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04100063 (2)CITY OF CUPERTINO� " `' INFORMATION `'r `'ee' - BUILDING DIVISION PER MIT *CONTRACTOR .._ BUILDING ADDRESS: 1102 HUNIFIRgTom PT. CRW INDUSTRIES PERMIT NO. 04100063 OWNER'S NAME: PERMIT ISSUE DATE RICHARD CO NE: SANITARY 0 OL NO. 4 ARCHITECDENGINEER: -- - - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSEDCONTRACTOR'SDECLARATION NS De 1 tl I hereby of LIC I am licensedONTRA under Provisions of Chapter 9 (commencing ��{y `!VJ'` ED with Section 7000) of Division Sof the Bush. and Prolusions Code. and my licence is in ran rase and err«� WINDOW Q GARAGE License Class Lic.g One Gan DEC ARCHITECT'S DECLARATION NOV 30 2004 I undersund my plans shall W used a public mcands n ® ' Licensed OWNER -BUILDER DECLARATION affix a� I I heresy affirm that 11. exempt from the Contamora License Lew for the hereby L I�V■ U I ® following reasan. (Sermon ]03 L5, Guiness and Code: Any city or county demolish. construct, slop Impmw, demolish, or which n,quims a permit improve. any machineant pearN its issuance. a e a sig am applicant for such perm'to Glnssigaw harterm License taw (Chepkr9 Sq. Ft. Floor Area � - � Valuatio rsuarequires that he is licensed pursuant In the provisions of she Comucmr's (commencing with Section ]000) or Division 3 of thc Business and Professions C, Oc) or shat he is exempt thmmfrom and dk basis for the alleged exemption. My violation of 3 APID 2.0l"er 0 0 Occupancy Type Section 7031.5 by any, applicant fora permit subjects the applsant W a civil penalty of not roam than five hundred dollars ($500). ❑ I.0 owner of the poprny, or my employm with waguu their sole compenauon, Required Inspections 9 P will do thcworkand imitation, is not intended aran<n,d for 111C (Sec. 7044, Business and Professions Code: The Coruscates License Law dear not apply to an owner of property who Wildsor improves uhmncon, and who doessuch work hunk through his owncmployeas, provided that such haps.o lou, artnotbanded oroRered for We. If. however, the building or improvement is said within one year of eomprleuan, the owner - Wilder will Tuve the Wrdm of proving that he did nos Wild of improve for purpose of salve.). n Las owner of the property. am exclusively contracting with licensed canuacbrs to construct the project (Sec. ]MC. Business and Professions Code:) The GonVarbes LU- ceme law docs not apply in an owner of property who builds or improves uherean, and who contracts for such projects with a comm cmrau licensed pursuant W the Conuacaors Liccnk law. ❑lam s der < B k P C for chis reason caner 0 KER' ENSATION DECLAR 09 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Ceru ram of consent W self -insure for Werimes Compere - aetian, . provided for by Section 3700 of the Labor Code. for dm Performance of the work for which this permit is Want. Fl 1 have and will maintain Workers Compensation Insurance, as requited by Section 3]00 of the labor Code. far Ne Nor... of the work for which this permit is iss«Q My Worker's L•omparamon InsuranQ sooner and Policy number are: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE i (This acc0an need not Wcomplesed if the Permit is form= hundred dollars (Stoll) or less) - - 1 certify but in the Performance of the work for which this permit is iss«d. I shall ma employ any reason in my mannersa M W became Object n the Workers'' Compensation Laws of California Dick Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subj«t W the Worker's Comrewutn provisions of the Usher Code, you most famil comply with such provisions or this permit shall W decreed mated. CONSTRUCTION LENDING AGENCY Ihereby affirm this lending agency for dm performan«of isard(Se it 3 ' the work for which Nis permit u issued (S«. J09'I. Co. C.) Lender's Name Lender's Address I certify that 1 have mad this application and sok the the move infomuGan is ' correct 1 agree to comply with all city and county on ina«n and sum laws relating W er upon the Wildingconstruction,by auth Wcmino above-mentioned Property for inspection purposes ave,nd anrzmpIncrasiwse City Of ago (We-) agree It saw, indemnify and keep harmleo Ne City or Cupertino against im I liabihims.judgmenu.easu expenses which may in any way secant: against said City ^� is pmmitDate APPAND WILL COMPLY WITH ALL N - m can eWHAZOUS Issued by: SOU Re -roofs Type of Roof ]IYR Of MATERIALS DISCLOSURE paretar handle haMrdous maknal Will the applicant orfuture Wilding occunt wa as defined by thin Cupertino Municipal Cade. Chapter 9.13, and the Health and Safety Code. Seedon 255321)? t7 - Ye All roofs shall be inspected prior to any roofing material being installed. ❑ If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future Wading Occupant me equipment or dcvires which salt ha'urdnua air conumirunts ata Bird by she Bay Area Air Quality Management all new materials for inspection. DBtricO C] Y. No I torypiejOhe hnallous materials requirements under Chapter 6.95 of the Califon. no Ne- c edc, Sections 25505.25533 and 25534. I understand Naz if Je Wilding d not how re n ni' my responsibility W mury the occupant or tW q ant nth t vd is YanttaraanifiestearQco Signature of Applicant Date ' All roof coverings to be Class "B" or better • eraram 'sera get ,m - Community Development J 10300 Torre Avenue ;t Cupertino CA 95014 a Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 �UPERTINO Building Department JOB ADDRWS: i/Op2 TC/ajBN Re- PMMIT # �6y,` soioo®63 BUSINESS LICENSE # OWNER'S N to C/Q PHO #-'/()e? - ,9- 7;Z9cl GENERAL CONTRACTOR: p ,G FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: �L...�10- -Ia-z& - `� Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wo Glass / Gla!'j Nen Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Ro T' �L...�10- -Ia-z& - `� Date CITY OF CUPERTINO CITY OF CUPERTINO D 4!� ( cS a C3 PERMIT APPLICATION FORM FAPN # 36 Z_ 2 2 Date: i Fee Group i Building Address: L Mailing Address f fferent fro building address): 11 Owner's ame: � Phone #: Contractor: License Boiler > 100K to 500K Btu MECHANICAL Contact: Phone: !�� y�p61VI5 Cupertino Business License#: Fax: BBOILER4 Building Permit Info: Bld Elect ❑ Plumb ❑ Mec Job Description: t 7it-)r Residential ❑ Cz=wr ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Gro / Type of Construction: Please check this 110 if th - ect is a BUILDING second -story addition: Pro'ect Size: Standard ❑ Laze ❑ Major ❑ BUILDING Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 >1.75MBtu 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 Invest; at;on fee BUILDING 1 of 3 2731,6 'o- �z3 'Y�? CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 2 of 3 Quantity Fee H) Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Conon. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 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 BPINI'ERCEP 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 Stom1/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING VIP BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/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 BREMBUSWAY Remodel Busways ELECTRICAL gREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > I 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 BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 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 Issue PLUMBING PPLBG Plumbing Fees foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3