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03040115CI'rY OF CUPEWrINO BUILDING DlvlsloN PERMIT GONTRAGTOR INFORMATION BT`lJ5`'3'SDDR9'TANTAU AV HELLWIG MECHANICAL PERMITNO.03040115 ff0tT PACKARD 1309 LAURELWOOD RD PBab"T'S" 1 "T 2 3 / 2 0 0.3 E: (408)727-5080 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH = 0 C= t� LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chap er 9 (commencing Job Description With Section 70(10).f Division 3 or the Business and Profcsuar aCode, end my license is in full force and effect. Licenseels Lie.g TI--MECHANICAL INSTALLATION/AC;T,9','.r� Date Contractor' ARCHITECTS DECLARATION r'i �G){�N I undeuund my plans[hall be need as public records APR 2 8 2003 Licensed Por essional OWNER-BUILDER DECLARATION 1 hereby reform. affirm Nut 1 am exempt from On Contractor'sContractor'sLicense Law for the following (Section NO 1.5, Business and Professions Code: Any city or county p BUILDING which requires a Permit In construct, alter, improve. Jmmnlish, or repair any structure prior to its issuance, also requires the applicant for such Permit m file a signed statement that he is licensed pursuant o the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area bl�%�W,{ljon - (commencing with Section 7") at Division 3 of the Bounces and Professions Crux) or �7 that he is exempt therefrom end on basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for • p .It sobjects On applicant he e civil pi of 3 n TATs xr�y� Al? sV V hir O O Occupancy Type oat mom Nan five hundred dbllan (s50D). - I, u owner of the property, or my employees with wag. as Neil sole romper scion, will do the work and On svummm isnot inmrWed or offered f ...it (See. 7044, Business 101_ tJDJDPRT+ A and Professions Code: The Comemfnsm e License law does not apply an owner of Inspections property, who builds or improves Hereon, and who doesauch work himselfor through his 102 - PIERS own empinyces, provided that such Improvements are not intended or offered for sale. If, lO3 — UFER however, the building or improvement is said within one year of completion, the owner- buildcr will have Ne burden of praying Nat he did not Wild or improve for purpose of 104 - REBAR [ale1, 105 - ANCHOR BOLTS ❑ 1, a owner of the property, am exclusively convecting with licensed contractors to (See. 7W, ProfessionsThe Conuactori Li- lO6 — SEWER & WATER mens, La does not wnerouand apply dsCode)or improves who. whocoawda.r suchplyman osvnerentra svhosedprunt tComites for such projects with econuecur(e) licensed pursuant m IW Conuactoh 202 — UNDERFLOOR PLUMBING Law. License Law 203 - UNDERFLOOR MECHANICAL ❑ I an exempt under Sec. , B & P C for Np mason 204 - UNDERFLOOR FRAME Owner WORKER'S COMPENSATIONDECLARADTION 205 - UNDERFLOOR INSULATION I hereby affirm under penalty .(perjury one of following declarations: 301 — ROUGH PLUMBING I bave and will mainui n a Certificate of Consent o self-insure for Worker's Compen- 302 — TUB & OR SHOWER sedan, as provided for by Section 3700 of the labor Code, for the performance of the 3 0 3 - ROUGH MECHANICAL work for which this permit ii issued. Cl I bave and will maintain Walker'. Compensation Insurance, as mquimd by Section 304 - ROUGH ELECTRICAL 3700.(the faanCode. for the performance tribe work for which this Permit is issued. 30rj _ [P�[V[Li' FRAMEHOLDO My Worker's Compe.ation Innsur�ann/c,e� carrier and � Policy number am: Cartier: G r/LNl-SPklky N-': 6 VV 305 — NS CERTIFICATEO EKFbIPTIONFROM WO KERS' 307 — INSULATION COMPENSATION INSURANCE 308 - SHEETROCK M13 section need not W completed if the Permit is for one hundred dollars nIM) 309 - EXTERIOR LATH of Its,.) 1 cenity Our in the performance of the work for which this permit is issued, I [hall not 3 10 — INTERIOR LATH employ any,.. in any manncranu hehemon...bjuuo Neworken'comPenutima ' 311 - SCRATCH COAT Laws of Califomia. Date Applicant 313 501 - ROOF. NAIL - FINAL ELECTRICAL ENERGY - NOTICE TO APPLICANT. It. after making this Ccnificam of Exemption, you shoulJ become subject m the Warker's Compensation provisions of the labor Code, you most forthwith comply with such provisions or this permit shall W deemed revoked. 502 — FINAL,PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that there is a construction lending agency for the performance of 504 - FINAL BUILDING ENERGY Ne work fur which this permit Is issued (See. 3097. Civ. C.) Lenders Name 505 506 - FINAL ELECTRICAL - GAS TEST LendefI Address 1 cenity the 1 have reed thio application and stats the eW in comma. 1 agree he comply with all city and county on inences and late laws relating to o 507 - FINAL PLUMBING bundingeansuvaiaaand of to ter upon initiationrepresentativesor Niachymenmr upon do F&INMVICAL for above-mentioned(Wagree Property for emnifyoa non ha. (We) egme m ssve. indemnify end keep harmless On City o(Cupertino agains 0 _ Fi'Hall lilies, judgments, ensu end expenses which may in any way accrue against said Cityin �\ 5 -NG cnnscqucnce of the lmoling of Nis permit. APPLIC T UNDERS DS D WILL COMPLY WITH ALL NON-POINT [$$sed by: i 23� SOURC' T[W 4 _ WORKSDate r Re-roofs Type of Roof I/a3/o? Signal re ofAplWastrCoarmemir Use, HAZARDOUS MATERIALS DISCLOSURE Will IW applicant or future Wilding occupant stem or handle haardous material as derided by the Cupertinoun'ciMl Code, Chapter 9.12, and the Heaph and Safety Code, Section 25332(x)? Y. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment of devices which ha'an nus air con es doom as defined by the Be, Arca Air Quality Management all new materials for inspection. Diwrict7 \\ II T-1 Yes . I have read the haaarthas materials requirements under Chapter 6.95 of on, Califor. nil Health& Safety Coo. Sectou 25505.25533 sm125334. l u uchreand but train Wilding does t currently have a an Nm it is my r.pmuibility m nouly tW raeupens of the req mentswhirn et riortuiss.an¢.racenirmamaJ(Zccpp OBJ Signature of Applicant Date /d3j All Too coverings to be Class "B" or better Ownee or mn.d agent Date s CeZ ?0CoCC �U7dLu CITY OF CUPERTINO TRR iNFOR1VIATIC GONACTO BUILDING DIVISION PERMIT ,. 'TVT5t'P1Vs: TANTAU AV HELLW I G MECHANICAL PERMIT NO. 03040115 'ffUtOtT PACKARD 1309 LAURELWOOD RD ""3W723/2003 PHONE: (408) 727-5080 SANITARY NO. CONTROL NO. ARCHITECTIENGI NEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH 0 0 0 0 LICENSED CONiRACTOWSDECLARATION I hereby licensed Chapter 9 Job Description affirm that I am under provisions of (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. incense cl Lie.• TI --MECHANICAL INSTALLATION/AC Date Contractor ARCHITECTS DEC RATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure prior m its issuance, also requires the applicant forsuch permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area $1 Y�W6 on (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption Any violation of 3 A 7) * Nob �2l'3lrJ {7 r Q Q Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). . ❑ 1, as owner of the property, or my employees with wages as their sole compensation, TT n*7' — FOUND �q.tµypyl Md will do the work. and the swaureisnot intended orofferedfor sale (Sec.7044,Businus and Professions Code: The Conuactors License Law does not apply to an owner of _s V Inspections property who builds or improves thereon, and who does such work himself or through his 10 2 - PIERS , own employees, provided that such improvements are not intended or offered for sale. If, 1 0 3 — UFE R however, Ne building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for perp= of 104 - REBAR sancta. 10 5 - ANCHOR BOLTS ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- 106 — SEWER & WATER cense Law does not apply to an owner of property who builds or improves thereon, and 202 — UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s) licensed pursuant to the Contractors 203 - UNDERFLOOR MECHANICAL 1 am sempt under Sec. , B & P C for This reason 1k11a exempt 204 - UNDERFLOOR FRAME Owner ate WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION 1 hereby affirm under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING ❑ 1 have and will maintain a Certificate of conunt to self -insure for workers Compen- 302 — TUB & OR SHOWER cation, as provided for by Section 3700 of the Labor Code, for the performance of the 303 - ROUGH MECHANICAL work for which this permit is issued. ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 304 - ROUGH ELECTRICAL 3700 of the Labor Code. for the performance of the work for which this permit is issued. 3 05 — FRAME My Workers Compensation Insurance carrier and Policy number are: Cartier: n aft , No.: W 306 — HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (This section need not be completed If the permit is for one hundred dollars($100) 309 - EXTERIOR LATH or Icss.) 1 certify that in the performance of the work for which this permit is issued. I shall not 310 - INTERIOR LATH employ any person in any manner so as to become subject to dre workers' Compensation 311 — SCRATCH COAT Laws of California. Date 313 5 01 - ROOF NAIL - FINAL ELECTRICAL ENERGY Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Cocst Cock. you mu forthwith comply with such provisions or this permit shall be deemed revoked. 502 — F I NAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) 504 - FINAL BUILDING ENERGY L.cnders Na mc 505 506 - FINAL ELECTRICAL — GAS TEST Lender's Address ICCrtify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to 507 - F I NAL PLUMBING building construction, and hereby authorize representatives of this city to enter upon the — F I N L MEC I CAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against — �' I U Ili Iiabilities,judgmens, costs and expenses which may in any way accrue against said City in g5— ZA NG consequence of the granting of this permitAPPLIC UNDERS DS D WILL COMPLY WITH ALL NON -POINT Issued by:_ C WORKSDate 3— SOURC G T Re -roofs Type of Roof Signat re of Ap ant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the CupertinoWopal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? r7 Yu All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? [:]Yes u I have read the hazardous materials requirements under Chapter 6.95 of the Califor. nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that if the building have a tenant, that it is my responsibility to nod fy doe occupant of the d4,,owhr','c�tR ret rior to issuance of a Certificate oj Occupan Signature of Applicant Date All roof coverings to be Class "B" or better zcd agent Date ,, - CITY OF CUPERTINO t -i TY OF CUPERTINO PERMIT APPLICATION FORM APN # , I)1 Date: 2--!) 03 Building Address: o �)c5 P, [AWML/ Owner's Name: Phone #: BBLDGFEE 4 - Contractor: License #: Boiler <= 100,000 Btu MECHANICAL Contact: Cupertino Business License#: MECHANICAL 1-71. Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: Residential ❑ Commercial Sq.Ft. Floor Area: S/Sq.Ft.: Boiler > 1.75M Btu MECHANICAL Cost of Project: 1� i Occupancy Group: Type of Construction: BCONSTAX Ind/Off/Comm/Quasi BUILDING Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permit sq. foot BUILDING 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 BELEC 1000 Elec 600V <= l OOOA ELECTRICAL ' BELEC 1001 Elec 600V > I OOOA ELECTRICAL✓ BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BE\TVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 h r uiTY OF CUPERTINO Cin OF PERMIT APPLICATION FORM CUPEkTINO 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 Ne�W 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 Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstalUAlter Water Pie PLUMBING BPWHEATER Water HeaterNent 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 BREMFLTRN Relocation of Furnace MECHANICAL BREMFLTRNOV Relo Furnace > I 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 2 of 3 CITY OF CUPEVI ]NO CITY OF CUPERTIN u PERMIT APPLICATION FORM Quantity Fee 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 Change BUILDING 3 of 3 CAC07 - PARTIAL MECHANICAL FLOOR PLAN - FIRST FLOOR EmLaus FAN COIL SCIMDULE (1)-A-QRAWR PLENUM 3"."'Is- -, SBEFFNOTES Cc) 00 0 < o � o Vi J NEW LOWER DETAII 41 ME 0, FAN COIL SCIMDULE (1)-A-QRAWR PLENUM 3"."'Is- -, SBEFFNOTES Cc) 00 0 < o � o Vi J NEW LOWER DETAII 41 ME 0, (1)-A-QRAWR PLENUM 3"."'Is- -, SBEFFNOTES Cc) 00 0 < o � o Vi J NEW LOWER DETAII 41 ME 0,