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03050070CITY OF CUPERTINO A =" CoTllii CTOR INFO;RMII,TION BUILDING DIVISION PERMIT , BUILDING AJDRESS: r VANNI BROTHERS CONSTRUCTIO ERMITN0.03050070 OWNER'S NAME: 914 HYDE AVE PERMIT ISSUE DAM PHONE: (408)253-7028 SANITARY NO. CONTROL NO. HITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB 0 0 0 MECH 0 LICENSED CONTRACTOR'S DECLARATION I herchy affirm that 1 em licensed under provisions ofChapterCoder 9 (commencing Job Des t with $Cor,.n Business and Professions Cotler and mylicense isI. fall an affect. cffeo Lic.It Licarom Class ADD 437 SQ.FT./REMODEL !�y Dam ContractorAPR ARCHITECTS DECLARATION 2 2004 I understand my plans shall he used a public records B'YICL)ING Licensed Professional OatNER BUILDER DECLARATION �/ 1 herchy. License Law for the that I am exempt tram he Colons followingacus.. Sect 7031.5, Business and o emoli Code: Any city or county improve, which reyuiru a porton to cnntlrvcL elle. improve, any swcmre Permit h permit t fie a sig prior a, its issuance, also pursuantIn the the applicant for such permit m Glc a signed statement he previsions of the wit pSectio License Lew (ChapterCode) Sq. Ft. Floor Area Va uauon (that (commencing with Section 7(and of Division 3 of the Guineas and Professions GMs) or commencing 7") the but he is Net he is exempt therefrom end the basis for he alleged exemption. Any violation of Section 7031.5 by any Applicant for aPermit subjects due applicant toacivil Penalty of APN Number Occupancy P 1YPe not more Nen five hundred dollars (55110). Y ❑ I, as owner ofthe prepeny, or my employees with wages as their sale compensation, will do the work, and the structure is not intended or offered forsalc(Sec. 7044, Business 101 - FOUND� d Inspections and Professions Codc: The Contractor's License law does not apply to an owner of property who builds or improves thereon, and who doasuch work himselfor through his 102 — PIERS own employees, provided that such improvements are not intended or offered foredo. If. 103 UFER however, the building or improvement I. sold within one year areompletion. the owner - builder will have the burden of proving that he did not build or improve for purpose of 104 — REBAR ale.). 105 — ANCHOR BOLTS . owner properly, exclusively contessions with licensedonnmaors to ru construct raj ct . Business notapply.oanOwneandrtywh WidsorOThoesthemor'aLi 106 — SEWER & WATER does wholawdeernotapplytoanownerofpmpcnywhobuildsoranttothedtereon,and who contracts for such projects with a can,anor(q licensed pursuant m the Comncmr's 202 — UNDERFLOOR PLUMBING License Law. ❑lam exam o. , der SecB&PCfsr this moon 203 — UNDERFLOOR MECHANICAL �( 204 — UNDERFLOOR FRAME Owner AAI f'SCOMPENSATION LARAT� 205 — UNDERFLOOR INSULATION I hereby affirm ocular Penalty of perjury one of $a fallowing declarations: 301 — ROUGH PLUMBING have and will maintain a Cardigan of Consent self -insure for worker's Camino. 302 — TUB & OR SHOWER as provided for by Section 3700 of the Labor Code. for the performance of the 303 - ROUGH MECHANICAL for which this permit is issued. ❑ I have and will maintain Workers Compensation Insurance, as retained by Section 304 — ROUGH ELECTRICAL 3700 of the Labor Code, for the performance of the work forwhich Ibis permit is Issued. 305 - FRAME My Workers Compensation Insurance carrier and Policy number am: 306 -, HOEDOWNS Policy No.: Cosier. CERTIFICATE OF EXEMPTION FROM WORKERS' 307 - INSULATION COMPENSATION INSURANCE 308 — SHEETROCK scainn need not be completed If the permit is for one hundred dollars IS 110) 309 — EXTERIOR LATH or lless)(This ' I acetify that in the performance of the work for which this permit is imu.d.I shalt not 310 - INTERIOR LATH employ any person in any manncrsn in to become subject to the Worko'Cnmpensation 311 — SCRATCH COAT Lim of Calirornfin Data Applicant 313 — 501 — ROOF NAIL FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: If. flat making this Ccnifiasm of Exemption, you should become subject to the Worker's Com genualprovisions of the Labor Code, you muss fonhwitoComply with such prnismasorthis permit shall hedeemed revoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY I herchy affirm that here is a consmeinn lending agency for the performance of the work for which Nis permit is issued (Sec. 3(197, Co, C.) Lenders Name 504 - 505 — 506 — FINAL BUILDING ENERGY FINAL ELECTRICAL GAS TEST Lenders Address I cenify bat) have read this application and ata, that the above informatiun is cancel. I agree to comply with all city and county ordinances and state laws mlating t. 507 — FINAL PLUMBING building construction, and hereby auhorim representatives of his city to enter upon the FINONG ICAL above-mentioned property forinspeelion purposes. (We) agree to leve, indemnify and keep harralss the City of Cupertino against O 9 F I liabilities, judgments, costs and expenses which may in any way accrue against said City in 5 conscqucncc of @c groming of this Pcrmil.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: 5 WORKS Date EREGU1'ONS,/� Re -roofs Type of Roof ��.s / b r 7 �SOU � /� �or gnamrc of ApphceHAZ racmr Data HAZARDOUS MATERIALS DIS SURE Will the applicant or future building Occupant,Chparose or hazardous materiel i. f u d, Sec by the nn Municipal Coda Chapter 9.12, utl the Health and Safely and the 32(.)? Codc, Section 25532(e)? ❑Yea Nu All roofs shall be inspected prior to any roofing material being installed. Will the applicant s future building occupant useegmpmcm ordemas which If a roof is installed without first obtaining an inspection, I agree to remove iI hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for Inspection. ell l ❑YesNo -. - I have rand the havardous materials requirements under Chapter 6.95 ofthe Califor- nia Health C Safoy Cud., Sections 25505,25533 and 25534.1 understand deaifhe building ' does nr, currently how a tenant, hoe it is my responsibility to notify the Occupant of he mtuircmc whiahma Hamer rtoi uanceoraccoiricateorOccupancy. Signature of Applicant Date - All roof coverings to be Class "B" or better /� or aunh rizcd agent Data Cin OF CUPERTINO &Y OF CUPERTINO 0 PERMIT APPLICATION FORM P_PN # Date: 5'/)(0163 Building Ad ss: Fee Description Fee Group s Name: Owner=10., ar �%��5ti P ne o� Z5S-icl Contracto: Q� UA VI VI'l VAnnt br�Fhe✓s icense #: Contact: ar_hm',� Cupertino Business License#: Building ermit Info: 1 -Bldg' ect Q' Pl b /ech rJ Job cription: BBOILER4 Boiler> 1M to 1.75 M Btu 'Rigidential �R ICommercial ❑ Sq.Ft. Floor Area: BCONSTAX $/Sq.Ft.: Cost of Project: 116oI C) Occupancy Group: v��l Type of Construction: BCONSTAXBQ I of Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <=100,000 Btu MECHANICAL BBOILER2 Boiler > IOOK 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > IOOOA 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 of ano CUPERTINO PITY OF CUPERTINO 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 BPINI'ERCEP Ind Waste Interceptor PLUMBING f BPLANCHK Plan Check Fee BUILDING BPLANCKADD I 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 Storm/Ram Water PLUMBING BPTRAP I 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 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 9 Heater Installation MECHANICAL BREMINHOOD Installation of Hood I MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL • 2 of 3 CITY OF CUPEkTINO 9 CITY OF CUPERTIN# PERMIT APPLICATION FORM Quantity 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 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 PPERNUTFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3of3 I •