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03040029 (2) CITY OF CUPERTINO ' ` �`' " '�`"� A •�'^ BUILDING DIVISION PERMIT CQNTRACT�R Ilvk'� BUILDI G DDRESS: PERMIT NO. i 6563 ESQUIRE PL 03040029 OWNEDIA,�f2MRON ,RICHARD P JR AND BA AR � IT�G04/07/2003 SANITARY NO. CONTROL N0. ARCHITECffENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH upp LICENSED CONTRACTOR'S DECLARATION Z Job Description C 1 hereby Millan that 1 am hemmed under provis con,of Chapter mm r 9(rnereing <t� with Section] of Division J of the Be,* and Pmfescinm Gude.and my license mfmllfm `d e /1 7i FINALE® Sq? ueenre cl /� a GAS FIREPLACE INSERT �—p Cont . ARCHITEA., ATIOI CONTRACTOR: CEN-CON i2y' lundcmand my plans ahallheumdup Tic recmN APR 17 2003 d 3Or3J I,i[enfCd PntfCS61nna1 OWNER-BUILDER DECLARATION 1 herehy offirm that I am exempt from the Comracmr's License Law for the BUILDING n O following resson.(Section 703 1.5,Business and Pmfessimce Code:Any city or county K m E which requires a permit to construct.a@t Improve,demolish,or repair any structure Fly prior to its Issuance.also requires the applicant for such permit to File a signed statement x6 that he is licensed paRUantWthe provisions ofthe ContractM%License Law(Chapter 9 Sq. Ft. Floor Area Valuation �F (commencing with Section 7000)of Division 3 of the Business and Profcssiom CMe)or 9 that he b exempt therefrom and the bub for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of APN Number net more Nan five hundred dmlbn($5110). O a y Type ),u owner of the property,or my cmployaa with wages u Ihev Sole compensation, 19r44 n�>o nn will do the work end Ne Swcmre IS not Intended proffered forsalc(Sm.7044.11usiness and Professions Coe:The Contractors License Law does not apply in an manner of Required Inspections property who builds or improve thereet.and whodees suchworkhimselfor Mough his 101 - FOUNDATION own employee,provided Natsuch Improvements arc not intended oroRereC for sale IL however,the building or improvement is sold within mm year ofcompleuon,the owner- 102 - PIERS Wilder will have me wrden of proving duetw did net wild m Improve for purpose of 103 - UFER ❑1,as owner of the property.am exclusively contracting with licrnsed comiactms to 104 - REBAR commuct she project(Sec.701a,Business and PmfcW=Coe:)Thu Conoactors a 105 - ANCHOR BOLTS c,nm law docs not apply to an owner of property who wilds or improves themon,antl who eamraeufor such projects with aemounnor(s)licensed pursuant in de,cmnnaetur.' 106 - SEWER & WATER License Law. ❑I am exempt under Se. ,B&P C fm Ibis reason 202 - UNDERFLOOR PLUMBING Owner Date 203 - UNDERFLOOR MECHANICAL WORKER'S COMPENSATION DECLARATION 204 - UNDERFLOOR FRAME I hereby aErm under Penalty of perjury,one onhe following declarations: 205 - UNDERFLOOR INSULATION have and will maintain a Certificate of Consent tosclf-msum forworkerseompen- 3O1 - ROUGH PLUMBING on,u provided for by Section 3700 of the labor Code,for the performance of the ,.rk for which this permit is issued. 302 - TUB & OR SHOWER ❑1 have and will maintain Worker's Compensallon luuranec,at required by Section 303 - ROUGH MECHANICAL 37M of tho Ube,Code.for the performance of the work for which this Permit 1,Issued. 304 - ROUGH ELECTRICAL MyW er1�C.n�^penseti�nsurene,carrier and Policy number re: r: ,)i�7a fyu/17 Policy No.: (: 3 05 - FRAME CERTIFICATE OF EXEMPTION FRO ORKERS' 3O6 - HOEDOWNS COMPENSATION INSURANCE (hissctlon need not hecomplemd Jfw(ermit Is forone hundred dol4rs($I00) 307 - INSULATION ittless) 308 - SHEETROCK 1 certify that in the performance of the work for which this Permit is issued,l shall not 3 09 - EXTERIOR LATH employ any person many manner m as to excmmesub)ect to the Workeri Compmentipn 31O - INTERIOR LATH Lawf cilifo s omi..Da¢ App[1eN311 - SCRATCH COAT NOTICE TO APPLICANT:IL after making this amilicne of Exemption,you should become subject to tire worker's Compensation provisions of sax labor coast,you most 313 - ROOF NAIL Z forthwith comply with such provnns or this permit shall w deemed remked.provisionseemezo 501 - FINAL ELECTRICAL ENERGY [--�� CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY thereby Miran Wt then is a construction lending agency for the performance of g4> thcworkfor which this permit 4issued(So,3M.Co.C.) 503 - FINAL MECHANICAL ENERGY Lender's Name 0. LenderiAddhoss 504 - FINAL BUILDING ENERGY U O I certify that l have read this application and sum that the above information is 505 - FINAL E LE CTR I CAL g4 F mocct.1 agree to comply with all city and county ordinances and stat,laws misting to 5k6 - GAS TEST wilding conswetion,and hereby authodm representatives of this city to enter upon theUahWb(WeimnW roreporlytoan for indmpCNn troopha FIN L PLUMB NG(Wc)agree re pw.Indcmmfy sod keep harmless N,City of Cupertino against AL liabilities,judgments.core and expenses which may in any way aceme against said City FIZ in consequence of the granting of this permit 5APPLICANTTsUNDERSTAA�NDS AND L COMPLY WITH ALLNOON/-�yOINT Issued by: Date SOI �f�'�1 N -tom--o S� ea'�/C ul3 tee., r D,re Re-roofs 514 INAL PUBLIC WORKS S' arm f HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant atom or handle hazardous material u defined by the Cupeninm Municipal Code.Chapmr 9.12.aM the Health and Safety Code,Section 25532(47 All roofs shall be inspected prior to any roofing material being installed. ❑tics U If a roof is installed without first obtainingan inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which P g it It odWx air rontaminants u recd by the Bay Area Air Quality Management all new materials for inspection. Wi[17 ❑YCS U �.- . I newt red the w.Scedo materials re 33 and 55 under Chemo 6.95 if the Califon fib HmlN&SafctyCo4.sectiou 25505.3557]and155Ja.I rIt the ,ofthe dun trommmt ccccurrently haws a tenant that(t b my respomihility b dm upant M dm rtyu is M pr iswencc oil Certify�f anry. Signature of Applicant Date �(/ n.3 ,Owner or authorized agehl Dom All roof coverings to be Class"B"or better Y - CITY OF CUPERTINO o v a ' RF PERMIT APPLICATION FORM CUPEI�TINO APN # Date: Building Address: / ✓rk�/ C✓ 0�1�� Owner's am : Phone#: 83� yt 7S—�Qy�G Contract _ License#: Ll7y�! 7 Contact: Cupertino Business License#: Building Permit Info: BldCL Elect i Plumb Mech ❑ Job Descripti^on/: 5 �—�` �✓ Residential L� /� Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Proje " �3 �� Occupancy Group: Type of Const tion: 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 IM 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 > IOOOA ELECTRICAL ;AEBELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Ener BUILDING BENERGYADDE Ener Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 7 1of3 2� 7 / Q� fJ CITY OF CUPERTINO CITY OF 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 BNUSFD New Single Family Res BUILDING BOVERTDAE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING Lp 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER WaterHeater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm - MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUIQ,WAY Remodel Busways ELECTRICAL BFD:T Li tin Fixtures ELECTRICAL :XBREiMINHOOD FURN Relocation of Fumace MECHANICAL URNOV Relo Furnace> l OK btu MECHANICAL HEAT Heater Installation MECHANICAL Installation of Hood MECHANICAL REMMISC MiA ELECTRICAL REMNRAA P Rem Non-Res A liance ELECTRICAL REMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTIN0 CITY OF 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 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 Temporaiy Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL C EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG I Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3