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03050129 (2) ;'�'iE;2G OF CUPERTINO '" ^"'°�t' I•^j'-ILDING DIVISION PERMIT �CUNTRACTURTIVF'U Ar .00i-01,"ooRFss: GREENFIELD PLUMBING PERMYPN003050129 •S NAME: 3513 MADRID DR P"'"iRV7�17/2003 WAH L AND SHIRLEY 4 O'E 9 21—B 9 8 O SANITARY NO. CONTROL NO. ARCHIIEC MN01NEU: BUILDING PERMrr INFO BLDG ELECT PLUMB MECH �oo LICENSED CONTRACTOR'S DECLARATION 1 hereby effort that 1 am licensed under provisions of chapter 9(Commencing Job Description with Section 7M)ofDlvIM.n 7 clam Be,' and Performers Cade,and my liconw is � Iuoacl n°J!�J�'(�� c WINDOW REPLACEMENT .k/�f1ECTS UC�:tw L i r35„j I UMcrmnd my plena alWl be need as public rtcarN yen Licensed AofeWonal OWNER—BUILDER DECLARATION 1 hereby affirm that 11- eumpl from the Caua7ah Dank law for ti0) COO following roan.(Suitt 711715 Business and Rofde oli Cade:My city or county $ pow its bt aPermitn,aim rectkmrocLalee,nprow,demo)W,rie a airsig ed uuCrum ment 3� pmurkuiensedprsua recisions the ovislo of forLk soh este mfiesALaw(Ch.penl g < thuheinikcnkd pursuant to the of Division of tithe Bukkh mod LicenseLawCode) Sq. Ft. Floor Area $G.gay.QtlOn Cru(commencingexempt viii Section and th Divbsan 7 oN0)egad mo aM ProfAny vi Codd)or 9 0S1 he u extmpl therefrom and 00)boo fm 00)alleged cumpnlan.Any violation of Section 7071.5 by my applicant for a permit abjew the applicant to a civil penalty of er 0 0 Occupancy Type not mart than ow hundred dollars(5700). ❑I.a owner orthe property,m my employees with wages u their sole campe^ullon, will do the work,and nhemorcure is notnknled oraffered formle(See 7044,Business — Iru and Powerma is Code:The Comseckrs Llcmx Law dao al apply k a awa.of 10 2 — PIERS e 1 Inspections pmpenywho buildsarimprows thercon,endwhodoessuch work himklrar Waugh his men employees,pmvlded that such improvements are runtarded or offered formale.If. 103 — UFER however,the building or improvement is old within eek year of completion,the owner- beflder will have the burden of proving that he did nal brimar Improve far purpose of 104 — REBAR mmaj' 105 - ANCHOR BOLTS ❑1.u owner of the preputy,am uemJvuy camorwao,with accused cotracmn ro 10 6 — SEWER & WATER construct the project(Sec.7066.Basis=asci Profesalov Code:)Ties M^CtOA U- romeLaw does net apply k..ofproperty who braids or imp-M akrenn,and, 202 — UNDERFLOOR PLUMBING whocommute,Law. a Uf°r such proJems witheccouakr(J licensed pursuantrotheCmuanoM1 203 - UNDERFLOOR MECHANICAL plamexempt under Sm. .0&PCfor this mnnn 204 - UNDERFLOOR FRAME Dau 205 - UNDERFLOOR INSULATION WORRER'SCOMPENSATIONDECLARA ON Ihertby effortsunder peuslty of perjury min or owing duluellrni: 301 — ROUGH PLUMBING . t] 302 - TUB & OR SHOWER it end will maintain aCeNf.k efCo mat k self-hams for Warker's Compe t. ufan,u provided for by Section T7M of the Labor Cade.for ate performance of the 303 — ROUGH MECHANICAL workrarwhichthispermitisiataed. 304 - ROUGH ELECTRICAL o�oesteZ�Iwrcam orthaan Nmee fn .mlrefnefooreinth°permbiamuea 305 - FRAME My Worker's Compensation lusuoance artier and Policy number art: 306 — HOLDOWNS Po1iry Na'� 307 - INSULATION CE0.77FIGXE MPENSATIONINSURANNE aRERs 308 - SHEETROCK (Then secthan reed not becomplekd if00)permit is foreee hmdrtddORan(SIM) 309 — EXTERIOR LATH mien`') 310 - INTERIOR LATH I artily that in the perfmmmee of a0)work for which this permit Is hound,I shall fat 311 - SCRATCH COAT employ any pen on mmmraas b°come� AE Iters'Compensation Laws olCallforola. eta 313 - ROOF NAIL NOTICalt14./ IL7ti NOTI"WAPPtdCADT:v,aWr making thin Cenificak of Eaempti°n,you should 501 - FINAL ELECTRICAL ENERGY hcromaydhfeci in the Worker.Compensation provisous of an Lala Code,you mum ,J'Zforthwith comply withsuchprovisionsorthispermitshallbe°amcdrevoked, 502 — FINAL PLUMBING ENERGY z0 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby afbm that there becnrmuclim wrong as agency for the perfarmemeuf 504 - FINAL BUILDING ENERGY the 505 - FINAL ELECTRICAL fir Q Lender's Name D,Z IanderaAddreemgreeu 506 - GAS TEST q^ _ U p I miry that I law read this application and sok Nm the stow information Is 507 - FINAL PLUMBING D, 60building l agree ct comply with y city and roomy ordinances and auk tavn rr Wing ro p wndm5barlaaacaroe^dherIIspretia,rrpreca lieearmi,buykdekrapnnthe FINAL MECHANICAL {L7 show-meni&S property for Inspection an purposes 0 F I C (We)agree k come indemnify and keep hay in m 00)City en Cupertino aryusl ql Ihe--es,Jwher"i judgments.come and expenses which eeryin anyvny acct.agalusl WoCily NG in L) APPLICANT UNDEof the RSTANDS ANrouting of D COMPLY COMPLY WITH ALL NON-POINT Issued by:5 C WORKS Date SOURCE REGULATI 0-- - Z Re-roofs Signature afAppl VC`s acror a HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will the applicant or future building aaupemekrt or Nrdie havmdoua material dell by the Cupertino Municipal Code.Chapter 9.12.and the Health end Safety / S�n..25532fi7?yes ° All roofs shall be inspected prior to any roofing material being installed. 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 emlt hoard”.air concomitants o defend by the Be,Area Air Quality Maagemcm all new materials for inspection. Dimrict7 ❑Yes 14NO Its ewmWtheh mummdalsrequimmenuunarCMpkr6.97ofWCalifor nta H.IthBSafmycode.SwU=25707.277T7am1255T4.Imdemmldthmifthd buildng does not currently haw a weenflyalum,it u my msponshility e,nou me aeupmt of W requirements which Ire pdormioumanola Cerda of ropaeq. Signature of Applicant Date er m 4e a en Date All roof coverings to be Class"B"or better C[TY OF CUPERTWO • .,,~arm^( "' BUILDING DIVISION PERMIT ,,CONTRAC„°< Ii�TURMAT ,,, �;9'•.,y, BUILDING ADDRESS: GREENFIELD PLUMBING P`"`TNo03050129 0367 BOT,T.TNCRR RT) OWNER'S NAME: 3513 MADRID DR P®`"LIT ( ' 7/2003 00 WAH L AND SHIRLEY HE (408) 921-8980 SANITARY NO. CONTROL NO. ARCHITEC IENOINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u00 LICENSED CONTRACTOR'S DECLARATION JbDescription 1 hertby of on that 1 am licensed under proo visions of Chapter 9(commencing n wiNSecllon703,C)of Division 3oftho Buai7antl Psufcssluns Cade,and my licenmb In fall eCIA lid t. / ` WINDOW REPLACEMENT LmnmG1 FINALaaE® Dam Can ? ARCHf1E7TSR I g�2 (�� Iundcrsund my pluu shall ho uudu public mcnrN UL 4'Z003 y 777 5 wct Licensed Professional J ^ OWNER-BUILDER DECLARATION 9 E 1 hereby.(Sore mel I ammexempt from the Cammustor'sCCu c:An C ty O for the ®lJ�lraD�NG is LI O following mason.(Section 7 I3,Business and Prafeasium Code:Any cm or County '�$_ which its iresinu•permit re coma rho,alcor.i,for f,tlemmWt,or,a sig any strucauumemm Sa Crimenits isssed perp rt to theaapCRcantfmsmhpermittoicece Lawdaummenl MID —�C feel he escingwitpursuant to the of Doions of me Conus uss nd Professions (ChapterCode)or Sq.Ft. Floor Area $ Ip$t10n Sp$ that he exempthhedfromaion ndIs basisofroftWeged exsantlon.Anynvi Code)of 3- Nel he is exempt therefrom slid the hula for the alleged exemption.Any vlola06n of session 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of er O 0 Occupancy Type trot more than Rw hundred dollars(5300). b I,u.oft.plopeny,or my emplayces with wiles as theb mm meapenanma, will do the work,and the structure is not intended or offered for sale(See.Man,Business T U I — e 1 - And Pmfesslans Code:The Contm mss License Law Fees not apply to an owner of 102 - PIERS d Inspections property who but Ida or improves thermn,and who does suc h work himself or through his awn employms,provided that Cush Improvements are not intended oratfered formic.If. 103 - UFER however,the building or improvement is sold within on year of cmnPletion.the owner- Wilder will have the burden of proving that m did trot Hund or improve far purpose or 104 - REBAR van')' 105 - ANCHOR BOLTS ❑I,as owner of the Company,Are exclusively contracting with licensed co tractors to 10 6 - SEWER & WATER construct the project(Sec.7044,Business and Professions Code:)The Contractor's U- censeLawdoesnouppiytoanownerofpropenywhoWildsorimprovestherom.and, 202 - UNDERFLOOR PLUMBING L�mLa Law. nuchproktewith econamr(s)licensedpurswnitotimConnmars 203 - UNDERFLOOR MECHANICAL Ann' ❑I exempt under See .Bre PC for this reame, 204 - UNDERFLOOR FRAME oar Date 205 - UNDERFLOOR INSULATION WORKER'SCOMPENSATIONDECLARA ON Ihemby anirm under penalty of per)ury one of owing dedaretions: 301 - ROUGH PLUMBING I have and will main WnaCmdricamorC...t uuse161mumfm Wmkm'sCompem 302 - TUB & OR SHOWER wren.an provided for by section 3700 of use V Wr Code.fm the Performance of Bre 303 - ROUGH MECHANICAL km warrwhichthisPermit1.iaaaed. 304 - ROUGH ELECTRICAL ❑1 have and will maintain Workers Compensation Insurance,An required by Saetion 305 — FRAME 3700 of the Labor Code,for the performance of Ne work for which this permit Is issued. My Worker's Compensation insurance,canter and Policy number era: 306 - HOLDOWNS Policy Na.' 307 - INSULATION CERTIFICATE OF E%EMPf10N FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK (GAssexttonnend rothecomplemd ittie permit is foronchundieddoBsrs($100) 309 - EXTERIOR LATH arIC3`) 310 - INTERIOR LATH I certify that in Lisp performance of the work for which this permit is Wood,I mall not areployanyxman alaxeran WibecomesubjecttotimWorkers'Compensation 311 - SCRATCH COAT Laws of Csliromin. am _ e 'g� n 3 APPne _.. &n 313 - ROOF NAIL Non,CWf�'ry}APP A :If.a rmakingthis CcnlRcamofExemption.you should 501 - FINAL ELECTRICAL ENERGY bectran fml he the Worker's Compenulion previsions of the Labor Code,you muss .J6 forthwith Comply with such provisions or this permit shall Wdeemedmvokca. 502 - FINAL PLUMBING ENERGY �y CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY [-a4 1hereby alfumchat more I.acomtmctionlending agency for the"fmmemeuf 504 - FINAL BUILDING ENERGY the work for which this permit Isismed(Sm.3097,Civ.C.) 505 - FINAL ELECTRICAL W 1<ndors Name aZ LemlesAddmss 506 - GAS TEST V O I eenlfy that 1 have mad this application and auto mat the @ban infmmodun If 507 - FINAL PLUMBING Ike. correct.1 agree to comply wife all city and county ordinances and amu laws misting to w O building consction.and hereby Authorize mpremmativeaofthis city toenter upon lhc FINAL MECHANICAL W shove-mentioned property fa inspection purposes F I i F1. (We)Agree to save.indemnify and kap hanceleu the City of Cupertino against rfn liabilities,judgments.euts and expenses which may in my myaaroeagainst WdCity A NG V 7 in consequence of the Starting of this Comfit.r1• APPLICANT UNDERSTANDS AND)YfI.L COMPLY WITH ALL NON-POINT Issued by:5A C WORKS Date SOURCE REGULATIONS, f`j..''— C'— � 2- Re-roofs ;Signature ofAppl' ✓ComsacmrHAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant m future building ocapantamm or handle hawdous mamoial Rncd by the Cupertino Municipal Code.Chapter 9.12.and lie Health ad Safely ,Se❑ction25532(,)7 t aAll roofs shall be inspected prior to any roofing material being installed. Will the applicant or f�m building occupant arae equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hav dnus air commatmnu as dented by the Bay Area Air Quality Management all new materials for inspection. icty ❑Yes 4Nu 1 have mad the hvardom materials mquimmcnu underCha Har 6.95 of the Califor. nix Health I Safety Crede,Secilam 25505,25533 and 25534.1 omemad tout If the building Jap not currcnlly hovea mmn at it ix my ]h it to Hai' to omupAMOCO. mqulrtmcmx which a,An prior m ivssuance Lar.ceNnpma mpan<g S i gnatu re o f Appl icant Date crura Ihonxedagen Dam All roof coverings to be Class nBn or better WFEE CUPS aa, gip, w� • APPROVED n ACCORDANCE ITH THE C Oh kl ✓�`Q CUPERTIN AND 0 1 CES QI )ATE ,IONED -------r--�" 'is set of pian nd specifications MUST je kept on the job at all times and it is un awful to make any changes or alterations in same without written permission from e bu,.ding Dept., City of Cupertino. he stamping of this plan and specifications D n 0 HALL NOT be heid to permit or to be ao lG op oval of the violation of any provision' a,v fits Oidmance or State Law. 'Y 2 7 2003 By • SUBMITTAL CC*Y OF CUPERTINO h2q ®�" CUPEkTINO PERMIT APPLICATION FORM -�I+ � 50 50 N# Date: Building Ad ess: Zo3 � o Owner's Name: J Pine #: 4 4,00 Contractor: ' ense #: 9 Contact: f Cupertino Business License#: u Bui rmit Info: 13 Elect ❑ Plumb ❑ h ❑ Job Descnptio ec Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING 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 <= 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 BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of t • Y OF CUPERTINO oDc o- PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 BOVERTIlvM Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE 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 Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pipe PLUMBING BPWHEATER Water Heater/Vent 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 BREM3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I 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 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEI,TINO Quantity Fee ID Fee Description 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 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 Insection 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 4 3 of 3