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03040047 (2) NRUELDINGADDREMS: UPERTINOr y BUILDING PERMIT COW,tRACTORINFORMfATION, ` k PERMIT NO. 0 FIRWOOD DR FISCHER PLUMBING & CONST 03040047 PERMITMUEDATE O DEAN AND SUSAN 2766 SCOTT BLVD 04/08/2003 NE: SANITARY NO. CONTROL NO. (408) 727-2426 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT- PLUMB MECH O 2 0 o LICENSED CONTRACTOR'S DECLARATION O O O I botchy erfrm that 1 am licensed under pmvNDM nr Chapter 9(commencing Job Description with Section 7")of Division 3 ofthe Business end Professions Cede,an my license Is inruurameander 'Z7 �' iso Licem.a., _Lie.S or BATHROOM REPAIRS Dam Con"t.n ARCHTIECTS DECLARATIbI �a fl� i understand my plans shell W used as public records o." APR 2 4 2003 Licensed Professional 3 OWNER-BUILDER DECLARATION P 1 hereby aRK that I am exempt from 0e Conmcmrs License Law for the ' pe O following mamn.(Seth..7031.5.Business and Profession.Code:Any city m county BUILDING U'pL.©I NG 9 which requires a permit m construct.9mr.hopmove,demolish,m repair any structure ID ,rZy prior to its issuance,arm mqulles the applicant for&Kh permit to file a signed Klement Ri< that he is licensed pursuant mthe provisions ortheCoommurrilittnscLaw(Chapter 9 Sq.Ft. Floor Area Valuation SCO (commencing with Section 7000)of Division 3oftheBusinevand ProfessionsCoee)or $8000 g$ that he is esmopt therefrom and the bilis for the alleged eserepdon.Any violation of Section 7031.5 by any applicant for•Permit subjects Ne applicant to a civil penally of br OccU anC T e not more Nan rose hundred dollars(M). 3�MM nF OO P Y YP tuownu of the proputy,mmy employtts with wegeeu theinole compenu0on, willde the were.and the structure Y not intended proffered for We(Sec.70".Business and Profesoans Code:The Contractors I.ianse law does ran apply to an owner of 101 - FOUNDA4NlitO Inspections property who buildsorimprovu thereon,mr!whodoessuchwork hlmseforthrough his 102 - PIERS own employers,provided dist such improvements tee not Intended or offered fmsale.It. however,the building or improvement is sold within one year ofcompledon,the owner- 103 — LIFER builder will e ba have the, or proving that he did nut wild m Improve for purpose of 104 — REBAR D 1,as owner of the property,am exclusively contracting with licensed contractors to 105 — ANCHOR BOLTS construct the pmjca(Sec.It3sa,Business and Professions Code:)The Conu abor's Lt. 106 — SEWER & WATER conte law dors not apply to an owner of property who wilds or improves thcmon.and, who convects fmm,h prejects with a coruesc a(0 licensed pmsuanuu the Cmaramur's 202 - UNDERFLOOR PLUMBING Licensetaw. D IamemmptunderSec. ,B&PCfcadlsmamn 203 - UNDERFLOOR MECHANICAL Danner Date 204 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION I hereby affirm under penalty of perjury one of the following declarations: 301 - ROUGH PLUMBING have and will mainuina CenmcneofConsent to Wr-comm to,Warker'aCompeo- 302 — TUB e4 OR SHOWER . ren,u provided for by Section 37W of the labor Code,for the peefomumex of the work for which this permit is imuee. 303 - ROUGH MECHANICAL D I have and will maintain Workers Compensation losurame,as required by Section 304 - ROUGH ELECTRICAL 3100 or the Laver Code.for the performance orme work for whim obis Permit is issad. 305 - FRAME My Workers Corttpensletion In rmw eerierend Policy numberatC l--r c.ma //T� NiJTE FauryNOM 306 - HOEDOWNS \ CERgIFICATEOFEXEMPTION NSURAN WORKERS' 6. 307 - INSULATION COMPENSATION INSURANCE (Dols section need not be completed ifthe permit is panne hundred dollK(SIM) 308 - SHEETROCK Or less.) 309 - EXTERIOR LATH 1 certify that in the performance of the work for which Nis permit is Issued,I shot not 310 - INTERIOR LATH employ any person in my manner an as to become subject to the Workeri Compensation 311 — SCRATCH COAT Laws of Caltfamia.Date NOTApplICE E NOTICE TO APPLICANT:If,after making this Cenifinea of Emmpuon.you should 313 - ROOF NAIL became subject in the Workers Compensation provisions of the Laver Code,you must 501 - FINAL ELECTRICAL ENERGY zO rorthwithcomplywwaucnprovidmnmthispermiunmnw"k nebedeceded. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY r Ihereb art.that then is•coembralnn lendin ac F y gFneYlortheprrumanceof 504 - FINAL BUILDING ENERGY C tint work for which this,permit is issues(Ss..J097.Civ.C.) �W q Landers Name 505 - FINAL ELECTRICAL z Leasers Aaema U0 I certify that 1 have read this application end mute that the above mbamulon is 506 - GAS TEST D. F coomm I agrce to comply with of ciiy and coumy oNinanm and Bste laws retm,to 5 7 - FINAL PLUMBING OU building construction,and hereby suthodre representatives ofthis city m enter upon the ?,a shove-(We) ogre,to property forinspefy an beerres. O — F IWECAL (R'c)ogre ro save,indemnify and kap esKkss the Cily of Cupertino against9 F IU Iiiliabilifics,judgments.costs and espenses which may in any wayaccrueagainst Wd CityUin consequence of the granting of this Permit. 5APPLICANT UNDERSTVDS AND WILL COMPLY WITH ALL NON-POINT Issued by, Date SOURCE R�GULAyI�b/y$r� _ y(V y'f 63 to Re-roofs Signe rto AppliceHAZARDO Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the epPlinm or Imam wilding occupant store or la t e Heallous material as definnd by the Cupertino Municipal Code.Chapter 9.13,me the Health and Safety epee,Sectiony.zss3xel7 - All roofs shall be inspected prior to any roofing material being installed. ❑Yes L3 No Will the applicant or future wilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it he ardous air romeminenta ss defined by the Bay Am Air Quality Management all new materials for inspection. strict? DYes C]No I have rtae the hazardous materials requirements undcrChapmr 6.95 of dx Califor- niaHut"Safety Cate,Sections,25505.25533 and 2.5534.1 undersand Nat irNa wilding dm not curcedy havee te n4 thm a u my roepons.1.1.y m nntily the oceupano M the myoremcnts wmnst ar usnance or.cenifute ar �Occupancy. Signature of Applicant Date Owner on authonxd agent ypate All roof coverings to be Class °B°or better 04/08/03 09:23 $4087773333 CITY CUPERTINO Q001/003 CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM APN# 3 2— Date: 41 y X03 Building Address: Owner's Name: Phone#: i017 �fCt/IrD /r/O� SSS- � 2g0 Contractor: / / License#: Contact: / Cupertino Business License#: Building Petmi o: Bld �@ Elect ❑ Plumb Mech ❑ Job Description: Residential KP Vo1As o Commercial ❑ Sq.Ft.Floor Area: S/Sq.Ft.: Cost of Project: or7 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> 100K to 500K Btu MECHANICAL BBOILFM 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 BMDING 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 Iof3 04/08/03 09:23 $4087773333 CITY CUPERTINO (6002/003 CITY OF CUPERTINO CUPEkTINO PERMIT APPLICATION FORM Quantity Fee M Fee Deacri tion Fee Grou 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 Sinpae Family Res BUILDING BOVERTMM luspection Overtime BUILDING BP13ACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXT'URE 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 rinkler/Backflo PLUMBING BPSTORM StonwRain Water PLUMBING BPTRAP Kitchen Imp PLUMBING BPVENT Alt of Drain&Vent PLUMBING BPWATER Install/Alter Water Pie . PLUMBING BPVPAEATER WaterHeater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT ReinVection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRIiAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Buswa ELECTRICAL BREMFDCT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> 10K btu MECHANICAL BREMItEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus BLECTRICAL BREMI RIWP Rem Non-Res Appha=e ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 04/08/03 09:24 $4087773333 CITY CUPERTINO (6003/003 i r f CITY OF CUPERTINO CUPE[�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT gcptl, Switch&Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT air/Alter Heatm MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs,Marquee ELECTRICAL BRFIATHEATR Theatrical lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation System MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM SvAmming Pool BUILDING BTEMP Temporary Power ELECTRICAL BT IWPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING • ELECTRIC Electrical sq foot ELECTRICAL EPERNUTFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical s , foot MECHANICAL MPERNMEE Mech Permit Issuance MECHANICAL PPERNIITFEE Plumbine Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chante BUILDING • r 3 of 3