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03070060
CITY OF CUPERTINO +�rvkw BUILDING DIVISION PERMIT <CONTRACTWINE®RMATION xs,>'iv�>,pvu3_u�>; BUI LDING ADDRESS: MICCICHI MASONRY PERMIT NO 03070060 OWNE•R'S NAME: 180 CHERIS DR PERMITLSUE DATE TOCHILIN EUGENE RT AT, NC: (408) 219-5964 SANITA0.Y N0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH J00 LICENSED CONTRACTOR'S DECLARATION mF I hereby affirm that 1 am limnd under provisions or Chapter 9(commencing lob Description �i`� with S«Jon�my)Of Division Sof the Bu' aM @rofcuinnxCode andmyliccnu is oy mfan roma rrp;cfr«t. (�-ti..�'`4csc� REBAR & FHA STRAPS Eq z ,cm Clan Lic.N �= Da Cunl Rtor ARCHITECTS RATION 1I' undcrsmn JUL 2 9 2003 >du =o Lie- uJ Pmcun '1 Y Oat I am BUILDER DECLARATION BUILDING M f I rte... affront Ihml 1 ons exempt from the Contractor's License Law for the 1.7 C pe0 following reason.Permit t 71131.5.Business and Profcssiom Cody:Any tiny Or county S: which requires a pctmin m construct,alma improve.Jemnitsh,or repair any structure prior tot its issuance,also requires the applicant for such permit to fila uigned statement < that he is licensed pursuant In the provisions of the Contractor's Limn Law(Chapter 9 Sq. Ft. Floor Area Valuation x�$ (commencing with Section 7070)of Division 3 or the Business and ProlvisasCryle)ur that he is eacmpl thctefrom m and the basis fm the alleged emption.Any violationr o32613121 . 00 Section 7031.5 by any applicant for a permit ubjects the applicant to a civil penalty of APN Number Occupancy Type not mom than five hundred dollars(5500). ❑I,asuwncrofshepropwy,ormyemploycuwithwguudeirmlecomMnusion, will do He work,end the awnurt is not imenced or offered fonelc(Sec.7044,Busimss — k U UNUP�k�IIYAd Inspections onucs and Professions Code:The Caors License law dose not apply man owner of 10 2 — PIERS P property who builds or improves shemon,antl who docs such work himself or through his own employms,provided seal such improvemenu are not inmaded or offered for salt.If. lO3 — UFER however.Nimprovement e building or ar is sold within ane yeOf completion,the owner builder will have Ne burden of proving that be did not build or improve for purpose of 104 - REBAR sale')' 105 - ANCHOR BOLTS ❑ 1.a Owner of fie propcny,am exclusively contracting with licensed contractors to construct me project(Sec.7041 Business and plutonium Cale:)no Contractors U. 106 — SEWER & WATER mnLaw does not apply toan=wnerofpropenywho Wilds orimprowsdemon,and 202 - UNDERFLOOR PLUMBING who contracts for such projects with a convacsor(s)licensed pursuant m the Com osc oes Rl,w 203 - UNDERFLOOR MECHANICAL Ll I am exempt under Sec. .B A P C for this won 204 - UNDERFLOOR FRAME D'm 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECL RATION I hereby amen under penalty of perjury one of the following declarations: 3 01 — ROUGH PLUMBING . I have and will maintain a CeniOcam of Consent to Riposure for workers Compere 302 — TUB & OR SHOWER cation,u provided for by Section 3700 of Nma e labor Code.for the performance of the 303 - ROUGH MECHANICAL work for which this permit is issued. wi I have and will maintain Worker's Compensation Insurance,es required by Section 304 - ROUGH ELECTRICAL 37110 ofthe Labor Cobc,for Ne performance ofthe work for which this permit is issued. 305 — FRAME My Workers Compensation Insumnm carricrand Policy minnim e: 306 — HOLDOWNS Comm: NO.: 307 - INSULATION CERTIFICATE OF EXEMPTIONTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK (This section moil not he completed if vermin is for one hundred dollars(S Hal) 309 - EXTERIOR LATH or thou.) 310 - INTERIOR LATH 1 ccnify this in the performs«c of she work for which this permit is issued.l shell not 311 SCRATCH COAT cmpinyanypersoni ray manner snasmbccomeaubj«iso the Workeri Campcnusion Laws 'C Celito ate 313 - ROOF NAIL Applippa��n, NorIQa TO APPucANT:If,after roiling this Ccnificam of Expmpnion,you should 501 - FINAL ELECTRICAL ENERGY Wdo t uhjcn m the Worker's Compcnsatinn proviaionv of she LeWr Code,you muxt ,JZ funhwith comply with such provkhonsOrthis perminaballWdcroadrevokcd. 502 — FINAL PLUMBING ENERGY z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY F� Iher which this that Here isacd(Sce.3W7,lending agency for Performance of 504 - FINAL BUILDING ENERGY a > the wurkader's urwhichthisp mit isiumd(5«.3(y17,Civ.Cd 505 - FINAL ELECTRICAL — W A IandcrS Name z Lord,,,Address 506 - GAS TEST U p I cenify than I haw read this application and sum that the above information is 507 - FINAL PLUMBING f" comm.I agree to comply with all city and county ordinances and sum laws missing to DU Wilding constnrenion,and hereby solhonne repwnmivv or this city to poor upon the FINjjjFN7G CAL N a above-mentioned property for impechon purfahm& (We-)agree lP save,indemnify and keep harmless the City of C9PCnlno against 09 FI o-F.t y liabilities,judgments,costs antl capcnswhich may in any way«trot ageinsI sold City 5 U Z in eon«yuan yofthc gran tingof hispermil. toAPPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NO PO T Issued by:5 ORKS Da[ SOURC EGUL TI S. Re-roofs igmtu a of ApplicanUCOmractor m HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the epplicam ur futum Wilding=upanutorc nr handle hazardous material as defined by the Cupenina Municipal COM,Chapter 9,12,and the Health and Safety nJe.Section,1"C ssz(.3? ❑YoAll roofs shall be inspected prior to any roofing material being installed. u Will the applicant or froom Wilding tau equipment or Jevieu which If a roof is installed without first obtaining an inspection,I agree to remove It hazardous air contaminants as JcfnW by the Bay Area Air Quality Management all new aterials for inspection. pYca �Tlu I have ad the humorous materials requirements under Chapter 6.95oftheCalifor- nieHcaltbA my Cafe,Scene.25505.25533 and 25534,1 understand that it the Wilding ' J s tenant,that it is my responsibility to notify the«eupnl of line to maccmnmmofocc ancy. Sig tureofApplicant at, Owner aut arircJ agent Dam All roof coverings to be Class"B"or better (Q- CITY OF CUPERTINO o 3 CITY OF PERMIT APPLICATION FORM CUPEkTINO PN# J Z Dat Building Address: 7 Mail' g Address (if different from building address): Owner's Name: QG / Phone#: /l 1 Contractor: © � License I tc Contact: Phone:a t 4 S TT 4 y Cupertino Business License#: Fax: Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Jobdescription: fl r Residential El /\✓ DQ ✓ Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: / ��v Occupancy Group: I Type of Construction: Please check this bo if the project is a second-story addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . 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 BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 1 .1+'s � � ) CITY OF CUPERTINO c'TM° PERMIT APPLICATION FORM CUPERTINO 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 New 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 S rinklerBackflo 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 BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM ' CUPEkTINO 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 BSCBT.VD Scb Snecific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING Bsv;im 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 EPERNUTFEE Elec Permit Issuance ELECTRICAL MPERMFEE 'Mechanicals . foot MECHANICAL MPERNIITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Feesq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3