04050119 _77
CITY OF CUPERTINO ''
BUILDING DIVISION PERMIT ,CONT°�C�TO -,I,,NPORMATIO '
BUILDING ADDRESS: MCLARNEY CONSTRUCTION PERMlrNN050119
IDER'S NAME: PERMIT ISSUE DATE
LE BOUL
PHONE: SANITARY NO. CONTROL NO.
4082468600
ARCHITECfyENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
L O O LICENSED CONTRACTOR'S DECLARATION
Yw
[Wish (firm that 1 am licensed under provisions of Chapter 9(commencing Job Description
<2 with Section 70plyb(Divlsion3afthe Buai dProfessumit Code,mdmyliemseia
imm�ralaws act 30 DAYS TEMP PERMIT (EXPIRE 06/18/04)
in erase Claws Lic.
Z;:, Da Contra i ORIG. #04010077
RCHITECTSDEC RATION
�i 1 understand my plana shall he used u public rtcnmda
i8t; Licensed Poi...I
H� OWNER-BUILDER DECLARATION
Con clo
�<I 1 hereby.(Sere on I em exempt from the Canons Code:
:License Law for the
E:00 following masa n. etch t ](131.;Business and improve,
dcaoe C.or:Any city or county
$ which requires a permit to requires
alter improve,demolish,ri repair any awment
y
prior to iasuance,am myuiru mWapions;of forsucthe Cohpermit Licenso rile a e
(Chamem
pps< (chat he ommencingwJpudtion70Wcpmviaision3heCaudinesaLiconselaw(Code)it Sq.F[. Floor Area - Vgf�iggcgig22
H9 (commencing with Section 7000)of Divisitn3nf the Businusand Profcsaiom Code)it
H9
that he is exempt thomfmm and dm India for the alleged exemption.Any violation of
,Sacuon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than Ove hundred dollars($500). P Y YP
36901029 . 00
❑Las ownerof the property,army employee wire wegeuWeir axle compenaetlon,
will do We work,and We structure isnot intended or offered foraale(Sec.7044,Busireas
and Profession Code:The Contractor's License law docs not apply to an owner of Q ire nSpD,
roperty who builds or lmprovu thereon,and who does such work himsetfor through hisown employees,provided met such improvements are not intended or offered for ale.ILhowever,the building or improvement is sold within au year of completion.the owner-
builder will have the burden of proving that he did not Wild or improve for purpose of
sa1c.).
[:]h as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Cade:)The Contractor's Li-
ccnu law does not apply to an owner of property who Wilda or improve daemon.and EXPIRsE--
who contracts for such projects with acont r(s)licensed pursuant o the Contractor's
License Law,
❑I am exempt under Sec. ,B&P C for this reason '
or, Data
WORKER'S COMPENSATION DECLARATION
I hereby aRnn under penalty of perjury ane of the following de ilentiotts:
❑I have and will maintain a Ccnificam treatment in self-insum for WarYcr'aCarrier.
utitn,as provided far by Section 37110 of the labor Code.far We performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's CompetmNon Insurance,as required by Section
3700 of the Labor Code,for We performance of the work for which this permit is issued.
My Ys Cnm nuBeI nom artier and Paliryn mWrue:
Carl Policy No.:
CERTIFlCATEOF EMPnONFR WORKERS'
COMPENSATION INSU NCE
(This sectim nec0 not W completed if the permit la(atone hundreddallara(SIegB
nr lcuJ
1 codify that in me performance of the work for which this permit is ismed,l shall not
employ any person in any manner an as in become subject to the Workeri Compenandon
Laws of California.Dam
Applicant
_ NOTICE TO APPLICANT:IL a0er making this Ceti of Exemption,you Would
become subject to the Worker's Compensation provisions or the Labor Coda,you must
O forthwith comply with such provisions or this permit shall he decreed revoked.
CONSTRUCTION LENDING AGENCY
ti
(-+ work
which M.War thea isscomwc.3097,Cis.agency lm We performance of
!Yi
the work far which this Permit is Issued(Sec.1097,Civ.Cd
QLender's Name
z Lentler's Address
U Q I cenify that 1 have mud this application and stale that the above information is
IL F correct.l agree to comply with all city and county ordinances and state laws reining to
DU building construction.and hereby authodn miummnteuvu of this city in enter upon me
r a lihove-menudgm property far inspection purposes r7
(We)agree to save,indemnify and keep harmless the City of Cupertino against
h ince liabilitiesjudgments,of the Starting of this expenses which may in anyway eccmc against said City
U'Z A consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by; Dale
SOURCE REGULATIONS.
Re-roofs
core of ApplicandContracmr pace
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant atere or handle havardous material
as defined by me Carolina Municipal Code,Chapter 1,11,end the Health and Safety
e.Section 25532(a)7All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or future building eccupam use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit hazardous air contaminants as dcOncd by tW Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea ®Au
I have not In,m srdwa mamriids requio:menm under Chapmr 6.95 of the Calirm.
nia Health&Safety Code,Sections 25505,25533 and 25534.1 umlmi that if he Wilding
does not currently new a tenant,that it 4 my mapomi ulity to notify the occupant of the
mgvimmcnasw'chhm�tst bout or to issu of mreamo acupency. Signature of Applicant Date
Owne authod-zed agent are All roof coverings to be Class"B" or better
CITY OF CUPERTIN�
CITY F tU' S
�CUPERTINO
PERMIT APPLICATION FO �v
APN# 6 U Date:
Building Ad es . Mailing A dress if differe t from building dress):
2-0y8� S Creek /vG
Owner's NanV Phone #:
nu / 3 77(,1—
Contract C K N l o License #: S)vz �y
i Gam
Contact: II \\ , 11 ,� L- Phone: yoe z V6-fib Cupertino Business License#:
l l t (�✓l4/f e Fax: 11o& z,/6-373
Building Permit Info: ,,(("" /�- ,
'Bld leq�`k] Plu Mc6ii-
Job escription:
Residential E] C mmercial El
Sq.Ft. Floor Area: $ Sq.Ft.:
Cost of Project: ccupancy Group:
Type of Construction: 1 ch ek this box if the project is a
addition: ❑
Project Size: S dar Laze ❑ a'or [-I
Quantit Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BB0ILER4 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 —En-ergy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
0TV OF PERMIT APPLICATION FORM
CUPEkTINO
ft
qwQuantity 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
Adik BPSTORM Storm/Rain Water PLUMBING
IV 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
BREMAMIAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation ofFumace 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
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELO ,A Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
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A S6,-
CITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Sips, 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 Mecbanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chan e BUILDING
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