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03050067 (2) CITYOFCUPERTINO «txY•^"- T •^ ��t�{ s" BUILDING DIVISION PERMIT ,0VTRW �QWINF6^ AJPRK" BUILDING ADDRESS: PERMITN003050067 0 3 0 5 0 0 6 7 1 S ' OWNER'S NAME: PERMTC�I�AA)'a 5/2 0 03 MAI)ILLO WILLY' S U7� 1 ult NE: SANITARY NO. CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO t� ELECT PLO I� Lop LICENSED CONTRACTOR'S DECLARATION ly 1 hereby affirm Rut 1 am littrued under provision of Chapter 9(eammcneing Job Description wW Senlon]0110) fDivlaion Jef tite BualsW ant Pro(Wioes cods.aM mylicena is Licfull muccme l. e � t0 RK" AMP CIRCUIT TO MONUMENT SIGN 58 limas Clas uc. n Da Co. rte �d CONTRACTOR: DEGRYSE ELECTRIC 9� ARCHRECr51 RTI FINALER3 undersand my plans shall W used u public mentis 3' Licensed Professional MAY 2 8 2003 OW NER-BUILDER DECLARATION 5< i berchy Mr.that I areexempt from the Conuacmrs License Law for the i O O fallowing mason.(Smdon 7101.5,Business and Prefesmuct Cade:Any .citym county $ which requires a permit m construct,alter.Improv,demolish,m repair Any swcture F�;n prior m its issuance.alsu Mquima the applicant for such permit to file a signed summent < Unit he Is licensed punuanLlnthe pmvislmesofthe Commerce's UccnmLaw(Chamer9 Sq.Ft.Floor Area xt� (commencing with Section 7000)of Division 3 of the Busiocas and Profevi.e.Code)or 4575 3$ Wt he u exempt Ibaefrom and Nan e basis for We alleged esphwt.Any violation of nodi mmart roti nK my ahundpplicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type 01.u owner of the pmperty,or my employees with wages as their sole compensation, 36901001 ' 00 will the the work.and RK sWCIYm is not Intended ornnemd for sale(Sec. But. RReei� dI05 eCt1005 and Poefaaloru Cade:The Com enc ora License Law does wne tout apply W an or or 101 - FOUNDATT� p pmpenywho Wilda orimpmvs theseon,and whodoessuchwmkhimselforthrough his own employers.provided that such improvements ase hot menthol cro@rcd forsale.If, 102 — PIERS however,the building or Improvmmi is sold within one year of completion,the owner. builder will have the l u cen of proving that he did net build or improv run purpose of 103 - UFER .Is 1. 104 - REBAR 0 I.as owner of fix property.am exclusively conuating with licemsed common W 105 _ ANCHOR BOLTS core=, Business project(Sec.7044.Businand protestation Code:)The Cmuanm's Li «radaw dues not appy W an owner of property who builds or improv thrcon,and, 106 — SEWER & WATER L� xe who contracts reach proJecuN wlaconvanortq Putman,to licensed Outhe Contractors 202 — UNDERFLOOR PLUMBING ❑I am exempt under See. .B At P C for this mason 203 - UNDERFLOOR MECHANICAL Owner Data 204 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION I hereby MOsm under penalty of pedury one of the following docl.rations: 205 - UNDERFLOOR INSULATION Is.wand will malnwnaCerhaateolcnWhtWalf.wnmrWWorkn'sCmnpet. 301 - ROUGH PLUMBING atm.,as pmvMed for by section 3700 of the later coda.for thn Performance of the 302 - TUB & OR SHOWER work for which Wer permit is issued. 303 - ROUGH MECHANICAL ❑1 haven ad will III Worker's Compensation Insurance,as required by section 3 O4 — ROUGH ELECTRICAL 3700 of the labor Code,for rite performance of the work for which this permit Is issued. My wr. o ntrusammce esrand Polity X.17-03 305 - FRAME r. sFi`c! —Policy 306 - HOEDOWNS CERTIFICATE OERS' COMPENSATION INSU ANCE307 - INSULATION (hu, Lt.need not be completed if We permit is for one hundred dollars(fl0h) 308 - SHEETROCK mlesa) 309 - EXTERIOR LATH I unify the to the performance of the work for which this Permit is issued.I Mall not 3 10 — INTERIOR LATH employ any permn in my manner a as W became abject to the Workcn'Compensadon Laws of C.11fomia.Dam 311 - SCRATCH COAT Applicant NOTICE TO APPLICANT-.If.after making Wu Certificate of Exemption.you Mould 313 - ROOF NAIL become subject W the Workers Compcnation provisions of the Labor Code.you mart �zforthwith comply with such Provisions or this Permit shall be demons revoked. 501 - FINAL ELECTRICAL ENERGY z0'-' CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY [..� I hereby affirm that Nen is a construction lending agency foram performance of 503 - FINAL MECHANICAL ENERGY 1Y'> the ew rks ndoes n for which mlmitPermit uissmm d(S .]097.Civ.C.I G 504 - FINAL BUILDING ENERGY W Nam CL. LerdersAddoess 505 - FINAL ELECTRICAL Up I cenify Nat 1 haw mad this application and sate that the above InformNun is 506 - GAS TEST ly F. coma I agree m comply with all city and county ordinances and aux laws mining in OU Wilding coMwction.ad thereby amhorise reprcanutiv or this city to enter upon tho FINAL &PLUMBI, Gseders-mentionedpsopenyteremnifyan keep ha 08 FINL (Wc)agreerosow,minspection hepesrmlW RW City of Cupeniro agMM141liabilities,Judgmcou.costs mdexpeneea which may in my way ecerve agalnat aid City e,In consequence of Ne grunting ter this perm .APPLICANT UNDERSTA DS AND WILL COMPLY WITH ALL NON•POINT Issued by51 G Date SO EREGULA NS. Ok Re-roofs S' urcof ApplicunhConmev DaW HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will she applicant or future Wilding occupant stom or handle humdoas material as dented by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety code,'Cum 25x3:(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Ya Will the applicant or future building occupant ata cyvipmcnl or devicra which If a roof is installed without first obtaining an inspection,I agree to remove mit hen mous air contaminants as defined by the Bay Ara Air Quality Management all new materials for inspection. District? Oyer 1 have mad the hazardous meterialsmquimemmu under ChAPter6.95 ofthe Califor. nix Hcalth4iSMely Cole.Secuom25505.25533md25534.IumlersWnd thnlfthe Wilding dors not emrcntly hew a Worm.Rut it Is my responsibility W nodry the occupant of the rats whish. be erpriermissgancc ora Certrna¢ Signature of Applicant Date t o wncr or authorized agent ,W All roof coverings to be Class"B"or better S' CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM v 3 CUPERTINO PkPN # :%j Date: 5 lso3 Building Address: o A Owner' Name: . I ,LLbC 4510- 'c38-x'111 Contragt.gr: IL' se#: � f SeG(eck6c 3o�gL49 Contact: Cupertino Business License#: Amro() f S2 Building Permit Info: Bldg ❑ lect Plumb ❑ ech ❑ Job Description: Residential ❑ Commercial Sq.Ft. Floor Area: Cost ofP Iectc Occupancy Group: L� fx� Type of nstruchon: Quantity 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 <= 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 1 of 4g, . CITY OF CUPERTINO CITY PERMIT APPLICATION FORM CUPERTINO Ask 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 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 Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo 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 clip 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 2 of 3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEf�TINO 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 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 Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3