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05080054 CITY OF CUPERTINO ' 'c" BUILDING DIVISION PERMIT ONTUACTORW I 4 BUILDING ADDRESS: PERMIT Noo 5 080054 10883 N WOLFF, Rr) OWNER'S NAME: PERMIT ISSUE DATE ("T7PF.RTTN0 VILLAGE ASSOCIATE'S OR/08/200S 3NE: SANITARY NO. CONTROL NO. ARCH17ECTIENGINEER: BUILDING PERMIT INFO BLDG MECH 'z LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under previsions of Chapter 9(commencing Job Description with Section 7000)of Division 3 of the Business and Professions Code.and my license is in fell f.!ce and rflbc& REPLACE DRY ROTTEN PORTS (11) i 7—i csmR an. Do- CONTRACTOR: CENTRAL BAY CONSTRUCTION X20" OMIT—Commuctiv, 0, — ARCHITECTS DECLARATION understand my plans shall he used as public records orstud Licensed Professional OWNER-BUILDER DECLARATION I bcomy affret that I am exempt from ft Contractor'S License Law for the following reimm.(SccUon 70315,Business and Profession,Code:My city or county which W,,ahws a permit to consurmi,after.Improve,demolish.or repair any structure Wimor to its issuance,also requires the applicant for each permit in rile a signed statement that he is licensed pursuant ent the provisions of the Commoners License Law(chapter 9 Sq.Ft. Floor Area Valluatiolf?0 0 0 (commencing with Section 7000)of Division 3 ofthe Businestrand Professions Cc*)or Ihotmhe Is exempt thamfourn and the basis for the alleged exemption.Any violation of Section 7031.5 by 1"applicant for a permit subjects Me ppllcaml to a civil penalty of APN Number Occupancy Type not mom then five hundred dollars(SSW). 31605053 . 00 0 I,umwofftpmpenymmyemploycowiLh�rsathirmlc=penutim. willds thework.and thehe a notinteraded orofftmd formic(Sec.70".B ".Bsimm and Profeembans Code:The Contaxime,License Law daus not apply 0 an omer of Required Inspections property who builds orimprovesthemon,Mutwho doesseels work himselfor through his now employcess,provided that such Improvements demos m not intended or Granted far ask.If. hovever,the building or Improvement in Mid within One year Of Oure Pletion.the roamer- outdoor,will have Me burden of proving Net the did not build or Improve for purpose of sal..). []1.as Owner of the property am exclusively contracting with licensed catureacusan,to construct Me project(Sec.71W .Business and Professors Code:)The Centimeter's Li. ocrom Law does not apply to on owner of property who builds or lmpmm Monsoon,and, who contracts for such pmjects with a contr000r(s)licensed pursuant to Me Carmacter's Limen,Law. r-I I am exempt under Sec. ..B&P C for Win mason Own" Dow WORKER'S COMPENSATION DECLARATION I hereby of under Penalty of perjury one of the following dleclanations: I ham and will mu matin a Certificate of Consent se self4sure for Wofte,Comport- s.d.,an pmvided for by Saction 3700 of the Labor Code,far the Performance of the o work for which this permit Is issued. 1 have and will maintain Workers Compensation insurance,"acquired by Sec ion C3 73700 of the Labor Code,for the performance of the work for which this permit I.issued. M My Worker's Compensation Insurance comer and Policy number arc: C. policy Noixl�Mv" Cmicr-'!��RTI CA �GFEXEMFTION FROM WORKERS' COMPENSATION INSURANCE (This secticss need notbacompleWd ifils,Permit is forone hundred dollen($100) or Im.) I certify that In the performance of the work for which this permit is Issued.I shall not employ any person in any museum a In become subject to the Workers Corepentathm Laws of California.Dow Applicant NOTICE TO APPLICANT.if.after containg,this Certificate of Exemption,you should become subject to the Wmicer's ComMuseelon provisions of the Labor Co1c,you must OZ forthwith comply with such provision or Was permit shall thc deemed Wanted. zCONSTRUCIFION LENDING AGENCY 4 1 thereby affirm that dame is•construction lending agency for the performance of fYi> the work for which this Permit In Issued(Sec.3097,Civ.C.) Lender's Home Under.Address I certify that I have read this application and ones,that We show infouraffin,Is nn FCorrect.I a&=to comply with all city and county ordinances and BMW Ism relating to building ounsuncifon,and hereby authorize,nopmemmusam or this city to enter upon the move-mentioned property for inspection purposes (We)agree to saw.indemnify and keep homeless the City of Cupertino against tiff liabilities,judgments.costs and expenses which may in anyway secrusan against said City in of the grounning of rmi APPLICANTconwqmncc UNDERSTANDSthis ANDpet. WITH ITH ALL NON-POINT Issued by: Date sou L lor ® V2!!E< '0 Re-roofs C7 Si cMppH=t/COn,mcwr DOW HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will til e.pplicam or future building countrantsmau or handle,hocardous maecrial as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety I'not,Section M32W)? All roofs shall be inspected prior to any roofing material being installed. E]Yes N(N. If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building Occupant too equipment or devices which it hasumbuss I,contaminants as defined by Me Bay Arco Air Quality Management all new materials for inspection. District? 0 Ye a 064, I have nual the haoxcluee,musecrials roquimmmans under Chapter 6.95 or the Califor. -1.Health Sk Safety Cook,SocMant,25505,25533 and 25334.1 understand Man ifft building dm Out ave.unuen. Ek. 9..pomlbilitymnotify the=up.tcar o. requil ents ch mv P muccoraccathrietanoroccuponcy. Signature of Applicant Date Dow 0 mA_uthTYxd agent All roof coverings to be Class"B"or better 1 I Community Development 10300 Torre Avenue OCIF Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: PERMIT# qi?rA 6 - 0 8-C�Os cl OWNER'S NAME: PHONE#951-- O —6317 GENERAL CONTRA OR: FAX# 3 c �-- I am not using any subcontractors: Signature Date Please check applicable subcontracrs 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO ,��� bS aCITO PERMIT APPLICATION FORM O CUPEkTINO N # Date:�� O 5— BuildingAddress: Q� Mai lin Address (if different from building address): Owner's ane: s Phone#: C ntrac or: License #: Z Contact: Pho :g3/-Wd-(3/] Cupertino Business License#: S/ Fax: F ! Building Permit Info: REi�j lB L odor ' Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 70LV rn Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ ro'ect Size: Standard ❑ Laze ❑ Major ❑ Quantity 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> 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL % BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING IMF 3b673 I of 3 �lJ , V7 CITY OF CUPERTINO CUPEkTINO PERMIT APPLICATION FORM AdIlL Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING IMF 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 . PbIg 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 rinkler/Backflo 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 Reins ection 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 Ligbting 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 BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEI�TFINO PERMIT APPLICATION FORM Quantity Fee 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 PlanBUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING Bsvlgm 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` —Plumbin-PermifIssue —PLUMBING —" PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3 CITY OF CUPERTINO CITYOF PERMIT APPLICATION FORM CUPEkTINO MbLk uantity Fee ID _ Fee Description Fee Group BREMSIGNAD Rmdl Sips 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 Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary BIdg 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 Permif Isme— ---PI;UMBING— PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3