03090210 CITY OF CUPER'f[NO ^*` •ora Wa?.+ * _
BUILDING DIVISION PERMIT s CONTRACTOR INFORMATION."
BUILDING ADDRESS: PERMIT N0.03090210
' R'S NAME: PERMIT ISSUE DATE
ISUNG KI MIN03
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
CJ 0 0
+Op LICENSED CONTRACTOR'S DECLARATION Job Description
N1 hereby affirm that I em limned oxer nroZ'[ons Cmofcnapmr v(mmmense is p
ii with Scctiortl�Aq of Division Jof the Ru sand Pmfcssinns Codc.and my license is
s<6 in full forteaw effect.
i'q_ Gimaccl Lief lZ5324 REPLACEMENT/RETROFIT WINDOWS
II-- Dam cmntru CONTRACTOR: ASPEN WINDOW & DOOR
4 q
ARCHITECTS D RATION ���
2226 U 5`I nticrsmMua rc
nJ my plans shall used Public cnrds F'N .i
=ot; Licensed Professional MAR 2 5 2004
1 3 OWNER BUILDER DECLARATION
Z a f I hereby.(sero o the,1 1. exempt from the Commas Co :An,c Lew for the
5 00 following mason.fermis t IDnstr Business and ve de funs Code:Any city or county
$E whim myuims n permit re conswct,alter,improve,h fermiit t ri e a siganyned statement_ZQ faionoitscensed pursuant
thcaprovisions
or rorsucthe Contractor's
icesaiaw stsmmcm
Nat he is licensed pursuant to thepmvisions of the Contmctoes LicenA taut(CheplerY Sq. F[. Floor Area 2
(commencing with Section 701X))ol'Division 3of the B usiness and Professions C,Jc7 ser
that he is exempt therefrom and the basis for the alleged exemption.Any violas'ion of
Section 7031.5 by airy applicant for a Permit subjects the applicant to a civil penalty of 3AINSlI91Re OO Occupancy-Type
not more than five hundred dollars($500). P Y
I,ea owner of the properly,of my employees with wages As their.anle compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7W,Business RRee
and Professions Code:The Communities Licenz Law does not apply to an owner of 101 - FOUNDATT16rSd Inspections
property who builds or improves thereon,and whodoeuuch work himself or through his U1V
Own cmploycea,provided that such improvements ire not intended oroRered for Ale.If, 102 PIERS
however,she building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving Nat he did not build or improve for purpose of 103 - UFER
AR.). - 104 - REBAR
I,as owner of Ne properly,,B exclusively crowning with licensed contractors i. -
conswet the project(Sec.]Bd4,Business and professions CodeUThe Conmacmr's Li. 1 05 — ANCHOR BOLTS
cmum Law dors not apply be in owner of property who builds or improves thereon,and 10 6 - SEWER & WATER
who contracts for such Projects with a contractor(a)limned pursuant to the Conuacmh
License Law. 202 - UNDERFLOOR PLUMBING
❑l am exem Is under See. ,B&P C for this reason 203 - UNDERFLOOR MECHANICAL'
Data204 -- UNDERFLOOR _FRAME
er
WORKERLA
'S COMPENSATION DECRATION
I hereby M.undpe only of Paj.,be.,rtbe 1.1owing declaration: 205 - UNDERFLOOR INSULATION
Nie and will maintain•Certificate of Consent to selGinum for Wortrri Compcm
301 - ROUGH PLUMBING
sation,u provided for by Section 3700 of the Labor Code,for the pesformanee of the 302 — TUB & OR SHOWERwork for
01banand illaparmit isinWorrcd. 303 - ROUGH MECHANICAL
❑1 have end will maintain Worker's Compensation Insurance, h required by Section
nr>oofinehb,resefor es,=perrorm.n=e,fOne work far wmrntnapermitiaiA,ea. 304 - ROUGH ELECTRICAL
My Worhees Comlcrom on Mae Ironer and Policy number are:_ wv�s 305 — FRAME
Cnrricc VPolio Nu.: ��r-r
RTIFICATE OF EMP170N WORKERS' 306 — HOLDOWNS
COMPENSATIONIN NCE 307 - INSULATION
(This section need nm he completed if be permit is for anchundred dollars IS 100) 308 - SHEETROCK
,.Ica,.) 309 - EXTERIOR LATH
employ cerlify Nat in the n an mane of Ne work for which this permit la issued,1 shell nm
Lawoanyperaonmany mannerAumtrcome subject to Wortrri Compenatan 310 — INTERIOR LATH
Laws ofCalifornia,Dam
Applicant 311 - SCRATCH COAT
NOTICE TO APPLICANT:IL aper making this Certificate of Exemption,you should 313 - ROOF NAIL
become subject to the Wortrri Compensation previsions of the Labor Code,you must
�Z forthwtthcomplywithsuchprovisionsorthispmemishallIngdeemedrevoked. 501 - FINAL ELECTRICAL ENERGY
Zo CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
l nder's or whichhereby am.bar them is.conmuctmn lending agency for the performance of 503 - FINAL MECHANICAL ENERGY
x>
to work
issued 504 - FINAL BUILDING ENERGY
Uder's Name
ILnJees Address
:)Z 505 - FINAL ELECTRICAL
;J p 1 eeNfy o c 1 have read UnaApplication
and tour end auto the the sham iws relation is 506 - GAS TEST
oohing l agree to comply hereby auchori rprea ordinances and sine laws r Open the
buildingconvection,and herebyection reosica. fives of this city to ewer upon Inc
� U ahme. - FIN L PLUMB NG
Q. mcn)Mac I.cava for dcoamftion Purposes. —
(sac)agree to Ave,intlemnify and keep humleu the City of Cupertino.faint O FI
AL
h liabi In]..jutlgmcno,costs, ,pe"isnes whoccomiich may in any wsyamroc again.said City _
..) rZ-t AcoW qp nccOr on"STA g u$AND WILL COMPLY WITH A NO POINT Issued by: 5 - ING Date
S URC G Ns,
Re-roofs
S rte re of ApplicaHAZARemr k
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futurebuildingCode,Chapttlomor handl Health
And Safety
Reed by the Cupertino Municipal Codc,Chapter 9.12.and Ne Health.nd Safety
Se=ders usJ2(a) All roofs shall be inspected prior to an roofing material beim
❑res �e+, P P � Y g g installed.
Will the applicant or future building occupant use equipment or devices which If roof is installedwithout first obtaining an inspection,I agree to remove
I havardous air contaminants A defined by the Bay Arca Air Quality Management all new materials for inspection.
xtria7 Wain
(C?No
I have mW the Wardiwsmaterials requirements under Chapter 695of the Califon
nix Health&SafelyC ,Saran 25N15,25577 and 25574.1 mumonand one ifths building
does ly het tenant Nat it u my m.pm onsibilky redly the omi,am of me
�ts =n abcMCI pri,rwsnun
iametieerdfi=stn ,man= - Signature of Applicant Date
mer 4ftion7ml agent „= All roof coverings to be Class"B"or better
r
CITY OF CUPERTINO
BUILDING DIVISION PERMIT QONT"GTan MOR' A.TI0
`?.taw
BUILDING ADDRESS: PERMIT NO.0 3 O 9 02 10
7917 RATNPnW DR
OWNER'S NAME: PERMIT ISSUE DATE
S 03
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELELT PLUMB MECH
0 0 0 0
0 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm in I.m I 'it dor provisions of Cbapier v(commeneina Job Description
6 with Sectihr 7 MDow.3of NC Bu s nd Profcssians Code.and my license i,
n full tart- effect
imeese ct Iic.1 12cj32� REPLACEMENT/RETROFIT WINDOWS
Dam ConaacCONTRACTOR: ASPEN WINDOW & DOOR
i� ARCall heu•da RATION FIN
p ���
YI undcrambd my plain shall he used as puhlic remrda /qL�a
iU
h Licensed Professional
3 OWNER-BUILDER DECLARATION MAR 2 5 2004
p 1 herchy affirm that I am exempt Tram the Chatrano,',License Law Inc,he
{O following mann.(SeNun 7031.5,Business end Professmm Code:Any city or county
I .which myuires a permit sea construct,alma improve,demolish,or repair any swctum
.e prior us its manner,also mquims the applicant for such permitio file a signed s,ammcat
G that W is licensed pursuant to the pro ommus of the Contractor's Licenm Law(Chapter 9 Sq. Ft. Floor Area BUILONS432
;$ (commencing with Section 7000)of Division 3 of the Business and Prafessions Cher)or
.— that he is exempt therefrom and are buts for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3ARN Htif Rt O O Occupancy Type . .
not marc Nan five hundred dollars($500). .
1,as owner of the limitary,or my employers with wages as Neo sole compensation,
will do the work and Ne structure is not intended or Offered for sale(Sec.7044,BusinessRR�� U dins ections
and Professions Codc:The Cantncal's Lt..Law docs not apply m an owner of 101 - FOUNDATT d1 p
pmpeny who Wildsarimproves Nemo.,snit who doessuch work himself or through his
Own employees.provided thatauen improvemems aremn intended M.11i ed fortune.If. 102 — PIERS
however,the building or improvement Issald within one year of completion,the owner,
builder will have the burden of pmving that W did not Wild Or improve far propose of 103 — UFER
saleL 104 - REBAR
1,as owner of the pmpeny,am exclusively contracting with licensed conewars to 10 5 — ANCHOR BOLTS
construct the project(Sec.7044,Business and Professions Code:)The Canncwr's Lt
come law does no,apply an an owner of property who Wilds or improves themon,and, 106 — SEWER & WATER
who contracts for such projects with a con"clor0)licensed pursuant m the COMONU r'a
License Law. 202 - UNDERFLOOR PLUMBING
I am cxemp,under Sec. .B k P C for Nis mssan 203 - UNDERFLOOR MECHANICAL
Owner Dam 204 UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I hereby affrrmunder penalty of perjury ON of the fallowing doclam,ionr. 205 - UNDERFLOOR INSULATION
' eveandwillmaintain.CeNOcateofConsenttoself-Insumforworker'sCumpen 3O1 — ROUGH PLUMBING
Was provided ter by Section 3700 of the labor Code,for the mce Perforanof the 302 — TUB & OR SHOWER
work for which this permit is issued. 303 - ROUGH MECHANICAL
❑I have and will maintain Worker's Compensation Insurance.as required by Section
3700 of No Labor Cod0.ter lW performance of the work for which this perm it is issued. 304 — ROUGH ELECTRICAL
My Workers Compen ,ion lnwnnennier and Policy number�m: o��� A 305 - FRAME
Cortico• i iVsR J' , Poli Na.: G 306 - HOEDOWNS
- ,( 'RTIFICATE OF EMPnON WORKERS'
,G/ COMPENBATIONIN NCE 307 - INSULATION
(Thu section need not W completed if the fermi,Is for Wehundmars
d doll (S 100) 308 - SHEETROCK
(Klass.) 309 - EXTERIOR LATH
1 C.r fy wet I.the perrmmare.of the work fm which this permit is issued.)anon nut 3 10 — INTERIOR LATH
employ any Person in any manncno u to Income subject m IN Workers'Compemation
Laws of California.Data 311 - SCRATCH COAT
Applicant
NOTICE TO APPLICANT:It.after making this Certificate of Exemption,you should 313 - ROOF NAIL
become subject to the Worker's Compensation previsions of the Labor Code,your must
,Z forthwith comply with such pravism.Or Nis Permit shall he seemed reversed. 501 — FINAL ELECTRICAL ENERGY
0 502 - FINAL PLUMBING ENERGY
73 CONSTRUCTION LENDING AGENCY
I nearby amrm Nat them is a constmcium lending agency for the permanxice or 503 - FINAL MECHANICAL ENERGY
Ne work fur which that permit unamed(Sec.3097.Civ.CJ 504 - FINAL BUILDING ENERGY
QLender's Name
;z LumeraAdd.. 505 - FINAL ELECTRICAL
p I certify that 1 have mad this application and sum that the above information is 506 - GAS TEST
carted.l agree m comply with all city and county ordinances and sate laws Misting to
'iUWilding convection,and hemby auWodae mprrsenlativos of Nis city in Omar upon the — FINAL PLUMBING
ahove-men0uned Pmpeny rte inspection Purposes AL
(We)egnm m save,indemnify and keep bumless the City of Cupertino against O = F I
liabilities,judgments.eosua xpea...which rosy in any wey accmc against said City
1 in ca uuFFa.Or the gnnO go his Permit.
A LI AIT iaRSTA S AND WILL COMPLY WITH A NOIssued by: 5 - ING Date
S URC rI eG NS. e
Re-roofs
S nes rc of ApplicanUConwctor D%
m
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will Nc applicmtur furore building accupents,orc or handl vudous material
as defined by the Cupertino Municipal Code,Chapter 9.11.and the Health and Safety
Code,section W32(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes �u
Will the applicant or future Wilding Occupant use equipment or Devices which If a roof is installed without first obtaining an inspection,I agree to remove
haxerdells air contaminants m JcOned by Ne Bay Arca Air Quality Management all new materials for inspection.
ict7sssCC[,,,''''''
❑Yc. L sets
I have mad Nehvsrduusmamrlalsmqui.dc 5vodcr Chapmd6 .Lifthe Caldiag
M HralN&SafetyC .Secuum25505,1557J and 25534.1uodersund NniflW Wilding
-- does c ly he tensa.Nat it 4 my mspomihility m notify the occupant ar the
cis lch W met prior m issuance of a Ccrulleate uparrc Signature of Applicant Date
noriraa ascot ate All roof coverings to be Class "B" or better
1
i
a° u
D
O t� SEP 4 2003
On
APPROVED
TN ACCORDANCE WITH THE CITY OR
D11PERTINO C ESA 0 INANCE9
DATE
SIGNED
This $e of jails and spec'lica— oo— n_s MUST
be kept on the job 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 N07 be hold to permit or tobe
or.
no
approval of the vluletlon of any p
,f Rog Olty Ordinance or Stete Law,
• I
y% C*Y OF CUPERTINO
CUPERTINO PERMIT APPLICATION FORM
N #
Building Address:
Owner's Name: VPhone #:
I `l3I ,2Z
Contractor: License#:
Con act: Cupertino Business License#:
Building Permit Info:
Elect ❑ Plumb ❑ Mech ❑
J Description:
Residential Commercial ❑
Sq.Ft. Floor Area $/Sq.Ft.:
Cost of Proj � l l ��Z Occupancy Group: r
i
Type of Co truction-
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
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 <= 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
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COY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
uantit Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family 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
BNUSFD New Single Family Res BUILDING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric 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 Repipe 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 Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 din 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
BREMMHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
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CITY OF CUPERTIl*
Cl of PERMIT APPLICATION FORM
CUPEkTINO
uanti Fee ID Fee Description Fee Group
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
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 MECHANICAI,,
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING_
BSPECIAL Special Insection BUILDING--
BSWIM Swimming Pool BUILDING ,,.
BTENT Temporary Power ELECTRICAL%
BTEMPPERM Temporary Bldg Permit BUILDING,
BTEMPSVCS Ternp Dist Svcs ELECTRICAL
6/1 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 Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
j
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