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04040030 (2) a CITY OF CUPERTINO77777 I BUILDING DIVISION M MITC0 1T'T1tA.CT0- TNFORMII.TIGIN 'xa�v �✓^m7,n.e _uu.4N� ;,vn"b= d BUILDINGADDR$ ESS:E6 MARVIN DAVIS CONSTRUCTION PERMIT"04O4003O 1C � WNER'S NAME: I PERMIT ISSUE DATE NE SANITARY NVO. CONTROL NO. ARCHIIECT/ENGINEE0.: BUILDING PERMIT INFO BLDG EIF.CT PLUMB MECH p o 2 E o Q dF LICENSED I sm ONeRACmA'S DECLARATIONhap x 1 M.70affirmthan1 3Ifflull under pmPoor iof mCltspter Y(my cc= lob Description <� with Section 70110)of DlvWon 3oflM Buvneas Prof lou Code.an mylicenseb �< Liinven¢mura m e"m- f� REPLACE SUBPANEL IN 'GARAGE 1- ;a? u Dam — — can r IRE DAMAGE ARCHnECPSD A ON In ewJ myrle_na ahgll6orris Licensed scions s.0FV �( BUILDER DECLARATION I I herehy IT,.that I am exempt from the Co imcme.License Law for the S:00 following mann.(Section 703 1.5,Business and Profcadom Calc:Any city in county vI$E! which requires a Permit in commm,4 alter improv,dcmolim.or mpsir my structure poorm its imuanec,also reltim the applicant for such permit o file 4signed moment Fs�sQoat he is licensed pursuant he Nc provision of the Contractors Liecom law(Chaptn9 Sq.Ft. Floor Area ValuatiOn55O mF$ (commencingwiNSedion7000)of Division3ofthe Budnmand Profeasiom Code)ur '7 '� .. that be u exempt therefrom and Um bub for the alleged exemption.Any violsuon of Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of ApN Number Occupancy Type tet mom than five hundred doilm(SSW). ❑I,umnuofritepropenynmyemplayenwlthwageautheirwle compensation, will do Neworltand the structure Isnot intended or offered forsaie(Sm.7044,euitru Required Inspections and Profealons Code:The Contractor's License Law does Mn apply m an owner of q p property who hu 11ds or improws themon,and who does such work himml f err through his own employees,provided Nat such improvements m not Intended oroOemd formic if. however,Ne building or Improvement is sold within one yea of completion,the owner- _ builder will have the burden of proving Net he did not Wild or Improve for purpose of 'w\S u10 ❑L an mvner of thproperty,am exclusively contracting with licensed contractors m construct the ej (Sec.7044,Business ad Professions CodeThe onsetctr L6 cense Law don not apply in an owner of property who Wilds or imprem Neuron,and who concocts for such pmjcm with a conuacmr(s)licensed pursuant in the Contractor's t License Law. - ❑I m exempt under Sm. .B At P C for this reason net Dam WORKERS COMPENSATION DECLARATION t I Wreby afErm under penalty of perjury one of the following declarations: / y I havemd will malnW n e CeWfinte of Consenuoself-Inwre for Workers Campe4:q� as provided for by Secuan 3700 of the labor Code,for the performance of 1W` which Nb Permit is issued. 0 1 I ban wtl will maintain Workers Compensation Insurance,u required by Section 7]00 flW Taber Code,fm theperfamanceaf the nark farwhich Nb pemitbimued. r Cam tet' Inwrantt eartiu and Policy��o�u//m��btctr��.mv.yy:��//,, •tom e �� n Policy No(LJrnir(1 'f //� RTIFICATE OF EXEMPTION HBOM)V�RIIKER__S' COMPENSATONI U CE (This merlon need not becompleted If the Permit Is fnron hundred dollen(SIM) or Int) 1 certify than in on ptommance of the work for which this Permit b issued.I shall not employ any person in my manner an as in become subject to the Worker's Comp mmon Laws of Califumis.Date Applicant NOTICE TO APPLICANT:If,after making this Cenineate of Exemption.you should become mojeet to me Worker's Compensation previsions of the labor Code,you mum .JO foMwho comply with such previsions or this Pcmh Mdl be deemed mwked. 'Zy CONSTRUCTION LENDING AGENCY .i f+v" Ihemby affirm thn there is.construction lending agency for the perfomanecof ai> the work for which Nb pemit Is Issued(Sec.3W7,Civ.C.) aQ Le do,.Nmc z Lender's AM. U Q 1 emify that I have read this application and sum that the above information is Ig. COMM I agree to comply with all city and county ordinances and jute lam relating to O building concoction,and hereby authorise representatives of this city to enter upon the W shove-mentioned property for indemnify keep hj. (Wc)acme m ave,indemnify end keep humloas the City of Cupertino against faA mainlines,Judgments.cote and expenses which may In my way memo against old City U z in consequence of the gmming of this Permit. C E UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date LATIONS. Re-roofs Signa' Ap tar ❑ H ARDMATERIALS DISCLOSURE Type of Roof Will applicam or future Wilding occupant mom or handle huaNuu material dcnned by the Cupertino Municipal Code,Chapter 9.11.and on Health and Safety $CeBon7S5J1(°)? � All roofs shall be inspected prior to any roofing material being installed. ❑Ya yJ Na n70n4194K'.d Will the applicant or future building Occupant mm equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hanrdnu air contaminants u dcnned by the Bay Area Air Quality Management all new materials for inspection. iet? ❑Yu u I have mW the limandmu materials requirements under CIsi 6.95ofdtefalifor- Health BSafdyCodc.Simmons25505,25533 au125534.l understand than ifdc Wilding r ran cummly haw a mnanl.Nat it b my maprebutu by m nmtify on occupant of the omcn hbh. the polar i u ecoraccni0camof Piney. Signature of Applicant Date a D, All roof coverings to be Class"B" or better T i 1 RECEIVED PR C6 M4 OFFM � � A aits sku14'1 n} d C i ERTIND C DATE SIGNED This set of plans and speci nations MUST kept on the job at all times and la is lawful to make any changes or. alterations on same without written permssion from the building Dept., City of Cupertino. The stamping of this plan and specifications SHALL NOT be held to permit or to be ar, Ipproval of the violation of any provnuocs anv City Ordinance or State ta" . I . i 5 ' JQkSrtf t •1� II 1•«� IrLiJi o +fli .i 3 it el _y�/��)�_/p/Y ,� � iA' 1 5. � * � 4 • 7 r � I 4 1 a CITY OF CUPERTINO v o v 20 CITY PERMIT APPLICATION FORM INO CUPEI�T APN# �-/ l D Date: (� --b —� Building Address: Mailing Address (if different from building address): & Ve, Owner's Name: Phone#: mut L�7 qts—pz� Contr ctor: License#:4 1✓�.r✓1is con"a 1 "I YY- . Contact: Phone: Cupertino Business License#: �1rlS c,,o(( Fax: 9-15-0(V06 B ' ding Permit Info: Y� cAx.e SJ Po. P� (v\ B d lElec I PlumbC] C, Mech ❑ Jo scri tion: Residential mmercial ❑ Sq.Ft. Floor Are $/Sq.Ft.: Cost of Pr •ect: Occupancy Group: Type of C nstruction: Please check this b ' ❑e project is a second-sto addition: uanti I 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 <= 1000A ELECTRICAL BELEC 1001 Elec 600V> 1000A 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 Iof3 � V � � i CITY OF CUPERTINO J. CITYCUPERTINO PERMIT APPLICATION FORM -Quantity Fee ID Fee Description Fee Group 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 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP 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 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Apphance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREM1vIISC 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 BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL WF 2 of 3 i CITY OF CUPERTINO cITM0 PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 Swinuning Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUS IC 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 ZADDCHG Address Chane BUILDING 3 of