03070181 (3) CITY OF CUPERTINO
a BUILDIhIGDIVISION PE IT Anka,CO]VT.RtvCT0W1NF0RMATIr0. R
BUILDING ADDRESS: SUNDANCE SKYLIGHTS PFx""'03070181
OWNER'S NAME: 10585 FOOTHILL AVE PERMIT L95UE DATE
ONE: (408) 842-9540 SANITARY NO. CONTROL NO.
CHITECTIENOTNEER: BUILDING PERMIT INFO
BIRO EIFCr PLUMB MECH
0 0 0 0
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 Mashy afOrm Nu 1 sin iia under pmvi".of Chapmr 9(cnmmcncin� p fan�r
b with SectioAZ(gR of Div" n7 of uteB en Proletarians me and my license is _?
manmdepdWBrom. W j 2 SUN TUNNEL/1 SKYLIGHT
Lice
p Data A CNERELG7San Dg '
a ATION AUG 1 II 2003
I unticr end my plans shell M used a puM1lic records
yU
Licenced Pnd.uionel BUILDING
UI DING
ta� OWNER-BUILDER DECLARATION 6 �V
0 2 I rossn.sM.eci that 11. exempt from tits GoalranC a Licence law for IM
p O following rues.Permit
t 703 1.5,Business mp Pmfessinfi Code:Any oily structure
$m which inquires a permit us mvwct.Blur,improea,d.mnhah.fie a sig any awment
Zy prior Ini6issmnce,also nquite the applicant for each permit micessigned statement
zzG that MisliccnttJpursuemlothcgmvisinn¢nfthe ConueauhLiccnttLaw(Chepu,y Sq.Ft.Floor Area Valuation
F$ (eommencinp with Section 7000)of Division 3 of the Business and Profesanns Coia)or
that he is;stomp,dur.fmm and the basis for the alleged exemption.Any viola4on of
Section 7031.5 by any applicant for a permit subjects the.ppiinnt to a civil penalty of APN Number Occupancy Type
not mon Nen 11.hundred dollen(S50)).
C 1,as owner of IM pmpmy.in my emplayeu with wages u their ants compensation,
will do to work and tho.ormu ,isnot intended or offend for sale(Sec.70th,Business 101 — FOUNDAIT'AWd Inspections
and Professions;Code:The Contractor's License Law dots not apply to an owner of 10 2 — PIERS
property who builds or harmonicasre
theon,and who does such weak himself m through his
own employee,provided thaterch haprovemcnu art not intended confirmed far.1,.If. 103 — UFFitR
however,the building or improvement is sold within ane year of completion,lie owner- .
builder will hex the Wrden or proving that he did not Wild or improve for purpose or 104 — REBAR
cats')' 105 — ANCHOR BOLTS
C I,as owner of an,progeny,am exclusively contracting with licensed contractors In
construct the project(Sec.7tla.,Business and Professions Code:)The CanVACIm'S U. 106 — SEWER & WATER
cove law does Tat apply to an owner or progeny who,wilds or improves denem,and, 202 — UNDERFLOOR PLUMBING
who conte for such pvjecu with a eormctor(s)licensed pursuant m the Conmuof.
License Law. 203 — UNDERFLOOR MECHANICAL
C l sm exempt under Sea ,B&PC for this noon 204 — UNDERFLOOR FRAME
Owner Date—
WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION
IMnbyammunder penalty ofperjury,aneofthe following declarations: 301 — ROUGH PLUMBING
have and will maintain a Cenificaa of Consent o self-iuum for Wortrb Compere- 302 — TUB & OR SHOWER
u provided for by Section 3700 of the Labor Code,for the performance of the 303 — ROUGH MECHANICAL
lm which this peso is Issued.
1 have and will maintain Workch Compensation Insurance,as required by Section 304 — ROUGH ELECTRICAL
3700 of the labor Code,far the performance of the work for which this Parrott is issued. 3053 — FRAME
yWo er'¢C pc nivandPolicy number he - 306 — HOLDOWNS
f.fG/t Policy No:
,,FICA OFEKEMPIONFRO R ERs• 307 - INSULATION
COMPENSATION INSN NCE 308 — SHEETROCK
This section need not M completed if be Permit is far dm hundred dollars is IM) 309 — EXTERIOR LATH
or Ica..)
1 unify the,In tea perfnrmmcc of the work for which this Permit LL issued,I small not 310 - INTERIOR LATH
employ any person bratty mann.,.as or become subjxtto lM Wmacroi'Compensation 311 — SCRATCH COAT
Lowe of California.DauApplcant 313 — ROOF NAIL
NOTICE
NOTICE TO
mAPP : after making Ns Certificate of Eaaoshould
biome mo to the Worr' Com hn provision of the Labor Cook.yourun
,SO1 — FINAL ELECTRICAL ENERGY
0 ronnwithrnsuplywithauehprovl¢iaysortiupermi,ma0nedcemeem.nkee. SO2 — FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 FINAL MECHANICAL ENERGY
I horebyaffirm Nal there is cavwcthm lendingagenry fm the performance of 504 — FINAL BUILDING ENERGY
'7 the work for which this permit is issued(Sce.3117,Civ.C.)
iq Under'sN.me 505 — FINAL ELECTRICAL
i z Landed Address 506 — GAS TEST
C) I deafly that I have need this application and state that the above information i. 507 — FINAL PLUMBING
contact I ji ce to comply with all city and county ordinances and sou laws relating m
i V Wilding conswnion,and hereby anthorix representatives of this cirymcnur upon lM FIN MEC CAL
�4k7 shove-memfoned progeny ser inspection purposes.rpaes.
(Wc)agree to save,indemnify and keep homeless the City of CuNrlino against 0 9 F I
s(aq ip
ensu and upevu may in.yvny aecrue against said City 5 NG
)? igaming al this mil
^' RST DS D OMPLY WITH ALL NON-POINT Issued by:5 C WORKS Date /
IO
Re-roofs
"lota,u ofApplicenAon DOUSMATERIAISDISCLO RE Data Type of Roof
Will the appl'ce orfuwrt Wilding uxupmt Tort orh.dlchvsNuus material
ss defined by the C nfno Munieigal Code.Chapter 9.13,and tie RUIN and Safety
Coda,Section 25571(.)? NA. All roofs shall be inspected prior to any roofing material being installed.
C Yca
Will the applicant.future Tiding accupam tie cyuipmenI a,devices which If a roof is installed without first obtaining an inspection,I agree to remove
't h.'aednus nit conumimods dc5ncd by Inc Bey Arn Air Quality Management all new materials for inspection.
Tict7
❑Yes Nu
I have mad the hanNuus materials nquimmenu undeTChnpwr695 of the Califor-
TiaHUlth&SafeiyCodc,Smuov25 5533.E 2553/.1 undcmlandlhdifthe Wilding
Joss not c tl hatt nanL el it' my IM1ilimy n suly the mcupanl of the
tri nchat otake ccoiBcam or Occupanry, Signature Of Applicant Date
P
Dw ,ortht'I m Date All roof coverings to be Class"B" or better
7
C
t
OFFICE copy r
to tart
APPROVED D c N a NiN(7 cl�i
TN'ACC RDANCE L91TH TN. ITy (IF i
CUP, IN DES .yD ,: ifil;NCcS
DATE p'
SIGNED e
This set ` plans and 's _
p,,:j— rz e a! (Q O
bake on the job of a,'!E:s z +iR r,�r�
lawful to make arty cha, m
on same wthort WO'-' • . %��� �J!/`
the building
Theof sta
mpirtg ttuS p'xOzm
SHAtE N67 6a lurid tb o Mir,
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r
PRE-APPLICATION FORM
Community Development Department
10300 Torre Avenue (408)777-3308/ Fax(408) 777-3333 .
Cupertino,CA 95014 planning®curertino.org
http://wNv:w.cupertino.org/planning
PLEASE NOTE:,
A pre-application conference is required prior to submittal on all
Residential Design Review applications. The purpose of the pre-
application conference is to determine if the application is ready for
submittal.
Please call your project manager to schedule a time for the review of
your application materials. We suggest you allow enough time prior
to the application deadline to prepare additional information or make
changes in case any are,heeded.
Please bring this form to the pre-application meeting for a signature.
Include this form in your application submittal.
Application Request:
Comments:
Signed (planner) Date
As a part of the application review process, City of Cupertino employees may visit your site in order to,take
photographs, slides and/or videotape. These materials may be shown at a city meeting. •
sheet 17 of 20
R1_app_2004.doc revised 06/78/03
C%Y OF CUPERTINO
CU ERTCITY OF O PERMIT APPLICATION FORM
N # �,! Date:
iii res ailing Addre (if erifferent from building address):
Owner's Name: Z Phone
Contractor: License#: 7 3.37
Contact: hone: lG Cupertino Business License#:
Fax: - s
Building P it Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Job Descriprion: ll `�j ` -%
Residential I� O o er 1 ❑ J 6�
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: 2 / Occupancy Group:
Type of Construction: Please check this box if the pro �s a
second-sto 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<= 1O00A ELECTRICAL
BELEC1001 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 BUILDING
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