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05020182 (2) CITY OF CUPERTINO BUILDING DIVI810N PERNIIT C"OIT�CTOR TNP'OTYMA.'CTON A`SN 4'C'�:.ixKF .Y.Ym ArA`n."CMS` '•AD " { .W`.A. 6u1LDING ADDRESS: CONSOLIDATED PLUMBING INC ""'05020182 OW NER'S NAME: PERMIT ISIIB DATE UNITED COMMERCIAL RANK 1712 T) r14ARTF.R PARY T),P ONE: SANITARY NO. CONTROL NO. 408 978-30 3 ARCHITECDPNGINEER: BUILDING PERMIT INFO BLDG ELECT P MECH at CZp LICENSED CONTRACTORS DECLARATION lb Description O O it 1 Whaley o y a n that I am licensed under provelolu of Chapter 9(commencing p nwidt Section 7000:4Division Sof the Business and PrefecturesCode,end my nicest is imm, mree anderrea So 6 Z; � GAS TEST Z Leon Wonm Clea G Q/ Lk.g W 'LS L,�. o� Conuuw ARCHITECT'S '� 1 undersand my plans WII W puhEc records , Licensed Professional od Owl I Am exempt Ir DECLARATION 9 I hereby.(Sat thin 11. exempt Prem to fess on,Co License 1<w for ted O o following retina.permit t 703 construct. Business and me.Profession,i Code:Any city s count' $Ixi which reyuirea•Issuance,al o r cares the aper, forsu h pencil.ee e a sig ed lannere �„ prior w its ensedpalso requires the led applicantofar Cmuscums it re filese:I.. samment F< (u merwin witpunuamtotheprovisions 3theMBusinessA dPoollaw(CMper9 Sq.Ft. Floor Area Valuation S S (cot he I.e g with Section70Mad t f Division f r thew eg Business on.Anynu Code)ee ml that he a exempt therefrom and the basw for the alleged exemption.Any=of notam 7031.5 fiw h ndrtdliccu� Permit subjects the Applicant m a civil penalty of 3]F P243Q@�er0 0 Occupancy Type ❑1,u owner of low pmperty,w my employer wit wrA u ftGmlc compenatim. will do low work,and themumure hour intended oroRered feature(See 7044,Businra Required Inspections and Pmfessiou Cade:The Co muctofs Litems law don tet apply o m owner of q p propeny w ho W1led or im proves thereon,and who dom auch work himself or through his own employer,provided dust such improvements are sol Intended nroBned fee AleIf. however,the building or Improvement is sold within one year of completion,to owner. Wilder will lave the burden of proving tat M did not wild or improve for purpose or 1,u Moa of the property,am exclusively contracting with licensed conuameea to comm l the project(Sec.7014,Business and Professions Code:)The CantramoYa U. cense law don not apply m m owner of property who builds or improves etymon.Nd, who contracts for such projects with a eonuaeto(s)licensed pursuant in to Contrscure, License Law. ❑I"Ameeptunder See .Bkpcfeethismasun Owner Dam WORKER'S COMPENSATION DECLARATION - I hereby alliin under penally of perjury arc of the following decimations: ❑I haw and will man Wn a CaMestA of Consent m sel6insure fur Wa runs Compcm Aeon,As provided Iso by Section 3700 of the Labor Code.for the performance of low week which this permit is issued. 1 haw and will maintain WmMes Compensation Insunnm,As required by Section 3700 of the Labor Code,for the perfermance of the work for which this pemlit Is issued. My Wo eYs ampenaeon luurence noier and Polity number art: CArtier.,YT 1L X Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (chis seedon need not be completed If the permit is forme hundred dtllam Eiffl) A mss) 1 cenify that in the performance of the work for which this permit is osrd,l shell not employ any person In my mmmrm As in became subject m the Worked Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Cenifirw of Exemption,you should become subject to dw Worker's Compensation provisions of the labor Cade.you most wJO foMwithcomply with such provisions w this permit shall W deemed revoked. [E`M CONSTRUCTION LENDING AGENCY EC 1 hereby 4M m that dem its construction lending agency I'or div Performance of Cithe work(ter which mths permit 4 Issued(Sec 3139'7.Civ.C.) a Q Ussic's Nae Z)Z Lender's Add. f)Q 1 certify that I haw read this application and sus that the abow informssWn is B,r' Correct.I agree w comply wed all city and county oNiwnes and sue IAm relating le building construction,and hereby authorim mprexnuuws of this city an color upon to Lid ahove-meneaned property for Inspection purposes. pyr (We)agree in am,indemnify and keep harmless the City of Cupertino against w.t IA Iwbilidsojudgmenu,cosu and expenses which may in my way aecme against said Cly V 7 ofdmgnmpng of to permit APPLICANT �i AUNDE STANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date -22/0-5-/o SOURCE RECU "J Re-roofs tin ApplicattComMmov Dam HAZARDOUS MATER DISCLOSURE Type of Roof . Will theapplicant lir fume building occupant seem wha ile haaudous material u dci ned by the Cupertino Municipal Cade,Chapter 9.11.and the Health and Safety ,dMK.de.Section 25531(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yr No Will the applicant or future Wilding occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hpuu rdmair conuminanu Oncd by the Bay Artie Air Quality Management all new materials for inspection. Dwtria? ❑Yr ❑44th I haw lead the hatmem materials requirements under C W por 6.93 of the Cali fon ria Hcul"SefctyCom,Sections VISAS,15533 end 21534.1 undersold low if the Wilding war m1 currently hew a 1eem4 thus it u my mspomihility w notify the aeupmt of the requirements whi Rbc incl Prior ti of a CenlRtaw of Occupancy. Signature of Applicant Date 7J All roof coverings to be Class"B"or better cr ter uthadmd Agent Dote' Community Development 10300 Torre Avenue -f Cupertino CA 95014 Telephone(408)777-3228 CIIY F Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDRESS: PERMIT # . l O S{-iii eve O S O �O �S 2 OWNER'S NAME: v G PHONE # ef7 9 ?o &3 3 GENERAL CONTRACTOR: C�yjj;,J,CC„4-A4 Q( FAX # go1k X72 309 I am not using any subcontractors: o-r— 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 er/Contractor Si a Date CITY OF CUPERTINO CUPEf�TINO NEW SINGLE FAMILY DWELLING PERMIT APPLICATION FORM APN # 31 (0 2 Cr, o ,? y Date: is- Building sBuilding Address: Mailing Address (if different from building address): -20S-10 Sets I vc Owner's Name: / Phone#: i to C oMM cav� 3a U 6`6 57 b 30 ,13 Contractor: License#: C� 5.(I mb IVBL Earl 6 2— L3.6 Contact: P ne:Cf744 3 e 9 1 Cupertino Business License#: feu Fax: C1 3o y! Building Permit Info: &/+S iGS I- ('0. 1�t, mle kr fNs"l I Single Story Two-Story ❑ Three-Story ❑ Basement ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Type of Construction: Project Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group 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 I Investigation fee I BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING 1 of e7 2-7 �1 7 (- CITY OF CUPERTINO CUPEf�TINO NEW SINGLE FAMILY DWELLING PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 Heater/Vent 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 BREMFIXT Ligbting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > IOK btu MECHANICAL BREMHEAT 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 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 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 2 of 3 CITY OF CUPERTINO CUPEI�TINO NEW SINGLE FAMILY DWELLING PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 PLLONGRNGR Long Range Planning/Residential PLANNING ZADDCHG Address Chane BUILDING • 3of3