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03060077 (2) CITY OF CUPERTINO �^ BUILDING DIVISION PERMIT , CONTRACTOk INF+ORMgION ; a ..,.",'t!, ..SMS. BUILDING ADDRESS: E Z ELECTRIC PERMIT No.03060077 OWNER'S NAME: 1250 BIRCHWOOD DR "T's"F9A,1.0/2003 NE: (408) 734-4282 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 000 LICENSED CONTRACIOR'SDECLARATION JobDescri tion tmi I Mmby affan that I am licensed under provisions Chapter 9(commencing P s< -r a Secdon7IX10)or Division3ofdm Buvn and Profeasimn Code.md myllcenols infullforcean e ea rig' ADD SUB PANEL/OUTLETS CIRCUITS 2 , L-F_ I r Lk. — r 9 Deu Co ARCHITECTS QBCLARA ON I motoral�d>ny plana shall ho used u public records 777 eLL Licensed Pmfcatianal 2003 10 OWNER-BUILDER DECLARATION JUN IU 7 N Z 1 ZO s I hereby.(firm that 11. exempt from the Qamrns Co L cense Law fes the D o following meson(Section ILI3L5.Business and Professionsdedemolish. Coir::Any tiny or county ZOO which mquins a permit to uires the ellen Impmw,h pawnit t or repair any ummurt prim w its issuance,also minims the applicant of fanuch panni.m Ole a signed summers (comma licensed cingwitpmoant$theofDivision3Man ofMeB sinesil.)ceaeLaw(Chapmr9 Sq. Ft. Floor Area (commencing with creion70nd of Division of Neeged exemption. Anyavi Crude)oMustr (3 Sec io u 31.5 b Nartfmm and far bash it Bre alleged emmpnt to Any it Penalty of not on than l ve any applicant far a pewit objects Ne applicant m a civil pcnslty of 3 APN MiMer 0 0 Occupancy Type not more than rw hundred dollen(fN10). ❑I,mowner of Ne property,m my employees with wages a their ale compounder, will do the work.end Ne,wmurt bones intended waRemA for agile(SM.7044,Business — Re T{� and Pmfeaimu Code:The Carriacou,License Law data not apply w an owner of 3 04 - ROUGH E� CTKn p�PA1JOHS property who buildtarimprows themon,and whodeartmch work himselforNmugh his T.. J� own employees,provided thin such improvements arc not bounded aro@sed forsale.If. 505 — FINAL ELECTRICAL however,the building or improvement Is old within arc year of completion,Ne awrer- builder .will ruse the burden of proving that he did not build or improve far purpose of sue.). ❑1.as owner of the pmpany,am exclusively contracting with licensed conwcors to conummu the project(Sec.7044,Business and Normal..Code:)The Conlnemri Li. conn law dean net apply o an owner of progeny who Wilds or impact.themon,and, who contracts for such pm)ecu with a commiro(s)licensed puauam to the Contramoh License Isco. ❑1 ran exempt under Sec. .B&P C for this noses Owner Data WORKER'S COMPENSATION DECLARATION I Mrtby drum under penalty of perjury ane of the fallowing dalandom: 1 Mve and will maintain•Cmifiauaf Consent to rtlbinaum for Wahera Compere seen,as provided for by Section 3700 of the Labor Code,fm the performance of the work for which this permit is lased. ❑I hew and will maintain Wahers Compensseor Insurer=,as required by Section 3700 of the labor Code,four Ne performance of the wart for which this pewit it issued. My Workers Compensad n huunew carrier and Policy number am: Po No.t��290Sf0! c ERTIF FEXEM NFROM WORKERS' COMPENSATION INSURANCE (Th4=Man need no becampleted if the pewit is foronc hundred dollar,(fla) or lea.) 1 certify Net In the per(uweme of the work far which this Permit Is issued.I shall not employ any Peron in my mamrcr w as in become subject to the Womers'Compenudon Laws of Cilifomia.Dam Applicant NOTICE TO APPLICANT.If,after making this Certificate or Exemption,you should become object w Ne Worker's CmuMma dm provisions of nW LaWr Code,you must 'Z forthwith comply with such provisions or Nu pewitorill Wrimmed mwked. Z O CONSTRUCTION LENDING AGENCY 1 hereby riff$that then is a construction lending agency for the perform®m of 'aid 7 the.,it fur which this pewit it issued(Sec.3097,ON.C.) W0 Lendcus Name z Lender's Address J Q 1 mrtify that I have sad this application and sum that the&hove information is L,,E ri comet.I agree to comply with all city ocounty ordinances and tuts laws muting to O SUWilding concoction,and hereby&uhorim representatives of Nu city to enter upon Nc �� show-mcmdoned property fm inspection purposes (hoc)agree w ave,indemnify and lamp hurnmss We City of Cupertino against Hy liabillties.judgmeru,costs and expenses which may in any coy accrue.&ala,nod City J 7 in conuquems of the granting of this Permit. r7 APPLICANT U DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date S`2 RE 5%NS.. !/� Re-roofs in....ofAp antlConuacor care HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF Will Ne applicant or future building occupant into or handle hasrdous material a darned by the Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety me.Seema2s532u)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes 11Sr4o Will the applicant m future Wilding weapon,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hoxadnus air com mimntt a darned by the Bay Arta Air Quality Management all new materials for inspection. Id ic.❑Yes Kiklu 1 hew med the usimous maurials requirements under Chapmr 6.95 of Ne CalifonHcolN&SfctyCodc,ScCWm2T505.25533em125534.1unk.=dNatiftha Wilding an nm..momyuimm wnkhm meta^ wiaaanceancertigan facnoO Signature of Applicant Date er or tnarirnd a ant Dam All roof coverings to be Class "B"or better En - CITY OF CUPERTINO e-? o 6 0 77 CITY OF PERMIT APPLICATION FORM CUPEf�TINO . APN4 tY 6 Date:J Building Address: !1 D' Ar �r l�} (/C (,a Owner's Name, —G 0 Phone#: Contract License #:S s Sd Z G O Contac !' Cu�� Busi ess License#: WTD Z7 % Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential ❑ Commercial N Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: 9yS�3oo Type oonstructi n: r� r QuantityFee 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 BB0ILER3 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 Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 CITY OF CUPERTINO CITY PERMIT APPLICATION FORM Ah CUPEkTINO Quantity Fee 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 BNUCOMNM New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUH DING 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER WaterHeater/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 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL. BREMFDCT 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 Apparatus ELECTRICAL BREMNRAPP Rem Non-Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 CITY OF CUPERTINO CII OFA PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 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 Inspection 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 3 of 3