The URL can be used to link to this page

05070017 (2) CITY OF CUPERTINOv >~ ' mm&,. BUILDING DIVISION PERMIT i(,90 "'m , �� . ,,.t eve, BUILDING ADDRESS: KEISER, ROSS GENER CONTR """05070017419. PALM All OWNER'S NAME: PERMIT SUE DATE ARIC JNE: SANITARY NO. CONTROL NO. (408) 446-4379, ARCHr1ECTIENOINEER: BUILDING PERMIT INFO BLDG ELECT O l� PLUMB MECH O O 4 repo LICENSED CONIRACIOWS DECLARATION ,�w1�w 777��Q ye ism I hereby mDirm Net 1 un licensed under ProvhiaN.1 Chapter 9(ammeneing J`1Y'� R QP ■ wins Section 70110)of Division 3 ofdu Business and Profession Code.and my limmic h �I'AV.v/w��■6 I.full farce and eR n'z Lima.Cisss Lk.Y 3o STUCCO OVEN (E) SIDI G ��— ED MDam Cnnlnclor e ARCHRECTS OEC R TION �� 2U�5 Y 1 underuend my Plans still be used u public rtenrN JU G Licensed Professional g OWNERBUILDER DECLARATION �■ pllp L®I� 4 E 1 hereby eft).that I Me exempt from NLicense Low Contractors LiceLaw for the U O O (ollowint reason.(Section 7(131.55.Business and ProfesaluN Code:Any city or rounry vo$vo which requires a Permit m eonurucL after.hepmve,demolish,or repair any structure z k`7 $C200 Prior in its Issuance,also requires the applicant fanuch permit In rile a signed Moment g Nat he is licensed pursuant oIn.provisions ofthe Comoutue.Lim.Law(Chapter 9 Sq.Ft. Floor Area Valuation a $ (commencing with Senlon 70DO)of Division 3 of the Business and Profession.Cod,)or '� .. that he Is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a Perth subjects the applicant In a civil penalty of 3 91LTOMfliberO 0 Occupancy Type not mon than Bve hundred dollen($500), ❑Lo hewerof the property,es Is employeesw o wagasortheir hale 044,8 main, will do the work,and the Th.Consumes icanded Liceme Law llecred of apply to anowneriof Required Inspections and Phafeaslov Code:The Cenvacters Littnx law don not apply m an owner or q P propempior ,pl irMprowsthereon, mmmdasanehwok aroffe dIhrougM1his own a er.the Wiprovided thusah Imprownnts are not year ofc moaend the ove.lf, builder .,the building a ImprovementIshalt within mu 3eac of complomon,Ne ower- builder MB low the Wrdn of prov)na that N did not build m Improv for purpose of sale.). ❑I.as owner of the property,am neluenlY contracting with licensed nntracmrs in construct Ne project(Sec.7014.Business and Prohembov Cade)The Caafrsebt's U. most Law does not apply to an owner of proPerY whe,luilda or Improves Nenon.and who contracts for such projects with acontrxmr(s)licensed punvat m the Cowtracmrl Lice.law. ❑I am esempt undo See .B A PC for this reason Owner Dau WORKERS COMPENSATION DECLARATION 1 hereby&M m under penalty of perjury oro of the following declarWev: 1 Nva and will maintain a Certifnu of Consent to xel6lnum for Worker.Compere action.as provided for by Section 3700 of the labor Code.for the Performance of the work for which his permit is house. ❑1 Nw and will maintain Workers Compensation Inwnnec,as required by Section 37M of the labor Code.for the performance of the work for which this perentt is issued. My Wmkers Compensation IN sea cartim and policy Muskrats: Cartier. P,-V aA(/ Policy No.: CERTITE OF MEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need notb,completed If IN permit Is faros,hundred dollar($IpH ser loss.) 1 certify Not in Ne performance of the work for which this Permit is Issued.I shall not employ any person In any marlmrsn as to Income subject In to Workers'Coml ensaOon Laws of Calif,nia.Dau Applicant NOTICE TO APPLICANT:IL after making this Cenifcam of Exemption,you should Income subject in the Worker's Compensation provisions of the Labor Code,you mum 0z forthwith comply with such provision or this permit shall be domed revoked. .'Z.t O CONSTRUCTION LENDING AGENCY [ti Iberebyars.that Nen is a connotation lewdingagency for the performance of a? the work for which this permit Is Wood(See.3097,Civ.C.) W to Lenders Name , 7'z lenders Mdreas U 1 ceni(y that I ban read this application and sum that the show information is it, cement.I agree to comply with all city mod county ordinances and state hues mlat ng to OSV': Wildint conuruc0on,and hereby amhmln representatives of this city in enurupon Ne , W shove-Mommeed property for inspection purposes. "gy (We)same to asw,indemnify and kap harmless the City of Cupenino against rA liabilities,judgm,nu,coos and expenses;which may in any way amuse galNt said City ()tzin"' APP�mmUN UOf ft NDERSTANDS AOf Is Permit. N PILL COMPLY WITH ALL ON INT Issued by: Date S- (� S EGUTATIONS. /01 Re-roofs Sidth of Appii Onmacm Dam HA7ARDOUS MATERIALS DISCLOSURE Type of Roof Will tM applicant,,furan Wlidina ecu. Mn rehandle havardoes material as defined by tits Cupenln Municipal Code,Chapter 9.12,and tiro Health and Safety IniaH..Iffi&S.fclyC.de,S=U..25505,25533�25534.lundeam de,Sec0on 25532(a)1 / All roofs shall be inspected prior to any roofing material being installed. O Yes 0tu Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove I Ween nes alr conn nimmos as deflect by Ne Bay Arca All Quality Management all new materials for inspection. stricl7 ❑Yca 0'Nr, than mad the hmndousmaurlals requlroments under CIOPur6.95of the Califon d dul(0mc ilding n not ally hew a u nt, t It h my AMFOOMbllity m nofy the oP ofthe ewhichmuu pdortoissunceoracerticama pp Signature of Applicant Date — I All roof coverings to be Class"B"or better caner or archon spent - r Date Community Development 10300 Torre Avenue 4 Cupertino CA 95014 Telephone(408)777-3228 C Fax(408)777-3333 �UPERTINO Building De artment JOB ADDRESS: PERMrr# Z2 2 OfO?Do ! 7 OWNER'S NAME: PHONE # 5/37Z GENERAL CONTRACTOR S FAX# I am not using any subcontractors:/ 7 SOS'' Signature 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date G CITY OF CUPERTINO CU PEI�TINO PERMIT APPLICATION FORM 6a tr 17 APN# b lir Date: 7ZS 0 Building Addres • Mailing Address (if different from building address): LL V Owner's Name: Phone#: Contractor: License #: assE/s T.? 30 Contact: Phone: Y06- f/y y3 Cupertino Business License#: r ,f Fax: Building Permit Info: S-r-q C co 0 vP�t -Px/Jiti' qi / /'moi Bldg El' Elect ❑ Plumb ❑ Mech ❑ Job Description: - Residential Kp ykI -ems Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 6a Occupancy Group: Type of Construction: Please check this box if the project is a AML second-story addition: ❑ Project Size: 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> 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 1 of3 3 `a 63 CITY OF CUPERTINO CUPEf�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 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 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 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 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 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION.FORM QuantityFee ID Fee Description Fee Group 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 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 3 of 3