04080078V f
z�
WC
UC
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4
CITY OF CUPERTINO���r
/� x'
PE R1�
C'0NT"CT0R �}O 'g'm v'�N
BUILDING DIVISION
At.
BUILDING ADDRESS:
LENTZ CONSTRUCTION INC, J
PERMIT NO. 04080078
OWNER'S NAME:
PERMIT ISSUE DATE
NE:,
SANITARY N6.-1 CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Scc on qN7 of Division3af Ne Businusangg�,erafessiuns Cnde.and my license is
Li<colao°cissa d` `-\
1 SKYLIGHT/1 SUNTONNEL/4 RECESSED LTS.
lex✓',5.52.8/6
Dare $'/ Cunneen, ! e .Cant C.>ur .n
ARCHITECTS DECD ION
1 understand my plans shall W used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm for 1 am exempt from We Contractors License Law for the
Following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, file, improve, demolish, or epoir any onecmm
prior, its issuance, also requ ms did applies, ru such permiuo Glc a signed amscmcnt
License Law
$q. Ft. Floor Area
Valuation
that he is licensed purauenno the provisions of the Contmelim's (Chapter9
(commencing with Section 7000)of Division 3 of the Business and Professions Code) or
,
that he is exempt Ncmfrom and the basis for has alleged exemption. Any violation of
3M18'4` 1214el00
Occupancy Type
Session 0031.5 by any applicam for a permit subjects We epplicanuo a civil penalty of
-
not more Nan five hundred dollars MOW.
r.
❑ Lu myampleycu withwagusstheifsec. eampematlera
Required IOSpeC[]On5
someoor
theis oat intended muttered a (pee. toad, Business
will ework. and the
work. and
Core
Pr fe rues but
Law docs nm apply lf an owner is
and Professions Code: The ws Orman. and such work himself edNmugh his
em who builds orimprovesch
impo.andwho an, net
awn employees, provided that such imp, offered for sale. If.
own are not car
owner
year of compledon. We owner
aid wits of c m
however, the building or improvement is sold within
/
Otte of
builder will have Nc burden of proving Net he did not build or improve for purpose of
We
Salm.).
a
��/� '
❑Las owner of ct Sec.) , am exclusively contractingfesss with licensed contractors t.
the project (Sec. toad, and Profusions Cade:) The Connectors s Lid
`e
ameLconstruct
of improves turner, and
dies not apply m an owner of property who Milds
owner
wholaw
n
who for such projects with a eonuacmr(s) licensed pursuam m the Comm�ofs
me Laeu
License Law.
❑ 1 am accept under Scc. . B & P C far Nis rcazon
O/
O�
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consenl10 self -issue, for Workcfs Compcm
stood, as provided far by Section 37M of the labor Code, for We performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, az required by Section
37W of We Labor Code, for We pafermance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Poli: /3d 7-JWO
r. Situ ft!VU
.
PI'I
Y' CERTIFICATE OF E%EMON MWORKERS'
COMPENSATION INS RANCE
-
Cfhls seenion need not hecomphoed if the permit is return hundred dollars gHNR
r less.)
1 certify Nat in the performance of the work for which Nis permit is issued, 1 shall not
employ any Person in any mannerso as to become subject o tine Workers' Compensation
Laws of California. Dale
Applicant
NOTICE TO APPLICANT: If, after making this Cenifteme of Exemption, you should
become subject to the Worker's Compensation provisions of the Ichor Code. you must
foM.dir comply with such provisions nr this permit shall M deemed revoked.
CONSTRUCTION LENDING AGENCY
a
lending agency for We performance of
I hereby affirm that there is aed
,
(Se.construction0
We work for which this permit is issued (Sec. J097, Civ. C.)
LendclName
%
Lender's Add. ress
')
agree Nat I have read this and lino is
Nes Ne andvc iws
\
city and coup diva m1
cording l agree rc comply with ill city and county ordinances and stem laws relating
e
mnhon p rfmar.ntativcs or this city m enter upon Nc
building conewctpro and far inspection
findmnifyan
shove -(We) acd
gree to avenly
keep humanness Cupertino against
(We) agree rte save, indemnify and keep harmless the City accrue
0 and,xptnuswhich may in any way aeCme against said City
enceo
thecosts
>' incoiseq
inconsequenceDERST ng of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITHNON-POINT
Issued by: Date
SOUR 'REGULATIONS.
Re -roofs
Type Roof
: -A.�;_ 3 ro uy
Si ore of Applicam/Conramor Date
HAZARDOUS MATERIALS DISCLOSURE
Of _
Will the applicant ur future building occupant atone or handle hasardmus memriil
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Codc,Section 25532(a)7
All roofs shall be inspected to any roofing material being installed.
❑Yes RN.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or rutum building occupant use equipment at devices which
,mit Mamdnus in, conmminanu az defined by she Bay Arca Air Qualily Mznagcomet
all new materials for inspection.
District,
❑Yes $I No
I have mad the hamrdous materials requirements under Chapter 6.95 of the Cali for-
nia Health& Safety Code, Sections M505.25533 and 25534.1 undersmnd that if the huilding
docs not currently have a tenant, Nor it is my responsibility mmy the occupant of the
`aCcmfccrnpancy.
,quite cnuwhiehmas, hemdtpdmrtoismanaarca
Signature of Applicant Dale
't
All roof coverings to be Class "B" or better
Date
Own authorircd agcm Dam
101
Ltio s\%(-NbCWh!1�
. ' C�pesi�t�a. C� gsa►4
SPARK ARRESTER REQU1106
t�pn 3ba. a4, ody
A•6PPROVE
wra ACE MANc WITH THE CITY OB
gfp13fi1No - A 0 1ANCES
SIGNED
This set of play- and s u !fications FUST.
de kept on + , job at/nll times and it s un,
lawful to make any' :hanges on alter flonq y2•
on same without w itten permission from ® 1 CO
the bu-Wing Dept., ((Y of Cupertino. ®®®
The stamping of this plan and specifics long bio 05 U (14444zz
3HALL' NOT be held to permit or, to b ! ar
ippmval of the viola ion of any Prov !lona
,t anv City Ordmanc ! or. )tate Law.
•' .. yE\ x
j
AUG 10 2p04
CITY pF C�cEgimo
krMENT
'l Io 40 Sh(a o�t� h� l l I tR1110i1�i4��Fl np
a. n :•.
.;G
rPCAN Vlaw.
Cbz
ziay tk. SIID of
CyPEiJ I NGS
0
un• tutu cumrrucleuot ma.
W / louts cquiredfor die frame. Skylights may beinstalled in the plane oftherooL
when
the roof slope is 45 degrees or greater froh
/ii/N m orizonral.
i
Jva skYG PROVIM IC60it.
/SND MANUFACTVRERtg. SPECS
LLJ \ PRIOR la FRAME INSP[CTIOH
112r SFIE1- T G
a DPEA1NFT c r.
Ll'% ES
Socllorl 506= gent Termination UNIFORM PLUMDING CODE
(a) Each vent pipe 01 stack shall extend Ihrot-- I— I�hing and
shall terminale verticallYnol less than six (G) Inches (152.4 mm) above
the roof nor less Ihan one (1) 1001 (.� m) )tom any vertical surface.
(b) Each vent shall lerminale not less Ihan ten (10) feet (J m) Irom,
nor
or at least three (3) feel (.9 m) above, any openable window, door,
ePe ning, at Intake orny lot Ineen ha t; alleyless andllhan Ilvee (3) leel (.9 m) In
every dire t n Irom a
Opt'
excepted.
WK V S S 8001= : SEE l=N(T/nlr r✓!2/ vCr
Ay�CK. .r
9oe
UNIFORM MECHANICAL CODE
(d Type L. 1
J Ille roof through wh ch ill passes ig lnor sless lthan 4 feet frol terminate not m any poss than ?ton ofeet f the
Q budding which extends at an angle of more than 45 degrees upward from the
horizontal.
H(q Vent 7innhmis. Veining systems shall terminate not less than 4 feet below
I oro fees I orizontal!y from. nor less than l foot above, any door, window or gravity
air tiller into any building.
CALCUL A-rfc,/VS 7qC: CUT
rr1I37- MONV7r�, /
77?tiSS CYC RL>s
610,4
To assist you in your planning, these charts provide the data useful for specification and installation of your VLLUX
=skylights„and hof wi cows. Each model is shown with the available size measurements and other necessary information.
/ Zc.Ge'12.
. �.TC®pmIuRED
:'ate:; /mpacr units should be specified as Type 0099 69.
Models OVE and QVM
150
ti{4
_.
306
Oxy
f �1�', •: .,'(`;:9"."s'
in.
'23316z23'/x
23156x46'.
30%x30%
®601
606
iadel$ V End VS
101
04
06
08
4
306
308
•'n,r' ie "" " 'In.
21'G x 77,
21'/• z 38'/•
21'h x 468
216.55
301 x 3Bh
30% x 468
30% x 55
412 x 276
d38 x 8
aUrde' hamek r Iw; x hl mm
1548 x 6991.
1548 x 9781
1548 z 11781
1548 x 139BI
1778 x 97BI
1778 x 1178)
1778 x 13981
11138 x 6991
11138 x 11781
11
"`s
`lwxhl
20%x26'/•
_
20..37/•
20A.45N•
20%x537•
29'•x371•
29'.x458.
276•x53%
43%x26'/•
3.40
',shed flame in.
mm
(521 x667)
1521 x945)
1521 x 11451
1521 x 13651
1751 x 945)
p51 x 11451
(751 x 1365)
(1l l I x 667)
111101'•
(1l l I x 11451
membra
,uBM1dWnlhglfdyS}
218x28 -
'21'.x39`
21'.x46'%
816x558
30Sx39
308x46%
30'.x558
'44%x20
44'/•x468
,Iw?x .1171..""
:mm
(548x 711)
1548 x 991)
(548 x 1191)
1548 x 14111
1775 x 9911
1775 x 11911
1775 x 14111
11138 x 7111
11138 x 11911
nigh For in.
21 h x 34'A
218 x 46'A
218 x 548
218 x 63'A
30% x 46'A
30A x54''
30A x 63'/.
44% x 34%
44'A x 54%
Roopening (wx hl
Roof Curb mm
(548 x 877)
15AB x 1172)
1548 x 13831
1548 x 16151
1775 x 11721
1775 x 1383)
1775 x 16151
11138 x
1383)
11138 x
:% Fhl
wgh�dpeolr,8; -;Iwra h�-,in.""218
x"30'/•"' 218x41'',
-1211. x 49%
218x588
30'h x418
30'6x49%
30%x 581E
0A
44%x30''
'4%x491'1
47A
1548.7681
(548'.10511
. (5AB x 1254)
- 15AB x 14771
(775 x 10511
1775 x 12541
p75 z 14171
17138 z 7671
11138 x 1254)
WE0.bof,Eu4sN; ,'r7, .';;, .
reo(glose)1w. h) in.
167x20'8•
16'A.3"
16'A x 39%
16%x48'
,257•x311
258x397•
258x48%
x 20('N1•`_`
_ 40x39''
,:..«,.
V 7' •• ^. 8 • ' 2 4''1 , ..•
'.
3.7 " ."
'4.6
5.6
5.7
7.1r,r ni*R �
(�AOO
'11 L1158rFNY1 11
a ono ;,..,.'sqr-�.
.
p II1�V�a�lll �L
In 1 II.
local VSE Only
'y'i's'R'••r• 1.08 �
3.50'
A.11
4.17
4.24
�L4.771 U
U115.Y3=
173
3.76
eiilllaha R'r!N; ins
I g) Q'.
Jet, weigi,ttwi8, jump. gloxs) lbs.
39
49
56
63
61
70
80
67
94
enlilation area (opening) in. R.
1.08
2.35
2.71
3.14
3.76
4.25
4.84
1.73
5.19
'S1"i;8 ii :__"I'_i_1:i:'i".,'.:
"'•,m v9` •._..
AA °
.' 53
62
62
73
75
67
90
:'ate:; /mpacr units should be specified as Type 0099 69.
Nate: Impact units should be specified as.7jpe 0099 69.
ARCHITECTURAL SPECIFICATIONS
Architectural specifications for VEIUX products are available at www.VELUXUSA.com/specifications.
1: r• I
"'t�3'4� ,'t• _ www.VELUXUSA.com
e ' nu
Models OVE and QVM
150
156
302
306
656
f �1�', •: .,'(`;:9"."s'
in.
'23316z23'/x
23156x46'.
30%x30%
30%x4686
4T 116x46Vi
Out ice frS'me,� 'fwx;hl. '
x 5991
(592- 1178(
(778 x 778)
1778 x 1178)
(1202 x 1178)
mm,
v.Rough
,(592
opening/ in.
221/, x 22'/2
22'/2 x 451/,6
298x x 298'
29$x 456
4611, x 45'/1e
(w x h)
FinisEed homing mm
(572 z 572)
1572 x 1150)
(756 x751)
- (756 x 1150)
(1181 x 1150)
°'I"hla 11 Ilse a'4 �`k:'
�,gI I . I
'18" x16//e
18�/xx398i
29/6x24
2Y/ex398i
4P/xx391/i
_.,la.
Daylight area sq. 8.
2.16
5.11
4.31
7.10
11.73
WntlhBon;orea.lopen,rg)„' "sq(B.
1.30 �
2.17
3.40
4.77
5.70
Nes lht bs.
49
63
40
73
115tvAth -
king. glass)
Nate: Impact units should be specified as.7jpe 0099 69.
ARCHITECTURAL SPECIFICATIONS
Architectural specifications for VEIUX products are available at www.VELUXUSA.com/specifications.
1: r• I
"'t�3'4� ,'t• _ www.VELUXUSA.com
e ' nu
•
38
MODELS VSE AND VS TEST RESULTS
AIR INFILTRATION'
1.57 psf
75 Pa
125 mphl
140 km/hl
0.17 cfm/fe
1 0.86 I/s/m'
WATER RESISTANCE'
2.86 psf
1 140 Pa
133 mphl O 5 US Bol/W/h
153 km/hl O 3.4 1/n; /min
No Entry
No Entr
THERMAL PERFORMANCE
All th b unit wmanc e SHOO, VR Iw VELU% Skylighh
All lNFRC pefili
and Ilsbd in the NFRC Product
aro NFRC cerRl d l ;n i
; .n,.e
Direcby. Iln «cwdance with NFRC q«edoresJ
GLASS
Comfort (75)
CoimfO tPlYs (741
Tempered, L. -F.
LominabdA. E',
Argon
Argm
Uiocbr IR F«Iwl
G.Oill.d
G.011ed
7«1a 1Rfacbrl
0.38 (2.21
0.4012.2)
SHOO
0.28
0.28
V1
0.43
0.42
FADING PROTECTION %
GLAZING
%
TOADING
TAL
POECTIO
Cwe61 P5187%
E
%
C.nW 731
87%
75%
C.d.0 us (741
99.9%
83%
STRUCTURAL PERFORMANCE"
DOWNWARD LOAD WIND UPLIFT
• 1775IPrQ 72961v10
ld, 108.182 Ipso 22-96(psf
lomim.mp
w
Taal b el[w6PC. wish AN.M/RWIMI6W7V2) ..vulurvuxl
SFFCBCAF FOP SKKK TS. Sire 606.41.eed d a 15-md pth.
.• M. V51..1d In .dam. w,lh KAOFedwlion Sn-.s, Inc.
A¢.p1wk. Cn6.m b 5bpd G6mg b Sdw ,, A.ea Core od
fl.Fo6rkm.d SEWghM1. S.. Noemol Emluanm Smk. R11610
NEM 216 ed KB S M.p.n FM4075, Akr14 VSE ie MORA 11.AmvR
e JWl Sw Hdlmwh R.pw1 Na 426.
MODELS OVE AND OVM TEST RESULTS
Please call customer service at
1.800-838-3589 for more
information.
I
1
MODEL FS TEST RESULTS
AIR INFILTRATION'
1.57 psf
75 Pa
125 mph)
(40 km/hl
0.05 cfm/h'
1 0.25 I/s/m'
WATER RESISTANCE'
= 6.0 psf 140 Pa
U 3j /,
E
THERMAL PERFORMANCE
1C0m0.b Uml wl«s.l
All Iharmal pmlwmance SHGC, VI whim for VELUR Skylights
are NFRC c.,Jilied. libeled and 6W in the NFRC Pm&cl
DirK wy. (In «nwdance wilh NFRC pr«edurm)
GLASS
Comfort 1751.
CoMfortPIUS (741
Tempered, Low E',
Wrninaled,!...V,
Argon
Argue
Godill.d
s-lilted
G.,
Uiocbr IR F«Iwl
0.37 12.11
0.3912.21
SHGC
0.31
0.30
VI
0.48
0.47
FADING PROTECTION %
GLAZING
CLASSICAL
PROTECTION
PROTECTION %
Cwe61 P5187%
75%
995
STRUCTURALI
PERF,QRMANCE'; I IU )I
DOWNWARD LOAD WIND UPLIFT
NW
Iomimbd. (pry 22961N0
HwiSk Ihemd 12 75
LemiroNd, 108182 (PA 2296;,1
bmpered
inW in wcm&me wish AAMA/ A I MAV=, YOIIM4rAPY
5HCACARION f0P SKYLIGHTS 5tr.606 ann bsbd m o IS'rd pmh.
•• Used in xmdame wA KBOf.aMrion Sn.esr, w Anepsmre
Cn.. b 56,d Gfi, In S ni-nr, %,n Cawr and Prebbdmbd
SIYFyhI 5 Nmmncl E.ohrlwn 5mi. R.b
pwr No NEI 716 e
K60 ES R. ER6075. Abdel i5b WOMA..E..d arrJmd See
NanmaA R.ro, Na Ate.
MODEL OFS TEST RESULTS
Please call customer service at
1.800.838-3589 for more
information.
IRED
it
stailation Tips
oosing The Right Size
he glass area of your roof window or skylight should
at least 10 - 15% of your room's floor space. If you are
olling a'roof window at eye -level in a low -pitch roof,
lose a,taller window since the roof's low angle will
luce,your field of vision. (See chart at bottom of this
hei, widifcotion
Ne offer o selection of VELUX Roof Windows and
✓lights that easily install between trusses. And, for rafters
16" on center,
all it takes is a
bit of rafter
El' 11 [:1 modification
as shown at
left.
iisM411echniques
f you build the soffit lining horizontally at the top of your
idow,Qandithe"sill
ng;verticolly, you'll
r.
mitimoreIlghtand
tributetitlmore
snly throughout the
nn:.You'lhalso
arove'the view and
ve:aicleaner finish.
.,n .
Mhaeldn=d46
w
d ERAbchwn NMh Mwko. Irc.
oper, Roof Window Height
Nhen:Installing roof windows it is important to insure
t the proper sill height is achieved so that there is a
clear and uninterrupt-
ed view while sifting or
standing. The chart at
right should help you
in selecting the proper
window height for
your particular installa.
Linn
NFRC Certification%
To help make the selection of energy efficient products
easier, VELUX-AMERICA INC. is participating in the ener-
gy ratings certification program imple-
me
nted by the National Fenestration
Rating Council (NFRC). The NFRC was
creating an energy rating, cernncanon M11ALMLLU"
and labeling program for fenestration
products such as windows, doors on
As one of Ih�11 r m the
pr' L C. hopes to move the Indus
try orward in providi!consumers and building profes-
sionals with accurate, standardized energy values with
which informed buying decisions can be made. NFRC cer-
tification labels are now being placed on all VELUX Roof
Windows and Skylights stating the certified U -Value.
Code Compliance
VELUX Roof Windows and Skylightssfrneet'tfie general
requirements of clly�l fmlodelhBWYCF&BO
ic I I I> i Eluting the
Standard Buil ing`Code One And Two Family
Dwelling Code, Uniform Building Code (UBC), International
Conference of Building Officials (ICBO), and Building
Officials and Code Administrators (BOCA).,(See NES
Evaluation Report NER-216.) In addition, all VELUX electrical
components are UVCSA approved.
VOCA
ES_ �� • GO*
Reef window InsteRerlee measurement for dBfww0 reel pechee--�"
Sin No. 104& 304
106 6 606
308 d 808•
410,'
A. Wind height
lin Inc�il 38111
463A
55
627h '
B. Insiallaeon height;
Ile inches) 174 76 78 80
174 76 78 80
174 76 78 80
1 74 76 78.80"
C. Mel h1 for clepr view
m Ignches - hom lop d bottom
it b Boor)
30'
60 62 64 66
56 58 60 62
52 54 56 58
48 50 52 51"1
35'
58 59 62 64
53 55 57 59
48 50 52 54
44 46 48 47 1 a
d0°
55 57 59 61
50 52 54 56
44 46 48 50
39 41 43 45•
ci 450
52 54 56 58
47 49 51 53
41 43 45 47
35 37 39 41
50'
50 52 54 56
44 46 48 50
37 39 41 43
31 33 35 37
•
Skylight Framing Detail
Roof Framing Around Openings
• Headers with a span exceeding 4' must be framed with trimmers and
header rafters that are doubled or of lumber of equivalent cross-section.
• The ends of header rafters more than 6' in length shall be supported by
framing anchors or rafter hangers unless the rafters bear on a beam,
partition or wall.
s,
Load-bearing wall or beam ---
MQUIRED
Double headers -
0 when span exceeds
4feet
Tall rafters
Length
Width
Double trimmer rafters -
when header span
exceeds 4 feet
Rafter
Wall or foundation
t
CUPERTINO
(Wco
*CITY OF CUPERTIN(V
PERMIT APPLICATION FORM 0
APN #
Fee Description
Fee Group
Date:
�3GQL a' -i -
0 z1
BBOILERI
I Vto- 04
Building Address:
BBOILER2
Mailing Address (if different from building address):
b O- S
BBOILER3
�•
Owner's Name:
..BBOILER4
Boiler> 1M to 1.75 M Btu
Phone #:
BBOILER5
Boiler > 1.75M Btu
MECHANICAL
"yoContractor:
Construction Tax
BUILDING
BCONSTAX
License #:
_
BCONSTAXBQ
Con. Tax for BQ Zone
—
Contact:
Phone:
yC4- d L ly-OS S
Cupertino Business License#:
3- —
Fax:
- � - "7
l
Building Permit Info.
BELEC1001
Elec 600V > IOOOA
,Bldg ® Elect E0
BELEC200
Plumb ❑ Mech ❑
Job Description: C.
W �a+ Sit.
Residential t
Energy
L�SCommercial ❑
Sq.Ft. Floor Area:
Energy Add Multi
BUILDING
$/Sq.Ft.: 1
Cost of Project:
BUILDING
Occupancy Group: r
SBoo —
Type of Construction:
Please check thisIect is a
second -story addition: El
ro'ect Size: Standard ❑
Large ❑
Major ❑
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBOILERI
Boiler <=100,000 Btu
MECHANICAL
BBOILER2
Boiler > 1 OOK 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 > IOOOA
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
26E
1 of
CUPERTINO
(W10
*CITY OF CUPERTINO
PERMIT APPLICATION FORM
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
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 .
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 cfrn
MECHANICAL
BREMAEU-IAN
A/C Units <=10,000 cfm
MECHANICAL
BREMAPPLI
Appliance Install
MECHANICAL
BREMBUSWAY
Remodel Busways
ELECTRICAL
BREMFIXT
Lighting Fixtures
ELECTRICAL
BREMFURN
Relocation ofFumace
MECHANICAL
BREMFURNOV
Relo Fumace > I OK btu
MECHANICAL
BREMHEAT
Heater Installation
MECHANICAL
BREMINHOOD
Installation of Hood
MECHANICAL
BREMMISC
Misc Apparatus
ELECTRICAL
BREVE RAP
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 Appliance
I ELECTRICAL
2 of 3
t ~.
CITY of
CUPERTINO
WITY OF CUPERTINO*
PERMIT APPLICATION FORM
Quantity Fee ID
Fee Description
Fee Grou
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
ZADDCHG
Address Chane
BUILDING
3 of 3
1.
•
CITY OF CUPERTINO
tfv �s '�5yyyy h�.����g R fi
s�T
' C0'NTkACT R -,IN 0I(MA��A\ ^'
BUILDING DIVISION PERMIT
- ..:
BUILDING ADDRESS:
;40 SHAIDOWT-1111 IN
LENTZ CONSTRUCTION INC, J
PERMIT N0.04080078
ER'S NAME:
PERMITLSSUEDATE
ONE:
SANITARY 1,1 0 ROLNO.
ARCHITEC (ENGINEER:
BUILDING PERMIT'INFD
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED COMBACnder p DECLARATION
1 Mmby affirm that 1 am tic TRA under provisions of Chapter 9 (commencing
Job Desc
mfull a on 3ofthc Bulinesan��,perrofmaions C.Q.add my license is
�' D
nJe)offoivision
License �W.7dM Lm. «'�I Ss68/6 a
1 SKYLIGHT/1 SUNTONNEL/4 R s
Dale Contractor r Anot2 Ca>ir rn
-�
�2$'y
1=7 ARCHITECTS DEC1 S IOr N
1 undersand my plans shall be used as public records
2004
Licensed Professional
RATIO
OWNER -BUILDER DECLARATION
R
I hereby vlfirm Not 1 exempt from me Contractor's License Law for the
BUILDING,,,, ®'
following mason. (Section 7031.5, Business and Professions Code: Any City Or County
U
which requires a permit to contract, alder, improve, demolish, or repair any smucmm
prior to its issuance. also mquiros the .pi lieaut for.uah permit m file a signed staamerd
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the Convector's License Law (Chapter 9
(commencing with Section 70110) of Division 3 of the Business and Professions Cute) or
that he is exempt Uniform. and the basis for Ne alleged exemption. Any violation of
3MiF1Oabeir00
Occupancy Type
Section 7031.5 by any applicant for a permit subjects me applicant to a civil penalty of
not mart than five hundred doll.. ($500).
,
0 1, as owner of the property, or my crophy ms with wages a their sole compensation,
Required Inspections
will do the work. and she swctum is not intended or offered Tarsale (Sec. 7044. Business
and Pmfessions Code: The Centimeter's Lborue Law does not apply to an owner of
property who builds urimpowas thereon, and who does such work himself or through his
own employees, provided Nm such improvements are not intended orolr,.d for ale. IL
however. fie building or improvement is said within one year of completion, the owner.
.
builder will have the burden of proving that he did not build or improve for purpose of
ale.).
❑ I, as owner of the prnpeny, am exclusively contracting with licenwd contractors to
construct Ne project (Sec. 9044. Business and Profusions Co kt) The Cont"etor's Li.
cense law does not apply to an owner of property who Wilda or improves Ihemon, and
who contracts for such projects with a mouractor(s) licensed puravant to We Contractor's
Lice se Law.
❑ lamevemptundersee. ,B&PCfmthismaon
or Date
,
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of Ne following decimations:
-
haveand willmaintain aCertificateofConsentmselfinsumfor WorkersCom n-
n, a provided for by Section 39W of the labor Code, (or the performance of the
let.
for which this permit is issued.
have and will maintain Workers Compensation Insu.nee, u required by Section
of the labor Code, for the performance of Ne work for which this permit is Issued.
Worker's Compensation lameence carrier and Policy number am:
V-4lie FunJ . Polic^ a.: 1YU/je?7' 1004
CERTIFICATE OF E%EMPfION MWORKERS'
COMPENSATION INS RANCE
(This section need not be completed if the permit is foranc hundred dollars ($1a))
arc laa.)
I certify that in the performance of the work for which this Permit is issued. I shall not
employ any Person in any mortician it; to became subject t0 the Workers COmpensallon
laws of California. Dam
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exmmption, you Should
became subject to that Worker's Compensation provisions of the labor Core, you mat
forthwith comply with such provisions or this permit shall be demand revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that than, is a construction lending agency for the perfunnunce of
the ..,it far which this permit is issued (Sec. 3091, Civ. C.)
Lender's Name
Lender's Address
I certify that 1 have read Nis application and nem that the shave informniun is
correct. I agree to comply with all city and county ordinances and sum laws relating to
building convection, and hereby authorize representatives of this city to enter upon the
alMVe-mmmleMd property for Inspection purpoYS
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liobithies,judgments, costs and expenus which may in any way memo against aid City
! _
I. consequm e. of to gaming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH A L NONPOINT;
I/
Issued byDate
SOUR REGULATIONS.
Reproofs
'
Type ROOF
fi'iu'uV
Si are of ApplicaDam
HAZARDOUS
HAZARDOUS MATERIALS DISCLOSURE
Of
WIII the applicant or forum building O. atom or handle transition; l
lthnd Safer
a defined by the Cupertino Municipal Code, Chapter 9.12. and me Health and Safety
Chaps
Settle. 25532(.)
All roofs shall be inspected nor to an roofing material bei. Installed.
P Y g g
0y., RN.
If
If a roof is installed without firs[ obtaining an inspection, I agree [o remove
Will the applicant or future building Occupant use equipment or devices which
mit haardnus air contaminants a defined by the Bay Area Air Quality Management
all new materials for inspection.
DistricR
❑Yes so No
I have read me hand ouamationds requirements under Chapter 6.95oftheCalifor-
aixHealth&Safety Code, Sodom 23W5,25533 and 25534.I on mr; dthrihim Wilding
`
does nor cu.cntly have a mn.nn, than h is my respomihility toO ul'y the meopent of the
roprom anis which most he mel prim m issuance of. Cam feer Occupancy.Signature
Of Applicant Date
7/
All roof coverings to be Class "B" or better
Own raathmiztcd agcnd Dam