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04030023 (4)dre, z �UE �G 5jz zc u 3 L Ct �GC �FFse �YC 4 CITY OF CUPERTINO - - ' - <y�'�8y'. '""e.�^� '+•-'� " ^'" • �g�k `' BUILDING DIVISION PRRMit^' BUILDING ADDRESS: 1012n PWAP TAL! DR PERMIT N'10 OWNER'S NAME: PERMIT 155110 DATE ONE: SANITARY O. CONTROL NO. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description escp (hot 1 am licensed under previsions of Chapter 9 (commencing I hereby affirmo wiNSecti..7 ID)af Diviaion3of Ne Businusand PmfcWons Code endmylicenmle cff= `9 3 inrcredfrjo]wo REPLACE SOLARIUM ROOF W/ RAFTERS--SKYLI LGHTS �a�nd seg assfo Dam —AlSL camracmr tg- a"°� CONTRACTOR: RICARDO REMODEL �! ARCHITECTS DECLARATION 1 undcntend my plans shell he used as public .,aid,' es�f Lianscd Pmfcssional OWNER -BUILDER DECLARATION I hereby .(Sect dwd 11. exempt from she Con,rns Law for the c: Fczzlk �LE nm Cmic: Any city m county following mads.. (Section IIB 1.; Business inti Ca Any c maxo which are. de repairanyswnum which mquha a to construct, alms improv, demolish, arrile ! e, also, a prior at its icueed wriamquims theappliaat forsucUses Contractor', ..Laedsummenl (CMpmr9 Nuhn firming pSecuem to date of thee, Sq. Ft. Floor Area f.I;;� q2 non Valuat o�000 BuncrosandPnsclAw it of Diviom I (commencing with Section 7000) of DivimonJnf the Busismss end ProfasinmC 01 L„_� d`-'' /00/. Nat he Is exempt therefrom and the basis for the elNgcd exemption. Any violation of ` T APN NumberQ'ecu ane e p y Typ Section 1D31.5 by any applicant for a permit subjects the applicmuo a civil penalty of not more Baa. five hundred dollen (M). 01. as owner of lie propeny,mmy employers with wagau Heir sole eompematon, 32618043.00 �j will do the work, end Ne swnme is nal intended or offered f ...1. (See.7W. Basis. Required Inspect) ns and Pmfeselom Code: The Comomme. License Law does .al apply to an .wmr of property he Wildsor Improves Nereod, and who d.ssoch work Mmselfor through his own employees, provided Ihauuch Imprommenlaen not intended mafTered forsale. If. however. the building m improvement is sold wiWim ods year of eo rnmilm. the owxr- Wilder will have tie burden of proving that M did Out Wild Or improve for Purpose of .1m). ❑ 1, an owner of the properly, am exclusively contracting with licensed centneton I. Comwct the project (Sec. 1614. Business and Profaslons Code:) The Conwct.h U. Came Law does not apply in an owner of property who Wilds or improves Neuron, and who comate for such projects with a coatracto*) licensed mounted to Ne Contractor's _ Li ends Law. 1 am exempt under Sec. . B & P C for this tem.. ' Owner Data WORKER'S COMPENSATION DECLARATION one of the following decWdam: 1 hemby aBmh iunder penally of perjurya ❑ I have and will maintain a Certifram of Cement m selGinsure for Wmices Comport. sedon, as provided for by Section 37M of Ne Labor Code, fm the pedom awe of the volt for which this permit Is issuW. C]1 haw and will mains n Worke's Compensation Insurance, ss required by Section 3100 of Ne labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Cartier end Polity number am: Cartier Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSU RANCE (This auction need not W completed If the permit Is for one hundred dollars (5IM) or. mill 1 certify that in the performance of But, work for which this permit is issued. I she not employ any nim maamrnmss to wcomo mtheWehcri CoDTpc ;Ct Lava or Celiforad, • �-sR n ea Inc N TO APPLICANT: If, sifter making this Ccaificam of Ezampd o, au should subject to Na Worker's Cora nvuon pmvish-1 of rite L`13 , Code, you mush foMwidhamplywith Suchprovlsm. or Nu permiu1 hedeem. mromd. CONSTRUCTION LENDING AGENCY I hereby a M. that ill is a conswctnn lndlnsCganq I. eperformmec of ' hework for which Iris permit u issued (See. ,Civ. C.1 Lender's Name Lenders Address 71 1 certify the, I have mod this tion and "hat the above infnamnim is torten. l agree in comply with all y IOU s miners and sate laws minting to building construction, and thereb u a sef[;resemalives of this city I. amr upon He shavcmemioncd propeny f ponos s (We) agree m sav , i if and keep harmless, the City of Cupertim against 7 liabill. a, ludgmcnu,c u he may In anyway eccmc against said City in consequence of tit my of is permit. e APPLICANT UN TAAt AND OMPLY WITHAL NO POINT Issued by:M6� Date SOURCE REG N I 3 m Re -roofs Type OF ROOF awrc o i nVC0mnean - Date HAZARDOUS MAT AIS DIS LOSUR dm aPlCard or future Wlldi aspens morhandlc heieNausmaterial as wflaud by the Cupeaim Murmip,Chep r I)AZ and Ne HaIN and Sa(my Code, Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yes Tp�f/ If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or f d ..Ic nt use equipment or devices which I mit h....do.. air can u e med by Nc Bay Area AlFOUi i,y Management all new materials for inspection. District? ❑ Yes I have re snuourt uimmems under Chapter 6.95 of the Cali for, nice He.lth auSafe understand thm if the Wilding does at c no mnenL end it u my reaporm r try m notify the we.p .f re foac��gp " man mmlWmetpriorl.lsawrow.facerdfica Signature of Applicant , Date All roof coverings to be Class "B° or better owner amhorizcJ agent S' q is J`'�`'/.4�2 Li4 P 2i v� JbJEO PRAlt GAP -bP-. RL6F-tcl-w sr-Hvy -eWwT' RECEIVED MAR 03 2004 CITY OF CUPERTINO BUILDING DEPARTMENT z I'% . ?PZ Tr -r L6CAT"►v fJ OFFICE COPY %DI kn N 1 -,Z -AA Or /Ro ?,rk7-4Y PLOT PLANS CHECKED BY PLANNING EPI'. -0/DATE /'3 _ � �' RI,IM:. "RPT. .;,:;ONK (C-) Ale. ,4!lgctr«6 W/ Sc 2,ws r x:rt-ir✓c, t:+A c.L I �5 r ' i � I RECEIVED MAR 0 3 2004 CITY OF CUPERTINO BUILDING DEPARTMENT PLOT PLANS CHECKED IBZ +ING Df pT, DATE RUM. DEPT QROF ESS/C�� 4N� 9l No. 045625 A �J'j9 C/VI �P i OF CAIIEa� AtFS�Gt'.T r� lotto PN�'Q- 07;, o��c� copy ;001 No. 2s Exp, f CIVIL. OF CA.0 V'Of ESS/p�, �Q�C�opPNIE(p q�F a .4-tJ Ctl} S I ri �goN LSI 2C� _ ! Kiri 4'i oU nS"C kltoJCa��S �� ---- a. 628 Exp. ! ?IIAC, JD 2j 3 S ra" 24 0.C. h N' (N) 2Kzf cr PRus Wkt �. w/ nouPatX TO r� i l s� FEi'r. tjj%t',)t�®�1-seec Tyuy R -E ►ot24 eh -Al - uW De. n CA eq 5k)j J �! I el : OOOD J. CITY OF CUants., PERTINO , :n C*OF CUPERTINO PERMIT APPLICATION FORM APN # 3 Z to r & O Date: Building Address: Mailing Address (if different from building address): a 1 Z6 PN,g/z !-A P C&.,0 X.TiNO 9Sa y Owner's N e: LB/Z EC,�T ,SCND Phone #: Contractor �iG4,COe =MODEL �/2t✓E�[A License #:. } Zgloe 3 Contact: Phone: Z 60 B'66 i Cupertino Business License#: ,61GA4DO Fax: Zel, e3 3 Al S-,* MECHANICAL Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: �lEiL9c� EX o a 1?jv* Residential sitrm 44 F>ERS - s 3XYZ4 ftWn • Commercial ❑ Sq.Ft. Floor Area: ! t L $/Sq.Ft. Cost of Project:Occu *61000 C3�au p' Type of Construction: Please check this box if the project is a Boiler > 1.75M Btu second -story addition: ❑ Quanti Fee ID .Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 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 BMITIGATC Comm. Housing Mit. Fee BUILDING _04 1 of3 �30 CRY OF CUPERTINO AlkCUPEI�TINO PERMIT APPLICATION FORM uanti Fee ID Fee Descri tion 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 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 cfrn MECHANICAL BREMAUU- AN 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 > 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 BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL 2of3 -��i� CITY OF CUPERTIN# C,TY Of PERMIT APPLICATION FORM 1`1 IDCDTIAIn vQuantity Fee ID Fee Description Fee Grou BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation S stems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDRZ BTEMP Tpmnarary Power ELECTRICAL BTEMPPERM Tem ora Rldo Permit BUILDING BTEMPSVCS T2mp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical s . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERNIITFEE Plumbina Permit Issue PLUMBING PPLBG Plumbing Fees foot PLUMBING ZADDCHG Address Chane BUILDING 1] 3 of 3