'ION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit.is issued (Sec.3097, �- OWNER-BUDECLARATION Lender's DEC Lender' s Name ' I hereby affirm that 1 am exempt from the Contractor's License Lender's Address • Lass'for the following reason (Sec.7031.5,Business and Professions I certify that I have read this application and state that the above Code: Any city or county which requires a permit to construct,alter, information is correct. 1 agree to comply with all city and county improve,demolish,or repair any structure,prior to its issuance,also ordinances and state laws relating to building construction, and requires the applicant for such permit to file a signed statement that hereby authorize representatives of this county to enter upon the he is licensed pursuant to the provisions of the Contractor's License above-mentioned property for inspection purposes. Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he is exempt therefrom and Signature of Appbcwt or Agent Date the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty - of not more than five hundred dollars (S5W).): "OWNER-BUILDER VERIFICATION ❑ 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not -'Attention Property Owner: intended or offered for sale (Sec. 7044, Business and Professions "An owner building permit has been applied for in Code: The Contractor's License Law does not apply to an owner of our mute end bearin property who builds or improves thereon,and who does such work Y g your signature. himself or through his own employees, provided that such -'Please complete and return this Information in the envelope provided at your earliest opportunity to avoid unnecessary delay improvements are not intended or offered for sale.If,however,the in processing and issuing your budding permit.No building permit building or improvement is sold within one year of completion,the will be issued until this verification is received. owner-builder will have the burden of proving that he did not build 1. 1 personally plan to provide the major labor and materials for or improve for the purpose of sale.). construction of the proposed properly improvement (yes or no) F11,as owner of the property,am exclusively contracting with licensed contractors to construct the project (Sec.7044,Business and 2 1. (have/have not) signed an application for a Professions Code: The Contractor's License lasv does not apply to building permit for the proposed work an owner of property of cts builds or improves thereon, and who 3 I havecontracted with the following person(firm) loprovide the Cots ntractor's such projects with a contractor(s) licensed pursuant to - 'the proposed construction: the Contractor's License Law.). Name E] 1 am exempt under Sec. A.BrP.C. for this Address City reason _— ;bone Contractors License No. Date Owner 4. 1 plan to provide portions of the work, but 1 have hired the following person to coordinate,supervise, and provide the major work: Name Address City Phone Contractors License No. S. I will provide some of the work but I have contracted(hired) the following persons to provide the work indicated: Name Address, Phone Type of Work Signed: Property owner Social Security number Date: