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04100014 (2) CITY OF CUPERTINO „z, E�d' . . BUILDING DIVISION PERMIT ic-0 .�1�ACT�QRi NFO,PMATION�_.•.� BUILDING ADDRESS: ANDERSON RADIANT HEATING PERMITNo04100014 L224 SIIADVr�=TR DR OWNER'S NAME: PERMITISUEDATE BOB 12 ONE: - SANITARY0. C NOL N0. ' ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uoii LICENSED CONTRACTOR'S DECLARATION - Job Description ' -- -- -- ui I Wo,by affirm that 1 am licensed sealer provisions of Chapter 9(rommcncing - ,p - n< with Section 7IXN3)of Divielon7af Ne Businesand Profusiam Code,end mYlicense is ._. .. .. .. ._ _ -ro< herullfmceatl ncft 7 Z Linen `� Lk. / HYDRONIC SLICER FOR RADIANI PANEL De Co ARCHITE E ON - I understand my Plea+Well be used as public rtcnMs OWNER-BUILDER DECLARATION if 1 hereby affirm that 1 am exempt from the Contme ofa License Law far the 0 0 following reason.(Section 7031.5,Business and Protections Cods:Any city or county F.$ which myuires a permit to mro rtud.site,improve,demolish,or,epai,any suvmum yi- prior to itsissuance.also retches the applicant rorauch permit,file a signed statement £ theth.isticensedpunnaniiothepmvisiomofthcContmwriUccn=UW(Chapier9 Sq.Ft. Floor Area Valuat on_. y $ d at an is a with Stttion 70n d th basis for n(NC alleged axe mtl on.Anynvi CnJe)or that he u accept therefrom and the base for the ellcged exemption.Any violation of Section 7031.5 by airy applicant for a permit subjects tie applicant to a civil penally of 3 7UI`ilIftA)V0 0 Occupancy Type not more Nan five hu clam dollars(115(10). ❑I.u owner of the property or my employees with wages Meir sale corepena0an, �p��LLLppp�� !!l111,,, will do thewons and the awcturtiatnot intended Livens Lawn forst ply in in owner ss of Require��L.grt4y�LE® - will Professions Code:The Conmemla Claws Law ed f rot ply man owner of `v' - preparty who builds or improve thereon,endwhodoes suchwork himselfor through his own employees,provided that such Improvements are not intended oroffemd foraale.If. however,the building car improvement is sold within one you of completion,the owner- - - - - ”- -- - builder will have the burden of proving that he did not build or Improve for purpose or aele.). OCT /9 2004 ❑1,as owner of the property,am ucludvcly contracting with licensed contractors to mrstruct the project(Sec.7044.Business and Professions Cade:)The C.Mostee.V- ceroa Law dose not apply to ts owner of property who sed a or improve Comae,and, BUILDING- 0 , 1 L®I p /�"who contractswdoes much projects an owner ontramr(s)licensed rmeo ro es Conuacmn - .. . �- ■�eY(l U N/V' License IAw.01.c.areptunderSm. ,B A P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury oro of the following declarations: I have and will maintain a Certificate of Consent to self-insum for Woriaes Comps. salon,as provided for by Secdon 37W of the I&bor Code,for Ne performance of the - workfor w' da.permit is unead. ave and will maintain Worker's Compensation Insurance,in required by Section 3700.17 the labor Code.for the pe famist ce of the work for which this permit is issued. My W0 r'e C I } shot In same carrier end Policyynumber am: t CeM Policy No,I � C RTI ATE OF EXEMP ION FR M WORKERS' COMPENSATION INSURANCE , (Thissection need not oc0mpletad if the permit is forembe ndmd dollars($)W) or lou.) - 1 certify that in the performance of the work for which Ibis Permit is Wwd.I shall not employ any perms in any manner not a b become subject o the Workers Compensation Laws of Califomia.Data Applicant _ NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should become subject to the Worker's Compensation pmvisions of the Labor Code,you must .`O forthwith comply with such provisions or this permit hall W deemed mvoked. z CONSTRUCTION LENDING AGENCY H [�+ thereby affirm then tom is a construction leadingitime,for to performance of a > the work for whim the permit u issued(Sec.3097.Civ.C.) QLeaden Name =Z Lcnaan Address U Q I certify Nat I h e read is applicaion and cute Net Ne above informetiun is ny (, toren,l agree m cc ly wit all city and county ordinances and sum laws misting m 0U building con6bucai ,snit by wthon.representatives of this city to color open the eItovo-mcntiunc miler for inspcNon purposes. 1 (We)e e to ver indemnify end kce lass the City of Cupe0in0 agairot liabili ecju me .cossantles ash may in any way sane against a a id Cit U z in ca the Bre this pcmtil. ^ APPLI UN ANDS AND WILL COMPLY WITH ALL NON DINT Issued by: Da - souR noygr� e Re-roofs a A plicaa Ccntracror ear HAZARDOUS MATERIALS DISCLOSURE Type Of Roof WIII applicant or ethic building occupant store or handle havallous material as creed b the Cupertino Monte p Code.Chapter 9,11,and the Health and Safety C a s an 15531(an All roofs shall be inspected prior to any roofing material being installed. _ .. Will the applican r IureuW,ldi .pant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove mit hesudnus air m nu a cJ by the ea Air Quality Management all new materials for inspection. V- 0 ices materlalsrequiremcnu under Chepurh.95oftheCalifon.SectionsZSS(15.155JJend25734.1understandthaifthe building tenard at It u my responsibility m notify the occupenl of the Iris ie,aanceoraeeni0cam a cy Signature of Applicant Date o rcar. :a enI ,ta All roof coverings to be Class"B"or better _ Community Development 10300 Torre Avenue it I It no Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPERTINO Building Department PERMIT # / OWNER'S NAME: PHONE # ' GENERAL CONTRACTOR: I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting A Linoleum/ Wood Glass / Glazing Heating Insulation . Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofin Sep ' T S eet M* heet)Kock T' er/Contractor Sigrtature U Date CITY OF CUPERTINO FURNACE/AC OUPEkTINO PERMIT APPLICATION FORM APN # Dat/� ,/ D Building A dress: T Owner's Ay �2 � gyp_D/qq nt ctor: Phone: �W "�t�Q Licens`aC#11/ 7/0 ntact:�C� � � � / ��Ph ne: D� ^' � Cupertino Business License#: Building Permit Info: �V �'/ N1v a �i Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description /J� dB 9y�j'�Jq/ Residential Commercial ❑ For Residential Installations: Attic ❑ l't floor ❑ 2nd floor❑ Adhere to min set back requirement❑ or Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Plgrjng Approval Required ❑ rP ' t: Type of Construction: Occup cy up:: d ❑ On Platform ❑ Bonded Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if A li b e Fee ID Fee Description Fee Group BENERGY Ener BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING } BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee 0 BUILDING 13USLIC Business License BUILDING CITY OF CUPERTINO BUILDING DIVISION PERMIT ,CU,NTRACTQ LTN 'U`XtMA'"C' gl Via`. rx „rte t BUILDING ADDRESS: COUNTRYWOOD TOWNHOME COMPL rMITND04070104 OWNER'S NAME: MAPT-PTRRP TER PERMIT L%UE DATE COUNTRYWOOD ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUME MECH 0 0 0 0 40ij LICENSED CONTRACTOR'S DECLARATION U 1 holey affirm Net 1 am licensed under provisions of Chapter 9 mommcming Job Description ii with Section 901N).f Division Sof the Business end Precsslam Coda.om my license is ^<a I.full to.And effea ELECT CIR. TO POOL LITE j License Class Lb.N o- Dam Contractor , FF ARCNRELTS DECLARATION U 1 u okmand my plans shall be used u public records A. t; Licensed Profassinnal '12OWNEm exempt f m Ce Conti ON 0 I hereby.(firm that 1 1. exempt from the ConuamA License:Ac law for the Ktl 0 (olkowhich ing moon. emit to ]LS,Business and Profession&Aou Code:Any city or nsc my $ which mqutma a permit m cn.wvct,micahm.mftu m,h pen it 1 fie sig any ed umnucm Pd.,inMet he >,0000 iuiensedpmoaru to Me thcapplic O far Contrarmtuo Rleasi .(Chtemem ��G9 thorrom licenwitpursuao7")pmvisionsofNcConuiness Lmons, Sq.Ft. Floor Area rat aluation (commencing with Suction 7")of Division Sof the Business And Profrssiaa Come)or ate A. $ that he u exempt therefrom end the bub fm dm Weged eamp l.n.Any violation or Suction 7031.5 by an)'applicant for a Pamir ubjeou the applicant m A dal Penally of 3 74fer0 0 � Occupancy Type ......than five bundmd dollars(SSOE, , 0 I,m owmr of the pmpmy,m my employcu with wM a dmhale compenution, will do the wok and the structure Is notimmnded maRered forsah(Sm.7044,Business and Professiau Ceim:The Com ac m's License Law does an,apply to an owner of Required Inspections properly who buildsor improvss thereon,end who docs such work himsslf or duough his awn employees.provided Natsuch improsemmu Are net intended ooRened fowls.If. however,Ne building Or improvement is to within one your of completion,the owner. builder will have the burem.of grieving that he did n.1 build or improve fm puryme of , sale.). ❑1,as owner of Ne property,am exclusively contracting with liceued conmums to construct the pmjen(Sec.7044,Business and Professions Cade:)The Contra or's Li. cense law does not apply to an Owner of propeny who build¢or improve thereon,and, who convects for such projects with a contractor(s)licensed pursuant to the Comnctofa LirnA Law . I ame sept .der SAO ah PC to Nb rtes. Data - WORKER'S COMPENSATION DEChA4A'[�Oj{ 1 thereby affirm under penalty of perjury am.f dm o owing declaations: 1 have and will maintain a Certificate of Cement o self-hoom far WorkeYs COmpen. seuon, As provided for by Section 37M of the Labor Cade,for the performance of the work for which this permit is issued. 01 have ad will maintain Wokcrb Compensation Insurance,u required by Section 371 of Ne Labor Cade,for the performance,of Ne work for which this permit Is issued. My Worker's Compensation Insurance carrier and Policy number am: Carrier. Polity No.: . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thb section need not N completed if the permit la inner.hundred dopers($100) or less) 1 certify Nat in N.performance of the work for which this Permit is Issued,I shall not employ anyperson Inany a9n !;sGu/bjmSIur he Works'Compensation LawsofQpep n N IC APPLICANT;If,nfmr making Nis CeniOcate of Exemption,you should boc bice.In Ne Worker's Compenation provisions of the Ichor Cnde,you mum .J0 roMwith comply with such provisions or this Permit shell W deemed revoked. CONSTRUCTION LENDING AGENCY 'Irice. I hereby Affirm Nm at there is construction lending agency fon Ne perfurmanof 04 7 the work for which this permit is issued(Sm.3W7,Civ.C.) WW Q Lender's Name z I-mmer's Add^.. U0 1 certify that i have read Nis application and some Nat Ne above infoormu un is W F coact.1 agme to comply with all city and county ordinances And sum laws relating to O V building convection,and hereby auNorixe mprea.mim of this city to enter upon the W shove-mentioned property for iapeNon purposes. F (WO)agree m ave,indemnify and keep hay I.An the City of Cupenst s id ity P.i,l Iiabilidu,judg re it,to casts and mnif y and keep may in any way City of Cogelnat said City 1 6)'Z in cancequence of the granting of this Permit. APPLIC NDERST AND WILL COMPLY WITH ALL NON-POINT Issued by: ate SOUR ULA S. j Re-roofs ngn ure of ApplinnUConuamr ata HAZARDOUS MATERIALS DISCLOSU Type of Roof Will she applicant or future building Occupant store or handle haardous materiel As defined by Em Cupertino Municipal Code,Chapter 9.12.and the Health and Safety cad, y.us32(a)? DL a All roofs shall be inspected prior to any roofing material being installed. O Yes D4N 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 mit haardou air contaminants a defined by Ne Bay Area Air Quality Management all new materials for Inspection. District? a 0Yet )dNu 1 have read Ne haallous materials requirements under Chapter 6.95 of the Califor. nu Health&Safety Cade,Smd.0 25505,25533 and 75534.1 undcuond tint ifdte Whom, doer rely have ant to it is my responsibility in mull'y the Occupant of the rt�whigMAIeZanc7r'4teaf. u .a Signature of Applicant Date Ower or euthmixcd agent // All roof coverings to be Class "B"or better CITY OF CUPERTINO CUPERTiNo PERMIT APPLICATION FORM APN# 32- T O Date: . Building Address:, Mailing Address fferen from building address): G'Udo.�i2T vvT2YwooO �ow.✓,y-o.hc Coy/ L��. Ods Name: � Phone#x GcuogAll-�— �D VoLLEsts 54o \ 37 - 5p/9 jP Contractor: License#: /4.Qe v'e Contact: Phoneme Cupertino Business License#: V'Z Fax: 4.8e vz Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description Residential ❑ ✓J7ilsz EiccCq T sL�CmmerciaaO L� 7C Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 1/SD _ Occupancy Group: Type of Construction: Please check this box 'I e project is a ! second-story addition: ❑ Quanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> LOOK to 500ICBtu 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 BELEC 1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING �iBMITIGATC Comm. Housing Mit. Fee BUILDING C/o r/WMdv--TY �A �4EM£/✓T rc�cvicE? __Z7_-,c_ / r i9.?.s" V y C.� ,� '0, r0/TE zo3 Zb 3 lI 1of3 ,4rTV �n �B SOAsC�S r r' ` CITY OF CUPERTINO cTY 1! ° PERMIT APPLICATION FORM CUPEkTINO uanti 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 BPINI'ERCEP 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 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 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> IOK btu MECHANICAL 13RENIHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Re 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, Mat uee ELECTRICAL 2of3 CITY OF CUPERTINO CU CITY FiNO 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 BSEISMICOM 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 Ternp 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 3 of 3