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
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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
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