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05060181 CITY OF CUPERTINO BUILDING DIVISION PERMIT CUNT"AC ,,QRJN�?OItMATION.� . lv * ro n BUILDING ADDRESS: CUPERTINO PLUMBING 111ITH105O6O181 ^OWNER'S NAME: PERMIT ISSUE DATE ONE: SANITARY NO. CONTROL NO. e ARC HITECf/ENGINEER: BUILDING PERMIT INFO BIRO ELECT PLUMB MECH e 0 0 0 0 dOo LICENSED CONTRACTOR'S DECLARATION lobDescri tion Fy 1 hereby affirm that l am licensed under provisions of Chapter 9(commencing p n�Pn wins Section 70fA)of Divisions 3rf du Business and Pmfesdons Code,and my license is nmlltameandcrcat.C2� (a2Y5 oS— REPIPE/WATER HEAER /WATER SERVICE z ucenec Clan (� �I Lk. E Dau (� Coaracu'J - ✓m ARCt IIECI'S DECLARA ON 1 a ie public records 7 U D\ HER- DER DECLARATION +� 7 I achy affirm that I am exempt from the Contractors License Law for the SAfollowing name.(Secure ar 7(01.5.Business d Professions Cale:Any city m aunty which random a permit to comprises.alter,improve,demolish,or repair any mnmTure nnn _Iso prior it)its issuance.also requires the applicant for such permit to Rte asigned sutemenl pp < muWUllaosedputmantWdupmvisioNnftkConbsewr's i =law(Chapter9 Sq.Ft.Floor Area Valuation e( $ (commencing with Section 7000)of Division 3 ofine Business and Promrsons Cade)m '� that W is axerept durefrom and me huls for me alleged exemption.Any Molati0e of Section 7031.5 by my applicant for a permluubjects de,applicant to a civil penalty of 3 SPIPNII'QIi eTO 0 Occupancy Type not mom than five hundred Mas(5500). ' Q I,u owNr of me property a mY emplryea with wa{ns a theh sole eompewtion, will do me work.and me suucture is notintaded or offered forsale(Sec.7014,Business arta Profawo Code:The Cmuumra License law dons hot apply lf m cough is Require dlI%5 eCC1On5 pmpenywW Wlldsaimpmwsmerern,rest whodasiuchworkhimselfamrough hit d own employees,provided that such Impmwmenta arc oat Intended or offered for We.If, however,the building or improvement itsold within one year of completion,the marten builder will have the buben of proving that M did ret Wild or Improve for purpose of ale.). Q 1.as owner of the property,am exclusively marmung with llarued contractors as construct the project(Sec.7(l1st,Baines to Prefectures Cade:)The Conuactah Li. cense law dues not apply je an owner of propertyum(s who sedWildsp or improvesthethercon.and who ew Law.for such projects with a eontrssror(q licensed punwnl m the Contractor's License Law. ❑lam exempt under See .B k PC for mis won Owner Dau WORKERS COMPENSATION DECLARATION 1 hereby affirm under mostly of perjury aro of the following deelaradoor I have and w0l maintain a Cenlliam of Caruset wself-Wure for WmkcesCanpen- IM700 ion,a provided for by Section 3700 of the Labor Code.for me performance of the rk for which this permit u issued. 1 have and will maintain Wakens Compensation Insurance,a myuimd by Section of me LaWr Cau,for me performance of me work for which Otis permit is Wood. y Workers ore sedan InYmmne,eerierend Parity numberare: rtier. . P*n/f Policy Na.:Gin 7G O(� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Tito tendon reed at W computed if me permit is foram WndoodoRam($100) or less.) 1 unify that in the performara of me wodt for which this permit Is)ssecd.I mill as employ any person in my manner as as he become subject to the Workers'Compensatim Laws of Califerms.Dau Applicant NOTICE TO APPLICANT:If,after matin{this Callum:of Exemption,you should become subject to the Workers Compensation provilons of Uu LaWr Code,you mum .J 0 ermdarned forthwith amply with such previsions or this pit"I be daed mwked. 'Z CONSTRUCTION LENDING AGENCY [-rI hereby alrnm met them ler cmntromlon lending agency for me performance of Di,7 the work for which mus permit is issued(San.3097.Civ.C.) MW Q Lenders Name z Lenders Address f,Q I certify that I have mad this application and sum that the AWw information is Ii. correct.I a{res m comply wire all city and county ounce es and tum laws relating ta 0 building construction.and Wmby someone represenmiwa of this city to enter upon me W aWw-mentioned propcny for Inspection purposes IY (We)seg to sew,undcmnify rest kap hsrmleu me City of Cupertino apinst pl isthiiides,jud nm.mss amcm; es which may u my way taxaa airat and City fJ inconseq mofth renting thispermit. APPL STAN S D WILL COMPLY WITH All.NON-POINT Issued by: Date ,9y-1` 25G^ .y' SOU ONS Re-roofs of Applicm/C Dem H RDO MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding=openumre or handle havudour maurim u Round by Ru Cupertino Man' 1 Code.Chapter 9.12,and the Health and Safety ode,Section 25532(1)? QYes All roofs shall be inspected prior to any roofing material being installed, Will the applicant or court Wilting occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it havaNaa air con wrinmu u dc0ned by the Bay Area Air Quality Management all new materials for inspection. 0trictT ❑Yes [haw ad the haard mualahrequiremenu under Chap oli.95 ofthe Califor. ole Hcx afytyCoon Sad 5,25533 and 75534.I unlmooded des iMc Wilding Jean I t e It u my res ibillty to end fy the aeupml of the myui i rivissa of aCertifiateofaapancy. Signature of Applicant Date er rr aathrrived assn 2 D6 All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue J' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEf�TINO Bu ilding Department JOB ADDRESS: PERMIT # /D/%5 /8l OWNER'S NAME: Ze& wIr r an PHONE # 5'7 a/3'`7 GENERAL CONTRACTOR FAX# 253 d(o� I am not using any subcontractors: �o• 2�,�S Signa' 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 Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing /70 U /7 Roofing Septic Tank Sheet Metal Sheet Rock Tile Z024�� lam. ZX.OS' 94v�er/C&t&cior Signature Date G - CITY OF CUPERTINO D a CUPEI�TINO PERMIT APPLICATION FORM / N# r ! ( o 6S' Date: J/ ,/20.05- Building Address- Mailing Address (if different from building address): 10105- kle57CM fir. Owner's Name- Phone #: e T Im n Nom) 252 Contractor I Um U I r] LicenseN�,O Contact: // //II ,,// Phone:�5-j /Y Cupertino Business License#: 17k' (.arGflO Fax: L53 GlD7$ Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: CoplPer ` u�-p&pc ii ez�)}er l c)sifc�r —_-e✓vice- Residential 1� Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ 11kro'ect Size: Standard ❑ Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 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 43c>/ 7 1 of 6 �- CITY OF CUPERTINO CUP EI�TINO 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 BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 BREMAEU-AN 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 BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL Ah BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 li CITY OF CUPERTINO CUPEi�TINO PERMIT APPLICATION FORM QuantityFee 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 Ins ection 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 3 of 3