03060188 CITY OF CUPERTINO > a
BUILDING DIVISION PERMIT "CONTRAC ;4 M
�TnPANFORMA I��
,rS I I d a_.o•, ,tom� °�„rk.e�-.,Yi'£'
BUILDING ADDRESS: BOYD THOMAS C AND JANE P PERMITN003 06 0 188
OWNER'S NAME: PERMITL4UEDATE
ONE: SANITARY NO. CONTROL NO.
'XICHITECTIENOTNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u0o LICENSED CONTRACTOR'S DECLARATION
mp1 hereby affirm that I am licensed under provisions Of Chapter 9(commencing Job Description
fZa, with Section 700f)O(Divigion 3 of the Business and Professions Code.and my licassit is
?p4 L eneClassdeffect REPLACE SIDING
y License Class Contract.,
or
v a
n k q
Data TS DELL
7W7W ARCHITECTS DECLARATION
)�U 1 undcrsund my ploy shall he used u puhlic records
to. Liccnscd Professional Vy Yom-f/r
OWNER-BUILDER DECLARATION
<Y 1 hearty affirm that 1 am exempt from the Contractor's Lieenu Law for the /]
0 C following reason.(SmOn 7031.5,Business and Profenions Code:Any city nr county 3
5 m which requires a Pctmit to construct,alter,improve,demolish,or repair any structure
prior to its isnomm.also mquims the applicant rot uch Permit to file a signed statement
pxx that he is licensed pursuant to the provisions of the Contractor',License Law(Chapter 9 Sq. Ft. Floor Area Valuation
iF$ (commencing with Section 7")of Division 3 of the Business and Professions Code)or
y Nat he is exempt therefrom and dm basis for the alleged exemption.Any violation of 37541021 . 00
Section 7831.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nen rive hundred doll...(5500).
rj i,as Owner of the pro any,or my employees with wages as their tole compen W1rm,
will do the work,and the structure is not intended or offered for sale IS".7044,Business — d Inspections
and Professes ions Code:The Committees License Lew donot apply to an owner of 10 2 - PIERS p
prapeny who builds ar improves thereon,and who does such work himself or through his
own employees.provided that such improvements are not intended oroffemd for able.IL 103 — UFER
however,the building or improvement is said within one year of completion,the owner.
•builder will have Ne burden of proving that he did not build or improve for purpose of 104 - REBAR
sale')' 105 - ANCHOR BOLTS
❑1,as owner of But prapeny,am exclusively contracting with licensed contractors l0 10 6 - SEWER & WATER
construct the project(Sec.7044,Business and Professions Coda:)The Contractor's Li
cestse Law does not apply to an owner of property who builds or improves Hereon.and, 202 — UNDERFLOOR PLUMBING
who comiscu for such projects with a contractor(s)licensed pursuant to the ConuvnaM1
LicousLaw. 203 - UNDERFLOOR MECHANICAL
I am exempt under Sec. B It P C for Or,...a
c.c�.�. 204 - UNDERFLOOR FRAME
0 ORIERC SCOMP ATI NDECLARAa N 'L) 205 - UNDERFLOOR INSULATION
1 hereby off.under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING
I have and will notntsi n a Cenifimle of Consent ulBiasure,for Workcts Compere 302 — TUB Se OR SHOWER .
n,as pmvidcd for by Section 3700 of the Labor Codd,for the perfarmmce of the 3 03 — ROUGH MECHANICAL -
rkforwhichBoxycrmRisissued' 304 - ROUGH ELECTRICAL
❑I have and will maintain Worker's Compensation Insurance,u required by Section
3700.1 the labor Coate.for the pefformvtce of the work for which this permit is issued. 305 — FRAME -
MyWmme.Compensation hummtceeanimandPolicy numberade: 306 — HOLDOWNS
Carrier: Policy No.; 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK1.(TITS section need not lc completed it the permit is for one hundred dollars($100) 309 — EXTERIOR LATH
I cenif3 310 - INTERIOR LATH
e cenify Nm in the nary mann of the work for whim Nis permit Is issued,I shall not .
employ any person in any manner so asmhccomc subject o the Workeri Compcns.tion 311 — SCRATCH COAT
"Laws of California.Date
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT.If,after making this Comfiest:of Exemption,you should 501 — FINAL ELECTRICAL ENERGY
Widow subject to the Worker's Compensation provisions of be Labor Cade,you must
.JZ' forthwith comply with such provisions or this Permit shall In wanted revnked. 502 — FINAL PLUMBING ENERGY
zO CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Ihereby affrmOur them isaconstruction lending agency WOO perfurmanccof 504 — FINAL BUILDING ENERGY
[4,> the work for which Nis permit is issued(STs.3(N7,Ci,C.) 505 - FINAL ELECTRICAL
Leadm
W Q' 4ndcYs Name
.,
7 z landersAddrets 506 ' - GAS TEST t
U 0 ,I cenify Nat 1 have road this application and sate that the above infmmui.n is 507 - FINAL PLUMBING
cancel.1 agree to comply with all city and county ordinances and state laws relating to
0U building construction,and hereby vu@oris repraunmtives of Nis city to enter upon the r MECHNtCAL
W above-mcnu.ned property for inspection purposes.
(We)agree Io save,indemnify and keep hannlev the City of Coconut.against %FIN
F INfts Bear lines,judgments,costs and expenses which may in any way same against aid Ci ty Gin
of the granting of
U APPLICANTCUNDERSTANDStANDriehisrm ILL COMPLY WITH ALL NON-POINT Issued by: WORKS Date
SOURCE REGULATIONS.
�J -3 Re-roofs
atom of Appica trContn r Data
` HAZA USMATERIALS DISCLOSURE Type of Roof
Will the applicant or mm building occupant store or handle oucolous material
as defined by the Cupertino Municipal,Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yns I've
Will theapprscantorfutvmbuimmgOccupantuseequipmentordeviceswhich If a roof is installed without first obtaining an inspection,I agree to remove
emit harOmous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
7
❑Yes NO '
I have mad the huraNrmsmamrialsmyuiremcnts untkr Chvp¢r 695 of the Califon
nixH.Il &SafetyCodc.Sccdans25505,25533and25534.1undersund NuiftM Wilding
does not cmren0y have.mmol,thin it is in,r it, HUY m naufydw mcupwL of Ne .
rictiremcnt,which must be and prion.Oso c ofd CcNficam of Om.ancy.l Signature of Applicant Date ,
i
0w .awn rrcdagcm Date roof coverings to be Class"B"or better
OWAR-BUILDER VERIFICATIOP
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
• A. All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
• portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signatur 414e: - L - 03
Job Address: 22 S y� Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
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CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng: Sub : Blk: Lot :
APN 37541021 . 00
DATE ISSUED. . . . . . . : 06/27/2003
RECEIPT # . . . . . . . . . : 22314
REFERENCE ID # . . . : 03060188
SITE ADDRESS . . . . . : 822 STENDHAL LN
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : BOYD THOMAS C AND JANE P
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4628
RECEIVED FROM . . . . : THOMAS BOYD
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : BOYD THOMAS C AND JANE P
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4628
TELEPHONE . . . . . . . . :
-ID ----UNIT----- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- --------- - ---------- ---------- ---------- - - - -------
BENERGY PERMIT FEE 77 . 00 23 . 10 0 . 00 23 . 10 0 . 00
BPERMFEE VALUATION 2 , 500 . 00 77 . 00 0 . 00 77 . 00 0 . 00
BSEISMICRE VALUATION 2 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
BPLANCHK PERMIT FEE 77 . 00 65 .45 0 . 00 65 . 45 0 . 00
---------- ---------- ---------- ---- ------
TOTAL PERMIT 166 . 05 0 . 00 166 . 05 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ -------------- ----
OTHER 166 . 05 VISA
TOTAL RECEIPT 166 . 05
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JUN 2 9 2
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APPR®VIS-0.
IN AC DRDANCE WITHi THE Ci7T l R
CUP. INO)C AN 0 INAN M9
DAI'E s I
This set of plt..
I " kept ontv. i ;:l z. Teasacdit'
laMul to tske r.ay c`ango> or alterations
on same withsuf -Bitten ;emission from
I the building Wpt., Cit'/ sf Cupertino. I
The Iatehipidg of this plan and specifications
'HALL NOT be hold to permit or to be art
1pptoval ul the violation of any provisiotm
• nHv City Ordinance or State Law.
C?1Y OF CUPERTINO • 0 3 d G (�C�
CITY O
CUPEf�TINO PERMIT APPLICATION FORM
N# —, ,0 Date: a
Building Address: �f �1�� V.-
0
;
Owner's Name: �M Phone#:
Contractor: _ �O License #:
Contact: Cupertino Business License#:
Bu' ing Permit o:
Z:
i
Elect ❑ Plumb ❑ Mech ❑
ential ❑ � U V o m tial (�IcJ
Sq.Ft. Floor Area: $/ q.Ft.:
Cost of Proje � Occupancy Gr p:
r--
Type of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILER] 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
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AY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
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
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 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
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IL . % CITY OF CUPERTIA
CUP ryOFFINp PERMIT APPLICATION FORM
QuantityFee 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 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
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