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03080079 (2)
CITY OF CUPERTINO "% BUILDINGDIVISION PERMIT CONTRA CTnRINFUItMATICIN ' BUILDINGADDRESS: PERMITN003080079 ER'S NAME: PERMIT ISSUE DATE OWE JOHN JR AND MARTHA 0,8/15/2003 NE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +ao LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description with Section 701 of Division 3 of the 8 and Professions Cede,and my licca is iRd c. in full c ad of m. ✓" iii License ° t> ue.a ''.21 (-y MAIN PANEL CHANGE i Darc —cwr CONTRACTOR: BONDI ELECTRIC q � ARCHITECT CLARATION £WGnticrstanJmyplansshallheusedaspublicrecords• PIIVALED ao� Limosed Pmfcso.m.1 5 OWNER-BUILDER DECLARATION <y I hereby affirm that 1 am exempt from the Contractor's License Law for the JAN 1. 2 2004 ❑O following reason.scedon 7031.5,Business and Professions Code:Any city or county <m 6! which requires a permit In construct,alter,improve,demolish,or repair any structure uZN prior to as arance,also requires the applicant forsuch permiuo File aligned statement :r¢ that he is licensed pummnuo the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area ®�atrttt11 79A'YIiP10 21-$ (commencing with Section70aB of Division Softhe Businesaand Protestants Codde)ur (j �ff'Q'e(a"It y that he is exempt Uncertain ad Ne basis for the alleged excerption.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of 3�ATa`hR1 cr00 OCCD anC Type not more Nan five hundred dollars p y - ❑I,as owner of the property,or my employees with wages as their sale compensation, will do the work,and the Simmons is not intended or offered form],(SO,.7W.Business g�� re�j I [� and Professions Code:Th.Commerce.License Law does not apply to an owner of 304 - ROUGHLOns pmpeny who builds or improves thereon,and who doessuch work himselfor through his own employees,provided that such improvements are not intended or offered formle.If, 501 — FINAL ELECTRICAL ENERGY however,the building or improvement is sold within one year of completion,the owner builder will have the burden of proving that he did not build or improve for purpose of 505 — FINAL ELECTRICAL sale.). ❑1,as owner of the property,am exclusively connoting with licensed contractors to construct the project(Sec.]OW,Business and professions Cade:)The Contractors Li- come Law does not apply m an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant o the Contractor' n Law. lam examp. ,under Sec. &PCfo Iis I..a nae 'Y / 0 i• WORKER'S COMPENSATION DEC ION ' 1 hereby&Hirm under penalty of pcfjury one Of the following declarations I have and will maintain u Cea ficroa of Consent to lel-insure for Worker's Compen- sation,in provided for by Section 37W of the Labor Code,for the performance Of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,m required by Section 37W of Nc labor Cod,for the performance of the work for which this permit is issued. My Wormes Compensation Insurance carrier and Policy number am: Cartier. Policy No.: _ _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE f (Thesection need not Mcompletcd if the permit is for one hundred dollars,($100) or less.) 1 certify that int perfmmanee fJ�c work fir which this permit is issued,I shall not employany pe many by cLmOaobjca to the Workers'Compensa,ion Laws nfC a/Daml !// ///CIIIJJJ% !! I' ant It I I �L —r]'�/✓ NbVETO APPLICANT:IL after making this Cer iOcam of Exemption,you should become subject to the Worker's Compensation provisions of the tabor Cade,you must O forthwith comply with such provisions or this Permit shall M deemed revoked. N CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a conswction lending agency for he performance of x rte. be work fur which this permit is issued(Sec.3097,Civ.C.) 1.1 A Lender's Name ' z Lender's Address J Q I certify that I have read this application and sum that the above information is y F building l agree to comply with all city and county ordinances and shiret laws relating e 'U buildingConstruction,prolaly hereby outhorine propmesenmtivesOf Niscitymenter upon the G above(We)agree property for emnif an keep s. (We)agree to save,indemnify end keep harmlcu the City of Cupertino against ( V / ✓ liabilities,judgment.costs and expanses which may in any way accrue against said City ;� z inconsCAN'rcofthe RSTANof this permit. APPLICANT DERSTAND AND WILL COMPLY WITH ALL rN-POINT Issued by: Date SOURC G A NS "fid " q X 440- Re-roofs Signalcol'ApplicaMComractor Dat. HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will theapplicantur futum building mcupem store Or handle hazardinomautnal , as defined by the Cmartion Municipal Code,Chapter 9.12,and the Health and Safety Section 25532(a)? 71 Yes 4Nn All roofs shall be inspected prior to an roofing material being installed. 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 haramous air contaminants as defined by,he Bay Arca Air Quality Management OLL"ort' all new materials for inspection. ❑Yes ANO Ihavc read the b- fetus ma tats requirements under Chapter 6.95 of the Califory nu Hued Safety c,Secdun 5.255JJ anJ 25530.1 undcrs0,md thmi(thc haDding ansa not c cm aro a¢m a it is my respansihility w nodly IINc a:cu ant of Nc req ' a hmust a cartolsmaomoraCerdfieamofOeepan Signature of Applicant Date 41 9 / 0 All roof coverings to be Class "B" or better woof sac Inct,cd agent Date, g CITY OF CUPERTINO " > ++ -' BUILDING DIVISION PERMIT CONTRACTOR INFORMATI0 ^„ a; __ BUILDING ADDRESS: PERMIT N00 3 0 8 0 0 79 OWNER'S NAME: PERMIT ISSUE DA7VE- ROWE JOHN JR AND MARTHA C)R /lr,/2003 INE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EPLUMB MECH 0 ELECT0 0 o p LICENSED CONTRACTOR'S DECLARATION ru P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description aw with Section?0Np Of Division 3 of the RuS and Professions Code.and my license is 'oma in full Ica ndofen.a ,, ss v MAIN PANEL CHANGE 3 q F3 License ss Lic.b Data u .< n3 metar c CONTRACTOR: BONDI ELECTRIC qq � ARCNITECTf CLARATION F W U `TLndersmnd toy plans.1mol he used as puMis maxods a epy Licensed Pnafcssinnal g OWNER-BUILDER DECLARATION a S I hereby affirm that I am exempt from Ne Contractor's License Law for the a O following mason.(Section 7031.5,Business and Professions Code:Any city ae manly <m which requires a permit to construct,Rher,improve,demolish,or repair any strumure eine poor o its issuance,also requires the applicant forsuch permit to file a signed statement mm< that he is licensed pursuonuu the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valua"000 z (mommming with Section 71100)of Division 3 of the Business and Professions Code)or i mot he is exempt creation.and the basis for me alleged exemption.Any violmian of Section 7031.5 by any applicant fora permit subjects the applicant m a civil penalty of - 3`ATiV2,i.uh1cC0 0 Occupancy Type tet are than five hundred dollars(SSW). P Y YP ❑ I,as owner of the property,Or my employees with wages as their sale compensation, will do the work,and Ne structure is not intended or offered for sale(Sec.704,t,Business and Professions Code:The Contractor's License Law docs not apply to an owner ofons property who builds orimproves thereon,and who does such work himselfor Drought his 304 - ROUGH eL ' � own employees,provided that such improvements are notmanded or offered for sale.If. 501 — FINAL ELECTRICAL ENERGY however,the building or improvement is sold within one year of completion,the owner. builder will nave the burden of proving that he dm not build or improve for puryoa,of 505 — FINAL ELECTRICAL sale.). ❑1,as owner of case property,am exclusively contracting with licensed automatic.to construct the project(Sec.7044.Business and Professions Cade:)The Contractors Li- came Law docs not apply to an Owner of property who builds or improves Hereon,and who conmona for such projects wi th a rn locatof(s)licensed pursuant to me Contractor's kiceInse Law. /�� 'i.✓� em exempt under Sec. ,B @ PC fo thi¢ azon aa--�� C WORKER'S COMPENSATION DEC ON 1 hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Conant to self-insure for Worker's Compen- ation,as provided for by Section 3700 of me Labor Code,for me pertormance of the W for which this permil is issued. ❑1 have and will maintain Worker's Compensation insurance,as required by Section 3Wq of m,labor Cotle,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Currier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This ardion need not be complcmd lithe permit is for one hundred dollars(Slap or tax,.) 1 certify shot in t performance of h k f r which this permit is issued,1 shall our employ any per any in As ec mcyspjcct to the Workers'Compensation Laws M_Wool. �V ` I'nnl LI i 1� :V c NE TO APPLICANT:If,al'Icr making this Certificate Of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,z forthwith comply with such provisions arms permit shall he deemed rooked. CONSTRUCTION LENDING AGENCY I hereby infirm that there is a e parnmetion lending agency for the performance of 3i> me work for which this permit is issued(Sec.3097,Civ.C.) Q Under's Name concert's Address J Q 1 sentry that I have rend this application and We that the above iaf ionatiun is y F martin.l agree to comply with all city spittoon county natives or and stem laws relating e �O buimingronnrvniomantl hereby ins,ocrposes.representatives of Nis city to enter upon the W ehnve-mentioned to save for emniflian purposes. (We)agree m save,indemnify and keep harmless the City of Cupertino against tir,OZ liabilities,cnquence of granting uintl of this permit, may in any way accrue against said City (//' (•� J z in consequence of the gmntin6 of this permit. �-ftUl I APPLICANT DERSTAND AND WILL COMPLY WITH ALL ON-POINT Issued by:344_�k6f Date SOURC 'G A NS /Jy� Re-roofs Signature of ApplicMConmactor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant marc or handl,It us material az d,Oned by the Cupertino Municipal,Code.Chapter 9,12,and the Health and Safety Cade,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. D Yea Chic Will the applicant or future building occupant use cyuipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove III hatoomms air contaminants as turned by the Bay Area Air Quality Management strict? all new materials for inspection. ❑Yes j.LNo - Ihave adde h' aNuus ma gals mum ircmmus under Chapter 6,95oftheCahror- niaHcalth@Safety e,Section a05,25533md25534.lunderstamlthetifthe huilding does not c t ave a mild ut a my resp9nsihility m moony the oecu ant of me on,gi nm,at a PdortrflssuancporacwBcamofac pan . Signature of Applicant Date d r 03 All roof coverings to be Class "B" or better 4!r un thorizcd agcm Dater Electrical changes to existing structure ,O John RoW HI5 PLAN SHALL PEMAIN ON 646 Phil Cd CONS au�O°"�°NG Cupertino, Ca 95014 APPROVSO� oa ][� COF1-V-6D IN ACCORDAN DE IT" TH f 0 AUf 5 2003 cup RTINO )ATE SIGNED_,_._.-- specifications Thls set of plan, and oe kept on the job at all nes and alterations lawlul to mI "'Y ermission from on same without written P ertino. the I uiidmg Dept.. City of cup • .,;-,, of ibis plan and specifications Install new outlets and switches inaexi$ting,ewallSmit or to be A 3ftALt 1�V rovision9 In Kitchen and Garage perpplans.ha violation of SAY P .•r stnv City Drd�narrce or State Law UFFR GROG rkeQUIRED,' . 1 of 2 -- it E ,- p ., APPROVED ,E IN ACCORDANCE WITH THE (IT) Of C COpfRTI' CO^ES AN' ORDI IA1ICt;S — `, : .r .. I � OA@E� SIGNED,,, This gat uji ns and specit atie is 6,—U T �' s na kept on t`i,' at all times an i i. is un lawful to,ma/kk any changes or f Ite agony M same ^ ihout written permission frons ?r , the building Dept., City of Cuperti to. I The stamping of this plan and spec fic tions SHALL NOT be held to permit or 0 1 e an approval of the violation of any f rov sfons If any any City Ordinance oL State Lav R THIS PLko't,'• SHALL REMAIN N E 1013 ALL TIMES DURING AUG 1 5 2003 'I ;x " �7 REQUIRED' it 9� .• y 1 r. i 1Y it I or0 m C%Y OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO -APN # _ Date: / D Bui din Add e Mailing Addre s (if different from building address): I (iC Owne 's N@me: Phone#: V�'n Con tr License#: or: I�\ = Q t�� 3; 11:P0 -Contact: 1 p Phone: Cupertino Business License#: ! (.10Ldlc L / — x: qAfi�ldiqg Permit Info: Bidg Elect Plumb ❑ Mech ❑ Job e cription: ential t Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: © � Occupancy Group: r� Type of COn do I•CJ Please check this box if thlevralvefis a C � i Cq 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> I OOK 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<= 1 OOOA ELECTRICAL BELEC1001 Elec 600V> 1 OOOA 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 �a- 1 of3 aus- C*Y OF CUPERTINO i CITYOF PERMIT APPLICATION FORM CUPEkTINO uanti 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 BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res 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 rinkler/Backflo 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 BREMAIl2HAN 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 Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 ' d CITY OF CUPERTIA CUP TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING i 3 of 3