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03060135 (4) CITY OF CUERTINO Bu1LDwcDrv1s1oN PERMITO CONTR�iGT0R,JNF' 'R�MATI BUILDING ADDRESS: PERMIT N0.03060135,3060135, OWNER'S NAME: PERMITISSUEDATE ,NE: SANITARY NO. CONTROL NO. ARCHITECfIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH °00 LICENSED CONTRACTOR'S DECLARATION .lob Description MI hereby affirm that I am licensed under provisions or Chapter 9(commencing with Section 7000)of Division 3 addle Business and Professions Code,and my license is in full force and effect. nLicense cissa Lies 7 ' FENCE r Dam Cantrvctor A�`D s ARCHITECTSDECLARATION c 1 understand my plans shall he used as public records � G LicensedPmmssianal N 2 9 2003 3 OWNER-BUILDER DECLARATION <f I hereby affirm that 1 am exempt from the Contractors License Low for the _ 00 Fallowing reason.(Section 7031.5.Business end Proressions Cute:Any city nr coo ILDI <m� which requires a Pemtit to mnetmct,.Iter,impmw,demolish,or aortic ay smug °it prion,,its uswnce.elw myuires Nc applicant forsueh permitm Rlc=signed stateroompp < thathei,Bamedpursuanttotheprovisionsorthecoamocmraux<nsevw(Chapter9 Sq.Ft. Floor Area Valuation Y~� (commencing with Section 7")o(Divislon 3 orthe Business and Professions Csw)ser ey.. that he is exempt swre mm and the tows for the alleged exemption,Any violation of 36219026 . 00 Section 7031.5 by any applicantfor i permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). ❑I.as owner of the property,or my employees with wages as their sole compensation, will do the work.and theswctum is at intended or offered for sale(Sec.7014,Business — and Professions Code:The Convector's License Law does not apply to an owner of d Inspections properly who builds or improves thcrcen.and who does such work himself or Nmugh his 102 - PIERS own employces,provided that such improvements are not intended or altered(w sale.If, 103 — UFER however,the building or improvement is sold within one year Or completion,the owner. builder will have the burden of proving Nat M did not Wild or improve for purpose of 104 - REBAR WIG)' 105 - ANCHOR BOLTS h as owner of the propeny,am exclusively contracting wit licensed convectors to eon10 6 - SEWER & WATER onw704 sct the project(Sec. 4;Business and Proportions TTtenm sions Code:) Caactors Li cense Law does not apply to an owner of property who Wilda or improves thereon,and, 202 — UNDERFLOOR PLUMBING wimoommacts forsueh *cu with a contractor(a)licensed pursuant to the Convectors Lion 203 - UNDERFLOOR MECHANICAL ❑l a mptun Co. ,BaaPcrnr Tare a 204 - UNDERFLOOR FRAME it NSOECLARI 205 - UNDERFLOOR INSULATION P A AT 'I heteb m".111 de penalty f rjuryo oflherollowing eclantiom: 3O1 — ROUGH PLUMBING hw eand will maintains CeniRcme�Con Do mlLlnsure for worker's Compcm 302 — TUB be OR SHOWER cation,as provided for by Section 3700 of tf Labor Code.far me perfmareme of the 3 03 — ROUGH MECHANICAL work for which this permit is issued. ❑I hew and will maintain Workers Compensation Insurance,as tcquimd by Section 3 04 - ROUGH ELECTRICAL 37W of the Labor Code,for the performance of the work for which this permit is issued. 3 05 — FRAME My Worker.Cnmpensahurt Insurance easier vad Policy number a m: 306 — HOLDOWNS Center. Policy No.: 307 - INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK mosacetion tined not becomplemd ifthe Permit is for one hundmddollars(SI00) 309 - EXTERIOR LATH 310 - INTERIOR LATH e certify that in the performance of the work for which this Permit is issued•I shall not employ C.hpmninanymonocratasmwcome subject theworters'Cnmpematlon 311 — SCRATCH COAT . Laws,,ICalifomia.Dam 313 - ROOF NAIL ApPlicam NOTICE TO APPLICANT.If,after making this Ccnificate of Exemption.you should 501 - FINAL ELECTRICAL ENERGY become subject to the Workers Compensation provisions of the Lobo Codc,you must J Q mahwithComply With such provisions orthis Permit shall he deemed mvoked. 502 - FINAL PLUMBING ENERGY Z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY 'T+ sNr I hereby affirm that own,is a Construction lending agency for the raorrommook,of 504 — FINAL BUILDING ENERGY e#> Lto awu',Nameenthlspemteisiaaued(sae:31n7.Civ.c.) 505 - FINAL ELECTRICAL W Q LenJcr',Addr z sndcr'sAJdress 506 - GAS TEST U O 1 certify that I haw read this application and tete that the above Information is 507 - FINAL PLUMBING torten.I agree to comply with all city and county ordinances and state laws rotating to pU building construction•and hereby suthorbe rcpmsentatives of this city to enter Upon the — FIWC AL W ahavc mentioned pmPerty Tor impccuon purposes. y (We)agree to save,indemnify and keep harmless the City of Cupertino against 0 9 F I N H bilines. en ,cos and expenser which a in any way weruc against sold City 14 U 7 in ea�$q�fey��a the n' g f is permit. Apl LICAN ND - AN W L MPLY WITH ALL NON- 1 Issued by: 5ORKSDate 5 UR U Re-roofs . cof p anU u ran j am AZARD S,MA RIALS DISCLOSURE Type of Roof Wi Na apPl' ant ser fu gqbuildi Occupant Store or handle havudous material as dofnc by the C vino uh' pal,C Jc,Chapter 9.11,and the Health and Safety Code,Section 15533 a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yat Will me applicant or future wilding v¢upant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District' �ff ❑Yes , 6 Ihvvc dW haxaNnus materials reyuimm under Ch to 6,95 of Ne Calif - niceHca�Nu afcs ode,Sc one 5. 5J3 5534.1 unJcrsmndthmir cavil ng dss n have a an t' sihiliry m nnV the t upant f Nc my ' c menta earaceni0eam Signature of Applicant Date rauthari deg 1 i ate All roof coverings to be Class "B" or better :C+ *TY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO PN# 2 ' 0 �T-1J A) Building Addres O tz� 1- W v-' uTZTI�Y 1 O O)m's Name: Phone#: Co actor: License#: Contact: Cupertino Business License#: Bilding,P, nnit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job est ption: dentia] ❑ Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Pr Ject: Occupancy Group: r Type o true ' • 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 IM 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 9 I of 3 / 7 ATY OF CUPERTINO ClAyi CUPERTINO PERMIT APPLICATION FORM Quantity 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 BNUSFD New Single Family Res BUILDING 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 BREMAMIAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM3USWAY 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 Ap Hance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTINP CUPa10 ERTiNo PERMIT APPLICATION FORM QuantityFee 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 Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL 1)JCULYi UVV U~VV3IFLV P1Wl BUILDL*IG 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 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 Chan e BUILDING F • 3 of 3