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04030202 (2)
CITY OF CUPERTINO a *:xt« k :� rF` BUILDING DIVISION PERMITCONTRAGTORINFORMATIO� BUILDING ADDRESS: PERMIT NO.04030202 4030202 a OWNER'S NAME: PERMIT ISSUE DATE SINGH MEC'KER ONE: SANITARY 0 AOL NO. ARCHITECT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH upp LICENSED CONTRACTOR'SDECLARATION Job Description U 1 numb,aRrm that I am licensed under provisions of Chapter Y(commencing wish Sayan]Btl0 fn*vision3ofde Butineuaggmtusiona Cale.andmylianxu ^�d in full forte a fm, ✓7`�r tVZ INSTALL LIGHT & J BOX j'q= Lpccnnc Clu L— /�I.ic. � ARCHhECTS DEC ON -' CONTRACTOR: DIABLO POOL SPE4irAJv�T �2© . ex understand my plans shall be used es ' Zums ; G Licensed Professional SES 2g 2004 3 OWNER-BUILDER DECLARATION 1 hereby affirm Sal 1 on,exempt Wm tlM Contractor's License Law for she OO following Moron.(Seetiun TID L5.Businessand Prefassiuns Code:Any city or aunty �aM ll Ron I m which mquirrs s permit rex eonswcL alMI.Immune.demol W,or Mixon any structure R'lis rmi t>nGA prior to its issuancc.abm requires Neapplieaut for such permit to flea sigoedmacrum �z< that he is licensed puts uanuo the pmvisi.m.1'th.Cmurectcos License Low(Chapter 9 Sq. Ft. Floor Area "ValU5t dYf375 OH$ (commencing with Section 7")ofDivision]ofthe Busineuand Prefessi.ns Code)., t _ that he is exempt therefrom and de,basis for the alleged exemption.Any violation of Section]031.5 by any applicant for a permit subjeou the applicant to a civil penalty or APN Number Occupancy Type not mart dun fiw hundred dollars ❑I,uowrcerofthepmp,ny.mmyemploymwithwaguutheirmlecomp,nudon, 35702002 . 00 will do tbework and the swmare is maimmmudcd arofrered for sale(SeeJO44.Business and Professions Cade:The Conuacmes Lkense Lew does nor appy to in owner of Required Inspections prepeny who builds or improws thereon,and whodoesamh work himself orthonugh his own employees,provided rhos such imProwments art nor intended oroQered forule IL however,the building or improvement is sold within ane year or completion.Ne owncr- builder will have One burden of proving Nas M did not build or improve for purpose of .Is) ❑1.u owner of Once property,am exclusively contracting with licensed contractor us consumer one project(Sec.]Ma,Business and Professions Cade:)Tho Contractor's W- com,Law does not apply to an owner of proPerry who Wilds or improws charter,and, who contracts for such projects with a conuacror(s)Iiccmed pursuant to the Contractor's License Law. I am exempt under Sec. .B k P C for this much Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby sufirm under penalty of perjury One of the fallowing dalarations: 1 have and will maintain a CeniBwte of Consent to self-insum for Wa luir'sComPon- aation,as convicted for by Section 3980 of the Labor Code,for the performance of the work far which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,u mquimd by Section 3]00 of the Labor Code,for the Performance of Ne work for which this Permit is issued. My Workcr''ss Compensation Insurance carrier and Volley number am: C JJI�4 ; Policy No M 'CERTIFICATEOFE%EMPr10N 0 ORKERS' COMPENSATION INSU NCE (Dissection need not bechmplc¢d trtha Permit is(munc hundred dollars(SIM) or leas.) T ccoify that in the perfom once of Ne work for which this Permit is issued,I shall not employ any Person in any manner se as to become subject to the Workeri Compensation Laws of California.Dom Applicant NOTICE TO APPLICANT:IL after making this Ceronem,of Exemption,you should become subject m use Worker's Compensation provisions;of the Labor Code.you most ,J 2 forthwith comply with men provisions ar Nis p,rma shall W deemed Mmked. zO CONSTRUCTION LENDING AGENCY I-. 1 hereby affirm that there is a couwctinn lending agency for the p.r(mmance of > the work for which Nis permit is issued(Sec.3097,Civ.C.) {Ll A Lander's Nam. C lenders Address U O 1 anify that I haw Mad this application ase a.M dist the shout information u "P Carta I agree M comply with ill city and county eNloarccs and sum laws rtlming th 0U Wilding construction.and hereby suthono,mpmsenutbes of this city to chief upon Me r G above-mentioned preNry for inspection purposes. (We)agree to save,indemnify and keep homeless the City of Cupertino against �F.h limila.judgments,cosm and cxpcnms which may in any way wento against mid City t"T U Z APPLICANT eUNDERSTANDS AND rWILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCEideREGU T NS. Aya —�31Re-roofs .Woatuol'Applicano'Cqu4sern Da¢ HAZ DOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or fmure Wilding occupant nam or handle hatmous material as defined by the Cupertino Municipal Code,Chapter 9.12.and the Heart and Safety ANILCmir.Scetiezss3zra)? Yes IN. 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 emit hmardnus air cmtu nirxuts as de0ncd by the Bay Arta Air Quality Management all new materials for inspection. Dismicc? ❑Ye No I have mad the bnrdous materials requirements undcrehapler 6.95 of the Califor- hiaHcalth&Socsty Cod.,Stevens 25505,25533 and 25534.1 umkrs, thasifthc building does not currently haw,Mnam,that it o my responsibility m notify a .."Our of the m Mmcntawhir xMet Poor toissuance cis rCMCIC,Mora ana Signature of Applicant Date 04 a,A., 7 Za All roof coverings to be Class"B"or better ner or mthon=gchoJ Do¢ _ Community Development 10300 Torre Avenue y. Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPERTINO Building De artment JOB ADDRESW PERMIT # 6 f 05 U D �;S - O JL OWNER'S N ;n) 2� PH #yob GENERAL CONTRACT FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin information 66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical (o ad R 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 D v �( . '.0" t ) ✓ ? -23 '2�1 /Contr1tor Signature Date CITY OF CUPERTINO C'TMOF PERMIT APPLICATION FORM CUPEkTINO APN # Date: Building Address: Mailing Address (if different from building address): Owner's Name: Phone #: L-I c Si'IJ - 1iUl c,e Q r Z Contracor: License#: �� oo l eu i t 8 20 Contact: Phone: e1z 5--- 455-;54i5)Cupertino Business License#: G DQ a-K_ Fax: Building Permit Info: �/ Bldg ❑ Elect Iq Plumb ❑ Mech ❑ Job Description: Residential C, w - (t 'i-co J( 6 6p Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction Please check this bo 'f the ect is a second-story addition: LJ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BB01LERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK 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 > IOOOA 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 6-2 O7cf . lr. 'CC CITY OF CUPERTINO CITY Of PERMIT APPLICATION FORM CUPEkTINO -Quantity Fee ID Fee Description Fee Group BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTME 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 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 Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 c8n MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace > IOK 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 BR.EMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL 2 of 3 SRI,, CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity- Fee ID Fee Description Fee Group 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • • 3 of 3