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04040179 (3)1� CITY OF CUPEWI'INO o- 'fYzCA 1101 =0 RmLmrvc ,vision PERMIT BUILDING ADDRESS: - EARS HOME IMPROVEMENT PERMIU4.040179 NER'S NAME: PERMIT WUH DATE ALBRECHT SCHOY ?83 F. AIRWAY R1 -VD- 04/28/2004 PHONE: SANITARY NO. CONTROL NO, :925)245-2000 ARCHITECT GINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH . l� Q LICENSED CONTRACT'OR'S DECLARATION v - Job Description I hereby affirm that 1 am licensed under of chop,. (commencing With Section )IX) of Division 3 ofNhe Business and ProfessionsCode, end my license Is I. mu mmeand effect. SIDING (792 SQ.FT./RIGHTSIDE ONLY) Limmic Clan Lic. N Data Contractor ARCHITECT'S DECLARATION - 1 understand my plans 'hill he sued as public records Lkcnsed Pmfessib..I OWNER -BUILDER DECLARATION I hereby .(Seth Low for me 11. exempt from me Crousefemum. h LiAny C following heuon. Business and Cade: Any city os county mam on IID L; are, dcanns which acquires •permit ha construct. a@r improve, nr,taig any ssmcme Permit C, thaw m its issuance, also pursuant acquires t a h Permit that he to he the applicant for such rermit m me s signed (Chapter m) Sq. Ft. Floor Area Valuation ofDiviomnrmecanarsctorani«n:chwtCatkry (commencing with Section )0007 of Division 3 of the (commenbnmcdparstion7 assets and vi Code) tar on.fMy Shed u exempt thcrtrom and alleged Any violation of beau for the alleged exempnt Section or to permit objects the Applicant 'civil Penalty of 326AENNi3rut&f) Occupancy Type P Y YP than rayatryleddena.($50 nolmbm Nan eve handled toRan (Sabo). net .6. 01. es owner of the property, or my employees with wager u their sole compensation, ' will do the work. and the structure is not intended or offered for sale (See. 7044, Business Required Inspections I and Pmmssiona Cade: The Conmclare Lkenm Lew docs not apply be an owner of .:. publicity who bulldsorimproves Hereon, and who doessuch workhimself orthrough his .we employees, ping or iOat rsuch improvementsarenatink Of araBamt thRussia. Owner- border ,sounding arimpubwment iesaltWithin one Kar of completion, them of bale.). wN love the burden of proving Nal he tad not build or improve for puryore of ask.). ❑ 1, a everter of the reopen, .m exclusively concocting with licensed contractors to ` - construct me pubject (Sec. 7044, Buainess and Professiotn Code) The Contractor. U. yY come Law does Am Apply to an owner of pmpeny who builds or improves lather, and who contracts for such pmjecca with a conwtuads) Remand pursuant to the Contractor's License law. ❑ 1 am exempt under See. , B k P C for this recon iter Data ,r WORKER'S COMPENSATION DECLARATION 1 M1emby'frit, under penalty of perjury one of the following dwhroarns: ❑ 1 have And will maintain a Cerdlicateof Come, to wif-insum for Workers Compere scion, At provided for by Section 3700 of the labor Code, for me Net..... of me work for which this permit Is issued. 1 have and will maintain Worker's Compensation Insurance, u required by Section 3700 bribe Labor Code, for the performance of the work far which this permit Is Issued. My Wallace. CaurFamalian Imursom am{o end Policy number em: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (11sHmctom need not be completed irthe permit is for unchurched dollars ($1130) ' or Ices) I certify mat in the perrmmance of the work for which this permit Is issued. I shall nut employ any Name in any mannerso As to become subject to the Worker' Compensation Laws of California. Data Applicant NOTICE TO APPLICANT. IL after making mie Capri of Exemption, you should become subject to the Woheb Compensation provisions of tM IaMr Crate, you most forthwllh comply with such prnvisions at this Permit hat[ W doomed revoked. ' CONSTRUCTION LENDING AGENCY I hemby affirm mm mere is a construction lending agency for the performance of OA work fur which this permit b issued (Sec. 3097, Civ. C.) Lenders Name .. Under's Address I comfy mat I have mad this application and scale that the Above information Is correct. I agree to comply with all city and county ordinances and scale laws mining to building construction. and hemby autharmi, representatives of dads to enter upon the above-mentiamd preter y for imtenion purposes (We) agree to an. indemnify and kxp harmlea the City of Cupertino against liabilities, judgments. emu and expenus which may In any way acerae against miss City 67a in consequence of the gmtding of this permil. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Type of Roof SiSignatureof Applicanor DataHAZARDOUS MATERIALS HAZAR Will the applicantorforum Willing occupant ern.1 or handle hoodoos material it. Chapter by the Cupertino Municipal Cade, CNpkr 9.12. and the Health tad Safety tc. Sed Je, Section 255)2(q7 ❑Yes ON. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or ru,m building occupant use equipment ordcvima which coal har rdnus air comominants As dcfncl by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes ON. 1 beve mal me havaNnuama,rialsrequiamenu under CheNr 6.95 of the Califon ria Heal" SafctyCode, Savom255o5. 25533 and 25534.1 understood tharif ret building does not currently haw • levant. this it is aly resrnmiNiity b notify the occupsut of me mquimmcnca which must he mel trial to hatience of a CcNBcatc of Occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better Owner or autharind agent Dale CITY O • CUPEITINO 4 CITY OF CUPERTINO PERMIT APPLICATION ORM o r 77 APN # 3a - 3 — QO Date: Buil ing Address: Mailing Address (if different from build g address): Address - (5 �� P o K �u E Rrl o Owner's Name: L$Ctcf Sc/yo Phone #: - %3 - /7-3 Contractor: E SeAgA"F l�"1 �� ,.5`t' License #: 7a/3 71 Contpct: Phon : '/ [J oAJ PSds 0\7.� Fax: ' d00 Cupertino Business License#: z3 017 Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: S74LL SEA r-$ 0 1 ^jy L & W 1,J % YA-W .Sdf-FiT ce i -93C J Residential J&t4T&1DF oe- Commercial ❑ Sq.Ft. Floor Area: I$/Sq.Ft.: MECHANICAL Cost of Project: �ao 699s. Occupancy Group: r ype of Construction: Please check this box i project is a Boiler> 1M to 1.75 M Btu 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 > 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/OfFComm/ uasi 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 73, D 1 CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description 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 BPINfERCEP 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 BREMAMHAN 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 > l 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, Mar uee ELECTRICAL 2 of 3 uS, am CUPS TING CITY OF CUPERTINO PERMIT APPLICATION FORM 3 of 3 1. • Quantity Fee ID Fee Description Fee Group 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 BSVI M 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 ZADDCHG Address Chane BUILDING 3 of 3 1. • MTOMER AStmtm * Q� -3� —7: A- T D H Y TIC Leff SMfi- SAM RxUlT SM, SK Tw - am, SUBTOTAL 5% ww ar OPENING8 SUOTOTAL 5% wl 104w 90 FT TM SGLMAES... WALL MMM"T [3 1 STORY �1 STORY E3 OCHER A MTHMALCOMMENTS LEFT SIDE- Rl*HT SIDE- AoorrioNAL $6F4 CORNERS......... 1D%WAM - TOTAL RMNING FT. owNsiONASOFF! POROH COUNG j [I Bolifff A FASCIA D FASCIA ONLY wffo l� - TME C01 112M b at 811 times and it 15 -to e t on the 10 1 t ' "' changes or altemw tF:1 �fiueli to .10 any arm�ss-wjj frair. witten P3 Wit Wit out k FASCIPL% I I 'Ity 01 Mprt�1-0- 1 wvw. r the III I mum 01 this plan and sped 0 ii "i" h6d to permit a, be,he , my vjdjoion ot r Moll", it "Ititp 1111". -xfj4;- VMML WA" *11111047 TAILSNOMSRNTµ WALL 0,#Wr w Al„.• Sc - 4.r al.' OX 141'.. 1611” - QV 301"•t10•-•173 tol". 'to" - ox 161"-110"-193 pril-1-220" 123, ev-- TO-- Ilv-1wl-ff It--. jul. Is' ggr-.SM- MY ,.L. do'. 0.7' 121" - iw,, Vill, It'll Itiv OSI-go"w 01•'. "7E' 10-