03080139 (2) CITY OF CUPERTINO *'P^` ';;�'�
BUILDING DIVISION
PERMIT CONTRACTORgINFORMATLON
DU ILDING ADDRESS: PHAN CONSTRUCTION CO INC PERMITNO03080139
040A MENHART
OWNER'S NAME: 870- S WOLFE RD PEFMITISSUEDATE
ONE: (408) 737-8323 SANITARY NO. COM04 N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
lop LICENSED CONTRACTOR'S DECLARATION
I
to hereby affirm that 1 am licenud under provisions of Chapter 9(commencing Job Description
yq with Sc 7kq�ml.frcDivision3 of NC Buaine�nd� s�nn Code.and mylicensc l5 `' �®
s in full for and effect. ✓--�—� ■`
'? Llcen Claw Lie SERVICE UPGRADE TO 20CAMP NAL
t: Date Comrecse
\\JJ ARCHITECTS D ATION {� n Q
l YuYtdcrstandmyplanashall W..coalpublic rccnrds SEP 2 2 2003
e G Licensed Pmfeasinnal R�
- OWNER BUILDER m Cd Contractor's
ON BUILDING
00 I maxo affirm that 1 1. aurin from tire Cssions Co Licensor Lew for the
00 following moon.Section 703 1.5,Business and improve.
de professions Cole:Any city or county
till! which requires•permit w cnnswn.Wcr,impmw.dcmolLsh,or repair any structure '
that he to the
sheapplicuf for C.dt.,t r'a Lt ..Lacdnaamcnt
_< thnheisliccnuJpursuomtothcpmviainnsnfthcCantmctoriLicensclaw(Chaprer9 Sq. Ft.Floor Area Valuation
ilt (commencing wi th Section 70W)or Division]of she Business and Profession&Code)tar
�3 S shat he in exempt therefrom and Ne bale far Ne alleged exemption.Any violation of
Section]031.5 by any applicant for a permit subjects the applicant bo a civil penalty of APN NumberOccupancy Type
not mart than five hundred dollars(SSD).
I,as owner of the property,in my employees wish wages a their sole compensation,
will do the work,and the income is not intended or offered foralc(Sec.7W.Business 103 — UFER
and Professioa Code:
The Conuactor'v License Law docs not apply w an owner of Required Inspections
property who builds or improves thereon,and who does such work himselfor through his 304 - ROUGH ELECTRICAL
own employees,provided that such improvements are not intended or offered for sale.It. 505 — FINAL. ELECTRICAL
however,Ne building or improvement is sold within one year of completion,Ne owner.
builder will have the burden of proving that he did not Wild or ire prow for purpna of
I,as Owner of she property,am exclusively contracting with licensed Contractors to - --
Construct the project(Sec.4004.Businca and Professions Codep The Contractor's U.
cense Law docs not apply to an owner ofpropeny who Wl ids or improves thereon,and
who contracts for such projects with a commetor(s)licensed pursuant o the Contractor's
License Law.
lanastrunnrn Sec. ,Bh PCfanhisreasnn -
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby effort under porosity of perjury one of the following deck ration:
I have odd will maintains Certificate of Cnnun0o ac16laum for Worker'.Cumpen.
setion,az provided for by Section]]W of the Labor Could.for the pcAormancc of the -
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3]00 of the labor Code,for the performance of the work for which this permit is issued.
M W kers Cnmpenvation ldrunnce cane OPolicy nu her art:
Ca . SM7Fi fl)Ili{�l Policy No.: ;=
CERTIFIC TEOF EMPnON ORKERS
COMPENSATION INSU ANCE
(net s mini..it not be completed if the permit is Toone hundred dollen(5100)
n Ica%.)
I cenify that in the perfoormnce of the work for which this Permit is isided,l shall not
employ any person in any manner an a be become subject o the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,aper making Nis C.mficare of Exemption,you should
become subject to the Workers Compensation provisions of the Iabm Code,you must
70 fonhwith comply with such provisions or this Permit shall be deemed revoked.
Z M CONSTRUCTION LENDING AGENCY
I hereby affirm that there its construction lending agency I'or the performanm of
1a Ne work fur which this permit is issued(Scor.ID .CO.C.)
37 Under's He.
z Under's Address
J 1 anify that I have read this application and stare Nem the abew infernal..is ,
.� (~ stoThet.I agree to comply with all city and county ordinances and abase laws relating to
� building construction,and hereby authorine representatives of this city so enter upon the
Uabovcmentioned property for iapection purposes. is
(We)agree to save.indemnify and keep harmless the City of Cupertino against
rat inconsequenc of
pricing of this pe which may in any way accrue agaial said City
J z A APPLICANT
of UNDERSTANDS
of this perm]]. Cf
F-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
q2
SOURCE REGULATIONS.
/
—7"'(11414 Re-roofs
S' to of Applicata Conuamr Oslo "
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or Tulare Wilding occupant vmre or handle haudom material
as defined by due Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.de.Section 2ssa2(,)?
_J Yes AN. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupam use equipment or dcvica which If a roof is,installed without first obtaining an inspection,I agree to remove
it humerus air contaminants a defined by the Bay Arca Air Quality Management all new materials for inspection.
iatrim?
\.- ❑Yu FTI Nu -
I haw mad dmc baandoOr materials requimcments under Chapter6.95 or Ne Califor.
nie Hanlon,&Safety Codi Secti,a 25505,25533 and 25534,1 understand tha if Qua Wilding
Duca ata cunemI haw a renanL Nab it is my msp.n.ihiliby m nodry bor tiXupent of the
mquircmcnu which run mel prior to issuance ofa Cenifcau:of upan�cf Signature of Applicant Date '
lib All roof coverings to be Class"B" or better
Owncr .-Inciredo cm Dam
S�I " CITY OF CUPERTINO
61
CITY OF PERMIT APPLICATION FORM v`'? `3
CUPEkTINO
PN# Date:
% 7x- 16 - o0� 9 �2G o3
Building Address: / _ Mailing Address (if different from building address):
t 0 4 D q Ate H4ka Gum 1
Owner's Name: . Phone#:Ion 74- - Z6 7 3
A-rv�,411�A'RAS �
.
Contractor: License#:
fH?WCOVCW( Pur,Z,`vk IA),---
Contact:
NLContact: Phone: +oi364a-3 Cupertino Business License#:
T tEU Fax: 40073 –23J
Building Permit Info: -
Bld EI(c Plumb ❑ 49 Mech ❑
Job escription: q�� l� O 1
Residential ❑ �f— Co ercial
Sq.Ft. Floor Area: $/Sq. t.:
Cost of Project: / Occupancy Group —,
Type of Construction. Please check this box i t e project is a
second-story addition: ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to IM 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<= IOOOA 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. Housing Mit. Fee BUILDING
z� 1 7
tots , �, .Z 7
CITY OF CUPERTINO
�- CUPEI�r PERMIT APPLICATION FORM
QuantityFee 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
BOVERTBAE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g 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 rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BRENLkMHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREM13USWAY Remodel Busways ELECTRICAL
BREMFIXT 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
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bVl
CITY OF CUPERTINOO
CITY OF PERMIT APPLICATION FORM `
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
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 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 Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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