03010106 CITY OF CUPERTINO
BUILDING DIVISION PERMI -aCON;l'RACTOR INFORM�dT "
BUILDING eoDRFss: TIMBERLINE BUILDERS INC - PERMITNO,
11209 STAUFFER LN 03010106
OWNER'S NAME: 22850 ASPEN DR. APPLICATION SUB DATE
IGNACIO TEVIS AND CONNIE M 01/21/2003
HONE: (650) 868-5291 SANITARY NO. CONTROL NO.
di
RCHITECrIENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
�oo Lm than IDCONTsed-rd,moviuL.ARAT ON
hap Job Description
a hereby affirm Nu I em f the Business
under and
Podoss of Chapter 9(commencing
with Section 1IX of ecDivision 7 of tint Dusinem entl Profeuions Catic,end my license is
m(eueClass effect.
WATER DAMAGE REPAIR
F,gj DanmGlw CLie..,un FINALE®
Dam C"S DECLARATION
qqq ARCHITECTS DECLARATION
oU l umentand my plena ahan W urea a pmmm rctnrw JUL 1 6 2003
u�3 a Licensed Profwmnel
CLL 0 3 Oat I am exempt DECLARATION ComTION
F 1 hereby.(Sent that 1 em exempt from tint Cssions o License law for the BUILDING
y 5:00 following moon.(Section 1 t l3,Businw and in.cam li Code:Any tiny or county
s�$E pooch requires a permit re cores the alms improsu deermit t file
repair any structure
Foy hather to slts censed prHo requires proappns,ofant for such Permit lofense Lacdstammcm
€o (commescingwitpSectio 7000)to the orDiviomofthe theBusiness ndProflaw(Chapter 9one)or Sq. Ft. Floor Area 3`0�0(8[ion
$ (cat he
(commencingwithremfrornadth Division?oft he Business endon.An nom Code)or
— Net io Is 31.5 b therefrom and the buns for the Waged exemption.to Any violation of
Section than wsoyapplicantfor•pemthmbjectsNeapplicantmecivilpentlnyo! e Occupancy Type
net more then five hundred dollen(g500).
❑I,ex owner of the property,or my employees with wages u their este rompcnmion,
will do But,work,and the strocwm is not intended or offered for We(Sec.1116.Business —
and Perfm iota Code:The Committees License Law des not apply m an owner of 102 - PIERS
equlred Inspections
property who Wilds orimprows,thereon,end who doessuch work himselfor through his
own employes.provided wt each improvements are nonimendel proffered for W&If. 103 — UFER
however,the Wilding or improvement is sold within one year of completion,the owner-
Wnder,will have the human of proving that the dm not Wild or improve for purpose of 104 — REBAR
ml`')' 105 - ANCHOR BOLTS
Lot wner the
the propenyam exclusively and contracting CmR:j Thux Cmonttuar's i. 106 - SEWER & WATER
0 ower Ne protect(get.1046,Business end Pro(essiou Code:)The Conmacmri Li-
cense law does not apply to an owner or property who Wilds or improves thereon,ad' 202 - UNDERFLOOR PLUMBING'
who contracts taa
r a°th pmjettspithnntraztmanmenmd pursuant to mm
the Contractor's
License Law. 203 - UNDERFLOOR MECHANICAL
❑ Iamt mpt under Sec. ,B&PC for Nis recon
qqyP��(�j ��7 � 204 - UNDERFLOOR FRAME
:aGr woRKeas NDEC {.namN ) Z5 O 205 - UNDERFLOOR INSULATION
ll Ihereby afmmnunder Penalty ofperjury amofthe following dxluaeom: 301 — ROUGH PLUMBING
(have end will maintain•Cem ficateof Consenttoself-imum for Workers Compen. 302 — TUB & OR SHOWER
tion,as provided for by Section 7100 of the Labor Cade,for the performance of the 303 - ROUGH MECHANICAL
ri,for which this permit is issued. 304 - ROUGH ELECTRICAL
C)1 have and will maintain Worker's Compensation Irmance,u required by Section 305 - FRAME
?RID of the labor Code,for the performance of the work for which this permit is issued.
My workers Compensation Insurance artier and Policy number aro: 306 — HOLDOWNS
c'mi"` Policy He.: 307 - INSULATION
CERTIFICATE OF FXEMPPION FROM WORKERS'
COM PENSATION INSURANCE 308 - SHEETROCK -
rrbissecdanneed not hecompleted Rdollars H;the 309 - EXTERIOR LATH
I carte.)certify Net in the per sore of he wort tar Which this .it is issued,1 shall 310 - INTERIOR LATH not 311 - SCRATCH COAT
$Applicant
vaimeny pc mannfM1wsst1f afro subject to the Workers'Cnmpenution
ws — d m - 313 - ROOF NAIL
RA r
ICE TO APPL .IL afro mak cors emRcaw of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
Anne soojmplywit Worhpro ismsordionprovitshallons edthe
medrv.ke,you must 502 - FINAL PLUMBING ENERGY
Oz Sunmttothe such provisions Conmmthis ppreisioallWde Labr Coded.,
z O - CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
F -� I thereby affirm than men is a construction lending agency,for the performance of 504 - FINAL BUILDING ENERGY
C >
the work far which this Permit isissued(Scc.709].Civ.C.)
Landers Name 505 - FINAL ELECTRICAL
W O
z
Lands,',Add. 506 - GAS TEST
Up IcertifythatIhawmadnisapplicationandsoteNattheaboveinformatiunis 507 - FINAL PLUMBING
W F' coned.l agree to comply with all city and county ordinances and stall laws relating no
OU buildingconswetion.andherebyauth-lbeolresentativiceofthiscitytoenterupontht FINAL MECHANICAL
W ahow-mennionedproperty for inspection purposes.
O9 FIN
y (We)agree to ave,indemnify and keep harmless the City of Cupertino against
ti Co) liabilities,judgments,costs and expenses which may in any way accrue against mid City 5 Gi //
U 7 in coraco mace of the granting of this permit / t
•7 APPLICANT UNDERSTANDS AND W L COMPLY WITH ALL NO DINT Issued by:51 WORKS Date
SOUR C G�ULATIONS.
d 10
� Re-roofs
W.W.of AppImant/Commct Data
HAZARD0 SMATERIALSDISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle hawdous material
as derived by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
Code. 0Yen15572(x)? �° All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
Will
hamrdnus air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
let?
❑Yes ANu
I have mad the haurdnus mamriair requirements under Chapter 6 95 of Be,center-
ant Health&Safety Code,Secuom]5505,25577 and 25574.1 understand that if the Wilding
does not currently have a u nem,Be,it is my mobility m no' the meupu,of the
require which must ix Ipdonoissumao Ccrdfkmc I w cy. Signature of Applicant Date
y 5
Ow rauthorvcdagent D In All roof coverings to be Class "B" or better
GIs- CITY OF CUPERTINO
cirvO 3
CUPEkTINO PERMIT APPLICATION FORM
APN# Dat
il '03
Building A ss:
1120 a SFaLk4� I AhL
Owner's Whe: Phone #:
Yll - ylGtGtD 406 ZSz--sgZo
Contraclg -pp � J_ ! License#:
Tm
1 �hv� TJI�i� S (oSS
Contact: Phone#:
&50
Applicant/Contractor: Fax#:
uil i Permit Info:
Bld Elect Plumb Mech
o escription:
Residential: W4+f- a `r-- Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
2� 6
Type of Construction: Occupancy Grbup
uanti Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind—/Off/Comm/Quasi BUILDING
BCONSTAXB 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
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
I of3 .
-21 ? . %7
7,
CITY OF CUPERTINO
CITY OF
CUPEI�TINO PERMIT APPLICATION FORM
•
Quantity Fee ID Fee Descriptio-n- Fee Group
BNUMULTI New Multi-family Res PLUMBING
BOVERTIME Ins ection Overtime BUILDING I
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 rinkler/Backflo PLUMBING
BPSTORM Stomi/Rain Water PLUMBING I
BPTRAP Kitchen TLa2 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 clip MECHANICAL
1BREMPOLE
REMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
REMAPPLI Appliance Install MECHANICAL
REMBUSWAY Remodel Busways ELECTRICAL
REMFIXT Lighting Fixtures ELECTRICAL
REMFURN Relocation of Furnace MECHANICAL
REMFURNOV Relo Furnace> l OK btu MECHANICAL
REMHEAT Heater Installation MECHANICAL 1
REMINHOOD Installation of Hood MECHANICAL
REMMISC Misc Apparatus ELECTRICAL
REMNRAPP Rem Non-Res Appliance ELECTRICAL
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 ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
2 of 3
H-1E
all
CITY OF CUPERTINO
CHY OF
•
CUPEROTINO PERMIT APPLICATION FORM
Qu antity Fee ID Fee Description Fee Group
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD _Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSF&2FAM -Single &2 Family BUILDING
BSFNA Single Family New Add 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 Electricals foot ELECTRICAL
EPERMITF—EE -Flee Permit issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
• PPLBG Plumbing Fees foot PLUMBING
ZADDCHG Address Change BUILDING
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler>500K to IM Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 --Boiler> 1.75 M Btu MECHANICAL
3 of
i
t s
o_
IN ACCORDANCE WIT 1 vrx,1TY o6 %J ri�P
CUPERTINO C i A DRI NANO
DATE_ J o
Sl EU_ -- - .
I This sat a pans and Spell)r ns MUSL
bo kt pt , the job at all t��ar artd itis urt+
JAvjJ l to rna'e any chang:ur alterationS
i '
on SIIa1e Vlith'-nt wdttEn �n. 1�SSIOn ffOn1 ,.
the bu d,n3 LOP t-, City of Cupertino.
T;,a s:amP r ;f this pian and specificatfon9
S,41 No.1 to he to Permit br to be art
�. • � ,; a s cf Y e victation of ani, Provisiof o
:r -,v G:Y'r+C°.d.nance or Statel Law.
i � t
kP
SUgMITTAL
' S
3 �[
U d — 3 S Y
V 2 kP l
L1L' AN 2
1 2003
BY IS 0.
/ `cl oL
• it � �__cc-_� � � �
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORIINFORMATION l;
BUILDING ADDRESS: TIMBERLINE BUILDERS INC PERMIT NO.
11209 STAUFFER LN 030 0106
OWNER'S NAME: 22850 ASPEN DR. APPLICATION SUB DATE
IGNACIO TEVIS AND CONNIE M 01/21/2003
"E (650) 868-5291 SANITARY NO. CONTROL NO.
ARCHITF.CDENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
0 0 0 0
00 LICENSED CONTRACTOR'S DECLARA3'ION Job Description
+�a F 1 Mrchy aRnn that I am licensed under provisions of Chapter 9(commencing P
with Section]IMApof Division 3 of die Business and Professions Calc,and my license is
.1w. in mu force and effect WATER DAMAGE REPAIR
_q: I.bemr.class Lie.# pa�
Date—Consism �a� �,p(`��
FyogZ.q ARC...TECT$DECLARATION — ^��®
ag 06 U I understand my plans shall be used as public rccools
to Licensed Professional JUL 1 6 2003
OWNER-BUILDER DECLARATION -
5 wad<I I hereby afli,m that I am exempt form the Contractor's License Law for the
i 6 00 following micron.(Section 7031.5,Business and Professions Code:Any city or county
a §F� which acquires a permit to aonslrucl,alter.improve,demolish,or repair any structure BUII
poior to its issuance,also requires the applicant Tor such Permit o file a signed statement
�Z< that he is licensed pursuant to the previsions Of the ConTracmr's license Law(Chapter 9 Sq. Ft. Floor Area $3 1i,n
at (commencing with Section 7(M0)or Division 3 of the Business and Professions Cole)or
Ed that he is exempt therefrom and Ne basis for the alleged exemption.Any violation Of
Section 7131.5 by any applicant for a permit subjects the applicant to a civil penally of
not more than five hundred dollars(5500). 3 bfg(1`4�bela 0 Occupancy Type
❑ L as owner of the propeny,many employees with wages as their jolt compensation.
will do the work.and Ne euucture is not intended or offered for sale(Sec.1044,Business
and Pmfessiam Code:The Conluactor's License Law does not apply to an owrmr of equtre
10 2 - PIERS d Inspections
proper who builds or improves thereon,and who dies such work himself or Through his
ownemployces,provided mourner improvemersear,notintended rroffcredforaalc.If. 103 — UFER
however.Ne building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that be did or Wild m,improve fur pm m.of 10 4 - REBAR
calx' 105 - ANCHOR BOLTS
I,as owner of the property.am exclusively contracting with licensed contractors to
'X106 — SEWER & WATER
o struct the project(Sec.]NW ,Business and Professions Code)The COluracam's Li
cense Law does not apply to an owner of property who huilds or improves thereon.and 202 - UNDERFLOOR PLUMBING
who contracts lbrsuch projects with a conbactorod licensed pursuant to the Commcitre'
License Law. 203 — UNDERFLOOR MECHANICAL
❑ lam(e`}'QmpIunderSec. ,B&PC I'mMisreason 204 - UNDERFLOOR FRAME
WORKER'S PENSATIONDEC aT10N t Za 205 - UNDERFLOOR INSULATION
thereby affirm under penally of perjury nnc oflhe follrwingdchratimme 301 — ROUGH PLUMBING
❑I have and will maintain sCenificae of Consenuoself-insuac for WorkchCompew 302 — TUB & OR SHOWER
sation,M provided for by Section 37W of the Labor Code,for the performance of Ne 3 03 - ROUGH MECHANICAL
work for which this permit is issued. 304 - ROUGH ELECTRICAL
1 have and will maintain Worker's Compensation Insurance,as required by Section 305 — FRAME
3700 of Ne Labor Code,for Ne performance of the work for which this permit Is issued.
My Worker's Compensation lnsumnce collier and Policy number art: 306 — HOLDOWNS
Cartier: Policy No: 307 - INSULATION
CERTIFICATE OF hEMPTION FROM COMPENSATION INSURANCE
308 — SHEETROCK
(Theaccoon need not bcclmpleesdifthe permit isfonmc hundred dallats(511MB 309 - EXTERIOR LATH
nrless.) 310 - INTERIOR LATH
I certify Nel in be per ante of the work!m which Nis peanut x issued.1 shall not 311 - SCRATCH COAT
employ an pe
mannF lu.5 t� v�r suhjen to NC Workex Compensation
laws orcafrrm plc Os 313 - ROOF NAIL
ApplIo'sCE 1,
ICE TO APPLICAM:11,ane mak cols enmcareof Exempmrn,yrr anrmd 501 - FINAL ELECTRICAL ENERGY
me jubject to rbc Wnrkch Compensation provisieast l'Ihc labn Code,you must 502 - FINAL PLUMBING ENERGY
OO forthwith comply with such pro visions or Nis permit a hall be deemed revoked.
z CONSTRUCf1ONLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirm that thereiso conswction lending agency Bothe perfvrmrme..1 504 - FINAL BUILDING ENERGY
fX > the work for which this permit is issued(Sec.3(y11,Civ.CJ 505 - FINAL ELECTRICAL
{al Q Lender's Namc
az Lenders Address 506 - GAS TEST
J 0 1 certify Nat I have read this application and slow that the above information is 507 - FINAL PLUMBING
I,L t, comet 1 agree to comply with all city and county ordinances and state laws relating tit
O V building construction,and hereby authentic represenmivesorMiscity inemerugmthc FINAL MECHANICAL
W above-mentioned property,for inspection purposes. O9 FIN
a (We)agree To save,indemnilj and keep harmless the City of Cuperlinn against
60 R
(n liabilities,judgments,costs and expenses which may in any way accrue against said City 5 G / s
V Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND W L COMPLY WITH ALL NO OINT Issued by 51 WORKS Date
SOURCER&CULATIONS.
a l9'w %[ '103 Re-roofs
Nature r(Applicum/Conbacv Date Type Of ROOF
HAZARDO SMATERIALSDISCLOSURIi
Will the applicant or fmure building occupam some or handl,homicides material
az defined by the Cupertino Municipal Code,Chapter 9.11.and IM Health and Sarety
I, CrWc.Scetinn255R(a)7 All roofs shall be inspected prior to an roofing material being❑liesNr P P Y g g installed.
Will the applicant or fumrc building axupam use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
tout harallous air contaminants as defined by rhe Bay Area Air Quality Management all new materials for inspection.
D'suieO
❑Yes �6No
1 have read Ne heoaNrus mmerialm,m ements under Chapit ofthe Califon
its Ilcallh&Satiny Gale,Smthar,25515,25533 and 25534.1 understand that lithe building
does am cumnlly have a bound,than it is mLmigomilholity to mLk4 M oxcupam of Me
require which must he IIF or tried nceo Ccudfcam of_ ,r. Signature of Applicant Date
Gw r muldo z,d agent o 25 All roof coverings to be Class "B" or better