Loading...
060100651 z z 0 ITY OF CUPERTINO ' �k -"'w r � '' K ' ` "' , "' CONTRACTORiINFORMATION U; DIVISION PERMIT �^ F"�BUILDING 'ILDING ADDRESS: 117 YORKSHIRE TIR CUPERTINO PLUMBING Pum""006010065 OWNER'S NAME: FERMPT ISSUE DATE ROBERT WHITTEN 1300 DELLA 01/11/2006 NE: SANITARY N0, CONTROL N0. (408)253-0618 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTORS DECLARATION IOb Description I hereby affirm dam 1 am licensed under provisions of Chapter 9 (commencing p with Section ]IXIU) of Division 3 of the Guiness and professions Code. and my liceme is Lrell tome and Cf ct. �,;tygUS REPIPE REPLACE WATER HEATER uan,e Lk.. Da¢ f— Contmcmr + s... Pb— ARCHITECTS DECLARATI en 1 understand my plans shall E TSused u public records Licensed Padessi... I OWNER -BUILDER DECLARATION I Wraso .(Sero that 1 License Law for the cxcmpt from the Cssiom following mason. o ]11]1.5. Business and Prokuiuns Code: Any city of county 1. which rtyuire permit t C ore permit any ttrucmm L alma improve, dernath ctme 0 0 0 re prior m its issuance, also requires the applicant the Cont Permit m file a signed statement n ices di Permit t a s, is licensed ft Conuanessan aeselsons (Chapter Sq. Ft. Floor Area Valuation (rhat commencing Sectio 7to (commene xem it t Section of Division of the Business and ")provisions 3 of Code) or Professions Codc) of that io u and aged Any violation of on. m bun far Ile dieted exemption. tMmfmm and or 31.5 b or to airy applicant fore permit subjects the applicant m a civil penalty of r (]CCU ane Type not oar mom dun five hundred dollars ($500} domf five p y ❑ I, u owner of the property, or my employcu with wage u their sole compensation. will de, the work, and the structure u at intended ora@red for side (Sec. ]Old, Business and Profusions Code: The Contractors Liam Law does not apply in an owner of Required Inspections propeny who builds or improses thereon, and who docs suc h work himself or tluough his own employee, provided that suck improvements am not intended or offered for side. If, however, she building or improvement is sold within one year of completion. Ne owner - Walder will new Ne burden of proving that M did nos Wild or improve for norpoa, of sal'.). ❑ h as owner of Ne property, am exclusively contracting with licensed core acmrs to construct the project (Sec. ]Bed, Business and Professions Code:) The Contractors U. cane law doss not apply to an owner of proper y.who Wilds or improve daemon. and who contracts for such pmjects with a con essum(s) licensed p soMam to the Consracta/a License Law. ❑ 1 am exempt under Sec. , B & P C for this mason wnerWORKERS COMPENSATION DECLARATION 1 hereby arErm under peoalty of perjuryone of t e fallowing declarations: i 1 haw and will maintain a Cervi icabe ofConsent msel6lnsum fm WorkeriCorepcmlon, u provided for by Section 37M of the labor Crude. for the performance of the woh for which this permit is issued. ❑ 1 haw and will maintain Workefs Compensation Insurance. u requited by Section "Out of the tabor Cade, for Ne performance of the work far which this permit is issued. My Workmen Compensation Insurance carrier and Policy number 1 �V 2 Cartier. airm..4-" Policy No.: CERTIFICATE OF EKEMPnON FROM WORKERS' COMPENSATION INSURANCE ' (Thnsection need not bo completed if the Permit is foronchundred dollars (SIM) or lou) I certify Nat in the performance of the work for which this Permit is issued. I shill net employ any person in any manner an As to became subject to tM Workers- Compensation Laws of California. Disc Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject in the Worker's Compensation previsions of tW Labor Cook, you muss foMwith Comply with such previsions or this Permit shall W deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby abuse Nat Nero is • comtrwarom lending agetcy far tW performance ser the work for which this permit is issued (Sec, 3O9], Ci,, C.) Lender's Name Leader's Add. I certify that 1 have read this application and ser¢ that the elbow information is comet. I agree to comply with all city and county ordinances and state laws relating to building Construction, and hereby authome mpmsenutiws of this city to enter upon the abovcmentioned property for inspection (We) agree to saw, indemnify and keep harmless the City of Cupertino against costs roil expcnus whichpurpairs. may in anY way earoc against said City in COmxpA, CC of the match in corucqucncc of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCEREGULATIONS Issued by: Date Re -roofs Sig rota E., Apel o M Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof w Will the applicant or forum Wilding occupant Gore of handle haardou material Asdefined by dae Cupertino Municipal Cook. Chapter 9.13. and tW Hcallb and Safety ode. Section 25532(.)? ❑Yes 9*117— All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining inspection, I 8 an agree to remove P mit havardnus air contaminants As dcrined by the Bay Area Air Quality Management District? all new materials for inspection. C YesJ�diw- 1 haw mail the haan mis materials requirements under Chapter 6.95 of thc Califon niceHealth&Sdcty CoM.SMtiwu25M5.25533an1 25534. lundersrandthatifde Wilding dos rat currently haw a tenana that it is my mspmuihility in notify tW occupant of the qutmidcnuwhi W-t®rpti mnaa pe oroccupancy. Signature of Applicant Date All roof coverings to be Class "B" or better Owner sdage Dote CITY 0, �UPERTINO I] a Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: ///'7 l'orksh,r<— 0(, a+ PERMIT # d 066 OWNER'S NAME: 1fC h rtFen 5a -4z 3 PHONE # GENERAL CONTRACTOR: Q Qlu,„b l FAX # EVA I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information Date Own `Contractor Signature Date 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 Own `Contractor Signature Date CITY Of CUPEI�TINO CITY OF CUPERTINO PERMIT APPLICATION FORM v 6' a l o a b .�- N # 3a0 L/ Date: -//-o( uilding Address: Mailing Address (if different from building address): /1% Y!'1< xlrc �r Owner's Name: \Jh 1 sten Phone #: asa- 9a 1 Contractor: b License MECHANICAL BBOILER2 Contact:`/ n P one: 2.5 ce, 9 Cupertino Business License#: Fax: Building Permit Info: / BldgEl Elect Ly' Plumb Er' Mech Job Description: 2p (qp 16,6-e . Residential Commercial ❑ three �ixh..c5 Sq.Ft. Floor Area: ,� q.Ft.: Cost of Proiec�t: Occupancy Crro MECHANICAL BCONSTAX Type of Construction: Please check this box if the project is a/ lJ second -story addition: ❑ roject Size: Standard ❑ Laze ❑ Major ❑ BCONSTA)MQ L 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 BCONSTA)MQ 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 BELEC20U Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING z 7d9z 1 of 3 CITY OF CUPERTINO Cil OF PERMIT APPLICATION FORM CUPERTINO 14 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 MIXTURE 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 Lamm S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstaU/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cIm MECHANICAL BRENLAMHAN . A/C Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install 1`fCHANICAL BREMBUSWAY Remodel Busways_ ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace DT—CHANICAL 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 L 2 of 3 Aff an o CUPERTINO CITY OF CUPERTINO 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 AlECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISNUCOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special ection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEI\I[PPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL / EPER MFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL / MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Commel Multi -Faro PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUU-DING 3of3