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03040107 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT RMATIOW,, CONTRACTOR"1111 1Td'6'96't!RVER DR GE ASH JOUNG PERMIT NO.03040107 All�ff_"99YI: JOUNG 10660 CARVER DR PERMIT TSS[IdaA)1�1/2003 NE: SANITARY NO. CONTROL NO, ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG, ELECT PLUMB MECH z LICENSED CONTRACrOR'S DECLARATION EEI C r7 r,—A'Pob OesVri�ti@b I bronclay affirm that ..It need under previsions OfCmPICr 9(Commencing I.fall force awl,ffmL Lima.Class-La.N KITCHEN ODEL Dow Contractor ARCHrrEC7S DECLARATION I undaraland my pians shall k used 0 Public records, Licensed Professional OWNER-BUILDER DECLARATION 0 i�x I hereby afflarn that I am exempt from the Contractors License Law for the :0 2following miscon.sation 7031.5,Business and Prorcearions Code:Any city at county which"Wris. .it to cwtuaii,after. &.0ish.Or.,air an,armus. un poor to its issuance.also mquims the applicant rOr Such peranii to r0c a signed SiAmotern _� thea he is licensed Pursuant to the provisions of the Contractors Loome,Law(Chapter 9 Sq. Ft. Floor Area $Y�Oi6ion ga (mooncocing with Section IBM)of Division 3 Of the B usimos and Proafessions Com)or that he us exempt therefame Ind be beris for ft alleged exemption.Any vi.l.tan of Section 7031.5 by any applicant for a permit Subjects due applicant to A Civil PCOARY Of ;1 0 five hundred dollar,S5WL 3 4811 N9111*1 0 0 Occupancy Type �,M�f-w'cor of the property,or my employees with wages se andf SOIC COCIPCOM1011, will do the work.end the sumcum,is not intanced or offend for saic(Sec.7044.Busions, - FOUNDATej6Wd inspections Ind I'voreshmi Codi TV Concoactor's Licands,LAw does ne,apply to an owner of 101 Property he build,.,I.,..Ih,.n,.nd he dco.nm unit Itionself.,thangh his 102 - PIERS own camployces,provided that such improvements are not intended aroffroad forrale.If. however,the building or Improvement Is sold within am year ofeamplelion,the owner- 103 - UFER builder will haw the must of proving am[M did not Wild or improve for purpose of 104 - REBAR sals). C)1,as Owner of the pimpen,,am exclusively contracting with licensed contractors to 105 - ANCHOR BOLTS consumer the pmjccL(&a.7f4a.Business and ftforsions Code:)To,consent's Li. 106 - SEWER & WATER Came Law does no,apply to an Owner of propeny who Wilds or improves;darmon.and who contracts for such predicate with a comomer(s)licensed pursuant to do,Contamtor's 202 - UNDERFLOOR PLUMBING Lumsel-a.. 203 - UNDERFLOOR MECHANICAL [_] am exempt on r cc. B&P C for this nation 204 - UNDERFLOOR FRAME owner Data- I WORK ER'S C04�JNSATIWECLARATION 205 - UNDERFLOOR INSULATION I hereby 0ion under Penalty of pedury am of the following declarifionev. 301 - ROUGH PLUMBING law end will maintain.Coniffeato of Consent to SCI NOROM for Worlar's Comper- 302 - TUB & OR SHOWER tima,u provided for by Section 3700 of the Labor Code.for ths perforroonce of the w"' "a work for which this Permit is usentead. 303 - ROUGH MECHANICAL E]I haw sad will maintain Worlaers Compensation Insurance.as m4uimd by Section 304 - ROUGH ELECTRICAL ///Z 31v_3 37M of the Labor Care.far on,patfunnamm of am work far which this poor it is issued. 305 - FRAME My Workers Compensation Insurance carrier and Policy number am: 306 - HOLDOWNS Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 307 - INSULATION COMPENSATION INSURANCE 308 - SHEETROCK mosecc,toor wed nothecompletediftlac Permit is for one hundred dollars(SIM) ...OIL) 309 - EXTERIOR LATH C/� I C,mfy last in th. ornowwo of no work far which this Permit is issued.I shall at 310 - INTERIOR LATH employ any person in any reenact an a or become subject to the Workscre!Compensation 311 - SCRATCH COAT Law fC.1ifionle.Dow A,Fplinttl 313 - ROOF NAIL NOTICE TO APPLICANT.If.after trikint this Ccruificae,of Exemption.you should boucome Ubjw W the Worker's Comaccourawn Provisions Of the Lator Coda,you am 501 - FINAL ELECTRICAL ENERGY z forthwith comply with such provisions or this Permit shall m dccmadl mwimm. 502 - FINAL PLUMBING ENERGY zo C7 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY 5.1 1 hereby affor that them I,,Contraction lending agency far the acrgoonswo or ace work for which this parmit is issued(Sm.�,Civ.C.) 504 - FINAL BUILDING ENERGY r) Lender's Name 505 FINAL ELECTRICAL Under',Address 506 GAS TEST I canify dust I he.read ads application Smi UAIC that the show information I. contract.I agrm to comply with all city Ind county Oldiiaramas Ind Saw laws misting to 507 FINAL PLUMBING D U thinking construction,Ind hereby authorim acrommialins,of this City to enter upon ffic 'hove-mortionct!prorcrty for Inspection purposes. 61C� FIN L MEC ICAL (We)agree to saw,indemnity and loop hormalm ft City of Cupertino against FI Hathlitics.judgroma.mns Ind copenseas which may I.say way amom against said City OA M Z in Consequence,of due gainfing,of this permil. �5 NG APPLICANT UNDER 14.1`11:1�00MPLY WITH ALL NON-POIW Issued by: 99NWORKSDate SOURCE R ULATNNIS. C J"6::��) — Re-roofs (�;7 Signwurc of AppluarnorCom 'g or am HAZA=RDOtU1YATERIAaISCLOSURE D Type of Roof I to Will due applicant Or future building occuman"ore or handle hionous material E:0 a' , as dtfood by tho Caperton Monte P Code.Chapter 9,12,and the Health and Safety P Or ;CW..Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed. [Dy. I Wi It 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 a 'a a it,hwardous air Contaminants as d.lamd by the Day Area Air Quality Management all new materials for inspection. OYCS ff<O Ih...dffi�h.,Ard...awHalsmq9immenuundcrChipWr6.95afLhcCalifor- sodding does not Currently haw a board,th I It's man... a amity the Weapon,of are met;or W ifj_E_2=yr an,of Occupancy. malum, Signature of Applicant Date F�4 All roof coverings to be Class"B"or better kth,or authorized agent ---a,- ont CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO VFAPN# 3 7�— 7 Dale: Building Address: cn- Owner's Name- G —0 \J Phone#: cifq-!J�S— �— Contractor: License#: Contact: --�oQw-f*eowAw W f Cupertino Business License#: Building Permit Info: lewqsw --4Zr,,-., K, Bldg Elect Plumb Mech Job DescriptP Residential Commercial El 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 Permit sq. foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to I M Btu MECHANICAL BBOILER4 Boiler> I M 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 <= I OOOA ELECTRICAL BELEC1001 Elec 600V > I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BULDrNG i ?, � 66� I of 3 z , 7d' CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO 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 BNLJCOMMP 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 Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDfNG BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM StormlRain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER InstalUAlter Water Pipe PLUMBING BPV,THEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN AJC Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BRENEURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL lob BRENfNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Ak Quantity Fee ID Fee Descripti6n Fee Grou BREMPOWER Power Device/Apparatus ELECTRICAL 13REMRECEPT Rcptl, 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 ELECTFLICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems —MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSETSMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECLkL Special Inspection BUILDING BSWM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTENIPPERM Temporary Bldg Permit BUILDING BTENDSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITHE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3 of3