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03060165 (2) ;"CILDING TY OF CUPERTINO .rtprc ,; -% - BUILDING DIVISION PERMIT CONTRACTQR INFORMATION E . 7ADDRrT12ANY12N PQ BALDE MARINKO AND LAURA M PERM1rND.03060165 ER'S NAME: PERMITMUEOATE NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INTO BLDG ELECT PLUMB MECH 00 LICENSED CONTRACTOR'S DECLARATION ui g I hereby affirm Thal 1 am licensed under provision of Chaper 9(commencing Job Description �<a with Section 70100 of Division 3 of Ne Business and Professions Code,and my license is FICA ® < in full forte and effect. apt LiecneClua LL.0 GAS LINE of Dow Contractor rgL003 ee ARCHITECT'S DECLARATION SEP 18 i lundentandmy plans shall he used as public records JyU t0� Licensed Professional OWNER-BUILDER DECLARATION BUILDING i x 1 herchy affirm the,1.m ewmpl from IN,Contractors License Law(o,the GU 0 following mason.(Section 7031.5,Business and professions Code:Any City nr County which requires a pmmil to construct,eltea Improve,demolish,or repair any structure _ �iyprior at its issuance.also mahatma the applicant for such permit to file a signed stnsmount p < that he is licensed pursuanto the previsions of CC Contractors on ctors License Law - Sq. Ft. Floor Area Valuati £FC (Commencing with Section 7")of Division 3 of the Business and Professions Cade)or y that he is exempt Netefrom and the basis far the alleged exemption.Any violation of 3 4 2 7 0 Section 7031.5 by any applicant for a permit ubjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollen($500). I.u owner of the property,or my employees with wage a their compensation.lecompensation. [. w, do the work,and Ceatmcture is no,Intended or offered forage(Sec.7044,Business - l'f'e WAER WYApections said Professions Code:The Contractor's License law deaf not apply to an owner of 2 02. UNDERFLOOR PLUMBING property who builds or Improves Nm eon,and who does such work himself or through his - Ownemployea,providedthatsuchimprovementsarenotloundeloroReredforale.If, 301 — ROUGH PLUMBING however,the building or improvement la sold within one year of Completion,Ne owner builder will have Ne burden of proving that he did not build or improve for purpose of 302 — TUB & OR SHOWER ale.). 502 - FINAL PLUMBING ENERGY 1,a tweet of the property.,B exon.and contnnin,with licensed convemora i. conewa the project(See.o an Business and ry who Wilds dsCode;)mpro Contractors Li. 506 - GAS TEST cenm Law does or such apply mwowner o(pmpeny whosedprstmprovu Cortin.and. 507 - FINAL PLUMBING who se Lacufor such projccu with aconvenor(q licensed Dunu.mmIbe Conux,ora License law. ❑te/¢ t undeg 5e� B&PCfor this reason ner /Na Vntat/Il- I9c Data t7' WORKER'S COMPENSATION DECLARATION 1 hereby affilto under penally of perjury one of the following declarations: I haw and will maintain a Certificates or Consent to elf•bnum far Worker's Compere cation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 hue and will maintain Workers Compedalion Insurance,as outfitted by Section 3700 of the Labor Code,IN the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Pal icy number am: Carrier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' y COMPENSATION INSURANCE (This section need not accomplced If the Permit Is retain hundreCdollars(51O0) or lcsa) I Codify that in Ne performance of Cc work for which Nis permit is Issued,1 shall not employ any pawn in any manner so as On become wbjun to the Workeri Compensation Laws of California.Dae Applicant NOTICE TO APPLICANT.IL after making this Cat ifica a of E.emptinn,you should become subject to Ne Workers Compensation provisions of the Labor Code,you must ., z fonhwi In Comply with...h provisions or this Permit hall 4 doomed revakcd. zO CONSTRUCTION LENDING AGENCY Ir 1 tomtryaRrm that Narc is a commuclian lending aScne,.far%be performance of !Yi Ne work fur which this permit is issued(Sec,3(97,Civ.C.) W Q Lander's Name a. a z I.enderi Address U 0 1 certify Nu I have rad this application and sum Nu Ne show information is ly H correct 1 agree to comply with all city and county ordinances and stere laws relating to 0 U building construction,and hereby autharler mpresenudves of this City to enter upon the r G ahovcmentioned property for inspection proposes (We)agree to taw.indemnify and keep harmless dw City of Cupertino ayainsl rrn liabilities,Judgments.Cast,and espouses which may in any way..against said City U z in consequence of the granting of this Permit. a-, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU REGOL ION Re-roofs gnuure of Appbc HAZARmm"DOUS MATERIALS DISCLOSURE Data Type of RoofWill the Ne applicant tar future building occupant,ere or handle h toodous material - a defined by the Cupertino Municipal Code.Chapter 9.12.and the HUIN end Safety Code,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed. ❑Yu No sum I, applicant car future building Occupant caw=ahaipmemardevi=a whish If a roof is installed without first obtaining an inspection,I agree to remove it hmardaui air m deraminIs ss d pit it by the Bay Area Air Quality Management all new materials for inspection. ICOR ❑Yes 1 have mad the ho Dad.,materiahrequircmcn0 under Chapecrb.95 of Ne Califon nia Health&Safely Calc,Secduris 25505.25533 and75534.1 automated Nm lithe building data a I currently an a erwt Na,it u my maponsihility in notify Ibe Occupant of are require q/�/gu�awhich /y(.b5as�cl prior�in issuance Ora Cenincave of Occupancy. Signature of Applicant Date ///LI(UW4W it'TD`1LQ OsineraraamaNvedagent Dae All roof coverings to be Class "B"or better ;rog,, CITY OF CUPERTINO o3 CITY OF PERMIT APPLICATION FORM CUPEkTINO APN# .3 Y2- l D 2, Date: / 7 S © 3 Building Address: F FJ {'\ (0775 sMUFxtS C'm, OAJ UZ¢t G4pEQ7a/d fro/4,r Owner's Name: A A glAe�e0 4q `O f- Phone#: �pF y S 76 qL Contractor: `, i lMI 2 WkO 6i4U� License#: l Contact: ^^ A�N�`��J)A ( y� ^ Cupertino Business License#: M" 1 Cl, UC B mg Permit Info: ld Elect ❑ lum i Mech ❑ ption: (/✓/L Resi ential El Commercial El Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: MW Quantity Fee ID Fee Descri tion 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 BCONSTA)CR 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 zz279n Vi CITY OF CUPERTINO CITY OF ' PERMIT APPLICATION FORM M . CUPEI,TINO ) 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 BOVERTEV E Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BP URE PbIg 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 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 BREMFDCT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL Ak BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 S��r- CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Grou BREMPOWER Power Device/A aratus 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 BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special his ection 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 EPERMPTFEE 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 Chane BUILDING 3 of 3