03110070 I CITY OF CUPERTINO ;� .asJ
BUILDING DIVISION PERMIT I,:,CO INS RMATION
i BUILDING ADDRESS: PERMITNOID 3110070
10605 N WOLEE ED
OWNER'S NAME: PERMIT ISSUE DATE
COURTYARD BY MARRIOTTT 11/13/2003
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
!0, LICENSED CONTRACTOR'S DECLARATION
CC F I hereby affirm that 1 am licensed under provisions Of Chapter 9(commencing lob Description
e m with Section , fOfvision 3nfdm Busineasen (iris s�nJe.end mylicenu is
In mBfmaa t. ROOF TOP AIR CONDITION
i � License Cruse d Coder V �S CONTRACTOR: FRANCI AILP,Sf�IIJ & AIR
cb, Oatc Cunvactor�/ CaLd
eqqAECTSDECLq_ 1 N
L 8 I understand my planss shall shall he used as public records (s p
�ap� Licensed Pmreuion.I Ijt2003 9
,.1 OWNER-aU11DER DECLARATION
aE 1 hereby affirm that 1 am exempt from the Contractor's License Law far Oc
20 following mason.(Section 713 1.5.Business and Professions Cole:Any city or county
m f! which requires a Permit to construct,altar,improve,demolish,or repair any structure nING
iy
prior to its issuance,also requires the applicant for such Permit to File a signed scattrucht
Othat he is licensed purmanuo the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuat0t?500'
$ (commencing with Section 70DO)of Division of the Business and Professions Cudc)or
that he is exempt deuterium and me basis for On alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjecls the applicant to a civil penalty of
not more man five hundred dollars($500). Occupancy Type
❑ Lasownerk,the On intended
orowagesasthei(ale 044,8 amens
will domework,and On he mre I,be, oroverdotorula(See 7044,Boniness
and Professions Cook:The Conuanum.Lieeme law docs nm apply to an Owner of Required Inspections
property who builds ar ed that such improvements
mp,end who aces such work himself.,throughhis
owneer,fee uipmvior imatsuch n,is s<menuartnot intended Or leered formic.If,
builder ,mebuildingorden of proving
sold within one year of completion,theowner.
of
builder will have the burden of proving Nat he did not build or improv for purpose of
,sled.
❑ 1,as owner of On property,am exclusively contracting with licensed contractors to
construct the project(Sec.70,14,Business and Professions Code:)The Convector:Li.
cense Law does not apply to an owner of property who builds or Improves thereon,and
who contracts for Such projects with a contractor(s)licensed pursuant to the Contratoes
License law.
I un exempt under Sec. .B k P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of pc jury one of the fallowing declarations:
1 have and will maintain a Cant fncote of Consent to self-insum for Worker's Compen-
sation,.....load for by Section 3700 of the labor Code,for the offmmancn of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Seddon
371W of the labor Code,for the prf ncomme of the work for which this pens it is issued.
My Worker's Compensation Insunna esprit,and Policy number art:
Cartier. Po.:
CERTIFICATE OF EXRMPTIO OM WORKERS'
COMPENSATION INSURANCE
(Thea section need not hecomplewd If Ile,pereh Is fmonc hundred dollars($100)
ser less.)
I certify that in t rfo n f t work for is permit Is issued,I shall not
employ any any rr fine to the Worl ,i CitNamlion
Laws of Cali mice.Dale
Appl'cam
NOT APPLICANT:I a a c this fftonc of Walfrieg.you should
become uhjac,m do We l e,C.-P. provisions or the labor Cede.you must
�z forthwith comply with...h provaim.or rob pe.I,shall be deemed mvaked.
ZO CONSTRUCTION LENDING AGENCY
1 hereby eMrm mm dmm is•construction lending agency for the perf ....of
2' me work for which this permit ii issued(Sec.3097,Civ.C.)
Uj Q' Lender's Name
CL
J z Lcndeh Address ..
J 0 1 eenify mat 1 have read this application and state that the above Information is
jy (, cortect.1 agree to comply with all city and county ordinances and slate laws relating to
V building construction,and hereby emhorire mpreaulf
nvas of this city to enter upon the
C) 0twc-n dnlioned property for inspection pugmees.
(We)agree to ave,indemnify and keep harmless Oc City of Copcnino against 3
F+� liabilities.judgmenu,coru and e.pcmes which may in any way acervc......laid Ctry
U z in consequence of tM rmit.
APPLlIffff TAN D ILL COMPLY WIT NON-POINT Issued by: Date
SOUR¢ U A 0 .
vv
Re-roofs
Signature of I' Dem '
AZ RDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant future building Occupant store or handle hawdous material
as derided by the Cupedi no Municipal Code.Chapter 9.13.and the Health and Safety
dg&.da,Seclfon25532(a)3 All roofs shall be inspected prior to any roofing material being installed.
❑Yes u
Will the applicant or tore banding occupant use equipment or device.which If a roof is installed without first obtaining an inspection,I agree to remove
nria7h haxcema,air romi
nmnan as]caned by the Bay Area Air Quality Man......I all new materials for inspection.
❑Yes No
1 have read the havardlous materials myuimme ds under Chapter 6.95 or me Califor- -
m,H 1 &Safety Code,Secd s7S5f15.255JJanJ 25534.1undemtaddewif the building
sea¢fie my reapoufhility to n.tily the Occupant of the
re me to aeeoracegpmorOcea ancy. Signature of Applicant Date
03 All roof coverings to be Class "B" or better
Owner ser D m
CITY OF CUPERTINO v 070 7O
FURNACE/AC
CUPEfZTINO PERMIT APPLICATION FORM
APN # Date: D3
(� T ! 3
Buildin
O er's Name: Phone #:
tractor:, Phone: ol) — Li- Voncgn� 6� j
(nacd--3 0)2, 51D) _)5S _:
5 : 16
ct: Phone: Cupertino Business License #:
� D— 3S5
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Jobcription: \ ^ I^
�
Residential ❑ Commerci
For Residential Installations:
Attic ❑ 151 floor ❑ 2"d floor❑
Adhere to nli;; et:back requirement❑
For Commercial Installations:
Replacement same weight &9, Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New instajlation Planning Approval Required ❑
Cost of jec Type of Co c ion•. Occupancy oup:
1
Strapped ❑ On Platform ❑ Bone Sq.Ft. Floor Area:
New Location ❑ Re lacemen
Alklicable Fee ID Fee Description Fee Group
BENERGY Ener BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIItHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbin Permit Issue PLUMBING
BPERMFEE Bld Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
'7�