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04040147 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT' a CONTRAGTMJSIFORMATTON' s . BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMITNO04 0 4 0 14 7 1 -�-�2 SEVEN S2RTNnR DR OWNER'S NAME: PERMIT ISSUE DATE STEPHEN LEECOMMERCIAL —.Q4/22/2004 ONE: - SANITARY NO. CONTROL NO. (408) 536-0420 ARCHI)EC-HENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t� 0 0 0 �OOOF LICENSED CONTRACTOR'SDECLARATION - "ra u`� l hereby affair that I am licensed wader pevi.sit ns of Chapter 9(commencing Job Description wiNSaaIkm7NX)of Division B srncss end Prufcssinns Cndc.antlm license is jHs in fullfnecanJeffec a y REPLACE SIDING Ltccnse Class Okla. Dao ConTSDEof JUL 2g 2004 ARCHITECTS DELL ATION el U I understand my plans shall W used as public accords Licensed P..fcssimml yq� affirm OWNER-BUILDER DECLARATION �� a I 1 hereby arm that 1 am exempt from the ComaactorBUILDING rai�sLN's License Law for the - - i 0 O following feasan.(Section 7031.5,Business and Profession Code:Any city or county k$ which requires a permit in construct,alter,impmve,demolish,or repair any structure prions its issuance.also requires the applicant for such permit to rile a signed statement o hat he is licensed pursuant to the prOvionorm of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7")of Division 3 nNha Btainess rand Professions a. or a. that he is exempt Ncrefram and the basis for the alleged exemption.Any violation of Section7031.5 by any applicant for a permit subjects the applicant loecivil penalty of not momRan rive hundred dollars (S5p0), 3 1er00 Occu ane Type ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and Ne strumurt is not intended or offered for sale tSec.7044.Business and Professions Code:The Contractor's License Law docs not apply to an owner of. Required Inspections property who builds or improves thereon,and who does such work himself or through his awn employees,provided that such improvements me nut intended oroRered forsale.If, 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 Wild or improve fur purpose of .[a.). ,as aware of Ne property,am exclusively contracting with licensed contractors to c street the project(Sec.7044,Business and Professions Cocia)The Convector's Lt. reuse law does not apply to an owner ofpmprrly who Wilds of improves daemon,and Who contracts for such projects with a comractor(s)licensed pursuant to the Contractor's License Law. ❑Imo exempt der�r. ,B&P C for this reason Owns / Date ORKERS COMPENSATION DECLARATION 1 hereby affrn under penalty of perjury one of the following declarations: I have and will maintain.Cenificam of Cmnscnt m sal.hood.for WorkersCumpen- sation,as provided for by Section 37M of the Labor Code,for the podmmance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,Or required by Section 3700 of the Labor Code,for Ne performance of Ne work for which Nis peamit is Issued. My Worker's?, Insurance artier and Policy mork'a: / Cartier: / 4Y (.� Policy No.:(�� �C CERTIFICATE OF EXEMPTION FROM ORKW ERS' COMPENSATION INSURANCE (This section need not he completed trine permit is for one hundred dollars(Slap or less.) 1 certify Out to IIIc performance of the work for Which this permit is issued,)shall not employ any person in any manner an u Or become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:IL star making this Ccnifcate of Exemption,you should become subject to the Worker's Compensation provisions of the Ichor Code,you must .J O forthwith comply with such provisions or this Farm it shall W deemed evoked. .zt h CONSTRUCTION LENDING AGENCY [r I hereby affirm that from is a amoomcttnn lending agency l'm the performance of - ai 7 the work for which this permit is issued(See.3097,Civ.C.) QLcndca's Name M z Lender's Address U Q I ramify that I have read this application and sate that the above information is LL P cored.I agree m comply with all city and county ordinances and state laws rotating to 0 building construction,and hereby authorize representatives of this city to enter upon the Idl aMwetms,Judgetl progeny for inspection purposes. y (We)acme to save,indemnify and keep harmless the City of Cupertino against UN in encs amts.costs granting of this expenses which may to any way accrue againstmitl City U '�[ in cnnuqucncc of th,granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued,by: Date SOURC E NLS/J Re-roofs S'at d ppbf.H HAZARDOUS Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or forum building e,Chapter stole orhandle and the andSafety material as I,food by the Cupertino MunicipaLCotle,Chapmr 9.12,and the HcaIN and safety oJc,Section 2553$a)? All roofs shall be inspected prior to any roofing material being installed. ❑tics No Will the applicant or future building occupant ma equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hasardnm air contaminants n JcfncJ by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes ❑No I have read Ne home ous materials requirements under Chapter 6.95 of the Califor. nia Health k Safety Croft.Saar 25515,25533 and 25534.1 undefstand that if the building docs not currently have a tenant,that it is my responsibility to nouly the mcupam of the ragaireno h OrssuenceoraCaniOcamofOeeupaaryy. Signature of Applicant Date owaer r of cJ agent Date All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: PERMIT# C-ti 5' O OWNER'S NAME: GENERAL CONTRACTOR: 4 ,q FAX# I am not using any subcontractors: X -23•—o c, Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 S CITY OF Fax: (408)777-3333 CUPEkTINO Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City, the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: OL 'e S 4 ti H ti - 2 Job Site Address: / S �.a� S' v n<r�S Q� Roofing Company Name: A plfcant'sSignature: Date: Greg eel Building Official Revised 1/30/03 Printed an Recycled Paper CITY OF CUPERTINO o CUP TYof OF O PERMIT APPLICATION FORM o APN# Date: Building Address: Mailing Address (if different from building address): s .Owner's Name: Phone #: %bb ntracto Cor: License 1 Contact: Phone:�yo Zory-55NI Cupertino Business License#: Fax: Building Permit Info: o X123 BldgW Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential 'p c-E S 6 Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: f Cost of Project: Occupancy Group: 00O�'— Type of Construction: ,�yl Please check this box if the project is a gib,n e )a cu� second-sto addition: ❑ Quanti 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/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 5;2 77 1 of q� �� CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEki INO 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 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 An 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 BREMAHUiAN 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 Fumaee > I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc-A aratus 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, Marquee ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEI0 PERMIT APPLICATION FORM QuantityFee 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 BSEISNUCOM 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3of3