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04070018 (2) CITY OF CUPERTINO .. - - BUILDING DIVISION PERMIT - X-ONT.RA.CTOR INF,O�t1VIATIUN: -- •� BU ILDING ADDRESS: BOB GERE MASONRY PERMIT NOO 4070018 0430 STOKES AV OW NER's NAME: PERMIT ISSUE DATE GAIL DAVIS 1585 JENNIFER TiN 02ZD212004 ONE: SANITARY N0. CONTROL NO. (408) 847-0599 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT' PLUMB MECH 0 0 0 0 400 LICENSED CONTRACTOR'S DECLARATION m❑U 1 hereby affrm that I am licensed under provisions of Chapter 9(commencing Job Description wiNScction 70fX1)of Div 'o ofNeB m sort afaalum Co endmyliccnseis in Misr a� k CHIMNEY REPAIR z Li n^ De COntrut OV I rail my plans shell he used u public rtcnrds // a3.C� Licensed Pmfcssional 9� to y g OWNERBUILDER DECLARATION co <S I hereby alfinn that I em exempt firm the Contractors License Law for the ❑O following rearm.(Section 703 1.5,Business and Professions Cade:Any city ar county ywhich mquirm a Permit to construct,shot,improve,demolish,nr repair any soucture HZe prior in its issuance,also requires the applicant forsuch Permit a file a signed statement. - FP that he is licensed pursuant to Me Provisions Of the ContmcuraLicense Law(Chapor9 Sq.Ft. Floor Area Valuation r4�0 (commencing with Section 7000)of Division 3 of the Business and Professions Ca dor Nat he is exempt Nemfmm and Ne basis for the alleged exemption.Any violation of Section 703 LS by any applicant for a permit subjects Ne applicant to a civil penalty of erO 0 OCCU anC e not moo Nan Eve hundred dollars($50D). P Y `7 P ❑L,as owner of the property,in my employees with wages as their aide compensation. will do Nc work,and Ne suumure is not intended or offered for sale(Sec.7044,Business and Profusions Cade:no Conumun's License Law does not apply to an owner of Required Inspections Property who Wilds.Improves doomen,and who does s tach work himseh f ar through his own employees,provided that such improvements art not Intended o,.Rered far sale.If, however,the building or improvement is sold within one year of completion,Ne owner- builder will have the burden of proving Nat he did not build or improve for purpose of sale.). ❑1,as owner of the proper,,am exclusively contracting with licensed contractors to construct the pmjen(Sec.704x,Business and Promeions Cade:)The Contractors Li. come Law does not apply to an Owner of property who builds or improves theman,and who contracts for such projects with a cormaclor(s)licensed pursuant in the Conto clar's License Law. ❑I am exempt under Sec. ,B&P C for this mason Owner Dam WORKER'S COMPENSATION DECLARATION I hereby aRnn under penalty of perjury ore of Ne fallowing declarations: 1 have and will maintain a CcNfiam of Consent to uhf-insum for Worker'sCompon- Nation,u provided for by Section 37M of Ne labs,Code,for the performance of the work for which this permit is iuucd. 1 have and will maintain Workers Compernadon Insurance,as required by Section 3700 of to Labor Cade,for Ne performance of the work for which this permit is Issued. - aNyWorks Compensation insurance carie,and Policy number am: Cam <�U L) E Policy N444. RS' ERTI C OM EXEMPTION FRO�fOYORKERS' COMPENSATIONINSUR CE (Th&ural.need nm IN completed if the permit is for one hundred di(g100) - orless) I certify Nat in Ne performance of the work for which this permit is issued 1 shall not employ any person in any manner an as m become subject to the Workers'Compensation Laws Of California.Dam Applicant NOTICE TO APPLICANT:If.after making this Centfmate of Exemption,yen should become subject to Ne Worker's Compensation provisions of the Labor Cram,you must Oforthwith comply with such provisions or this Permit shall be deemed revoked, z""" CONSTRUCTION LENDING AGENCY F+4 I hcmby aRrm Nat Neo,iso cmuwctinn lending agency for the perfma on of Ci> Ne work for which this permit Is issued(Sec.3097,Co.C.) GQ Under's Name z Lender's Address U C7 1 certify mid�1 have road this appliatlon and see don me above inforodart is IL correct.I agree to comply with all city and county Ordinances and smts laws relating to building construction,and hereby authorize rcpre mm nivu of this city to enter upon to FU1.1 abovomantiuned property for impaction purposes. y (We)agree to save,indemnify and Mop harmless the City of Cupertino against rn liabilities,judgment,costs and expenses which may in any way same against said City � U z in conu uence a[Ne granting ofthis Permit. " APP NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date S R R' S y Re-roofs iSignalurtofA��l'p n Contmem, Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne applicant or future building occupant some orhendle ha'amous material as defined by Ne Cupertino M Ipal Code.Chapter 9.13,and the Health and Safety oil Section lss3z(an All roofs shall be inspected prior to any roofing material being installed. Yon Nu Will the applicant fmuo,building occupant use equipment or devem which If a roof is installed without first obtaining an inspection,I agree to remove mit ha'rardnus air canteZiumcfncJ by Nc Bay Area Art Quality Managcmcnl all new materials for inspection. Disuict7 ❑Yes IhavcrcadNchaiabmquimmenuunder Chapor6.95oftheCalifor- nia Health&SafeiyCodc,Sccuom 35505.25533 and 25534.I understand thus if the building dors rpt cu m rely have a to an,Net it is my uspomihility in nobly thee oceupent of Me _ _( ��+ J uquire t'is hic �r t norsoisommoafa Ccnifca f penZ9.� "i Si attire of Aa ate o All roof coverin cr mxa1mn2d g DaIC s 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 ADD S: PERMIT ! 3o o Q (yo 7ovi OWNER'S N L 4±-11111S GENERAL CO RACTOR: Ge,K e VV FAX I am not using any subcontractors: Signature Date- Please atePlease 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 D� Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile a � t� /Contractor Signature -� Date CITY OF CUPERTINO ° CUPEQTINO PERMIT APPLICATION FORM jPkPN# Date: Building Address: Mailing Address (if different from building address): Owne� N�e: ��S Phone#: —o�� S J, �E� Contracto • Licenseq Q ��'c fd�`� 02&_G a Contact Phone: Cupertino Business License#: P_zy�_l Fax: Building Perraft Info: Bld Elect ❑ Plumb ❑ Mech ❑ JobDescription: Residential ,te4 Commercial ❑, Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project- _ Occupancy Grou . Type of Construction: Please check this box if the project is a second-story addition: ❑ 11�i o'ect Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 9J 1 of 3 // CITY OF CUPERTINO CUPEIZTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTRAE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING 01- 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 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 BREMAMIAN A/C Units <= 10,000 efm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDCT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> l OK 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 2 of 3 CITY OF CUPERTINO CUPE(ZTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Ligbting 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 Inspection 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 Plumbin Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 1 3 of 3