03110029 (2) CITY OF CUPER'I'INO + + s A'
BUILDING DIVISION PERMITd :^ ,.r. aP t,N•�4r WATION...
ci•.y es
BUILDING ADDRESS: ALAN PENN PERMITN"O 3 11002 9
992 CRANBERRY ng
OWNER'S NAME: PERMIT ISSUE DATE
Alk ALAN PENN 11/06/2003
In NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
100 LICENSED CONTRACTOR'S DECLARATION
fu❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
ZW with Section 70V)of Division 3 of Ne Business and Professions Code,and my license is
in full free and effect. REPLACE CIRCUIT BRAKER PANEL
p Z License Class Lic.A
DdIC Contractor
]"S DECLARATION
FINAL
E®
aKY., ARCHITECTS DECLARATION 6
1 understand my plana shall W used as public records
>yU
gay
Licensed Pndcasioml NOV 1 0 2003
a� OWNER-BUILDER DECLARATION
<f 1 hereby edam on 11, exempt from the Contnctm's License Law for Nre
m O� following reason.(Section 71131.5.Business and Pmfeatinns Code:Any city or county
e_ which requires a permit to conslrucl,stop improve,demolish,or repair any structumal 1141 250
Zi pnorto its iuuance,also requires led applicant for such Permit to file a signed natemenl
e < that he is licensed pursuant to the provisions of the Contractors License Law(Chapter9 Sq. Ft._Floor Area a sea 1 n -
�'ct (commencing with Section 7000)of Division 3 of the 0usinds and Profeuinns Code)or
$ Nat he Is exempt therefrom and de basis for Ile alleged exemption.Any violation.f 36202005 . 00
Section 7031.5 by any applicant for.Permit subjects de applicant o a civil penalty of APN Number Occupancy Type
not more than five hundred della.($500). P y YP
❑1,As..a,of the properly,or my employees with wage As their ole co i'masu ons,
will do de work and Neswctue is not intended or oRce4 for ole(Sec.7044•Business
Add professions Code:no Comnmofs Lim.Law does Aral apply to an comer of Required Inspections
property who builds or imrrows thereon.and who doessuch work himaclforthrough his
own employed,provided than such improvements arc not tneMed uraRereel forula.If.
however,the building or improvement Is sold within one year of completion.the owner.
builder will have the burden of proving that W did not Wild or improve fur purpose of
sale.).
❑1.as owner of the property,am exclusively contracting with licensed convectors to
construct the project(Sec.7044,Business and Professions Code:)The Comrseuri Li-
cense Law does not apply to an owner of property who Wilds or Improves Nemon,and,
be contracts forsuch projects with a contractor(s)licensed pursuant to the Conumofa
l'o'ne Law.
ftY l And exempt under Sec. ,B&PC lc this rimsurd
wnerJW
l l 6 0
SAT A
I hereby affirm under pedlry of pe one of the find owing declarations:
1 hart and will maintain a C.Mfime of Consent to self-insure for Workoes Compen.
Orion.As provided for by Section 37W of the Labor Code.for Ne performance of the
work for which this permit is issued.
❑I lave and will maintain Wmkori Compemtion Insurance,As required by Sectio..
3700 of the Labor Code,for the performance or the work for which this permit is headed.
My Worker's Compensation Insurance carter and Polity number are:
Carrier. Policy No.:
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
TTY's section decd not W comrleed lobe Iermtt is Rod.hundred cholla.(SIM)
or leu.)
1 unify N.in the per ormanec of Ne work for which Nis ermit a issued.I shall not
employ any peon ins goner sn um Msome suhjenm cW terY Compemation
Laws of California,
ApPli�cgqn
NOTICF,IfO APPLIC ( eki ti cam of Exemption,you should
tomhjeet to the oher's Com Penution provisions of the L mr Code,you mind
'O funhwith comply with such provisions or this permit shall W Occurred mmkcd.
ti� CONSTRUC ION LENDING AGENCY
I herchy affirm that there is a construction lending agency for the Performance of
'Yr
to work for which this permit Is issued(Sec.3097,Civ.C.)
{glQ Lenders Net.
= z Lender's Address
U Q I Certify that I have read this Application and sue that IW above information Is
fL P CMMCL.I ague to comply with all city and county ondma om and sure laws relating to
�U Wilding commotion,and hereby authodm eprcfenmivu of Nis city to enter upon the
.h.vray foreves.
(We)agree 1.se,indcmnity and Irup
harmless use City of Cupertino id against
u I,IZ in Consequent ents,of
granting
or this Parrott. may in any way come Against acid City
C.)Z to mnsequence of the gaming Of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON- OINf Issued by: Date
SOURCE G ATIONS.
t t 0 3 Re-roofs
Sigolom,of AppluanUCOn r arc
HAL OUSMATERIALSDISCLOSURE Type of Roof
Will the.pplica ,or um.building Occupant store Or handle ha.rduus material
u donned by on,Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
-saLcode.sectio.zss3z(a)' All roofs shall be inspected prior to any roofing material being installed.
�Yor ON.
Will dm applicant or future building occupant use equipment or dcvleds which If a roof is installed without first obtaining an inspection,I agree to remove
It hm,rnem,air contaminants u dCrA.d by the Bay Arca Ail Quality Management all new materials for inspection.
strict'
❑Yes khlo
1 have toed the hu>aNnuTi meerlela requirements under Chapter 6.95 of the Cali(or-
die Health&Safety Cede,Sued..25515.25533 and 25534.1 undonst nd that if Ne Wilding
does not currently have a enank Net It is my msp uihility to nodl'y IW dram of Nc
irements i. dAWm ' rmissuamc.or.comirnaeofocc Signature of Applicant Date
it All roof coverings to be Class "B" or better
Owner Or amherircd agent Oatc
, 1
CITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM o 3 [ L 2-7
N# Date: , 1 / 6 03
Buildin Address:
Owner' Nam Phone#:
of :�Qvtn (40
g) Z
Contractor: License#:
0�n a-✓` b
Contact: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description:., I b�aL an
Residential ® ep a c� G i Yc``� �'►�✓� Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Proj co Z Occupancy Gro p:
Sp—
Type of C strucf .
Quanti 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 1 M 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. HousingMit. Fee BUILDING
-# Z37Ug
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�' CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
BMPTIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Famil 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 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 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 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace 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 Appliance ELECTRICAL
13REMPOLE Pole/Platform Fixture ELECTRICAL
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lN CITY OF CUPERTINO
o PERMIT APPLICATION FORM
CUPERTINO
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 S ecifio 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
MPERMFF,E Mechanicals . foot _ MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPL BG Plumbin Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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