03030165 (2) a -CITY OF CUPERTINO "
BUILDING DIVISION PERMIT �,� �-..,* 'r POW,)
' g,, a.
BUILDING ADOILESS: - PERMIT NO.
' DON WADE ELECTRIC CO
I
OWNE PERMIT IS A
16320 HARWOOD RD
N SANITARY OL NO.
(408) 377-2323
ARCHIlECD1:NOINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION
j 1 hemby auum Nn 1 am licensed under provisions of Chapter 9(commencing lob Description
wiNBect on 701D)al Dlvinon 3 offt BurinW rad Profesitms Code,and my llceme u F I N A I®E D
in I.
foram and eRutt
^� �enseClasa LID.0 NEW SPA & ELECT. PANEL (�
e ARCHIIEMDECLARATION APR O 9 2003
�i lea+ 1 understand my puns shall be tared u publicranNs
3 uu..
Licensed Pnneasional
R='o OWNER-BUILDER DECLARATIONeClearnc BUILDING
o 1 hereby.(Siem o n I am exempt from the Conuecm o :Anse Law for the
Oo followingmoon.
ermitiin7031.5,ommoBulinus andve.de an Code:Anycity or county
$ whlrh require a pemtu m UIM the alkt.hnpmse,demolWt,or repair my atroauM
MOr 10 Oat heltsiensedpaln Mgoithe the vision o theCohpermlULAccomo rile a Law
(Chapter
t < womeencing with
punuammthe of Division of the
Dusk" ilJaekulan Chapler9 Sq.FI.Floor Area It� IOM
o that he exempt
S.tion70ndth loulson7 eltheeged cnOldmpt Rokannvi Code)of 7UU
� that he u e=mPr therefrom and the bests for the al1cyW ewnpam Any violadn of --
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofP y Type
not marc Nan Rw hundred dollars(2500). 3 M 3NdT'r 0 0 Occu arse e
❑to owner of the property,or my employee with wages as dubsole compermahm.
andProreewft"*...d flumucture on,Code;The Con Iuaclorsnuanded License law does not appps"iy'to an awnewi 101 - FOUNDAWgtWd Inspections
property wMbulldaorlmposratMeon,are who doetauch work himselfofavuugh his 102 - PIERS
own employee,provided thalsuch Imprommenuare not Invaded wormed funk.if.
however.the building or improvement is sold within one year of completion.the owmer- 103 — UFER
builder will haw the When of proving that he did not Wild or Improve for purpose of
MID). 104 - REBAR
"owner of the Property am"elusively contracting with licensed conbacmn to 105 - ANCHOR BOLTS
comuuct she project(Sec.7011,Business and Proleanoe Code:)The Contractor's U. 106 — SEWER & WATER
coon law does not apply m an own.of property wW holds or improve thereon,and,
who contracts for projects with a comracmns)licensed pununt to No ConmaWs 202 - UNDERFLOOR PLUMBING
License Law.
of mneemptunderSec .B&PCf.dds. 203 - UNDERFLOOR MECHANICAL
Owner -d . "7Yt a.�..,..) oath 7l 204 - UNDERFLOOR FRAME
WORKEERR'S g.PENSATIONDECLARATION 205 - UNDERFLOOR INSULATION
I hereby affirm under penalty of pedury can of the following declantioese 301 — ROUGH PLUMBING
haw and will maintain a Cerdfiak of Consent malr-ware for Wariness compen. 302 — TUB & OR SHOWER
on,as provided f.by Section 3700 of Ne later Cade,for rise performance of the
work for which thispemmieinued. 303 - ROUGH MECHANICAL
❑I haw and will maintain Workers Compensation Insural u required by Section 304 — ROUGH ELECTRICAL
3700 of the labor Code.for am performance of the work for which this pefmitis Issued. 305 — FRAME
My Workers Compensation msunnce ani.and Policy number are:
Card": Policy NO.: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS 307 - INSULATION
COMPENSATION INSURANCE
(nu healon meed all tecompkkd lithe pemtil U forcoehundfWdollan(SIM) 308 - SHEETROCK
.len) 309 - EXTERIOR LATH
I costly that the performance or the work for which this permit is found,I shall not 310 — INTERIOR LATH
employ any person In mynormal an as in become abject man warlmrs'Compenuaan 311 — SCRATCH COAT
Laws of California.Dam
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If.all making this CcniRcak of Exemption,you sbuula
become subject DO we Worker's Cienpeaation provision of the Labor Code.you nun 501 - FINAL ELECTRICAL ENERGY
.70 forthwith comply with such provision or this pemrilahallkdoemodmwked. 502 — FINAL PLUMBING ENERGY
Z yCONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
pew Ihereby affirm that Nen is a construction lending agency for an performance of
x� the work for which tidspermit ItIssued(Sme.3097.Co.C.) 504 - FINAL BUILDING ENERGY
w Ca
Leaders Name
lenders Adarru 505 - FINAL ELECTRICAL
z
U p I cerdty Nn I haw seed this application and sum that the&how information Is 506 - GAS TEST
OE correct.Iagree mcomply with all city and=my oninseceandsoklawsMining to 5k7 _ FINAL PLUMBING
VC building construction,and hereby author=representatives of this city m enter upon the
w
show-mentioned property for Inspection purposes. O FIN L MEC ICAL
�'gL (We)agree m taw,indemnify rad keep harmless the City of Cupertino agaitw 9 F I
i..i v�y' IISEIIWe,judgments.cosundcapenca which may in ray nyamt¢agnnn WdClty
in
Of the
APPLICANTeUNDERSTANDSthis
AND WILL COMPLY WITH ALL NON-POINT Issued by: 5 NG Date
URCE REGULATIONS. yq
—
Re-roofs
SignnuMot AppllcenaConnactm Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she applicant.future building Occupant me or handle hanrdon material
as dented by an Cupenlno Mun ipal Code.Chapter 9.12.rad the Health and Safety
Code,Section 255320)7 All roofs shall be inspected prior to any roofing'material being installed.
❑Ya No
Will he applicant m future building Occupant on equipment or devices welch If a roof is installed without first obtaining an inspection,I agree to remove
it ha7ardn m at,comarefmnu u defined by the Bay Area All Ounby Management all new materials for inspection. -•
Rrct7
OyerG4 p
t
I have mad the maximums mal.lalsrequimmenu under Clupmr6.95ofan Califon- •f
nlalkalN&SafelyGatic,Sortie=25305.25577 nd25374.1 undertlmm NalllNc Wilding
does not currently Wve a Intik N.It is my Maponibl0ty m amity the usupnt of On
requirements which most below pint m usual¢of I Cenirkak of Occupancy.
Signature of Applicant Date
o
caner or authorised a sit D,M All roof coverings to be Class "B"or better
tF-
,
; �Jo
IE
curAOC:0`4net WA H
nao Cfn
cnnL.s+) ORDt� CES
ATE —13
(^ his set p:is err®Us t/nations
e kept -n fne int)at as h oes o MUST
I { �
awfu) to make a;:Y c^en.,: nd it is on
same w;ihuut 1 or alterations
Dept.,w clan °:ncssion from
u. hu+'dinn Y cf
u tlGt
51 ivt `,.. y tra S;amp,np o .his uPe,tino.
t I< r H.vLL ftUt 1, u`n 'n 1 specifications
P ne.d [a
oprnval of the wulatinn�nit or to 6e an
r' t� rf naq ny Provision,
State law
I
CITY OF CUPERTINO
a6TO '
PERMITAPPLICATION FORM D 3
CUPEkTINO
APN # �3 T 3 Date.
3i 0
Building Address:
10370 CXty-l- 7kEE Lfr�f
Owner's Name: Phone# 57
V ;'
a d (y07 2 -67,6L
Contractor: License #:
`� o l✓ 4J P m +�
Contact: �/L Cupertino Business License#:
3 7? Z 2 3
Building PennA Info: �� S �� �q lv o T C-7' . e1q til 12r L
BldgIV
Elect UK Plumb p-� Mech ❑
Job Description:
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: D 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> 1 OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to IM 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
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CITY OF CUPERTINO
c'TM0 PERMIT APPLICATION FORM
• CUPERTINO
uanti 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
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
MIXTURE 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 Pipe PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cf n MECHANICAL
BREAUMAN 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 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
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CITY OF CUPERTINO
cupEwo PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BREMPOWER Powdr 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 Lio*g 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
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