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03080093 CITY OF CUPERTINO TRACTOR INP ORMATION MA IR BUILDING DIVISION PERMIT FCON . BUILDING ADDRESS: SP HOME IMPROVEMENT PERMIT"°03080093 OWNER'S NAME: 1030 WINDSOR ST. PERMRISSUEDATE "E` (408) 777-8918 SANITARY N0. CONTROL N0, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELF.Cf PLUMB MECH op LICENSED CONTRACTOR'S DECLARATION U I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description tz�ly with Section 7000)of Division 3 of Ne Business and Professions Code.and my license is ±�N infuPoOfbaaand e a I g? claELECT SERVICE UPGRADE L ll ss Lic.N ;,in Dam Contractor ij�{ ARCHITECTS DECLARATION 1 understand my plans[hail he used u public records Licensed Professional s S OWNER-BUILDER DECLARATION F 1 hereby a1Tam that I am esempt from the Contractors Liccese Law for the ❑0 (nllnwing ambos,(Section 7031.5,Business and Pmfcuinm Code:Any city m county 5$ which squires a permit m crosuum,alter,imprnve,demolish,or repair any strutter, pHer In its iasaance,eleu squires thcappliwnt Rtsueh permit to filcasigncdstmement qnn < that he is licensed!pulsuan°o Its,provisions Of(he Commuter's License Law(Chapter 9 Sq. Ft. Floor Area Valuation (cote meneing with Section 7000)of Division 3 of the Business and Profeuinns Code)or $ that he ih escm,t therefrom and the basis for Ne alleged esemption.Any violation of 35910005 . 00 Section 7031.5 by any applicant for a permitsubjecs the applicant o a civil penalty of APN Number Occupancy Type j not more Nan five hundred dollars($510). ❑1,as owner of the property,or my employees with wages as Mille sole compensation, will do Ne work.and Meswcture is not intended or offered lot sale(Sm.7044.Business _ uired Inspections � and Professions Code:The Contractor's Liceose Law deet am apply to an owner of 304 — ROUGH ELECTRICAL Own proere property who builds or impecomthon,and who does such work himself or lhmugh his own employee,provided that such improvements are not intended or offeree for asks.If. SOS — FINAL ELECTRICAL ve however.Ne building or improvement is hold within one Kthe of completion,purpose of builder will lothe burden of proving Nn h,did Orn Wild or improve for puryose of s ,). 1,as owner of the property,am exclusively convecting with licensed contractors to cc tract Ne project(Sec.7644.Business and Professions Cade:)The Contractor's Li. cense Law does not apply to an owner of property who builds or improves thereon,and, who cones for such projects wish a comnctoms)liccmed pursuant to the Conuacmts d License Law. 1amtae under es,. .B&PP CCffn�this mason O Damm /r 7''/ 3 WORKS COMPENSATION DECD ON—[—O-'4" t 1 hereby affirm under penalty of perjury,one of Ne following declarations: I have and will maintain a Certificate of Consent to self-insum for Wmtrr's Compete sation,m provided for by Section 3700 of Ne Labor Code,for Ne perform4me of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of Me Labor Code,for the performance or Ne work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number art: Cartier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thusecdon need not beemai leted ifthis,permit is boom hundred dollars($100) or less.) 1 Beni fy that in the performance of the work for which this permit is issued,I shall not employ any person in any manner an as to haemo subject o the Workers'Com menstion Laws of California.Data Applicant NOTICE TO APPLICANT:IL after making this Ccomficam of Exemption,you should become subject to the Worker's Camp,Mallam provisions of the lobo COM,you most JO forthwith comply with such provisions or this perm it hall be deemed revoked. ,ZyCONSTRUCTION LENDING AGENCY F"`Z, Ihereby affirm Nat them its moureeinn lending agency for the perfmmarce of !Yi 7 Ne work for which this Permit Is issued(Sec.3097.Civ.C.) WLender's Name � Q a Z Lender's Addreas U 0 1 aniry that I have read this application and sate Nat the shove information is B. P corse,.1 agree to comply with all city and county ordinances and sum laws relating to 0 U building construction,and hereby auNorimrepasematiseh of this city to corer upon Ns, W ahovomcationed property for inspection proposes. (Ws,)agree to have,indemnify and kap hnmlcss the City or Cupertino against E-'p2 liabilities,judgmens.coss and m,sonscs which may in any way accrue agamstsmid City U Z in conscmosco of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH AIL NON-POINT Issued by: D3 M — ate SOU REGULATIONS. G Re-roofs azure of APPlicanV car Dam ARDOUS MATERIALS DISCLOSURE Type of Roof WO10 app am or future building Occupant nine or handle havatdous mammal as daZd by the Cupertino Municipal Code.Chapter 9.12,and Ne Health and Safety code.[„annzss32(a)7 All roofs shall be inspected prior to any roofing material being installed. Will the applicant or of turebuildingOccupant ueequipment ordcvimswhich If a roof is installed without first obtaining an inspection,I agree to remove 'it he,ardous air contaminates u wrincd by Ne Bay Area Air Quality Management all new materials for inspection. unlet? rrr�� ❑Yes X. 1 have mail c,a Ne hrdous materials requirements under Chapmr6.95 of this,Cxlifor. nim Health&Safety Code,Setimm 25505,25533 and 25534.1 undenund Nat time building Ones not currently have a ornate that it is my mepmsihility,or modillY Mc occupant of Ne or reyulre wh th RbemeI nortoissuanceofaCcrufl OcP71y. -7 Signature of Applicant Date Ow r ora moo agcm h/p,c 1 All roof coverings to be Class"B” or better Ir aCITY OF CUPERTINO CITY Of PERMIT APPLICATION FORM CUPEI�TINO APN # 3S7. l v o� Date: vz Building Address: "'d 2-049v— 5" Mailing Address (if dif rent frbuilding address): [�L.D Owner's Name: JG' Pho�n�e � Contractor: \ License #: Contact: +� Phone: Cupertino Business License1A: F,ax: Building Permit Info: Bldg ❑ ElecK�D Plumb ❑ Mech ❑ Job Description: Residential ❑ i C� (�C0 me Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: •— Type of Construction: Please check this box if the project is a second-story addition: ❑ 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 ,I 1- 7 1 of3 �3 . z7 aam CITY OF CUPERTINO CUPEYOF PERMIT APPLICATION FORM QuantityFee 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 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 BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storni/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 cfm 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/Appazatus ELECTRICAL 2 of 3. ` 11 Sea CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 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 Bld 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 3 of 3