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05090138 CITY OF CUPERTINO "-^• F ✓ "`"`'" �� '�� BUILDING DIVISION PERMIT a rCONTRACTORINFORMATIOIV .°. BUILDING ADDRESS: CUPERTINO PLUMBING PERMITNO.05090138 OWNER'S NAME: PERMIT ISSUE DATE DUANE STEVENSON 10297 S DE ANZA BLY 09/21/2005 ONE: SANITARY NO. CONTROL NO. (408) 253-0618 ARCHIECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 o t� :00 LICENSED I A CONTRACTOR'S DECLARATION of CON rd I ion? )firm that 1 ern licensed under provisions of Crude, 9(mmmcnse is lob Description with Section 7")of Division 3af me Business ana Profcuina Code,and myliceacit ^ N in full forte and erten. /t" Zf yo{ REPIPE/WATER HEATER . 2 jgj? Licensecd as 5 LIc.N - Ganlrtttof GAS LINE FOR COOK TOP ARCHITECTS DEC ATION 5a 1< 1 unticrstanJ my plans shall W used As records corJt JyU N 'Ct; Licensed Pmfcesional 03 utIA.OWNER-BUILDER onDECLARATION 0 I hereby affirm Out 11. exempt from EW Conlon o License Law for rhe kp yO which re mason.(Section 703 1.5,Business and cro li Code:Any city or county 3_LL which)its isrcasuance, 0emus]rouimte alter.improve,h Permit i are a sig anytatement u¢y Prior m its tensed also require am applicant for such muter'w files signed smmmcm YFm< that mencingwitpursuant70th)ofDivians 3theseBuinessa License ionsCopmr9 Sq.FL Floor Area Values[ Co000 that M is(commencingwithSecG.n 7000)ofbasis for of Ne Business pion.Any Code)of Q�� Nes he u eaempl thcrtfrom and Ne baa for Ne alleged cacmpGon.Any violathon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mom man RK hundred dollars($M31633082 . 00 P y Yp ❑I,uowtmr o(Ju propmy,ar my employee with vnge aslhe'v s.lc rompenssdan, will do mewrrk,and the structure is notimmmded oroRered fors.].(Sec.7014.Business And Professions Coae:The Conuaclo's Lima.Un,does not apply to an owner of Required Inspections Property who bei Ids or im proses thereon,and w ho dans such work himself or duough his Own employees,provided that such improvements art notinleodca maRefe i forsale.If. however.the Wilding or improvement is sold within one year of compictirn,the owner. builder will have the burden of proving that W did not Wild or improve for purpose of u]c.). 0 I.as owner of the property am exclusively contracting with licensed contractors in construct me pormet(Sec.7014,Business and Professions Code)The Contractors Li. cents,law dors not apply to an owner of prop.ny who Wilds or improves thereon,ad who contracts for such projects with a contractor(s)licensed pursuant to IW Contractors Lkcns,UW. ❑l am exempt under Sec. ,B 6 P C for mu mason Ownc Dau WORKER'S COMPENSATION DECLARATION 1 hemby affirm..at penalty of perjury me of the fallowing declarations: I have and will maintain a Can Beau vto of Consent selGinsure for Workers Criterion.satim,as provided for by Section 3700 of the Labor Code.far lie performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker Com fennli.n lnsunnc.carrier and Polity number aro: Cartier. �� M Policy N..: 71LO6, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not becompkicd if the pnmil is foronc hundred dollars($]OW) Icas.) 1 certify Out in the peif...of set work for which this Permit is issued.I shill nm employ any person in any manner so As to become subject to On Warkeri Comfensmium Laws of California.Date Applicant NOTICE TO APPLICANT:If,of err making this Cenifiam of Exemption,you should become subject to me Wohtr's Compensation provisions of me Labor Code,you most .JO foMwith comply with such provisions or this permit shell he deemed revoked. , Z in CONSTRUCTION LENDING AGENCY (~ l hereby affirm that tMrt u a corn uchon lending agency for set performance C me work for which this permit is issued(Sec.3097,Civ.C.) ftl� Q Lender's Nam. Z Lenders Addnvss U O I sonify that I have led Ws applismen and sure mat the.hose information is it, E' crostL I agree to comply with all city and county on insrxes and sou laws misting to V Wilding construction,and hereby sumorim representative of this city 10 enter upon lW ahovomcnuoncd progeny for inspection purposes. F 0. (We)agree m aaK,indemnify and trey harmless the City of Cupertino apinst EZ) IiabiAJ.dg.cn ,tarit and expenae which may in anyway accrue agarnstsdd City U Z in ccgmaing of this iL ^ APPERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date �21 z(- SOUT S. Re-roofs gtn t Dam HA'ARD007MTERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle bAcnmus material a defined by One Cupertino Municipal Code.Chapter 9.13,aM the Health and Safety ode.Qaon 21 ',al? All roofs shall be inspected prior to any roofing material being installed. Ye Will me apPiicem ornature building ucEp..t use egdpmenl or atviaa which If a roof is installed without first obtaining an inspection,I agree to remove it hevaNna air contaminants As defined by tW Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have mad the allouxmaterialsleii immcnuunderchap¢r 6.95 ofine Califon nice HcalthhS ty �Secvoa ZT505. acv amt]353d.lunderstaod muifthe Wilding Ones sett ly awns¢n %mu it' m rjsponsibility m notify lW acupanl of me rogcimm. . n CI moracertintate fac cy. Signature of Applicant Date own res orimaegenl Dam All roof coverings to be Class"B"or better Community Development {i^t10300 Torre Avenue i^ Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPERTINO Building De artment JOB ADDRESS: PERMIT # /UNgLA Lr?. a �"O �13� OWNER'S NAME:i gYl PHONE # (p65 Zi1Z8 GENERAL CONTRACTOR: o (,� FAX # r, a I am not using any subcontractors: Si Date Please check applicable subcontractors 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 �C Plumbing V h1 (012 Roofing Ing Septic Tank Sheet Metal Sheet Rock Tile Owner/C act t e Date Swim& CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM 05U �'Di3 8 APN# /2 IDate: I /-V •�S Building Address: / -/ A00, lD / 7e Mailing Address (if different from building address): /�/'U17�iT/L'e (� Owner's Name: Phone #: DL'a.17e r) Lo0 S;- Lo y za Contractor: License #: (,tJper4,no `Plumbing ,1nc. . Co2lUCl05 Contact: Phone: VS-;S OLei g Cupertino Business License#: F lapv- clara,a Fax: 25 3 c>( -7 �vl Building Permit Info: V- Bldg ❑ Elect ❑ Plumb Lr Mech ❑ Job Description: fwoWe k ner' )4eafer, Li 4s UNC Fay- GoGKTa, Residential Kr Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: vo Occupancy Group: AWLType of Construction: Please check this box if the project is a second-sto addition: ❑ Pro'ect Size: Standard ❑ _Lar ❑ Ma'or ❑ Quantity Fee ID Fee Description- Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 fielp CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb 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 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 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 chn 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 App liance ELECTRICAL 2 of 3 ' ' CITY OF CUPERTINO CM OF PERMIT APPLICATION FORM CUPEI,TINO 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 Inspection 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 PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING f 3of3