Loading...
06010064 (2) CITY OF CUPERTINO ' BUILDING DIVISION PERMIT COµN. TRACTORINFORMATIQN BUILDING ADDRESS: CERTIFIED ELECTRIC INC PERMIT No.06010064 S986 SUTTON PARK PT. OWNER'S NAME: PERMITLSUEDATE AOL KATHERINE TIE ZEN 14781 POME 2006 NE: SANITARY NO. CONTROL N0. (800) 521-1495 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EI.F.CT PLUMB MECH O O O O u0p LICENSED CONTRACTOR'S OECLARATION Job Description �wustoic❑ 1 hemby affirm that 1 am licensed under provisions of Chapter 9(commencing p wiN$ection 7IX)U)of Di ision 3aftbe Busines and Professions Code,endmylicenseia imm�fowan!cfferi L 0 Z ��p PANEL C/O 90 AMP TO. 90 AMP^^^��� p�Z Lice Cl L'.D '7 �����® p Dam mnctor ruv'� 7W A CH DE O I understand my plans m It ;toy Licensed Proressional y /n 006 C, 'LAR i�m 1 hereby affirm that I w exempt from the Contractor's License Law far the OO following mason.(Section 701.5,Business and Rofcasion Code:Any city or county t3 pp 5$ which requires a Permit to conrr,truci,alter,improve,demolish,or repair any structure _ k' 0 0 l l i C.i PA\ t''2 4 prior to its issuance.also scouter to applicant for such permit to File a signed suawment ££ that he is licensed formant to On provisiom of the Contaccor's License Law(Chapter 9 Sq. Ft. Floor Area UU I.!=_'-Valuation Y�$ (commencing with Section 70M)of Divuion3 of Ne Businessand Profession Cede)ur — that W Is exempt therefrom and de basis fm dm Wcged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty ofO not mom Nan fiCCUaraC live hundred dollars(5500), r Occupancy Type I,as owner of Ne property.or my employees with wages as Nei to compensation, will do Newark.and Ne swcwm u not intended m oRercd forsele(Sa.70u,Busrc.• and Profession Code:The Comsat,."Lt..Law does am apply ban he,of Required Inspections property who builds or improves thereon,and who does such work himself or through his ownemployce,provided Nat such improvements art not intended mortared forsale.If. however.lie building or improvement is sold within one year of completion,the owner. builder will have the burden of proving thus k did not Wild or improve for purpose or sale.). ❑1,as owner of one property un exclusively convecting with licensed convectors to construct the pmjca(Sec.7014.Business and Profntions Code:)TM Contractor's Li. cease law does not apply to an owner of propenywho Wilds or improve thereon,and. who contracts for such pmjcm with acontraeurs)licensed pursuant to the Cootracbh License Law. 1 am exempt under Sec .B&P C for this reason Owner Dam _ WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I ham and will muntain aCenificam of Consent le self-insert for Wodrcrs Compete 7tion,as provided for by Section 3700 of due labor Code,for she Performance of the k for which Nis permit is issued. i 1 have and will maintain Workers Compcnation Insurance,u required by Section 0 of the LaWr Code,for the perfomunee of the work for which this Permit is issued, WorkersCamprusho nwrance carrier and Polity number amrtier. 5' 1 Policy No.:t las 0 z� CERTIFICATE OF EXEM PrION FROM WORKERS' COMPENSATION INSURANCE (Thu action need WL W camplcmd If ted permit Is forme hundred dollars(SIM) or less.) 1 eemfv that in the performance of the work for which Nis Permit is issued.I shall not employ any person in any manner at as an became subject to the Workers'Compcnauan Laws of califomis Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject In the Wmkef's C.-Nouution provisions of the labor Cedc,you muse .JO foMare with comply with such provisions or Nis Permit shll W decreed revoked. 'z y CONSTRUCTION LENDING AGENCY 'N l hereby affirm that Nese is a construction lending agency for the perfurmaac of C the wash for which Nu permit is issued(Sec.3097,Civ.C.) fit A Lenders Name =z 1<nder's Address , fJ C) 1 certify,that 1 have reed this application and stem that Ne above information Is ly P coned I agree to comply with all city and county oNinances and sou laws relating to 0 V building conviction,and hereby authome representatives of this city to enter upon the I�[ /��yr(/ / N a how-mentioned prop costs for and a pe expenses Purposes / (We)agree to tam,indemnify and keep harmless the City of Cupertino against F y liabilities,judgments,costs and expense which may in any way accrue against said City V z intone coftheg tin spermi '—' 'A 1 U D AND W COMPLY WITH ALL ON-POINT Issued by: Date 0 , . Re-roofs � Srgnabrc of ApplicanUComma /. _ D. HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or forum building e,Chapter of Modic Hcallous material u defined by de Cupertino Municipal Code,ChaPmr 9.13,and the Health and Safety Code. 0yea 25532(a)? U` All roofs shall be inspected prior to any roofing material being installed. []@s Na If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future Wilding..,art sex cyuipmcm or devices which g P D,Witt h.,doses it contaminants as dcrined by We Bay Ansa Air Quality Maaagcmcnt all new materials for inspection. ❑Yes Ulu — I have mad the law dous mamrialsrequimmnts under Chapter 6.95 of Ne Califor. his Flcallh&S91IYCWe,Savona 25505.25533 am12553.I understand thatifNc Wilding docs met currently Mx•mom dues it is my resp o ibilily to notify tbe..P.,or Oc mquircmcros whi must bemtl prior .nuance ofd Certificate ofOc`u—1t mSignature of Applicant Date Owner'o m a 1 lo, IAll roof coverings to be Class "B"or better Community Development ` ✓ C p0mno CAAvenueorre 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESSsgB� � Q PERMIT # OWNER'S NAME: — j PHONE # / GENERAL CONTRACTO FAX # I am not using any subcontractors: Signature T 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 S gnature Date GAF CITY OF CUPERTINO 6 6 UP TYOF' O PERMIT APPLICATION FORM o o APN# D Z Date: �7S S.- -building Address: Mailing Address (if different from building address): Owner's Name: Phone #: f�a. ,, % zs 3 - 93 / Contractor: License#: Contact: �, n Phone: &V S21-t y4 Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Descripti Residential )0 Q 'To -4 q0 q mp Commercial ❑ Sq.Ft. Flooi Area: $/Sq.Ft.: Cost of ProjectZ: Occupancy Group: oo� Type of Construction: Please check this box if the project is a second-story addition: ❑ Pro'ect Size: Standard ❑ Lar e ❑ Ma'or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK 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<= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Ener Add Multi BUILDING BINVESTIGA I Investigation fee BUILDING 1 of 3 a-m CITY OF CUPERTINO PERMIT APPLICATION FORM CUPEI�TINO 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 BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE PbIg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING r 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFLYT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l 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 Heatin MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 v CITY OF CUPERTINO CITY PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 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 Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3of3