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03050064 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT ""CoNTRACTOR INFORMA'IaI, alllLIDDINGADDRESS: TIETZ GARY W AND MARY V PERMITNO003DO50064 1052n rAqTTTjF. Air OW NER'S NAME: T�(J 5A15/Z 003 TETZ GARY W AND MARY V SANITARY NO. CONTROL NO. NE: ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 a�ip0 LICENSED CONTRACTOR'S DECLARATION Job Description w❑ I hereby a( no Net I am licaased under provisions of Chapter 9(commencing P of the, 3 of NC Business and Prefessions Code.and my license is iW with Secdon]IXIU) in full License Cleandefrcca WINDOW REPLACEMENT �tRZ License Class Lie.N Zr, Date Cantrmmr ARCHITECTS DECLARATION I understand my plans shall be used u public mends 7 ;offX01 Licensed Professional , 01 OWNER-BUILDER DECLARATION ez� I beach,.(Sere Nat 11.,exempt from the Carvne;Co License Law for Ibe OF. o following reason.(Sada 1 700 Lr Business and Pm demolish. Code:Any city m county m which its u issuance.permit a cnnswa.alter,improv,h permits or repair any swmum 41lPnaor riaslensepalmantto the provision of for Contractor's onrarmllto EICse Laed w(Chapterstatement ,�c (commencing tmencttascd pursuant la the provisions of of tho Btmcmr'andPrsrlaw(Chaptery Sq.F[.Floor Area 63V��I�tlOn pF$ (cat be I,exemptb therefron om and theof ivas for of the alleged! Business mod on.Any Coda or 77 that he u exempt therefrom and Ibe baso for the allcge0 exemption.Any violation of Sa3on 7031.5 by any applicant for a permit subjects the applicanuo a civil penalty of 32R4T4QiMcr00 Occupancy Type not mon Nan two hundred dollars(5500). Lo tho work(the pmpcny, re is intended with vngessstheirsa.comps mdan. will Pr Newark.and the ax ComisnolLicense row donted not apply town oris•-(reas dins eCC10D5 a,d Profusions Coca:The ConuacmrS License Law doer not apply to an owner is 102 — PIERS P Own employees. builds or ed that well t ll impr and who dacasuch work himsel offered M1f. however.the Wilding that wcM1improwmentstiemyonot undedmlaumd for tole. , 103 — UFER however.the building or improvement is sold within arc year or improv far purpose owners builder will bow the buNca of paving thn he aid nm build er improv fm poryose of 104 - REBAR sale)' 105 - ANCHOR BOLTS 0 1,as owner of the progeny,am exclusively contracting with licensed convectors m 10 6 — SEWER & WATER construct the W e project(Sec 7d.Business and Profusions Code:)The Contractor's Li ase law does not apply in an owner of property who builds or improv Ihemon,and. 202 — UNDERFLOOR PLUMBING Lwaiha� Wu for such pmu jccwlNeconmaor(s)Iiumed pursuant to de Canvuloh 203 - UNDERFLOOR MECHANICAL am caemp under See .B&P C far this won 204 — UNDERFLOOR FRAME re ° .3 205 — UNDERFLOOR INSULATION WO CER'S COMPENSyq17�T1pDN DECLA 10 wm Ihereby efri ndcrpenalyorperjyplone or emuowmg as dans: 301 — ROUGH PLUMBING I have and will maintain a Cenlli teof Contin to self-inxure forwarkers Campcn 3O2 — TUB �s OR SHOWER salion,as provided far by Sadon 3703.17 ate labor Code.far Nc performanee of the 303 — ROUGH MECHANICAL ware for which this Permit is issued. 304 — ROUGH ELECTRICAL 0 1 haw and will maintain Worker's Compensation Inmmnce,u acquired by Section 37()0 of the labor code for the performance of the work for which this permit is Issued. 305 — FRAME My Worker's Compeuadon Insurance carrier and Policy number are: 306 — HOLDOWNS carde Policy No.: 307 — INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 — SHEETROCK Creis acelm.needmi be completed if Ne le.I,is faros,hundred do][.(SIM) 309 — EXTERIOR LATH OrI'm) 310 — INTERIOR LATH 1 certify that in the performance of the work for which this Permit is issued.I Abell not 311 - SCRATCH COAT employ any Noton in my harborm u m became subject to the Workers uad Comperon Laws of Cahfomia Data 313 — ROOF NAIL Applicant NOTICE TO APPLICANT:If,after making this CeniEcata of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject in the Worker a Compensation provisions of the lobar Code,you must �Z forthwith comply with much provisions or this North mail be deemed revoked. 502 — FINAL PLUMBING ENERGY zCONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY 1beauty efrom that Nem iso caavuctim lending agency far the Pc,(am.of 504 — FINAL BUILDING ENERGY 2' > Ncwork for which this Permit isissued(Sec.3()97,Civ.C.) 505 - FINAL ELECTRICAL W Q Under'e Nam, 4 Under'sAddress 506 — GAS TEST >.z CJ O 1 certify that l law read this application and nate that the above information is 507 — FINAL PLUMBING caeca I agree to comply with all city and county ordinances and sure laws aladng m O V Wilding construction.and hereby authodae repreunulivu of this city to arm,upon the, FINA MECHAN CAL r W abovcmentiuned property for inepcedon pmpess O9 FIN F gy (We).,Me to rove,indCmnify and ace,hIIrnl.NC City of Cupertino ag.i.1 y Imbilides,judgmi costs and expenses which may in any way secret,against mid City 5 A G V z APPLICANTerDERSTANDSthis AND WILL COMPLY WITH ALL NON-POINT Issued Ii WORKS Date I / SOURCE REDYLATIONS �a� u' /L`� Re-roofs reof scar anvartar //� r, ARDOUS M RIALS DISCLOa RE Type of Roof Will too appl lar future buil ng Occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code.S❑doo 355 (.)? NaYesAll roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building omupmt use equipment or dcvima which If a roof is installed without first obtaining an inspection,I agree to remove ,mit nazardnus air conami arta az dcOncd by d¢Bay Area Air Quality Managemcm all new materials for inspection. cam,Cl] ❑Yes NO \ I have mad the hamrdrms materials mquiremems under Chapter 6.95 of the Califao- nia Health S,Safety Cale,Sections 25505.M533 and 25534.1 understood Nazifthe building does not eunenrl haw a tenant.Nat il'u my rupoaaihilitY m notify dte oaup ar dre require a mug bcmerprip[_ '••u aar.crrdRaarearacapm`y. Signature of Applicant Date /g. Owner or authcri7e rat Data All roof coverings to be Class"B" or better C(l ATY OF CUPERTINO SI 3 -a-0 6"� CITY OF PERMIT APPLICATION FORM D CUPEkTINO APN # Date: 's Building Address: i /q VE CUPrRTIN0 CA 95JIy /0 6& CftSTIN Owner's Name: Phone#: MARY 4-GARY TiETZ A/o8 733 oyiy Contractor: License #: Q to ri e4" Contact: Cupertino Business License#: B uTg Permit Info: Id Elect ❑ Plumb ❑ Mech ❑ ob es 'ption: ReP�cu$ /I Sly a pomp u1Lft Iru�s (m a lwnC W t // g �2ylei Res ntial ® , Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: #3705 -fb,- rjlct; UHjdAwS Occupancy Group: Type of Construction: Alcoa on PvW ^ 4eco $u�A,I9 RCJVA 2, Quandt 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 1of3 '- tTY OF CUPERTINO CITY°FPERMIT APPLICATION FORM I�TINO CUPE 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 13NEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL 13NUCOMMP 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 PbIg 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 rinklcr/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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI �Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDCT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> 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 2of3 � - CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO 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 • 3 of 3 ' L I i ! ` ! I i I l I_� I i I �r�,-rfr✓� !z�i�-!��% �!� I ! �� ! I�_I_ I I- f I I � I _ i i I I _I I___! I i I�•�L I_ � I ! I i i � I I I— I. ---------- -0 F10o r i 4 I �— I j I ---- I ! ifbE —T 11 - I � 1 P - 1 1 I I i �—I—; i i f—.�---i�—I - I � I I �i • i f 6o- _ - _ r — �! I 1- tncinVE ETHE CITY Qfl I I I P hlTnie 1 _ = �mand I �nz es i is up�, — -- r ---- h -'"— �Da�aP — _�_ +i I ma4e any change¢ oGf alteta u -- —i-- —I ►��+ plihnnt IN mi of _ cup nor i dFe Dail iag cf t�lis plan and spec---ifiatlons>—i I- --- - ! ;H ll rOT!be V1S�006 I gt_any P� • I Ci`h_bldinancO or.$tte'la�Y -- -�—i—T-�-- =;—i—i--I--'—r—I —�--•—;—!--+--�--�_,}�rt_v_ __:..—;—_! I 1 I- 1 ! CITY OF CUPEWfINO "^�'- '� t"✓'"e `er .�'s� BUILDING DIVISION PERMIT '0 NTRAC�TOR�INF�ORMATION BUILDINGADDROS: TIETZ GARY W AND MARY V PERMITNO03050064 7AROCIATTECTIENGUNEER' ER'S NAME: PERMIT`'I(TATE52003 ETZ GAR W SANITARY NO. 1 CONTROL NO. E: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 0 0 +0' LICENSED CONTRACTOR'SDECLARATION lob Description with 0"C I hereby affirm that I am liaved under provisions of Chapter 9(commencing U Section TOM)of Division 3 of the Business;and Professions Code,and my license is -,y in full mroeand effect. WINDOW REPLACEMENT T at pq? Dianne class Cie.0 = Comp p Dam Commcmr ARCHITECTS DECLARATION i 1 understand my plans ahnll W used as public mcerds JyU C G Liccnud Professional 5 OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contra.ors License law for the no following reason(Section 703 L5,Busiuss and Profession Code:Any city or county sza S� which mquias a permit to construct.alter,improve,demolish,or repair any mructu e v-'^ prior to its issuance.also rcquims the applicant for such permit to Glc a signed statement ��< that W is licensed pursuant to the peovisimus of the Com eacwr's Lieu sc law(Chapter 9 Sq. Ft. Floor Area $JN�b Stion 'ti-$ (commencing with Section 7")of Division 3 O the Business and Prorcesium Core)or E N_ that he is exempt(hent'om and the basis for the alleged eumption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3 WAT40crO 0 Occupancy Type not ream than five hundred doll..(5500). 0 1,as owner of the property,or my employees with wages as their sole compensation, will do dw work.and the structure is not intended or offered for sale(Sec.7044,Blriness iui - and Professions Code TW Contractors Liave Law does not apply m an owner of 10 2 - PIERS d Inspections propany who builds or improves thereon,and who does such work himself or through his Own employes,provided that such impmsements art not intended eroffered foraale If. 103 - UFER however,the building or improvement is sold within one year of completion,the owner- builder will have the Wrden of proving that he did not Wild or improve for purpose of 104 - REBAR sale.). 105 - ANCHOR BOLTS I,u Owner of Ne propeny,am exclusively contracting with licensed centfacloms to construct the project(See.7o6d,Business and Professions Code:)The Contncmr's U. 106 - SEWER & WATER ante law docs not apply to an owner of propeny who Wilds or improsss thereon,and 202 - UNDERFLOOR PLUMBING LhcnrcnLaWu for ouch projects wimacnnuacwr(:)uarrYaPursuant mJm cnntrxmra' 203 — UNDERFLOOR MECHANICAL am exemp under Sa. .B&P C for this reason 204 - UNDERFLOOR FRAME m 3 205 - UNDERFLOOR INSULATION r Wo ER'S COMPENSA N DECLA O / Ihercby afnt�ncar penalty of perj oa of)M following sec tion: 301 — ROUGH PLUMBING ❑l have and will maintain a CcrtiGcam of CbmmL to self-insure for Worker's Compcn- 302 - TUB & OR SHOWER nation,as provided for by Section 3700 of the Iatmr Code.for the peAormance of the 3 03 - ROUGH MECHANICAL work for whichoirPermitisinuad. 304 - ROUGH ELECTRICAL ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 37W of the IaWf ends.for tha performance of the work for which this parmil is issued. 3 05 - FRAME My Workers Compensation lnsupram carrier and Policy number am: 306 - HOLDOWNS Carrier PolicyNo.: 307 - INSULATION CERTIFICATE OF EX EM MON FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK (This secdcn need not Weompleted lithe Permit is formic hundred dollars(SIM) 309 - EXTERIOR LATH .,it.) 310 - INTERIOR LATH 1 certify that in the Performance of the work for which this permit in issued,I shall not employ any Person in any manner so as to become subject to the WorkeffCompertsation 311 — SCRATCH COAT Law ucanE iromia Date 313 - ROOF NAIL NOTICE Ncome subject APPLICANT.r's co makingthisvisinsBOf of E aIncir odk.yuMulJ 501 - FINAL ELECTRICAL ENERGY Wceme subject y it Worker's mCompensation provisions of tii Im d Cook.you must .JZ roMwithenmplywithsuenprowiinonorminparmitmanxaamarrew,kad. 502 - FINAL PLUMBING ENERGY zo CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY (:.L' IWmbyalTvmthatft.isaconstruction binding agency for theperfonnenaof 504 - FINAL BUILDING ENERGY G'> that work for which this Permit isissued(Sec.3097,Civ.C.) 505 - FINAL ELECTRICAL U.) Lendcri Nnmc = z <ndersAdrrcss i GAS TEST1 ccnify that 1 have read this application and sum that the shove infomation is FINAL PLUMBING correct I agree so comply with all city and county ordinances and state laws relating to Wildingeommouction,andWn:bymubminerepresentativesofthiscitytoenteruponft FINA MECHAN CAL abovcmemiunrb property forimpecdon purpnsez FIN11(We)agree to save,indemnify and keep harmless the City of Cupertino againstliabilities,judgments.costs and expense which may in any way aame against said City A GU Z, APPLLIICANTaof due DERSTANDS Asuding of Is Permit.ND WILL COMPLY WITH ALL NON-POINT Issued by: WORKS Date (/ SOURCERE ATIONS. I dal /` Re-roofs Si urtofA lican onuutar ��// bc ARDOUS M IAIS DISCL06(IRE Type of Roof Will the apps torfutureWil ng occupant store or handle haadous material as defined by Ne Cupertino Municipal Code,Chapter 9.12,and Ne Health and Safety c.SectionoYon 25532(a)7 �A o 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 bmardom sur omtmr ts.defined by tW Bay Arca Air Quality Management all new materials for inspection. District' ❑Yes No 1 hate read the hvaNtws mamriaH rtquirtmcnts underChapter6.95 of the Califor- niaHcalth@SafclyCodc.S d..25th)5.25533and25534.1un@.Orbthaifthe Wilding docs not Correnti hoax a¢.ant that it u my marmolhility m notify Ne scup of Na mquim . . momp r ce:n aofacen"""facepancy. Signature of Applicant Dale /I. C,pr.nthona nl oam All roof coverings to be Class"B"or better