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03010142 CITY OF CUPERTINO BUILDING DIVISION PERK C04 R'AGTOR INFORM QN •:- , BUILDING ADDRESS: A PLUS BUILDERS PERMITNO. 939 PROVIDENCE CT — 0-4010142 WNER'S NAME: 5602 CROYDON AVE APPLICATION SUB DATE YANG ALBERT I AND JUDY C 01/24/2003 PHONE: (408) 978-7500 SANITARY NO. CONTROL NO. ARCHITECTrENGINEER: BUILDING PERMIT INFO BLDG ELCCT PLUMB MECH 0 0 o t� �00 LICENSED CONTRACTOR'S DECLARATION Job Description 0 I hereby affirm that I am licensed under Provisions of Chapter 9(commencing p �Dwith Section 7(g10)of Division 3 of she Business and Professions Code,and my license is „ in fill Lice. yQ 2 BATHRMS REMODEL / ZotaZ License Lirvg 01 A LTS DE 0 1 unrsunJ my plans shall be used ublic..,us de Xy laI LL C Licensed Professional C— 5 OWNER-BUILDER I am exempt from pECLARATaON a2 2200 1 bereby off dams 1 1. exempt tram the Corns Co License Law for my u°a160o whichfollowingrcwon eocdun 703um Business,Im,, andProfessions Code:Any city or county wZ� which itsumes apermit moues tht,almaimproro,h Permit to ore a sig any structure FZy polar in its iensedprsant1.the the of for sucC.moscon',Licem.Law ned that sed pursuant to the of Diviom of the Littnxations Code)or S Ft. Floor Area x o q $18&'A49tion $ dcomm is exa Pd15emion Rand ofDivision3 of the Business and Pro Any vi Code)of that he is exam t derefrom and the baso for be alleged exemption.Any violation of not on iirive031.3 by aundredialta.($nt for a peemhaubjeetstheapplicannoecivilpenallyor Occupancy Type not more Nm five hundred dollars(5500). p y yes ❑T.as owner of the property,or my employees with wages as their role compensation, will do the work,and d,muc"re is not intended or offered for We(Sec.7DN,Business and Professions Code:The Convuome,License Law does not apply to an owner of 10 2 - PIERS egwred Inspections E aperty who bull".,improves thereon, cs eon,and who dosuch work himselforthrough his ownempmAct,provided Net such improvements are not Intended oro@red forsas.If. 103 — UFER however,to building or improvement is mid within one year of completion,the owne, . builder will have the burden of proving that be did not build or Improve for purpose of 104 - REBAR sal`')' 105 - ANCHOR BOLTS ❑I.u owner of she propony,am exclusively contracting with littesed contracrou m 10 6 - SEWER & WATER construct Ne project(Sec.7044,Business and Prmessiom Code:)The Contex"h U. cause law does no,apply to an owner of property who builds or improves Berton,and, 202 - UNDERFLOOR PLUMBING who contracts terx r such projects wish a comror(s)licensed pursuant to the Contractors License Law. 203 — UNDERFLOOR MECHANICAL ❑Iamexemptunder Sec. ,B&PCfardfspomm 204 - UNDERFLOOR FRAME Owner Dam 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING I hereby affirm under penalty of pedury one of the following decimations: I have and will maintain�Cenmcam ofComent m sef 302 — TUB & OR SHOWER ❑ i.for for WoekeM1 ce of the n provided for Section 3700 or the labor code,rr the Performance or dte 3 03 — ROUGH MECHANICAL work 01ha and fix antwaiorkee 304 - ROUGH ELECTRICAL ❑1 baro end will maintain Workers Compensation rte for which h required by Section 305 — FRAME My of the labor Code,for Nc performance of the work far which Nis permit is issued. My Work 's Com nwdon lnaueFin ee carrier and Policy number are: 306 — HOLDOWNS " F/f7 PolicyN 307 - INSULATION ERTIF COMPENSATIONIINSURA CB� RKERS 308 - SHEETROCK (This xainn need not the completed lflhe Permit is feronc hundred dollars(SIM) 309 - EXTERIOR LATH of 1e ) 310 - INTERIOR LATH employ certify Net in she performance or she work for which this permit isssu issued,I shall not mployeny person in any manner mw"become subject o the Workers'Compensation 311 - SCRATCH COAT Law,of Calimmis.Dam 313 - ROOF NAIL Applicants NOTICE TO APPLICANT.If.after making Nis Codifies"of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become Subject to the Worker'sCompensation provisions of the labor Code,you muss 7O7 502 - FINAL PLUMBING ENERGY O forthwith comply with such provisions or this permit shall be deemed revoked. a 0 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY F .. Ihereby alTumthat done is3Construction lending agency for Eye Performance of 504 - FINAL BUILDING ENERGY de work for whim this permit is issuer(sec.3097,Civ.C.) UJ Lenders Name 505 — FINAL ELECTRICAL 0. Lentler D r Address ' D� 506 - GAS TEST -- J 1 conny that I have read this application and sate that be above information is 507 - FINAL PLUMBING H. H cooecs.I Agree"comply with all city and county onfinaoees and sure laws relating to - O V building construction.and herebyemhodmrtprtxnutiroaofthis city mcn"rupon the 5 FINAL MECHANICAL L>a above (We) progeny hfor erebyemiorim rpoxs. 09 FIN L1, (We)agree ro save,indemnify and keep harmless the City of Cupertino against W liabilitoo judgments.Cos"and expenses which may in any way seem agaimssaid City CJ NW in consequence of the granting of this permit.APPLEQQAAjjJJTT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by5 1RKS Date SOUREG10fj15; O� �� r Re-roofs Signature of AppiicanJConuaaor De" HAZARDOU MATERIALS DISCLOSURE Type of Roof Will the applicant or tutu uilding occupant slosh or handle hawrdmn mdedal as defined by the Cupertino Municipal Code.Chapter 9.17,and de Health and Safety rode,Section 2553I(a)? ❑YOyuW3eNo All roofs shall be inspected prior to any roofing material being installed. ` If a roof is installed without first obtainingan inspection, I agree to remove Will she applicant or antra building occupant use equipment at devices which P ,g emit hawmous air contaminants az defined by she Bey Arca Air Quality Management District? all new materials for inspection. ,,,111 ❑Yes pp Nu I have mad the havn dousma"rials requirements under Clup"rti.95 otthe Cahror, nia Health&Safety Code,Smtiona25505,75533 and 25534.1undersund that ime,Wilding does not cu ntIs have a¢moa dm it u my responsibility to,wdfy IM occupant of dr rtuimmen ichmust tic ottpu issuanccof.Cenifician I aPanc.' ature of Applicant Date ncr or as aired agent p," �� All roof coverings to be Class "B" or better �•.ii �w lo T143 JAN 2 4 2003 ��o' p�sstiecc 9vz-a,�ic.c IlA s 71./a Slfc/�E7Z 1 (/U) SS it fu (laLvE ®(N) gT(N) RDA,NCE WITH THE CM Ui 7j F Tb ©(1J) / r "� ls�G•! f/ i�!�:insnd�/ 'ir/.2/v� 6` 57 GGc cS !2 J� E i ,r: t°3 jab at�vn(e un tis i r--`e any changes or alY�g2Cl� w..th;ut written parmissl�n .ram Ci7`ept. Cj "n ' u � d '-1/ / s1N� ofthis ! he'd to permit or r— �tc Gt Violation of any P'0191011f lN � �>cG•� ��/''tet,! 7,D �', f. s% LAW iN� • Gni G1 1�t7 o/? 6)3 l �� t// 5) � , -535 - *CITY OF CUPERTINO o o CITYOF PERMIT APPLICATION FORINT • CUPERTINO APN# Date: O Building Address: Owner's Name: Phone Contractor:` License#: p Contact: Phone P v Applic t/Contr Fax#: /Building Permit Info: Bldg Elect M !/ Me t JDb-Descnption: Residential: Commer al: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuationn: �U p� Type of Constructi .L:i'��CJ�tcL (�(J lj Occupas C�/C/ uantit Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi 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 BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM I New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING lof3 r 'd.. CITY OF CUPERTINO CITY OF CUPEI�TINO PERMIT APPLICATION FORM • Quantity Fee ID Fee Descri tion Fee Group BNUMULTI New Multi-family Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE PbIg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINfERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING 13PLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e 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 HeaterfVent 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 BREM 3USWAY 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 Re ai k-iterHeating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD I Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marguee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL 2 of 3 CITY OF CUPERTINO CITY CUPE TkT INO PERMIT APPLICATION FORM —Qwn$ity Fee ID Fee Description Fee Group BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL . BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial , BUILDING BSEISMICRE Seismic Fee Res BUILDING BSF&2FAM Single & 2 Family BUILDING BSFNA Single Family New Add 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 Elee 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 BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 300K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75 M Btu MECHANICAL • 3 of 3 CITY OF CUPER'1'INO , �. .,,.,.;�., ., `.• � 'Ha),. ... BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: moo_. B UILDINGADDRISSo A PLUS BUILDERS PERMITNO. 939 PROVIDENCE CT ER'S NAME: 5602 CROYDON AVE APPLICATION SUB DATE YANG ALBERT I AND JUDY C 01/24/2003 Pf10NC: (408) 978-7500 SANITARY NO, CONTROL NO. ARCHI?ECT/CNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECII 0 0 0 0 POO LICENSEDCONTRACTOR'SDECLARATION JobDesci ❑ s we P I hereby affirm that I am licensed under provisions of Chapter 9(commencing {R„ �U� with Sectirn7(XXBof Division3.f NC Bluffness and Rofcssiom Gale.and mylicenm is ffid0 R n�11 n„ iton mree feel Lily�t /1-] 2 BATHRMS REMODEL C ^ A Oz—,zL 19 tricerl CCSD /�—..7 Dam Com ar —g l :usedin or AUG 2 1 2003 1 underhand my plans shall he used a ublic records 6 i53 w Licensed Professional N £�O OWNER BUILDERDECLARATIONthe Cum oho BUILD' v' K Y 1 hereby.(sero on 7I 1. exempt from the Cuntm,Cod License law for the SpO which nquires aPermtiun 7031.5, aftessand Professions Cr alt:Any city or county 1—$ which requires a permit re iesthconstruct,altar,improve,demolish,or repair any structure prior to its issuance,also requires the applicant tOr hesuch peemit m rile License signed stxmment yry?SSat that(Com i nine and provisions 3 of the Business mcmr'anPrssion Chopter9 Sq. Ft. Floor Area $1$6'fl4klllOn teat bees xempth&ctirn7100)ofaddth Dlvisinn3of theeged exempt Professions Code)mers or — that he u exempt thertfrom and the haze for the alleged exemption.Any violation of Section]031.5 by any applicant for a permit subjects the still COIL to a civil penalty of not more than five hundred dollars(5500). bC Occupancy Type ❑I,as owner of the property,or my employees with wages as their sole compensation, will do she work.and the slncmre is not intended or offered for sale(Sec.7 W.Business and Professions Code:The Croq sates License Law does not apply to an owner of 102 - PIERS equlred Inspections properly who builds or improves theme.and who does such work himself or through his own employees.provided that such improvements arc not intended oroffered for sale.If, 103 — UFER however,the building or improvement is mid within one year of completion,Bat owner- builder will have the burden of proving that he did not build OF improve for purpose of 104 — REBAR .10.). 105 - ANCHOR BOLTS ❑ I,as owner of the property,am exclusively contracting with licensed contractors m 106 - SEWER & WATER crnhmcl the project(Sec.71,14,Business and Professions Code:)The Contractor's Li- cerise Law does not apply toanowner ofproperty who builds or improves thereon,and 202 - UNDERFLOOR PLUMBING who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. 203 — UNDERFLOOR MECHANICAL I am exempt under Sec. ,B&PC for this name 204 - UNDERFLOOR FRAME Data 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATIONDECLARATION 301 - ROUGH PLUMBING I hereby affirm under Penalty of perjury one of the following declarations: 302 — TUB & OR SHOWER ❑ 1 have and will maintain a Cerlilica,of Consent to self insure for Worker a Compen- sation,as Provided for by Section 3714 of the labor Code,fnr the perenceof the 303 - ROUGH MECHANICAL work for whichthisP.itisissued. fmm304 - ROUGH ELECTRICAL ❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section 305 - FRAME 3710 of the Labor Cade,for the performance of the work for which this Permit is issued. MY W/ork 'a Cont tiro Insurance carrmr and Policynumber am: 3O6 — HOEDOWNS �amCr: 'Fk.mv Policy N=.A 307 - INSULATION ✓w CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK Cons section need not W completed ifthe permit is fount hundred dollars($100) 309 - EXTERIOR LATH `',lest) 310 - INTERIOR LATH I ccnify that in the performance of she work for which this permit is issued.)shall nut 311 - SCRATCH COAT employ any permit in any manner m as In Become subjectto the Workers'Compensation Laws of California.Da1e 313 - ROOF NAIL Applicant NOTICE.TO APPLICANT:It,after making this Cenificae of Exemption.you should 501 - FINAL ELECTRICAL ENERGY become subject to the Worker's Compensation provisions of the Labor Code,you must 502 - FINAL PLUMBING ENERGY OO fontwith comply with such provisioner,this Permit shall Be deemed invoked. Z 0 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY (-. .. I hereby dRrm that there is a construction lending agency lot tre Performance of 504 - FINAL BUILDING ENERGY a > the LmddZkfor wmmthis P mitiaissued(s".3(97.cv.c.) 505 - FINAL ELECTRICAL W� Q Lender's Nam' z <ndcr'sAddre506 - GAS TEST U O 1 unify Nat 1 ham read this application and sole that the aWm information is 507 - FINAL PLUMBING lg, t~ correct I agree to comply with all city and county ordinances and state laws relating to Wilding construction,and hereby amhurim rcprcunmtircs of this city mentor upon she 5 FINAL MECHANICAL abom-me ion dl property for lnspectio.purposes. 0 9 F I N (We)agree us save,indemnify and keep harmless the City of Cupmind against H h sneer litics.judgments,costs and expenses which may in any way accrue against said City 5 INAL U Z in consequence of she granting of this permit. ^ APPLIgVT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by51 - WORKS Date SOURf[9^tIF.Gyj.4TIOy5. Z 07 1— is Re-roofs Signature of ApplicanUCuntracmr Date IIAZAROOU MATERIALS DISCLOSURE Type of Roof Will the applicant or rule aiding Occupant store or handle hammuus material as defined by she Cupeninn Municipal Code,Chapmr 9.12.and IN Heal n and Safely We.Section 25532(0)? ❑Yes W3a Nu All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? �1 o Yea pq No ve 1 horead the hammouus`materials mqu ere cuus under Chape r6.95 of the Califor- nia 11.101&SafetyGale.Sections 255115,25533 and 2553+.1 und,..d Brand the building cuts dol to of Brix a tenant,Nat it is my responsibility to notify IM Occupant of the re uintmcn nice muhta: IPo rissuanm ora Ccnificam of uPanc ' i2ature of Applicant Date 0 (it au rriredagent Date (�-S All roof coverings to be Class "B" or hater