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05080008 (2) ;,0 ITY OF CUPERTINO '�."9 3r13;adfr rc" BUILDING DIVISION PERMIT GONdTRAC`TO. RINF'ORMATIOe LDING ADDRESS: PERMIT NO.0 5 0 8 0 0 0 0631 MERRIMAN RD NER'S NAME: PERMIT ISSUE DATE PATRICK MONTIJO08/02/2005 NE: SANITARY NO. CONTROL NO. ARCHD ECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 100 LICENSED CONTRACTOR'SDECLARATION JobDescri tion F❑ I hereby affirm that I am licensed under provisions of Chapter 9(commencing P to with Section]Ogl)afDi inion 3 of the Business and Prafeseiom Code.md my license is ',„ in lull lorma lt!m - � UPGRADE ELECT. SERVICE (200AMP) lqz License C Lie.« CONTRACTOR: HOWDEN ELECT. -F p Date LmUhmh r nZ ry ARCHITECT-S DEC A Of K 1 Mc rad my plans shall he used as public cards 5�u o Licensed Pmfcssionel 5 atIa.OWNER-BUILDER DECLARATION Contr ON a C I hereby so .(Sc n e. 1 am exempt from IW f ommis Co Lkcnsc Law for the O O following remora.permit t 5onstr B,Act. and Prove do o] Code:Any city or county 5$U` which rite ism n permit to comuva dkn WPmse,h permit i or repair any swment _Zx< loath m'li.uupu...Lw ftpmdic asiount for eCohpmmr's Licmn rile a signedstatement £F OutW;sRcenwit lurwnnt w N.lmvisiov of Ne doBusiness nd Prof Isw(Chapter9 Sq.Ft. Floor Area Valuer[ (]0 (couy 'at he isc rennot Section and the basis or of Wac,cdnexempt Professions Cmk)or $ Nat he u exempt 1Mmfmm and Ne b.0(err the die{cd exemption.Any violation of Section 7031.5 by airy applicant for a permit subjects Ne applicant to a civil penalty of APN Number Occu ane T am mom than ev.hundred dollars(Ssoo). 34216083 . 00 P y Type 0 I.as..or of IW property,or my employ..with wages u their sok compenadaq will do the work,and themucture u.1 intended or offered for sale(Sec.7W4,Bumrcas and Professions Code:The Contractors License law does cwt apply in an owner of Re 3red pections pmperty,who builds or improves Ameon.and who does such work himself or through his own employe.,provided Ad such improvements are nothumaded orogen d forsale If. huilder.the building or of pmentishathwithinone year of completion.Nepose of builder will have Ne burden of proving that he did not Wild of improve far purpose over of / sale.). �(' / r 0 I.u owner of IM properly,am exclusively contracting with licensed contrition to Y/� construct the project(Sec.70x4,Business and Professions Code:)The Contractor's Li. I (� come Law does not apply to an owner of property who Wilds or improves themon.and V who contracts for such projects with a contractors)licensed pursuant to the Contractors License law. 0 1 am exempt under Sec. .B k P C for this reason Owner Dau WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury are of the following declarations: 1 hive and will maintain a CeruR.0 of Consent to self-insure for WormesCompen- milen,.provided for by Section 37M of the labor Code,for the pernormm of the work for which this permit is issued. 0 1 have arrd wiB maintain Workers Compensation Insurance,as required by Section 3700 of dm labor CodN Code,for e perforrome,of the work for which this permit is issued. My Worke' CompemationlnnW.ricrand Politynomk,mr: CapriE 0 NW KERS' S' COMPENSATION INSURANCE (TLisxcuan reed rant becompleted little permit is foranchuncl ed dollars($100) or less.) 1 certify Not in the Performance of IW work for which this permit is Wood,1 shall not employ any person in any manner was to become subject to the Workers Compensation Laws of California.Dau Applicant NOTICE TO APPLICANT:If.after making Nu CcNfcate of Exemption,you should become subjm in the Worker'a Compensation pmvidons of du Lab.Code,you mug .J z foMwith comply with such provisions or this Permit shall W deemed rooked. Z i O CONSTRUCTION LENDING AGENCY Is:'7 1 hereby affirm that Vert is a eomtrrman e,uction lending agency for N.perfoof 6Ne work for which Nis permit is issued(Sec.3097,Civ.C.) W 0 Under's Name =Z Lenders AM. U 0 1 certify that 1 have read this application and sum that IW above information is LT. P Correa 1 agree to comply with all city and county ardinances and sou laws relating to C)U Wading construction,and hereby au0wrin mpmsenutives of this city in cour upon the aWvc-menudgm propcny for inspection which May F 9L (We)agree to save,indemnify and keep harmleu the City of Cupertino against Z incolues,judgmenhecmuandmg ex Penspermil may in anywayacme aggnslsaid City U z in comcgmnee of the granting of Nis lermit. APP CANT END RST NDS AND WIL PLY ALL NON-POINT Issued by: Date SOU S. igago.of APPlican (m am Re-roofs HAZAUSMATERIALS DISCLOSURE Type of Roof Will tits appliant or arum Wilding occupant Vote or hurdIc hmardom ma¢rim ' as deBntd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety ,lMohCode,Section 25532(a)? [[[!!!��- All roofs shall be inspected prior to any roofing material being installed. ❑Y. ]kNo If a roof is installed without first obtainingan inspection,I agree to remove \Pill Nro e applicant of furore Wilding occupant use equipment or devices which P g it hatardous air contaminants as d.Ened by the Bay Arca Air Quality Management all new materials for inspection. grict? 0 Yca wrNu 1 have read the humdous materials requirements under Chapter 6.95 of the Califon his Hed"SafetyCode.&Co.25505.25533 and 34.1 undmsund that if Ne Wilding cu ently ban a masa Nat it is my ibiliry.n 'y N.mcupam of the USLWomtpn to, of.CemB fOccupancy. Signature of Applicant Date OwmermwNmi.e a ant Dam 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# ,&-;' Ce J Y-000 OWNE 'S NAME: C HONE # GENERAL CONTRACTOR # I am not using any subcontractors: Signatur Date Please check applicable subcontractors and complete the following information: 66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood C\ Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Con or ignature Date U` CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO PN# Date: Bu Id ng Address: Mailing Address (if different from building address): i Owner's Name Phone #: Contractor: License #: J Contact: Phone: Cupertino Business icense#: / gFax: Building Permit Infos G -2oD.7-1 Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential J4 Commercial ❑ Sq.Ft. Floor Ar : $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Co truction: Please check this box if the project is a and-stor addition: ❑ trojectSize: Standard ❑ Large ❑ 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> IM 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 - / C BUILDING 1of3 9 Jo6 / 4- 2-0 /-. � 6 Q CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO MIF-Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING lop BMITIGATC Comm. 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 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 rinkleI/Backfio 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 cfm MECHANICAL BREMAPPLI Appliance 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 BREMMISC Misc A aratus ELECTRICAL BREMNRAPP Rem Non-Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rcpt' Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R air/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMSIGNAD Rmdl Sigris 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--- —Plumbin-Permit"Issue PI UMBING — — PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3of3