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03050136 (4) CITY OF CUPERTINO BUILDING DIVISION PERNIIT G�ONT� T1,01 �CNkO MATT 1, BUILDINGADDROS: RUDOLPH & SLETTEN INC PRRMITNO03050136 WNER'S NAME: 989 E HILLSDALE BLV PERh""`b"l 3n8/2003 EWLETT PACKA D PHONE: (415) 572-1919 SANITARY NO. CONTROL NO. ARCHITECTENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECN t� I� �06 LICENSED CONTRACT'OR'S DECLARATION Job Description z I hereby am.that 1 un licensed under previsions of Chapter 9(Commencing p n< with Section]IXNn of Divielan3ofthe Bu n antl Pro(csaions Co .red mylken.b �� � ❑❑< in full force an ,Reck!\ j{9Z Licen¢CI '-i 9 TI-NEW TRAM E A ION L3F Dam 'd1�,;r Conlranw c ARCHITECT'S D ATION I �undersand my plana shall W used u public rceorde JAN -- 2005 n y0 Lkcmcd Pmfcuioml OWNa.ER-BUILDER DECLARATION COC I Wrchy.(Sa Net 11. exempt from me Comslessomnoh License city o for the COC following mason.(Sadao 71013.Business and Profrsdoas Cade:Any oily or county S1 Fs which inquires a Permit to construct.alter.Wprow,demolish.or repair any structure -ZS Prior m its ismanee.alsu mquiros memplicant formch Permit m limed statement w FE< mat he itIlcen.d mmo mnuo the provisions of the Comrm er'sUawo law(Chapter 9 Sq.Ft.-Floor Area $2 4 14 y ration . Sg (commencing with Section 7000)of Division 3 of the Business and Professions Code)Or l� Nat he is commit themofrem and the basis for the alleged eumpdan.Any vlolNon of Section 7031.5 by any oppliant two permit subjects the applicant to a st Penalty Of 3 MWTSt i6er 0 0 Occupancy Type nal more Nm Rw hundred dollars(SSW). R�I,as owner of the property,or my employes with wages u their mle compensation, will do the work,and Wswnure is not intended oraRered for sde(Sec.7044,Business - I dInspections and Professlom Code:The Contractor's Llan.Law does and apply to an Owner of 102 - P I ERS property who builds err improws themon,end who does such work himsel f or through his Ownemployoex.provided that such lmprowments an,not Intended wuaesed for sale.If, 103 - UFER howewr.the building or Improvement is mid within one you of compledon,me nower- builder will haw the burden of proving that he did not Wild or Improve four purpose of 104 - REBAR sale.). l`') 105 - ANCHOR BOLTS ❑1.to Owner of the property,am exclusively communing with licensed conuecmn On 10 6 - SEWER & WATER coastmet the project(Sec.7014.Business and Professions; de:)CoThe Contrmmr's Li. acme Taw does not apply m an owner of property who Wilds or hnprows thereon.and, 202 - UNDERFLOOR PLUMBING whoconeacts for sueh projects With acontsae.r(U Incensed pursuant.the Conumme. License Taw. 203 - UNDERFLOOR MECHANICAL ❑I an exempt under See .B A PC for this recon 204 - UNDERFLOOR FRAME Owner Da1e 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby afOnm nu under penalty of pery ons of rte following decimations: 3 01 - ROUGH PLUMBING . ❑l haw and will mainuina CeARama(Con.nlmmif-Iasumfor Wodmfs ComNn- 302 - TUB & OR SHOWER salon,an provided for by Section 3700 of the labor Code,for the performance of the 303 - ROUGH MECHANICAL work far which this permit lalaswtl. 304 - ROUGH ELECTRICAL ❑I how and will maintain Workoes Compensation Insurance,at required by Section 3700 of the labor Code,for the performmce ofine far which this permit la Issued. 305 - FRAME , MyW ker'e Compensation luunnce aortia andP iry number ase: 306 - HOEDOWNS t1µCFlrn/� rats m.:WC 344F'id'7G3 307 - INSULATION' C RTIPICATE OF EREM FROM WORKERS' rt N k�{-1f COMPFNSATIO NSURANCE 308 - SHEETROCK I'f�f ll lelinn hd not W completed if tie Permuts ter one hundred dollma 100) 309 - EXTERIOR LATH `rles`') 310 - INTERIOR LATH 1 certify that In the performaac of tW work for which this permit ts issued.I shall not 311 - SCRATCH COAT employ any peaon in my manner m u m become subject to the Workers Compensation Lawsaf California.DateAppl313 - ROOF NAIL NOTICE Ncome suOAPn[be APPLICANT: Compensation o pensationp Certiriate of Exemption.you you 501 - FINAL ELECTRICAL ENERGY becomeh compbjecIt m the Warks ro COm ator this providam of the Lotteound r wise you masa .Jz' fOMwitheomPlywim mchpmvWoaswthupermit abet Wdermad revnted. 502 — FINAL PLUMBING ENERGY Z� CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY p+► Ihereby affirm that them is.cowwss.kndingageayfor mePafmmanceuf 504 - FINAL BUILDING ENER T�� C> the Work for Which this crmitI.Wood(Sec.3W7,Ch,C.) 505 - FINAL ELECTRICAL W Q Lender's Name �z Lender's Address 506 - GAS TEST UO Icertifythat Ihow radthis m,licationand smmmatheaW.i.formalbni, 507 - FINAL PLUMBING jr. eomet,1 agree to comply with all city and county ordinances and stem laws mining to O SV: building cons ICLIm,and hereby authodze,mpmsenudws of this city to crac"pon theFINAL MECHANICAL W 'Im.-nmllOned property for WpeedOa purpose 0 FI may, 6, (We)agree to saw,indemnify and kap homeless the City of Cupertino again run IlablOtia,judgments,costs and expenses which may in anyway accrue against said City NG I�/ U 7 IInnlonso umcoo R TAll NDS ROf IND WILL COMPLY WITH ALL NON-POINT Issued by:5 C WORKS Date t� s0U E GUL S. Re-roofs ig re afA plian uacmr Glue HAZARDOUS MATERIALS DISCLOSURE Type of Roof 7:WiII the applicant or future Wilding Occupant scum or handle hasardous material as de0ned by the Cupertino Mrkipal Code.Chapter 9.13,and the Health and Safety calm.section sss33p)7 All roofs shall be inspected prior to any roofing material being installed. ❑Ya No 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 emit It dons at conmmi coned by dm Bey Arca Air Quality Management all new materials for inspection. District? ❑Ya ❑ u Ihavc madmel,carmyy Oto als.qui.menmunderChapmr6.93artheCalifor- ria Hcalm A Safety Cadvj,Scctjpm26506.36333 anJ 35334.1 undcremnd motif the building docs not ep Only owo1 6ddd4 ren it h my..,.IMlitymnodi' Ne axupanl of me rcquim amu ma man n Ipda witmana aQen'ties f aapmcy. Signature of Applicant Date n r� J �� All roof coverings to be Class "B" or better Owner a ma�( decd egen� Da. CITY OF CUPERTINO Oem 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 31607046 . 00 DATE ISSUED. . . . . . . : 05/28/2003 RECEIPT # . . . . . . . . . : 21967 REFERENCE ID # . . . : 03050136 SITE ADDRESS . . . . . : 19091 PRUNDERIDGE 46 # BLDG SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : IMPACT AREA . . . . . . : OWNER HEWLETT PACKARD ADDRESS . . . . . . . . . . : 19091 PRUNDERIDGE CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : RUDOLPH AND SLETTEN CONTRACTOR . . . . . . . : RUDOLPH, ALLEN LIC # 5335 COMPANY . . . . . . . . . . : RUDOLPH & SLETTEN INC ADDRESS . . . . . . . . . . : 989 E HILLSDALE BLV CITY/STATE/ZIP . . . : FOSTER CITY, CA 94404 • TELEPHONE . . . . . . . . : (415) 572-1919 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ----- ----- ---------- BPERMFEE VALUATION 249, 000 . 00 1384 . 00 0 . 00 1384 . 00 0 . 00 BELEC1001 METERS 1 . 00 88 . 80 0 . 00 88 . 80 0 . 00 BPLANCHK PERMIT FEE 1, 384 . 00 1176 .40 0 . 00 1176 . 40 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BSEISMICOM VALUATION 249, 000 . 00 52 . 29 0 . 00 52 . 29 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 2737 . 01 0 . 00 2737 . 01 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 2737 . 01 725125 TOTAL RECEIPT 2737 . 01 • �� �Y OF CUPERTINO 0 D 3 o,�d( 3 � CUPEI�F PERMIT APPLICATION FORM APN# 31 ©� _ Od ' — Date: 2� 03 Building Address: Ow er's Name: Phone B; - - - - �-> 60 Co tractor: L N LicenseA o Q o C ntact; Cupertino Business License#: �C Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: .- Residential ❑ w i Commercial Sq.Ft. Floor Area: $/Sq.Ft.: 2no o o SF Cost of Project: 2 O o o Occupancy Group: -Z Type of Construction: p� v 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 <= IOOOA ELECTRICAL BELEC 1001 Elec 600V> I 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 I BUILDING 1 of 3 � �f o, z73 L Y OF CUPERTINO CITY0 PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMTI'IGATR 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 BNUSFD New Single Family Res BUILDING BOVERTME hispection Overtime BUILDING BPBACKFLOW Atmos heric 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin 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 2 of 3 •L Ile - CITY OF CUPERTA OF PERMIT APPLICATION FORM CUPERTINO 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 LigWg 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 a 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 PlumbingFees foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3