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04070020 CITY OFCUPERTINO < BUILDING DIVISION PERMIT " GONTRAGTpR INk'ORMA'�IgN - a BUILDING ADDRESS: "'"""04070020 OWNER'S NAME: PERMIT ISSUE DATA (Ad 1h DAVID & MARTHA BILLS ONE: SANITARY NO. CONTROL NO, ARCHITECOENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 100 LICENSED CONTRACTOR'S DECLARATION 1700 u 1 hereby grim that I am licensed under provisions of Chapter 9(commencing Job Description ^� with Section 70M)of Division Sof the Business and Professions Code.and my license is ifoe exact nnC crtecl LiceocClm a o'7- 32— ELI 9 INSTALL 30 AMP CIRCUIT Dam Camnelo Rif B nV110,15 CONTRACTOR: ERIC B EVANS CONSTRUCTION ARCHITECTS DEC TION 1 andcougar plans shell he useJ mmrrLS 3 p Licensed Professional OWNER-BUILDER DECLARATION f 1 hereby affirm Nat I no exempt from the Contractors License law for the a n O following moon.(Section lin 1.5.Business and Prafessium Code:Any city ar county v�$ which requires a permit m corauum,alma improve, mo olish.no repair say swctute SSxGprior to its issuance,also requires the applicant for such permit to file a signed statement Nat he is licensed pursuant to the provisions of the Contracture License Law(Chapter 9 Sq.Ft. Floor Area ValuatiJ350 s s'$ (commencing with Section 7000)of Division 3 of the Boimas and Professions Coda)or — Nat he is exempt themfmm and the bobs for the alleged exemption.Any violation of $mom 7031.5 by arty applicantfoa lertnitaubjemx the applicant o a civil penalty of ane ppN Number Occupancy'f�,� not mom than five hundred dollars($5001. p y '7 pe ❑I,is;owner mfthe property,or my cmpleyces with wages in their sole compensation, 36901066 . 00 Will do the wort and thestsunum la not intended oroffered forme(Sec.7044,Business and Professions Code:The Contractors Licerae Law does oat apply to an owner of Required Inspections property who Indicia orimpmsrs thrreon.and who dmswh work himself or through his awn employees,provided that such improvements are not intentled oraRered rorsam.If. however,Ne building or impmwment is sold within one year of completion,to owner. builder will haw the burden of proving Nat he did not build or borrow for purpose of .in). ❑1,o Owner of the property,am exclusively contracting with licensed comaeton to convect the project(Sec.7044,Business and Professions Code:)The Contractors Li• cense law docs not apply m an owner of property who builds or impmws thereon and who contracts for such projects with a contnno(s)licensed pursuant to dseContractors License law. ❑1 am exempt under Sec. ,B R P C for this moan Owner Dam WORKER'S COMPENSATION DECORATION I hereby afthm under ParWly of perjury ms,of the following derlantioo: 1 have sOm and will maintain aCcneaof Consent to self-insure for Worker's Campen- n0an.in provided for by Section 3700 of dm Labor Code,for the performance of the wok for which this permit is issued. ❑I have and will maintain Workers Compensation luurance,as required by Section 3700 of dm labor Code,far One Ifformauce of the work for which this permit is issued. My Warkets Comleoation Insurance carrierand Policy number we Cartier. 5 ,kIt- Policy No,J 00 t O b ERTIFICATE OF EXEMPTION IWIR WORKERS' COMPENSATION INSURANCE (Thusection need not Wrompleted if the permit Is for.hundred dollars(SIM) or leas.) I certify Nat in Ne performance of the..,it for which this Permit is iamnd.I shall oat employ any person In any manner so as to become subject in[be Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:IL after making Nis Cenifcate of Exemption,you should become subject to the Worker's Compensation previsions of use labor Code,you must Oforbodb comply with such provisions at this rental,shall Ise deemed mvaked. r""" CONSTRUCTION LENDING AGENCY IherebyMEmichth that dome is, onatmNnn]ending agency Inn Ne perfurmarme of IX a h be wufor which th'v permit Is issued(Sec.3097,Civ.C.) o Lendcr's Nam, z Lender.Address U Q 1 certify that 1 haw mad Nis application and stem that the above Information is f'+ cevecL 1 agree Ir comply with all city and county ordinances and stem laws misting to OU building convection,and hereby suburbia mpremnutives of this city in enter upon the _ G abevooenuunedpmluny for inspection Puryoses (We)agree to sew.indemnify and trop harmless the City of Calamine against F h inconseque consequence of thecosuand exrons,a which may in any way accrue againat said City Uz Acansequ1,17 ofthegrantingofthis DWI .SOURICA ST ILL C�'MlwS/WITH AL��soy Issued by: at SOURC EGULA 0 f Re-roofs WliVol'Applicaunt/ConarictorDam < 77/ HAZARDOUS MATERIALS DISCLOSoaE/ Type of Roof Will be applicant or future building Occupant stem or handle harudous material xaaju dcOned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety oJe,Sccuon 25372(a)? ❑Yes All roofs shall be inspected prior to any roofing material being installed. �Nu Will the applicant or future building Occupam use equipment or dcvi=which If a roof is installed without first obtaining an inspection,I agree to remove mil havardous air conteoimmus as defined by Ne Bay Area Air Quality Management all new materials for inspection. 7doos istrict? ❑Yea s9d Nu 1 hew mol the hoamoo materials mquimmcnu under Chapter 6.95 of the Califor- aH tshaSafelyCodc,Sccuom25505,25533and25534.1undcr thatifthc building Out currently haw a scram,that it u my responsibility to notify the occupant of Ne yuimmcnu hichmustmejgritlwissjonceancm0amerQapaacy. SignatureofApplicant Date Ow fir as arivsaasent D6 oK All roof coverings to be Class"B"or better CITY OF CUPERTINO C ob d 2-0 COPE TING PERMIT APPLICATION FORM APN# 3 6 9 O I Q 6 6 Date: x/6104 Building Address: Mailing Address (if different from building address): 20q(68 skevans Cre DIVA kg20 Cuper- icmo CA q5vIS Owner's Name: Phone #: DCL-:C, Contractor: License #: &r,c. 6 . lr v0...S 70232.9 Contact: Eric 1 NKv 5 Phone: 408 489 6044 Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential ® 30 A�p 210 C, .,cj,t Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: oa Occupancy Grou : � 350 . - Type of Construction: Please check thi ox if the p ect is a second-storyAdsk addition. Project Size: Standard ® Lar e ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI 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 <=206ELECTRICAL ' BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 30/6- ,lam Y ( Z/ t� 9 CITY OF CUPERTINO CUPEI�TL PERMIT APPLICATION FORM QuantityFee 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 BOVERTRAE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINI'ERCEP 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 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 BREWOLE 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 2 of 3 CITY OF CUPERTINO CUPEI;TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING i 3 of 3