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03020051 & 04010133 CITY OF CUPERTINO > ' BUILDING DIVISION PERMIT CONTRACTOR INFOR�MATI6N:; BUILDING ADDRESS: T H GENERAL CONSTRUCTION C ERMITND03020051 OWNER'S NAME: 10474 SINGLETON RD PERMIT ISSUE DATE MY THU VAN NE. (408) 629-3090 SANITARY NO. CONTROL NO. ARC HITECrIENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH L� 0 0 0 ±Op LICENSED COMHACTOR'S DECLARATION Job Description lU I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P m with Sectio f.f Division 3of NC Busimssand Professions Code,and my been.is 11 human affect. 1 ADD 1496 R: FT. IF$W License a 'c.M �j �� o o c aO r CONTRACTOR: T H 01[)N�(708/18/03) J < -\-.41 ummound my plan,hall be urs Ds public records JUL 2004 G y Licensed Professional OWNER-BUILDER DECLARATION af 1 hereby affirm that I am exempt fru.the Comracmr's Liken.Law for the O O following reason.(Section 903 LA Business and Professions Code:Any city or county BUILDING V'L®IY a�a��g\G `k m which requires a permit to construct,alter,improve,demolish,or repair any structure °iy prions its issuance,also requires applicant for such permit to Elcasigned statement Vz-e that he is licensedpursuanlaotheprovisionsoftheContractor'sLicenseLaw(Chapter9 Sq.Ft. Floor Area Valuation Lha (commencing with Section 70110)ad Division 3 Of the B Orionis ad Professions Code)or .- that he is exempt Ncmf ion and the hands for the alleged exemption.Any violation of $300000 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type .of more Nan five hundred dollao(SSW). ❑1,as owner or Ne property,army employees with wages u their sole eamponsmion, 3 1628001 . 00 will do the work,and fee Structure is not intended or offered for sale(Sec.7014,Business and Professions Code:The Centractnh License Law does not apply tp an owner of Required Inspections property who builds or improves thereon,and who does suchwark himulf orthmugh his own employee..provided that such improvements are not intended or offered formle.If. 101 — FOUNDA'T'ION - however,the building or improvement is sold within one year of completion,the Owner. builder will have the burden of proving Nat he did not build or improve for purpose of 102 - PIERS .it)' 103 - UFER ❑ 1,as owner of the Protein,am exclusively contracting with licensed contractors In 1 O4 — REBAR construct the project(Sec.7044.Business and Professions Code:)The Contractors Li. seLaw dock not apply toanOwner ofproperty who Wilds orimproves dmreon,and. 105 — ANCHOR BOLTS who contracts for such projects with a co motto(s)licensed pursuant to the Contractor's License Law. 106 — SEWER & WATER ❑I Or exempt under Sec. ,B&PC far this...a 202 — UNDERFLOOR PLUMBING Owner Dam 203 — UNDERFLOOR MECHANICAL WORKER'S COMPENSATION DECLARATION I hereby amen under penalty of perjury one of the following deelarmions: 204 — UNDERFLOOR FRAME l neve and will maintain a Certificate of Consent m self-insure for workers Cumpen- 205 — UNDERFLOOR INSULATION sntion,as provided for by Section 3700 of the labor Code,for the performance of the 301 — ROUGH PLUMBING work for which this permit is issued. 302 — TUB & OR SHOWER ❑I have and will maintain Worker's Compensation Insurance,as required by Section 37M of the Labor Care.for the performance of the work for which this Permit is issued. 303 — ROUGH MECHANICAL My Workers Compensation Insurance carrier and Policy number am: 304 — ROUGH ELECTRICAL e: Policy ban: 3 05 — FRAME CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 306 — 'HOLDOWNS (This section need not ha completed ifthe permit is foram hundred dollars(SI00) 307 — INSULATION . mitts) I Can matin rfimmanec of Nc work for wM1ich permit h issucd.l ban rat 3 08 — SHEETROCK employ any person r y mnne �folemt Workers'Compcnsation 309 — EXTERIOR LATH Lawso can a, . ate 310 — INTERIOR LATH ApQQNi�ayyt NO'I'1[�ro APPLICANT,theWorracemakingthis Cenin,of ofE Ube, you Code, mod 311 - SCRATCH COAT hoL h comp y it Workers Compensation provisions of the Labor Code,you mon .J$ forthwith comply with such provisions or mit Permit shag nr deemed revoked. 313 — ROOF NAIL Z CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY F 1 hereby affirm that them is a construction lending agency ror the poformarod of 502 - FINAL PLUMBING ENERGY c4 > the work for which this permit s issued(sea 3fN7,Civ.C.) 503 — FINAL MECHANICAL ENERGY GQ Lender's None � z <ndm'sAdemaa 504 — FINAL BUILDING ENERGY U O 1 certify that 1 have read mit application and stem that and above ws habiting is 505 — FINAL ELECTRICAL cortcct.1.grey to comply with all city rad county dordinances and sum Taws relating to pU building construction,and hereby aathorim repmsenmtivas Of this city to enter Upon the GAS EST W shave-mentiuncd properly for inspection parlous. \ Iy (We)agree to save,indemnify and keep hasmfeas the City of Cupertino against 07 F @�� I rp liabilities,judgments.costs and expense hi ch may in any way accrue against said City 5 ICAL 1 in in U z APPLICANTCof the granting of UNDERST NDS rot D WILL C PLY PTH ALL NON-POIN Issued by:5 Date SOURCEREGUNAL S ° Re-roofs 510 — INAL PU13LICNWORKS sore o manU ZA DOUS MATE0.IALS DISCLOSURE em Type of Roo 14 Will me applcantor future building Occupant store or handle havardous material az denned by the Cupertino Municipal Cuda,Chapter 9.12,and the Health and Safety Code,schen 2s53za>7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ISI Nu Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It hazardous air contaminants as dermcd by the Bay Arca Air Quality Management all new materials for inspection. suiel? J ❑Yes YJ No I have read the haaallous tats reyviremcnts under Chapmr6.95 of the Califnr rata Hcalth&Smcty Code, duns 5(15.255)7 nd25534.1 undc"mad thmion.hold docs not camandy h nen mitis rcsponsiM1ilitY m nntily thew pot n the yuircmcntswhir: t unesconCcrdfmnof u cY Signature of Applicant Date net era o rods t tu All roof coverings to be Class"B" or better C C ITAOF CUPERTINO INGIDIVISII PERMIT COI RACTgRI1 FOXMATIQNw� BU ILDIN rADDRESS: PHAN CONSTRUCTION CO INC PERMIT"03020051 OWNER'S NAME: 870 S WOLFE RD PERMIT ISSUE DATE MY TT4TT VAN NE' (408) 737-8323 SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 i0' LICENSED CONTRACT'OR'S DECLARATION�dE Jb Description 1 hffi ereby arm the,I am licensed under provisions of Chapter 9(commo encing wilasoetion9(MA � 1 trDivivion3af the Bosh{sx end Pmfcssinm Codc,antlmylieenu is ce� in full forte .n [&of tom/ A�. / ADD 1496 SQ. FT. & REMODEL- ARCHITECT'S DECLARATION tNL �i 2< I undcrsranJ my plans shall W used as public rccONx OyU 'a.t; Licensed Professional OWNER-BUILDER DECLARATION 0 0 1 booby affirm(hat 11, exempt from the Comnnoos License Law for the 2O followwhich re reason. crinin 9onstr Businessand improve. Code:Any city mcounty which its requires issuance,permit Ie construct,elme im for Su dem ch emit t or repair any structure Fz that heor rs¢ dpursuarcquireuhovisiosof for f the Contractors Bicae Law statement £ < (comma cingwidpunuanU(t of Division3oftheBuacmrandProf6aw(Code) 9 Sq. F[. Floor Area Valuation y�$ (eat he is (commencing Scnffore(amid the basis 3 of al Business exeand Professions Coact or .- that he is exempt therefrom antl Ne basis for the alleged exemption.Any violation of $300000 Section 7031.5 by any applicant for a permit subjects the applicant tO a Civil penalty of APN Number Occupancy Type net motion Nan five hundreddollars(nW7. P Y YP C 1,as Owner of the property,or my employees with wages as their sole compensation, 31628001 . 00 will do to work and the structure is not intended or offered for sale(Sec.IDM,Business and Professions Code:The Conuaclor's License Law does not apply to an owner of Required Inspections property who builds or improves Iherion.and who does such work himself or trough his own employees,provided that such improwmenu arc nor intended or offered for sale,If, 101 - FOUNDATION however,the building or improvement is sold within one you of completion.the owner ` builder will haw the burden of proving that he did not wild or improve ver purpose of 102 - PIERS sale.). C 1,as Owner of the property,am exclusively contracting with licensed Contractors to 103 — UFER construct the pmjeCI(Sec.9044,Business and Professions COde:)Too Contractor's Li. 104 - REBAR cense law does not apply to an owner o(propcny who Wilds or improves thereon,and, lO5 - ANCHOR BOLTS who contracts for such projects with a contractor(&)licensed pursuant to the Contractor's License Law. 106 - SEWER & WATER C 1 me exempt under Sec. B&P C for this..an 202 - UNDERFLOOR PLUMBING owner Dat 203 - UNDERFLOOR MECHANICAL WORKER'S COMPENSATION DECLARATION l hereby affirm under Penalty of perjury one of the following declarations: 204 — UNDERFLOOR FRAME Qon, haw and will Consent maintain a Cenificate or self-inaure veker r Woman's Complain. 205 — UNDERFLOOR INSULATION as provided for by Section 37W of the labor Code,for the performance of the 301 - ROUGH PLUMBING work for which Nis permit is issued. C 1 have and will maintain Worker's Compensation Insurance,u required by Section 302 — TUB & OR SHOWER 37W of the labor Code,for the performance of the work for which this Permit is hated. - 303 - ROUGH MECHANICAL My Worker's Compensation Insurance Cartier and Policy member am: 304 — ROUGH ELECTRICAL Ca 5�(,Ld'[ POlic o.: 1755'L144-2co3 CERTIF CANE EXEM FROM WORKERS' 305 - FRAME COMPENSATION INSURANCE 306 - HOLDOWNS or (This section need not W completed ifthe Permit is foroac hundred dollars($l W) 307 - INSULATION I cent.) 308 - SHEETROCK 1 eenify Neter the performance of the work fm which this permit is issued,1 shell not complo,Laws of California.oninanymanncrsnamhowmcsubjccuCmeworkers'cnmpcnaa0on 309 — EXTERIOR LATH Lawaof CalifoDate APPlicent 310 - INTERIOR LATH NOTICE TO APPLICANT:IL after making this Cenifcate of Exemption,you should 311 - SCRATCH COAT become subject to the Worker a Compensation provisions of the labor Code,you must ,J ,z forthwith CnmPly with such Provisions or this permit shall he deemed revoked. 313 - ROOF NAIL zt O CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY [-+ I herchyaflirm Nn there is a construction icndingagency for We Performance of CC� to work fur which This perit issued(Sec.31091 Civ.C.) 502 - FINAL PLUMBING ENERGY w q Lendcr'sNain 503 - FINAL MECHANICAL ENERGY a z LondeftAddreas 504 - FINAL BUILDING ENERGY U O 1 cantly that)have read thirty and Coun and state that in.above w$rmering is 505 - FINAL ELECTRICAL gy building 1 agree re comply with all city and county ordinances Of and sole bws relating e OU abovengcotioned ion,and hereby authonpurposeumatiws of this city to cines upon the GAS EST �G above mentioned property for inspection Purposes. (we)agree In sew,indemnify and keep bay in a the City of Cupertino against 0 7 AFI 'Iiabiliti( j)grenIn,costs and hodennify and kie mayinany wryaccmcapertinsvitl City 5a'W"11 ICAL V,`�[ in consequence of the granting alibis permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 Date SOURCE REGULATIO >/ Re-roofs 5(14 INAL PUBLIC WORKS S' reof Appli mU ntracl r Out. HAZARDOUS MATERIALS DISCLOSURE Type of Roo Will Ne applicant or future building occupant store or handle hazardous material m defined by Ihv Cupeninn Municipal,Code.Chapter 9.12,and the Health and Safety Cuoc,Section 25532(!)? All roofs shall be inspected prior to an roofing material beim ❑Yet PS No P P Y g g installed. Will the applicant or future building eccupanl uac equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove heaasd-to eir conmminan¢as donned by the Bay Arca Air Quality Mmagemeat all new materials for inspection. sin? CYcs ®'j NO 1 have read one havallous materials requirements under Chapter 6.95 of the Califon nia Health&Safety Code,Seedons 255(15,25533 and 25534.1 understand that irthe building does nal curtcnlly hvw v minor,Nat it is my napansibility m nndly the n¢uPanl of Nc equircmenLwhich priorNis rti0cato of OcCup� Iki�la7 / Signature of Applicant Date '6wnmmamheed agnnt •�o e 2 All roof coverings to be Class"B"or better a Z,i'. ITY OF CUPERTINO • p 3 O Z o eS CUPEkTINo PERMIT APPLICATION FORM APN# 3 v o v I Date: 2 2 - 3 03 Building Address: 141160 W* o e-A ro Owner's Name: Phone#: 69 q6- err Contractor: License#: vf� COVZ c UIC7,`U'l to l ti,- '17,1 y 9-/- Contact: Cupertino Business License#: TtE-ce Building Permit Info: . Bldg Elect Plumb Mcch Job ]Description: a`j� � Residential ® pzenm S ommercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of P ojec : R p'f C Occupancy Group- Type of ns ruction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permit s . foot BUILDING 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 Ener2y BUILDING BENERGYADD Ener Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 tTY OF CUPERTINO • cuP TY0 PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Grou 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 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 eOfFixtures PLUMBING • BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Stoan/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pipe 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 BREM 3USWAY 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 f CITY OF CUPERTINO 0"OF PERMIT APPLICATION FORM CUPEI�TINO Quantity' Fee ID Fee Des cri tion 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 Sips,Mar uee 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 Inspection BUILDING BSWRA Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Teinp 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 Chane BUILDING • 3 of 3