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03080047 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT ;CONTRACTQR INFO,RMATI�ON . BUILDING ADDRESS: PERMIT NO03080047 3080047 . 1014R CRRRTON DR OWNER'S NAME: PERMIT ISSUE DATE Alk CRANE ELIZABETH A NE: SANITARY NO. CONTROL NO. ARCHITEC;ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ±Oa LICENSED CONTRACTOR'S DECLARATION iI hereby&farm that I em liahmd under provisions of Chapter 9(commencing Job Description with Section? B of Division 3 of Ne Broin rad Professions Cade.and my liccne is '� A �C® in full force fe ,t r�1 G >qz Lieeng, �� ase.»��II[r-r� UPGRADE ELECT PANEL .TO 200 D.a cantraY CONTRACTOR: GT ELECTRIC ARCHITECTSD RATION AUG 1. 8 2003 Ice no land my Elan;stall W used As records y - YIA o Lirong,J Prnfcsri nal 1 OWNER-BUILDER DECLARATION BUILDING .0 1 meso .farm the 11. exempt from the Contractor's Code:Any C Law for the ep 0 whicfolloh re reason. crit t 7 ensu Bmimtsa and Professions h,aAny city as county $� which requires a permit m cnnawct,el¢q improve,demolish,m repair any structure ' v` prior m its issuance.also requires the applicant for such annitto file a signed statement MNat he is licensed par lto the pro,kiomof the Cmuracun's License Law(Charter 9 Sq. Ft. Floor Area Valuatj 3y000 (commencing with Section 7000)of Division 3 of the Budom and Professions Code)or $ Net he is exempt therefrom aid the bask for Ne alleged exemption.Any vinladon of Section 7031.5 by any applicant for a permit subjects Ne applicant o a civil Nulty of 3 2k9H 7dd Mer 0 0 Occupancy Type not more Nan five hundred dollars 45010), ❑1,As owner of the property,Of my employees with wages As their&ole compere loo, will do the work,and Ne structure is not intendctl or offend for sale(Sec.7044,Business pp ,,{� ,,µl,Taft$ �(�1 and Profemions Code:The Contrremr's License Law does no,apply to an owner of 3 04 — ROUGH L^les I'.�1IC1at ff`DS property who builds or improves thereon,and who doer such work himself or through his own employees,provided Oil uch improvements Are not Intended or offered(male.If. 501 — FINAL ELECTRICAL ENERGY however,the building or improvement is suld within one year of completion,Ne Owner. builder will have the burden of proving Nat W did not Wild or impmw fur pumping,of 505 - FINAL ELECTRI CAL Ago.). 1,as owner of Ne property,an exclusively contracting with licensed contractors to construct Ne project(Sec.7044,Business and Professions Code:)The Contractor's Li. came Taw does not apply in an owner of pmpeny who Wilds or improve thereon,and, he contracts for such pmjecu with a contractor(s)licensed pursuant to Ne Contractor's _ g,law. I Am e(xy�pl under Sec. .B&P[C forthismason wner V�M- 1 _� Data ` WORKER'S COMPENSATION DECLARATION 1 hereby affirm under pcmlty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to sel6in reforWomee,Cumpcn- ation,"provided for by Section 3700 of the Labor Code,for Ne performance of tiro work for which this permit is issued. ❑I have and will maintain Worker's Componeation Insurana,as required by Sccdon 37W of Ne labor Code.for IW performance of the work for which his permit is Issued. My Worker's Compensation Insurance carrier and Policy number am: - Curier. Policy No.: _ CERTIFICATE OF—EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ' (Thlsg,Ntp teed not W completed if the Iscrmil Is foranc hundred dollars(61(10) or kcal 1 certify Not in the performance of Ne work for which this permit is issued,l shell not emPloyany piers& y manner m as in Wobject N eome objeco ,Workers'Compensation Law&of Califgslft Applicant 5 //a• �S- -- —� NOTIC O APPLICANT:If.after making NB Ccnificate of Exemption,you should ouct to the Worker's Compensation provision,of the Labor Code.you mug .J Z farMwiN comply with such provisions or this Permitshall W doomed revoked. z CONSTRUCTION LENDING AGENCY I hereby alarm that Nem is a combustion lending agency ror Oto performacec or a Ne work for which this permit is broad(Sec.3097,Civ.Cd U.1Q Loaccrs Nene 5 z Lender's Address U O I certify Na 1 have read Nis applieaion std stale that the Aw.iafommiun is {T. carred 1 agree to comply with all city and county ordinances and ante laws relating to C U building conametion,and hereby authorise mpmg,nmiws of Nu city to enter upon the I17 shove-mcmioncd property,for ImPeNon purposes. gy (We)agree to ase,indemnify and kap bumlm the City of Cupcnino against / N liabilities,judgmenu,costs and expenses which may in any way accrue against mid City U in consequence of the granting of this permit 7 APP NT UNDERSTAN S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SO C EGULATIO a Re-roofs ;,nature of Applicant/ ommelor ate - HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the appll'son.,future bull ' g accupiantstore or handle haandom material A debncd by the Cupenina M .21 Codc,Chapter 9.12,and Ne Health and Safety ode.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes Na Will Nc applicant fir future bei C mcupam ug,cyuiPmom or devices which If a roof is installed without first obtaining an inspection,I agree to remove It haaadooa air cantanomme,as incl by the Bay Area Air Quality Mana,cmcm all new materials for inspection. istrict4 t]Ye Nu I haw read Ne haaNnus materials requirements underChapter 6.93of Ne Califnr- niaHcalN&Safmy Cute.Sections 25R15,25533 and 25334.1 understand Not lithe Wilding dots rpt c rely Mw a tenant Na it u my ramponuhility dry Ne occupant of the requi cots ichmuu etpnOftoissua¢CofaccrdflCele upawy. Signature of Applicant Date Owns ad agent /DowAll roof coverings to be Class"Bo or better 4 ( � CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEI�TINO 11P APN # ��J./� Date: OO vv ?,•o Building Address: Mailing Address (if different from building address): WVICA S 0K Owner's 1 C� �� hone#:6. t8- 36X- 9`! 7 Contractor: License#: T t` C i2i 75 / / Contact: Phone:yof.7fr1-0Vg7 Cupertino Business License#: v n Fax: Building Permit Info: f Bldg ❑ Elect EJ Plumb ❑ Mech ❑ Job Description- too �� 0 Residential E U 61 �Rd o S Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: 3�0 . Type Construction: / Please check this bo ,ect is a e rct E�ecT2 second-storyaddition: ❑ uanti 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 1M Btu MECHANICAL BBOILER4 Boiler> IM 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> 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 BUILDING 7K I of3 a� f a �� 7 CITY OF CUPERTINO CITY 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 BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING p, 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 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 BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 • CITY OF CUPERTINO cuPE2°0 PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 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 Pernut Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3of3