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06020079 F ITY OF CUPERTINO '' -' ?' "BUILDING DIVISION PERMITRACT'OR TNFOyiMATION -.R-,IATILDINGADDRESS; CUPERTINO PLUMBING PERMITNO.06020079 10445 WESTACRES DR OWNER'S NAME: FIERMITISSUEDATE ARTEMIO DAURA 1300 DELL AVE S E C 02/13/2006 NE: - SANITARY NO. CONTROL NO. (408) 253-0618 ARCHITEC 'ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o 0 0 u W p LICENSED CONTRACTOR'S under DECLARATION uC 1 hereby affirm that I am Iiansc0 under And Prooa of Chapter 9(commencing Job Description with Satian]OBr)ef Division 3ofthc Business and Pro(msioa Code.and mylieeaeIli P. in fullforccandefrW. a/ 9 REPIPE/WATER HEATER/WATER MAIN License Claim C ` Lic,, c Can:J- Co.nmrr r i�' ARCHITECTS DECLARA ION Same IunticnunJ my plans shalibeused upublic rtwrds LE JyU t; a k Licensed Professional F'NA 3 OWNER-BUILDER DECLARATION iP I lonely album that I am exempt from be Conuanar's License Law for the 00 following mason.(Section 703 1.5,Business and Professions Code:Any city or ecunsy FEB i which requires a permm it construct,alter,improve,demolish a Auction,repair anyAuction, 90- 2006 $5000 °i y poor N its L4varICC.alSa res,ii.NC A,,Ii,anl for such permit to File A signed aO@mcm, < thatMislicensedpursuantmNcprovisionsofdo,ContracwriLiccoxlaw(Chapter9 Sq.Ft. FI �e Valuation yhe (commencing with Section 7")of Division 3 of the Business and Professions Cade)ser y Nal he u eumpt themfr,m and the buts for be alleged exemption.Any=of Section 7031.5 by any applicant for a pc ref subjects the applicant to a civil penalty of Occupancy Type not more Nan Eve bundred dollacs(SS00). ❑1,as owner of the property,or my employees with wages As their mic compenation. will do be work,and IW structure u not uncurled or offered for sale(Sec.TOW,Business and Professions Code:The Conuxcuses Lin"•Law does tet appy to an owner of Required Inspections propcny who builds or improves bemon,and who docs such work himself or through his own employees,provided but such improvements we not intended oroffered forsale.If, however.be building or improvement is sold within one year of completion,be owner- build,,will haw be Wrdcn,f proving that M did nm build or improv for paryose of ark.). ❑1,as Owner of the pmpcny,am exclusively contracting with licensed conuncmrs to construct be project(Sec.7014.Business and Professions Code:)The Contrumri Li- ceme law does not apply an an owner of property who Wilds or improve thereon,and who contracts for such projects with aconuachi licensed pursuant to the Contractors License Law. ❑I am exempt under See. ,B B P C far this more weer Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury are or the following declarations: 1 have and will maintain a Cenifiam of Consent to xlf-satire for Wei Compcm lion,As provided for by Section 37M of de Labor Code,for be Performance of the work for which this permit is issued. ❑1 bac and will maintain Workers Compensation Inorance,as required by Section 37110 of be Labor Code,for be performance or be work for which er $this pmit is issued. My Workers Compensation Insurance Cartier and Policy numbe 7 a Cartier. '/�tifA•'✓� Polity No.: g ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('Ibis.eirm sed not W completed if the permit is(antic hundred dollars(5100) or less.) I cenify that in the performance of the work for which this permit is issued,I shall not employ any person in any manners,As m become subject to the Workers Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject in the Worker's Compensation provisions of the tabor Code,you must Qz forthwithcomply with such Provisions Or Nu permit shall be deemca revoked. z O CONSTRUCTION LENDING AGENCY 7- (hereby affirm Nat there is a construction lending agency for the performance of C tM work for which this permit is issued(See.3097,Ci,C.) 1 Q tender's Name =z Lender',Address U Q I Certify that 1 haw mail this application and sure that the A Ww information is F' Correct. a m Correct.I Agree comply with all city and county aNimazs and such,laws relating b 0 Wilding construction,and hereby auNortre mpmsenulives of this City to enter upon be W abon mentioned pmpcny for inspection purposes. (we)agree to save,indemnify ad kap harmless be City of Cupcnino against F"py liabilities.judgments,costs and 1,,1.which may in any way aarue agaimt said City U Z in consequence of the granting of this permit. / -i PPLICANT UNDER ANDS D WILL COMPLY WITH ALL NON-POINT Issued by: Date OURC I:A7 NS. � 2-�-06 Stgnm� p anti for Data Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will be apPli ent or future building Occupantamm or handle hsaardom material az defined by the Cuanino Municipal Code.Chapter 9.12.and the Health And Safely sae.Offen 2ssu(q? � All roofs shall be inspected prior to any roofing material being installed. res Will the applicant or future Wilding Occupant use equipment or devices;whim If a roof is installed without first obtaining an inspection,I agree to remove it harardnus air cunumimnts As dcfned by be Bay Ama Air Quality Managcmcnl all new materials for inspection. ' aria? ❑Yea Q� 1 haw mad the harardnus materials rquimmenu underchap cr 6.95 of the Califor. oNA,SaretyCode,Sections 25515,75533 and 25534.1 undersand Nat if the Wilding ars not currently he at it is my rap,nsihilby m nouly IW me pan,of the requimmcros Is me prior anmoracethEam,rae Signature of Applicant Date 0w ariud Dae All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue N 'J. Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: yt ��,AS FAX # I am not using any subcontractors:C: -/ - Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood is Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile er/Contractor Signature Date CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM N # Date: wilding Address: Mailing Address (if different from building address): yl� crts �c Owner's Name: Phone#: Ac-t- 0t5-rC--� 2SZ -- e,c�8co Con actor: r License#: G 2 Ll 9 US Contact: one: Cupertino Business License#: ! 'a Fax: Building Permit Info: / BldgEl Elect ❑ Plumb LK Mech ❑ Job Description: 1 � 0�c 1ti Residential Q'— Comm e /Y Commercial ❑ Sq.Ft. Floor Area: q.Ft.: /SG� Cost of Proiect: Occupancy Group: S'000 Type of Construction: Please check this box if the project is a second-story addition: ❑ roject Size: Standard ❑ Large ❑ Major ❑ Quant ity 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> IM 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 13CONSTAXH 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 1 of 4 J ] / 7 �� 2- ? y=am ' f CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM Quantity 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 Laity S rinklerBackflo PLUI`MING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING / BPWATER Iastall/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 ctm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways_ ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMIMAT 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/A' aratus 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 CRY OF PERMIT APPLICATION FORM CUPEfILTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sigas, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems 111ECHANICAL BSCBLVD Scb Specific Plan _ BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEDIP Temporary Power ELECTRICAL BTEll11PPERDI Temporary Bldg Permit BUII.DING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERAUTFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plambin Permit Issue PLUMBING PPLBG Plumbing Fees foot PLUMBING PLLONGRNGC Planning LR Commel Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran a Residential PLANNING ZADDCHG Address Change BUII DING 3of3