04110133 (2) CITY OF CUPERTINO s' ¢ •'E ' +' "^T `"" E - 9
BUILDING DIVISION PERMIT ,C,OR.A.C`T„QT.2Tl "U , Ttft
SUILDINDADDRESS: CUPERTINO PLUMBING PERMIT NO.05110133
1155 HUNTERSON 21.
ER'S NAME: PERMIT ISSUE DATE
OWN
AliMICHAEL LAITILA 10297
NE: SANITARY NO. CONTROL NO.
(408) 253-0618
ARCHITECT/ENGINEER: IL
BUDING PERMIT INFO
BLDG EIECr PLUMB MECH
0 0 0
LICENSED CONTRACTOR'S DECLARATION Job Description
I bunchy afOm tied 1 am Ilccmed under pavisimm of Chapter 9(mmme as
with Section 70110)mf Division 3 ofthe Buxncsaand Profeasiom Code,and my license is
u«�1are`,and=N L^3(o LIC-0U7llgps REPIPE/WATER EHATER/WATER SERVICE
31„ Da¢ Contractor
Wt 0192
ACX 5D RA ON vn
f I Y , tau On recortla�
3 U
p cad Lis, d pg�cadonal
k
OWNER-BUILDER DECLARATION
<q I kriby a1Dm that 1 am exempt from the Contrammh Licenm law far tic
pO following mawin.(Section 7031.5,Business and Profamiom Cade:Any city or county
$2 which requites a permit to cmuuuc4 ala,seismic.demolW,or mpolr my ewcwm $5000
-_zin prior m its Wanes,atm nu)uires the applicant for Such permit mfiu a signed autres.,
€o that he laResound pursuant tothe provisions ofthe Contrecines Ulecom Law(chumur9 Sq.Ft. Floor Area Valuation
Ey $ (commencing with Section 7000)of Division Sof the Bmineas and Profmaiom Cade)or
Y Nat he u exempt sem(rom and the basis for the alleged emmpdon.My violation of
SeNon]031.1 by any applicant for a permit wibjUll the aP ulteant m•dvil PUSIIY of r Occupancy Type
est mom caw five huMmd dollars(SSW}
❑1,a owner of llm pmperty,or my employco with wage u their wile mmpe=Oon,
W Pr _
ns
will tlm the work,and tie Muc7um a antmteMed or oReted farsate(Scc.7nM,Budnev
Profession Cads,The Commamoh I.kenm law dose rot apply m an awncr of file(tuired Inspecti
property who bulldaarimproms thereon,andwhodaa,uchwork himselfmduough his t� "30
own employees.provided Nat Such impmvnmmu are not intended croReted OWS11c.If. �00✓
bmvewr,the building or Impmwment is wild withat man year ofe mpldtion,the mance- atf
builds will thaw thaat harden of proving dust W did Out build or improve for Purpose Of
ask.).
co L as owma of the property,.B exclusively
escmwith enuamrm
cmmm the project(SecBusiness and Pro(csdom Code)The Connoisseurs
oLaw does amapply
nan owner
ofpmPeny+'hubuilds orimproes thrtmn,and.
who contractsfor such prro)tmwith aeonvectartO licensed pursuant mthe Cwitoh
seLaw.
01IDun
exemptueder See .Bl PC for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby ar Irm under penalty of perjury One of the following declanumtc
1 haw and will mmmalo•CaNResm of Com=nt m self-Wort fawcfteseompen-
So Ion,u provided far by Section 3700 O(dm LaborCode,for the perform.offt
Ion,
far which this permit a blued.
w and will maintain Woftes Companion Imuran¢,u required by Section
3700 of Ns,labor Cad=.for the performance alum work for which this permit is laamd.
My Worker ComPemWon lmuranro carrier and Policynumb=ram:
Carver.�/U/�' Y5 Policy No.:
CEIrfIFlCATEOFEKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This mialon reed mtbecompleud if tie pence is foram huntheddallua($100)
or les3)
1 mn11y that In the Performance of the work for which this Permit u issued,I Mall not
employ any person In my me perm u to become abject in tie Worker'Compmuation
Laws Of CaliFQMIL Data
Applicant
NOTICE TO APPLICANT:IL a0er making tida Cenilicate of Exemption.you Umuld
become sub]=in the Workecu Compensation provision Of use labor Code•you mux
.J ZO forthwith comply with Sch provisions or this permit Mall be deemed mwkcd.
z` CONSTRUCTION LENDING AGENCY
PThereby aflm this th=
im4m
I.. nmMoiling ing agency for de performance of
CL ^ the nark for which this pemlt is issued(Sec.30171,Civ.C.)
[tJ L Ous" Name
az L=ndee Addmu
U O 1«nify that I haw read this application and SUM use Oe above Inmmusden IS
IS, ^ correct.1 airs in empty with all city and county oNimrco and este Ism mlIcUl in
0 lr.•J! building construction,and hereby authodm rcpesmutim of this city in enter upon me
W show-rsn Toned pmpcny for Inspection purposes.
(We)agree caw•milcnmifY and keep hamkas the City of CYpC=tim against
Coll liabilities.judgm ,corm and expenses wltiM maylo anyway acctncagaimtuid Cily
U zin comeq nc the i711m o mu permit.
APPLI N ERST AND,WILL COM LY WITH ALL NON-POINT Issued by: Date _Z'L�D
SOU U TION .
//"Z3 O Re-roofs y
if urc Applicm err Dau
OO US MATERIALS DISCLOSURE Type of Roof
Will de sp ontinfunce building occupant store or handle haurdom material
as dcRmd by the Cupertino Mu '' 1 Code.Chapter 9.11,and the Health and Safety
ANVk-cile,Section 37333(3)? All roofs shall be inspected prior to any roofing material being installed.
❑Yon
Will the applicant or future Wilding occupant tic equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air conuminanu as defined by the Bay Amo Air Quality Management all new materials for inspection.
Dlsuict? ^
oya
I ho.M440c hemmtes materials requirements under Chapter 6.97 of the Callfmn
nia Hcolth than 133 and 31734.1 und=mund too,lfde building
does not tenorµ y responsibility m tlfy the occasion of tin
rqulro beeset in issuancearaccroll o(Oceup 7 �Signatureof Applicant Date
Ow r an arissd asemt011-4 Oau All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: // PERMIT # (/ 1
OWNER'S NAME: /,a -7L I !w. /'Yl G Go PHONE # -. 3299-5
GENERAL CONTRACTOR: FAX # 753 0697�
I am not using any subcontractors: 1 J/ D Gr
Si a Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring-Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing '
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving .
Plastering
,O Plumbing hp kjo /h (�/
Roofing
Septic Tank
Sheet Metal
Sheet Rock
e
Owner/C •actor Signature bate.
D-. CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO /� I /�
N# Date:
Building Address: I/Jas , lun / I ding Address (if different from building address):
Own r'sl N e: d�o l Phone #:
f
Contor �G License #:
1-1
Co tact: Phon 253a(ol Cupertino Business License#:
'Q'I G. Fax: 2S3 0(0")3 /
Building Permit Info:
Bldg ❑ Elect Cl� Plumb M/� Mech F�
Job Description: C,Gf-)9e✓ RiGp+ G , lnX HeAj-ev, W i[-
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro'ect Size: Standard ❑ Laze ❑ Major ❑
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> 1.75M 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 <= 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
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� _ CITY OF CUPERTINO
CUP
Ef�TINO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Ins ection 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 Re i eOfFixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP I Kitchen Trap PLUMBING
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 din 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
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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CITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Grou
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 Ensection BUILDING
BSWIM Swimmin Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary BldgPermit BUILDIING
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 Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
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