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03090213 (2) f CITY OF CUPERTINO 777, BUILDING DIVISION PERMIT COt�',TRACTO�INF�'iZMATIQ BUILDING ADDRESS: PERMIT NO.0 3 0 9 0 2 13 OWNER'S NAME: PERMIT ISSUE DATE TEPHANIE P 2003 JE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 3 0 o LICENSED CONTRACTOR'S DECLARATION- V Ep I hereby affirm Not 1 am licensed under provision of Chapter Y(commencing Job DOSCrlptl0❑ £z1W whits ion IXX))of0ivision]of thc0 ss end Profcssinm Codc.end my licenm is ' �Da in full fo antl L C ;�z Deco las, .« 7310 WINDOW REPLACEMENT p Dam Courts t CONTRACTOR: ALL BRAND WINDCR ED e ARCHITECTS IARATION MAL E0 loU dcrat halPhcme s public rccnNa od n,re OCT 15 2003 OWNER-BUILDER DECLARATION 0 o M I hereby aflon that 1 .exempt from the Convector's License Law for the following reason.(Section 703 1.5,Business and Pmfesxions Code:Any city Or county <$ which require.a permit ,,construct,alter,improve,demolish,to m,aif any suuc un, '. eli pdano its issuanegalm requires theappli�ant forsucn permit to file a,igned,tammef 2Fp that he is licensed pursuant tothe previsions of the Convacmr'sLicense Law(Chapter 9 Sq.Ft. Floor Area --van6300 i (commencing with Section 90W)Of Division J of the Business and Profession.Cede)or ,59 that he is exempt thnmfmm and the basis for the U.,d]c.emption.Any violaimn of Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty of APN� ih[i1�r00 .not more than Bvhundmd dollars($5(10). Occupancy Type -- ,. ❑Las owner of the property,or my employees with wages as their sole compensation. will do the work and Ne atmau a isnot intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor',License Law does not apply to an owner of 101 — FOUNDAT gr MKII Inspections property who builds orimproves thereon,and who doessuch work himself of through his own employees,provided that such improvements are not intended oroRered for sale.If. 102 — PIERS however,the building or improvement is sold within one year of completion,Ne owner. builder will have the burden of proving that he did not build or improve for purpose or 103 — UFER sale')' 104 — REBAR 01.as owner of the property,am exclusively contracting with licensed conwdon m 105 . -ANCHOR BOLTS construct the pmjcct(Sec.7W.Business and Pmfessions Code)Thntra To.Cocmr's Li- - came Law does not apply to an owner of property who builds or improves nhemon,and, 106 — SEWER & WATER who contracts(oraueh projects with a eonmcmr(a)licensed pumuanuo the Con ommrb L 202 - UNDERFLOOR PLUMBING kense Law. p l am exempt under Sec. .B At P C for this reason 203 ' UNDERFLOOR MECHANICAL owner Dam 2 04 - -UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty.1 perjury one Of the following declarations- 205 — UNDERFLOOR INSULATION . I have and will maintain aCenifieate of Consent o self-imum for Workn'.Compen- 301 — ROUGH PLUMBING - Inion,as provided for by Section 3700 of Ne Labor Code,for Ne performance of the 302 . - TUB & .OR SHOWER work for whim this permit i,issued. 303 - ROUGH MECHANICAL E]1 have and will maintain Worker's Compensation Insurance,as required by Section 37p of the Labor Code,for the performance of the work for which this permit is issued, 304 — ROUGH ELECTRICAL My Workers COmpensetion lmunneaTarierandP icy number am: y- 305 — FRAME Carir�r��i-�4 L�.f`N+�L'TN� Is N.: d�22J CERT ICATE OF E% N FROM WORKERS 306 - HOLDOWNS COMPENSATION INSURANCE 307 - INSULATION or (ITlaseclion need collate completed if be Permit is forone hundred dollam($100) 308 - SHEETROCK 309 - EXTERIOR LATH employ certify that in the in any panne of the work for which this permit rl issued,l shall not ws.anypermn many manner snmmbecame sabjm uotbe Workcri Cpmpen,afon 310 — INTERIOR LATH Applicant rnia.°am 311 - SCRATCH COAT Applicant NOTICE TO APPLICANT:IL after making this CcmlEcatp of Exemption,you should 313 — ROOF NAIL become subject to the Worker's Compensation previsions of the Labor Code,you must = ,Z mMwimComply with such provisions OrNiaPermit that]bedeemedrevoked. 501 — FINAL ELECTRICAL ENERGY z0 CONS RUC IONLENOINGAGENCY 502 - FINAL PLUMBING ENERGY I hereby affirm that there is a construction lending agency for do perfurmancc of 503 - FINAL MECHANICAL ENERGY yj0 Lender's Name thework far whimNispermit isissued(Sec.3097,Civ.C.) ]-t Q 504 - FINAL BUILDING ENERGY Lender's Addresa Z 505 - FINAL ELECTRICAL 1 certify that I have read this application and some ordinances the above information r eating i. 506 - GAS TEST building 1 agree to comply with all city and county oNtives of and stain lewd relating m j building construction,and hereby emM1oriae rcpresenutivm of this city menter upon Nc — FIN WING G a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against 0 8 FIL tiro liabilities,judilomu,coca and expenses which may in any way seems against said City Jz in consequence of the goofing of this permit. ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ON-POINT Issued by: 5 D4 ate * URCE REGU 2 � Re-roofs Si urs of ApplicaHAZA DOD LO em - HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne applicantforum building occupant stem or handle hmudou,material defined by the Cupertinono Municipal Code,Chapter 9.12,and the Healthand Safety Code,Section 23532(.)? - [DY.. ;6- All roofs shall be inspected prior to any roofing material being installed. Will the applicant a'future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It haaardoua air contaminants as outlined by the Bay Area Air Quality Management all new materials for inspection. iatrict7 C]Yes I have real Ne haaardous materials cluimments under Chapter 6.95 of he Califor- niaHcollh@Safcty COde,Sccdons25%5,25533and ZSSJ l mukraundthatifthchuilding *h- - does not cu h- ¢nanL Nat it o my maponsihil y w nodfy Nc occupant of the rcyvi cnuwhich tbcmet r; ,nanceoracc fica fRU-my. Signature of Applicant Date ' a All roof coverings to be Class "B"or better F Dau C*Y OF CUPERTINO q ITO PERMIT APPLICATION FORM o-3 CUPEI,TINO N # i- r Date: Building Address: TT.2 -,57 Dr C.r end .ti o Owner's Name: Phone#: �iGn� e ressnar� 650 62, .0330 Contractor: A,1 License#: fcvJ LJCY1do4 s :�3;/Oy Contact: Cupertino Business License#: Buildin Pe it Info: Bl Elect ❑ Plumb ❑ Mech ❑ Job escription: r � (� esidential Commercial ❑ Sq.Ft. Floor Area. $/Sq.Ft.: Cost of Project:/ Occupancy Group T e of Constructi � Ca 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/OfFComm/ 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 _z.3 1,7 1 of 3 �� CIOY OF CUPERTINO CUPEkTINO PERMIT APPLICATION FORM Quantity 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 Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING qw BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Stomn/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 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> 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 • 2 of 3 a CITY OF CUPERTIP* CUCITY TYOF O PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREN20WER 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, Marque 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 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING i 3 of 3 AL RECEIVED UBMITT SEP 2 4 2003 BY: zs CIA 4culxj CPl � �Ew,t� OF �� °"s +gust -,.�l S ecillcatirop,'ltris:urt� St_o plans b at h Yrme ornateraC�bns isS)9h ,r1�c1� + �.w.��-�iltieo� p8tt1�1D,ti�u�Q15 i � �J /,,z� ��,'�� `wo�'`�,� '� �iBA• SII e5k ;�' e�4-, n a X `r1 • s