04070108 CITY OF CUPERTINO, , ir"" `. P� `
v BUILDING DIVISION PERMIT. q C,C)N'I'RA�CT$QR ' ON-
BUILDING
ADDRESS: PERMIT N00 4 O 7 0 1 O 8
2032S STEMENS CREEK RTITT)
OWNER'S NAME: PERMIT ISSUE DATE
DE ANZA PROPERTIES
14 NE: SANITARY 0. CONTROL NO.
ARCHITECT]ENO1NEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Lp'z LICENSED CONTRACTOR'S DECLARATION JobDescribon
1 hereby MIT.Rut t am Ilaiu•A urrMr pmvidona of Chepmr 9(co rumens n{ p
WNSectlan7")af DiNsion3afdm Busi. (cuiav Code.mdmylicem is
I. if ee9derrFt'— (or `� TI--CONN. (E) A/C FOR ROOFING
519 z Liccnm �� Lk.N
m -7--7e-�''' contra.ar " CONTRACTOR: METRO MECHANICAL, INC
g CY��17R used u p oN
1',K-MratyBl r PI. e0 be used u pars enNe
D �T-
5 c se0 Professional
OWNER-BUILDER DEC ContraON
I Mrthy.farm Net 1 exempt from the Cssiom ra e:A nae city
o for the
my
aO which
following Permit
71131.5.rBusiness and Improve,
iuna Co de:Any city orratum
$Pi which mquiro a permit to construct.altar.Improve,demnllsh.m repair any s.ctum '
I-z La prior to its issuance,elan mqulme,the applicant for each permit in file a signed wkment Sq.Ft.Floor Area Valugti�0O(]
qqq < the,be is licensed Vumon,m the proviwvnf the Contractor's U..law(ChePmr9
$ $ (commencingviNSecdon7800)of DivWon3of NCBustn udPmfmiom Cmk)or
da Nn he Is exempt Nemfmm and the but&for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit Subjects the appllcam m a civil penalty of AITN Number Occupancy Type
not mom Nm five hundred dollars(5500). r
❑1,uaw•mof Ne property,mmy emplayoes with n{eautie'tr axle comI'mall n. 31626Q9 (]
will do the work and Ne s.ctum la not Sentient oolrerad Tunisia(Sce.7W.Business
and Pronation,Cade:The Comactara License Lew does not apply he an owner of Required Inspections
propemywhobuildsoimprot Such ien,andwho dusme not m wort himWfo!far W his �[ � p �®
own owenr,the Wil provided provehimprovementseune Tear of completion.
for owner. It`'tt rtfll +
haweveA 11 buildingha improvementt&mid within oroyear of completion,Ne owmw
builder vie have the burden of proving Nu he did not build m improv for purpose of
ole.).
❑1,u owner of dm property.ser Seclusively contracting with licensed cmnem:mn to S
corn..the project(Sec.7014,Business and Profession Cade:)The Comacmra U, I J- t: 2005
cove Law does not apply to am owns of property who builds m improves Nsomm.and,
who contracts for such projects with aeonwetoHU licensed pursuant m Ne Canwetab I
Licause muLow. Y
Iaemptunder Sce. .Bk PCforthuu
mon l](I ff�
wvr Data
F-- kj qU tt(111����
WORKER'S COMPENSATION DECLARATION -
1 hereby LAIrm under penalty of perjury oro of the following dech ratiav:
❑I have and will maintain a Ceniftcau of Covent m self-imaomfor WorteraCompen-
sedon,u provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑1 have end will maintain Workers Compensation Ivurence,u required by Section
3700 of the labor Cade,for the performance of the wok for which this permit is Issued.
My WorkehCm mNo harms rkr end Polkynumbere �S
c Pol'ry
CERTI•GT60F FXFMPn OM WORKERS
COMPENSATION INSURANCE
(This section toed not Wconpleted Hthe permit Is foram hundmddollma(51011)
on less.)
1 certify Net in the performance of the.ors for which this Permit is Wased.l"I not
employ any person In any mannerha as to become subject o the Workeri Compensation
Laws of California.Dam
Applicant
NO77CE TO APPLICANT:If,after making this CaniRcam of EXmCPLmn,yrs Should
become subject m the Worker.Compem union pmvt&ions of The,Lahr Cade,you mum -
,JO fmwwiN comply with such provision or Nis permit shall be deemed mated.
y CONSTRUCTION LENDING AGENCY -
[-r I herebyaffirm thea Neu t&a cormaCtinn lending egenry row dm performance of
a> the wars for which Iht&permit is Wood(Sec.3097,Civ.C.)
Q Lenders Name
7 z Lenders Address 1
U O I certify,That I have read this application and ham that the above information
0 F co..I agree to comply with all city and county mild S 01 and sum laws rtluing to
OU building conatmairoand hereby euNon purpoeunutives of this city mentor upon the
Liz eMve-mendaned property for inspection purposes.
(We)agree in give,indemnify and keep humled,the City of Cupertino against
r:L7oT Ilabilitimijudgmenim sou andexpenses which may in any way amus againe,uid Cty
in APPLICANTeUNDEof the RSTA goS1AIND WILL COMPLY WITH ALL NON-POINT Issued by: Da
S THRICE ULA T N I/
-3O� - Re-roofs 57
u
Si mofApplicarvoContrmr Det of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will tier applicant or future building occupant nam orhandle hudNms mamrial
u deRned by ft Cupertino Municipal Cade.Chapter 9.12 and the Health and Safety
cost,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yrs o
Wit)the applicant or future building occupant use cyuipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit intestines air oonuminmts as&nned by the Bay Arms Air Quality Management all new materials for Inspection.
District? w�
❑Yrs Iy Nm _..w
I have road the hundaus materials mquirenmnu under Chapter 6.95 of the Califon.
nu Health A,SarayCml Savour,255D5.25533 sad 255X.1 urnammnd Nn if dee building
doa not currently havea mnan6 that' ' my mspovibility m mdry the occupant of Om
mqui m hichmu etpri iuvanccaf CcNfi'am
Ofoccup =y Signature of Applicant Date
° All roof coverings to be Class"B"or better
w r utharimdagcnl am
aClOF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228 Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT # '
�0 3��—X638 (/erLc r��c B�✓�- x/0-7 0/(-? ?
OWNER'S NAME: / PHONE # -7
GENERAL CONTRACTOR FAX#
I am not using any subcontractors: -� z�—
Signature Date
Please check applicable subcontra tors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/.Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
-�d
Owner/Contractor Signature Date
' CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM o (� J 7 °� 0
APN# Date:
�I (� � v o 7
Building Address: /' // I Mailing Address (if different from building address):
0 -5 26 'j S Y."n,5aep/C
O r' Name: Phone#:
es X 738- Wy
Contractor: /) License#:
47�� 1 r C(4' i G c tYJ5--(�
Conta t:// Ph ne:�7-7Z7,L Cupertino Business License#:
OXII44 n Fax: X7_7 —Oc�i c
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mec
Job Description: o, rsyyC"nec/- 00Ietmrruc r4 ng ( rCoo
Residential E] Co,�¢ra c}sr. Comrhercial
Sq.Ft. Flo $/Sq.Ft.: v
r
C9 of Project: Occupancy Group:
/0 G -0
e f Cons do c Please check this box if the project is a
second-story addition: ❑
Project Size: Standard Laze ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 1OOK 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> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investi ation fee BUILDING
tof3 X277