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03100161 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT COFORMA NTR?,CT.nR=INTION BUILDING ADDRESS: CRW INDUSTRIES PERMIT N`03100161 11171 BUBB RD OWNER'S NAME: 1157 DELL AVE. PERMIT ISSUE DATE KING HARRISS T AND ILONA J 10/22/2003 ONE: (408) 378-2477 SANITARY NO. CONTROL NO. ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 +00 LICENSED m,ItonCONTRACTOR dmad.,Svimmaa DECLARATION Job Desc 1 ion 70(affirm that I am licensed under and Piomvs of Chhper 9(commencing r�[1[IQ,t1v rs n _zaa with Section 7(1(k1)of Division Jof the Business and Profcssinnx Code.and my license is Ilr�lltl lUlA\�1/1,�1 l� j� i^fall Tote==nd=fife t. :� ,/oggaq PATIO DOOR REPLACEMENT � Lianse— s R. L Lie '1 Dam obi T'S DEmr ATi 2003 \\� ARCHITECTS DGC1,ytATIONt UCS+ I K a 1 o want my plana snail rte used as prtVmcards Lau Licensed Professional p yn��B 'mg OWNER BUILDER DECLARATION Bl�BL®IYV a 8 1 hereby affirm that I am exempt from Inc Contractor's License Law for the 0 o following reason.(Sceuun 7031.5.Business and Professions Code:Any city or county m which ropores a permit to construct,after.improve.demolish,or topair any structure 4 0 0 0 Smi prior it)its issuance.also rcyuimuM applicantfor such permit to file a signed statement -¢¢a that he it licensed Pursmnu0the previsions^f the Contractor's LianuLaw(Chapter 9 Sq.Ft. Floor Area Valuation �Fot (commencing with Section 7000)Of Division 3 of the Business and Professions Code)ur `C Nm at he is exempt torefsoand Bit,basis far der alleged exemption.Any violation of 35620010 . 00 Section 7031.5 by any applicant for a permit subjecu the applicant to a civil Penalty of APN Number Occupancy Type not more man five hundred dollars(5500). P Y YP ❑1.as ownerof the prol or my employ.a with wages as Heir sole compensation, will do the work,and the sesame is nm intended or offered for sale(Sec.70x4,Business and Professions Code:The Contractors Lica e,Law does not apply to an owner of Required Inspections progeny who builds or improves memon,and who does such work himself or through his .we employees.provided thm such improvements am not amended or offered for sale.If. however,the building or improvement is sold within one year of completion,me owner builder will have the burden of proving that he did not build or improve for purpose of sale). ❑1,as owner of me property,am exclusively contracting with licensed contractors to construct the project(Sec.70x4,Business and Profeations Code:)The Contractor's Li cove Law does not apply to an owner of propeny who builds or improves Bureau,and who comraca for such pmjccm with o contracur s)licensed pursuant o Be Contractor's License law. ❑1 am exempt under Sec. .B&P C for this recon 1371W' ner Data WORKER'S COMPENSATION DECLARATION 1 hereby of nor under Penalty of perjury arc of Be following declarations: 1 me and will maintain a Certificate of Consent ulf-imeare for Worlur'sCumpen- an,v provided far by Section 3700 of the labor Code.for Be performance of Be rk for which mis Permit is issued. 1 have tied will maintain Workers Compensation Inaurame,u rbquirod by Scotian of the labor Cale,for the performance of the work far which this permit is issued. Woker's Compensation Insurance carrier and Policy number ate: mer.HsdAIfFJJ SNIT .I(a�XG✓ o.:0110948-2p?a �/ CERTIF 116 OM WORKERS' ✓ COMPENSATIO INSURANCE (Thissection decd not W complced if Ibe permit is for one hundred Collars($NB rz last) I cosily Nat in the performance of the work for which this Permit is issued.l shall not employ any person in any manner w as to berome sub)ccuo me Workori Compcvation Laws of Califomia.Date Applicant NOTICE TO APPLICANT:If,arm,making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the labor Code,you must D forthwith comply with such provisions Of this permit shall be deemed revoked. L O CONSTRUCTION LENDING AGENCY 1 hereby which mal Bete is s ed(See inn lending gooey fnnbe performance of k the work for which mis permit is issued(Sec.7097,Civ.C) tl Q tondo's Nan. 1 Lcndcr's Address � z Q 1 certify that 1 have read this application and sem mal and above information sating is - L F sorted.1 agree m comply with all city and county ordinances and sure laws r upon t to �O building Construction.and hereby authorim representatives of this city menserupnn the abovmmcndoecd property for insbod icm purfmca. y (We)agme m save,indemnify and lace,barriers the City of Catarina against N liabilities,judgments,court and expenses which may in any way accve against said City //fig j z in consequence of the grami ag of this Permit. / (� APPLICANT UNDE ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale I .. _Y2— SOJJIICE RE UL/A/T 3��r '/ ai/6Vryl,: �R�� .tY� Re-roofs Re ApphcaHAZAR cOr Data 1{AygRD0U5 MATERIALS DISCLOSURE Type of Roof Will the a Cupent or furore building e.Chapter star=m handle Health anmaterial az defined by the Cupertino Municipal Code.ChaPmr 9.11,and the Health and Safmy ode,�Ye..ni 25531(x)? �No All roofs shall be inspected prior to any roofing material being installed. Will mea licanl or future building t use equipment or devices whim If a roof is installed without first obtaining an inspection, I agree to remove PP g«cuptin 114 ialitrict?nmardnas air conmminanu u fined by the Bay Area Air Quality Maregmum all new materials for inspection. ❑Yes Nu' I have read the huvaNnus mmcrims regdremenm under Chap rr 6.95 of the CAim, nix Health&Safety Cndc.Secumts 25N)5,25533 and 25534.1 understand mu if the funding does not moment,have a¢noel ma it is my maintainability to nary the occupant of me reqs m bleb , mpriortoistaaneeoraComficamo apmay. Signature of Applicant Date owner caamorivrdag.mt Dole All roof coverings to be Class "Btt or better , CITY OF CUPERTINO SUR- CITY OF PERMIT APPLICATION FORM 3 J J l I CUPERTINO APN # Date: 35620010 /D-22-05 Building Address: 11171 150%38 RD. CuPea7iNo cl5oly Owner's Name: Phone #: NARR�SS K�Nfr 253-(,385 Contractor: License #: yoigeq Contact: Cupertino Business License#: yBaN Qgvvaaso,4 4o8) qa&-oel5 23525 Building Permit Info: BldgLTJ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential 2/Y4vio Voea RVLAcaa%a^11'-AL;Ke foa Auee Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: w Occupancy Group: y ODD—' uc, fa/w Type of Construction: 2 ry wcOP FqAw,-w- 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 z3- -K C> tof3 ta0� O' f - CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group lip 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 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 Pipe PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BRENLkHUiAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY 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 A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMPOWER Power Devi ce/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmd] 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 Inspection 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 3 of 3