05110104CITY OF CUPERTINO
�CoNTRr1CTR(TR�INFORMATION
BUILDING DIVISION PERMIT
LDING ADDRS:
BUILDING ES
PERMfT NO. 05110104
5938 SUTTON PARK PL
OWNER'S NAME:
PERMIT MUH DATE
JAMES ROBERTS
NE:
SANRARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
'
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j LICENSED CONTRACTOR'S DECLARATION
Job Description
I lmreby affirm that l am li¢ud under provianda of Clupms 9 (commencing
3 with Smtion70M)ofDiviaion7 foo BudneM and Profession Code.a my licevcis
nfaBroommul bl (
ADD ELECT. & GAS (FIREPLACE)
Licenw CI Llo. p
Dale
601 X 1/2 TO SUPPLY 32,000 BTU
As
CONTRACTOR: PRO-INSTALLERS
< undersunJ my plus shall o uMd u public rtcmds
admit uacdasspu
LuevcJ Pmfcssional
DECLARATION
S OWNER-BUILDER ON
F I aoinn 1 m Law for to
cwmpt from IW Conus; or'sCod UAny
J c
iso 1.3. BYa tun. and Pmfdov Cocc: Any city or County
mosso on 1.
ng rtvon. (mor
k t W, or any Rmmurt
i which rtqusu M pmmit m cnmvuct, alley. imfrove,
which
n apair
for such permit Limes, La em
^y prior i its alsot h crus
t e to Mpions
<
Sq. Ft. Floor Area
Valuation
d p.
o
(no ..nL W vision of the (Chmi
ocingwitpurstion7
)pro
com eBurnamarodPnwhw(Chaptcr9
inemiNSeNon7andth vi Codd or
(eat
=
$2000
anndons,M
that W u uempt dmrtlrom and the boar for the vlleged esempdan Any violation of
Ind a basisofrth alleged
APN Number Occupancy Type
Section 7031.5 by airy, applicant for a permit wbjmty the applicant W a civil rurally of
not am Nu five hundmd dollars (1)007.
0 1, M owner of Ute pmputy, or my employee with wages a thou Mlccompcvaeon,
will do chic work, and the suuctum is noti^Icnded or offered forsalo(Sm. load, Business
and Pro&ssiov Code: The Contractors License Law dao Out apply m an ow. of
Required Inspections
{Avp aa��jj �J t� q P
progeny who buildaarimgow thereon, and whodoessuchwmk hivuel(arthmuyl his{/t�t'f
[j��
awa cmplaMna. provided theeuch imyrovemuu madcinteddardffemdfm M1l lf.
howew. the building or impmvemeru W wM withinarc year of completion, the owonr.
Q/�Q(jr�attf�"S'
builder will have the Lustier of proving that W did not Wild or improve for puryasn of
01.DEC
,B exclusivelyasdd convuting with C conuam's t.
❑ 1, u mvrcr of the pec.
'5 1005
704 U.
the project ]Sec. load, Baines and Profesiov Codei The
:) Th.
timmors
cove Law doe notapplym u owner of propertywo Wilds or improve Norton. and,
mos La
lis q saw to
who. for such Projcma with aronvamor(s)Ikenwd pununttoto Contractors
IAlrJR[LpgN7i 'sA �l�
SOL
La
Licence hon.
�ff(�%f�aS tplV{Ijp
1 M\Vgrr'
❑ I am aacmpt undo lee , B B Peforthismaon
II'1171S
Own Data
WORKERS COMPENSATION DECLARATION
1 beroby affiam under parody of perjmy aro of to following dalaraoiav:
I as. and will crainuin a CmsiEcate of Covent to self-iuurt for WorkersCompcn-
sadon, as provided for by Section 7100 of the Labor Code, for dm peRmmanco of tho
work for which this permit is issued.
El I bave and will maintain Workers Compe11e110n Insurance, as telNmd by Suction
7700of the Labor Code. for the p ofornumof the wwk for which this pemtit is bound.
'
My Workers Compensation boon co carrier and Polity number son:
tinier. Policy No.:
" CERTIFICATE OF EKEMFT0N FROM WORKERS'
COMPENSATION INSURANCE
.
(TV niton teed not W completed if IW permit is for con hundred dollm (1100)
'
or lens) Q
,
1 cortify that in the performarce of the wort for which this permit It unhand. 1 shall am
employany'per any mann a c m Ibje roto orken'Compevallan
Laws of Calif
Applicant
NOTICE A , aha a:i Ni enificate of Exemption. you should
bomme Mbjcct to the Workers Compensation provisimu a este labor Cade you most
forthwith comply with such provisions or Nis ptrmil anal] W dccmd rtvotrA.
jf CONSTRUCTION LENDING AGENCY
I herebyich thi that dire is a lending agenry for the performanco of
the work for which this remit u us¢d (Sec. X57, Civ. C.)
Wood (Sm.ti30
� 4nders Address
'
1 certify cut I have mod this applicuion and sate that tbu Move information is
contact I slime m comply with all city and county ordiwues and soon laws misting to
building convection. and hemby authorim rtpreenotive or Nu city to enter upon the
U above-mentioned pm x ny for inspomon purpows
L' (Wel agme to save, indemnify and lop harmless We City of Cupcnlno against
0 liabilities. jdgmenu, cow and expense which may In any way omni..dost Mid City
in�cOuvll`L]�
LY WITHANON�PpINT
Issued by: Date
Re-roofs •� .
Type of Roof
%T/��
fAppls HAZARDOUS MATERIALS DISCLOSUREDam
Will ban applicant Or future W aiding aseupantsom m hadlc ha a rdous material
at defined by the Cupa,MQ Municipal Code. CLapmr 9.12. and than Health and Safety
ado. usJx(a)7
0y. ✓} a
❑Ye � y5]tv
All roofs shall be inspected prior to any roofing material being installed.
I
Will din, applicant or fumm building Occupant saw equiptonm or device which
If a roof is installed without first obtainingan inspection, I agree to remove
� g
mit ha ad^m it conominancs u dcfncd by the Bay Arta Air Quality Muagcmcm
all new materials for inspection.
Dwrict7
❑ Yu
1 have Teti the hasaduu mareriaWnquirtmcw underChapterd.95 ofNe Califon
ria HcalN&Safety Cade, Scetiwa 25305, 25513 and 2537d.lumknod thnif Ne Wilding
dao,Icy C y hatC a Nl out it y repamlhi 11 ty to nrdry TIC . pant a
Our,
maqu' knm bumet m (a
Signature of Applicant Date
xf
All roof coverings to be Class "B" or better
a morin ,gin, m
• .e
f ;�
CITY Of
�UPEkTINO
i
Buildin
JOB ADDRESS:
OWNER'S NAME:
GENERAL CONTRACTOR:
I am not using any subcontractors:
Please check anolicable Suhrnn+rartnrc anti
9
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
partment
PERMIT #
b r�/ o
PHONEPHONE#��
FAX # r c -p,
W
/D�Sr
Date
� I
� v
r • Contractor
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
T' e
� I
� v
r • Contractor
I
C
!,,u
CITY of
CUPERTINO
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
APN # S ? S 3 ,3 /
Date:
Building Address:
5-.q 3 $ su l em PL .
BREMFURN
Owner's Name:
o lr' S
Phone #:
1pSo 9 ro'7 88 ao
Contractor: � I � 1
l
License #:
Contact: + I 1
Cupertino Business License #:
Building Permit Info:
MECHANICAL
Bldg ❑ Elect ❑ Plumb ❑
Mech
Job Description:
k '7 D 6c,�,3 Y t TT)
c—k cs -r, e,A G lFt 2E R t
Residential Commercial ❑ /
�%2
'1-0 S
EPERMITFEE
Elec Permit Issuance
For Residential Installations:
Attic ❑ is` floor C'. 2"d floor ❑
/ MPERMITFEE
Mech Permit Issuance
MECHANICAL
Adhere to min set back requirement ❑
Plumbing Permit Issue
For Commercial Installations:
BPERMFEE
Replacement same weight ❑ Additional weight (structural calcs) ❑
BUILDING
Structural Calculations required for new installation ❑
BPLANCHK
New installation Planning Approval Required ❑
BUILDING
Cost of Project: _ Type of Construction:
20Gx::)
Occupancy group:
Business License
BUILDING
ouaFNcu u Un rtattOrrn u tionaeu LJ
New Location .9 -
Qty. if
ADDlicable
FPB TT)
❑■
Sq.Ft. Floor Area:
/ BENERGY
Energy
BUILDING
BREMFURN
Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfm
MECHANICAL
BREMRECEPT
Rec tl, Switch & Outlets
ELECTRICAL
BSEISMICRE
Seismic Fee Res
BUILDING
EPERMITFEE
Elec Permit Issuance
ELECTRICAL
/ MPERMITFEE
Mech Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issue
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
V? b'"J