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02070090-FPac, „11 CUPEk NO *HTY GIF CUPERTENO (* 7 # I” 1 1.111 1 -i l" I" l . l ( A 1 I (I)1 IFORM 1 APN # '� „� ,,� " 6e]4 ]Fee ID Date: !Fee Groujg BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Building Address: BUILDING Owner's N e: 1 �-- Ind/Off/Comm/ uasi Phone 46t Contractor: Con. Tax for BQ Zone License #:' Contact: Hotel and Motel Phone #: Stb p lic ontractor: Constax — Resi/Mobile Fax #: Building Permit Info: Elec 600V < =1000A ELECTRICAL Bldg Elect Plumb Mech Job Description: jN9vVM 61E:�- "C" 4(' 6- Residential: Commercial: ELECTRICAL Sq.Ft. Floor Area: BlENERGY $ /Sq.Ft.: } BUILDING - BENERGYADD Energy Add Multi BUILDING Architect/Engineer; O \ b�1 BINVESTIGA Tation: BUIL.DRiG Type of Cons t � BMITIGATC Occu r up: � BMITIGATR Res. Housing Mit Fee BUILDING . Quantity ]Fee ID Fee Description !Fee Groujg BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi BUILDING BCONSTAXqQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC 1000 Elec 600V < =1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BlENERGY Energy BUILDING - BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUIL.DRiG BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING . BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL, BNUCOMMP New Comm Plumb PLUMBING ?07 7 lof3 �� lD nS- CITY OF CUPEkTINO *ITY OF CUPERTINO * PERMIT APPLICATION FORM Quantity Fee ID Fee Descri Lion Fee Group BNUMULTI New Multi-family Res PUNMING BOVERTZME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Pip' System Fee PLUMBING WINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Re eat Fee BUILDING BPREPIPE Rep i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backilo PLMBING BPSTORM StomVRain Water PLUMBING BPTRAP Kitchen Trap PLUMBING 1 WENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAMIAN A/C Units <= 10,000 cfm MECHANICAL, BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT 4:1ghting Fixtures ELECTRICAL BRENUWN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 10K btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMLSC 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 Re air /Alter Heating ME CAL, BREMRBSAPP Remodel Res Ap2liance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix I ELECTRICAL, 2 of 3 0 CITY OF C UPEk WO 11 11 1 loll I Quantity ]Fee LID ]Fee IDescri don Fee Group BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISIECOM Seismic Comme>rdal BUILDDHNG BSIEISMICRIE Seismic Fee Res BUILDING BSF&2FAM Sin le & 2 Family BUILDING BSFNA Single Fan-dl New Add BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BIM-DING BTEMP Temporary Power' ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING -`, ELECTRIC Electrical sq foot ELECTRICAL. IEIFERMITIFlEJE ]Eke Permit Issuance ELECTRICAL MPERMFEE Mechanical s . foot MECHANICAL ' MF ERMITFIEIE Meclh Permit Issavace MECHANICAL PP ERMITFLIE RumbluR Permit Issue P LUMBHN(G PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 10OK to 50OK Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75 M Btu MECHANICAL 3 of 3 5 � CITY OF BUILDING DIVISION ]PERM* I CONTRACTOR RNTFORYA7�Te � BUILDING ADDRESS: PERMIT 10279 JUDY AVE 2070090 OWNER'S NAME: APPLICA'AOAt $U$ DATFi� 0 02 MIKE WARREN l/ / 1(D / G PHONE SANITARY NO. CONTROL NO. L' z0 za ARCHITECTfENGOTEER: ui 0[— EZV w z. LICENSED CONTRACTOR'S DECLARATION w — {{ 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. i c Q License Class Lic. 4 O a U Date Contractor I i y j CHITECT'S DECLARATION w I n n used as public records ne i p O essional ' d o 0 TIER- BUILDER DECLARATION to i I mby afft that I am exempt from the Contractor's License Law for the f z a foil owing ason. (Section 7031.5, Business and Professions Code: Any city or county i 2 which requires a permit to construct, alter, improve, demolish. or repair any sWcture ul 3 `—° pri r toils issuance, also requires the applicant for such permit to file a signed statement that he Is liccnsld pursuam_to ingprovisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business, and Professions Code) or that hf xempt iberifrorn and�the basis for the alleged exemption: Any violation "of-Section -703 t5 by any applicant for a'permit subjects the applicant to a civil'penalty 'ofaioi more than five•hundred dollars (5500). _.1 OE Z� U O >i U k BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u C_ --I L 7 Lu ADD 499 SQ . FT , Job Description ADDITION OF ACCESSORY, DEMO EXISTING SHOP BLDG SQ.-Ft. Floor Area - - . 37 Occupancy Type ❑ 1, as owner of the property, or my employees with wages us their sole compensation, 505 — FINAL ELECTRICAL Will'. do :the;ivbik;'and'1hei- siiuctilm is noiimended'or offered for sale (Sec.1044,' Business and Professions Code: The Contractor's License Law does not apply to an — 506 1 _ fired Inspections owner of property Who builds or improves thereon, and who does such work himself FINAL 102 - PIERS or through his own employees.. provided that such improvements . are not intended or. offered for salt. if, however the building of improvement is sold within one year of FINAL 10 3 - ._• , ,._. - UFER . , completion, the owner - builder will have the burden of proving that he did not build or FINAL 10 4 - REBAR improve for purpose of sale.). _....... - ._.... _ . .... ..... ........._.._............_. _ .. .......... - I ...... 105.._ ANCHOR BOLTS......... .._........__. _... ❑. l; as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's I 106 — SEWER & WATER ;:. .. License Law does not apply to an owner of property who builds or improves thereon, .and. 'projects. with a.contraator(s) licensed. pursuant to the . -.... contracts-for. ... _ 20.2 _.- i,/f .UND.ERFLOQR .PLLTM]3ING_,_._..._ Commio.cs Lice — exempt under B.A P C for this reason 203 - UNDERFLOOR .. MECHANI CAL ;te } 4.1 2 0 4 - UNDERFLOOR FRAME KER' h9PE O LARA770N Thb, 2 0 5 - UNDERFLOOR INSULATION affirm underpenalry of perjury one of the following declarations: 301 — ROUGH PLUMBING ❑ 1 have and will' maintain a Certificate of Consent'to self -inaarc for Workers 3 02 - TUB & OR SHOWER Compensation; its-provided- for by Section 3700 of the Labor Code, for ` the 303 — ROUGH MECHANICAL performance of the work for which this permit is issued. 304 - ROUGH ELECTRICAL ❑ 1 have and will maintain *orker's Compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is 305 - FRAME issued My Workers Conticnindin insurance carrier and Polity number are: '..:. 306- — HOLDOWNS _ :........ . ; -.... 'Policy. No.; � '�.... �' � ... ..: .307;- ,INSUL' ATI ON ' , CERTIFICATION' OF EXEMPTION FROM WORKERS" COMP.ENSATIONINSURANCE ..._ 3 Q 8 - S _..._._. _ ............. _._... EE R C H T O K ' "(This section neednol be completed if the permit is for one hundred dollars 309 EXTERIOR LATH (s100>.arlessa ,. .. ...., ... 3.1.0.... - LATH _ .. :. \\ ... ' • 1 cent fy that to the perforinad� of,the w rk for.wluch this permit isissued, 1 y 3 1 1 ..INTERIO:R _ c .. " SCRATCH - COAT'. shall not employ any person in any anner so o e subject to the Workers' Compe Lawsoi a a " ' 313 - ROOF NAIL "Ap ant: N_ o;Vc .. _ .. .. lartermakitg snnu ld. 501 .. - FINAL ELECTRICAL ENERGY _ J bee sub'ecer's Compensation provisions of the Labor Code; you mustrovisions orthispermitsha llbedeemedrevoked. forthwith eons ..'... _. ... . _ 502 - FINAL PLUMBING ENERG •- .. 'FINAL GY:..,.. .. .. ... _ ..... 503 .:-_ - MECHANICAL ENE • 7RUCTION LENDING AGENCY' ' CONSp I hereby affirm that there is a constriction lending agency for tie performance, 504 - FINAL BUILDING ENERGY. of thr work for which chid permit is issued (Sec: 3097, Civ. CJ. 505 — FINAL ELECTRICAL Lender's Ad.dre.ss - ......, . �.... ..,.. .... , . -. - — 506 .... GAS. TEST a I certify that 1 have read this application and state that the above information is. 50-7 - FINAL PLUMBING eorreet. I agree to comply, with all city and county ordinances and state laws relating to building consiniction, and hereby'authorize'representativrs of this'city to enter upon 508 - FINAL MECHANICAL the,above- mentioned properry for inspection purposes., _ (We) agree to save, indemnify and keep hamdess the City'of Cupertino against 509 - FINAL GRADE liabilities judgments costs and expenses which may m any way accrue against said 510 - I NG City m consequence of the'grannngof this permit a vD R ICL CO 9PLY mTfH ALLhO�(POII\ C .: ..r, IssJf Issued b5:1 I ORKS Date as.defiafd by the Cupertino h Code Section_25532(aA p Ye: Will the applicant or f emit, hazardou's air comama in District? ' ❑ Yes ' `.'l have rcad'the haizi it of[ is MATERIALS DISCLQ$URE' Building occupant store or liandle`haisrdars material i 'pal Code, Chapter 9:12. and the Health and Safety building occupant use equipment or devices which defined by the Bay-Ama Air Quality Management �inazerials requirements under Chapter &95 of'the ecdons 2550517.5533 and 25534:1 understand that baveatenant .thatitismyrcsponsibilityto otifythe rich must tie met prior to issuance. a Ce fi.ke of vnec a onzea age tv, Re -roofs ' Type of Roof. All roofs. shall be inspected prior to any.roofing. material. being installed....... If a roof is installed without first obtaining an inspection, I'.agree to remove all new materials for inspection.. Applicant understands and will comply with all non -point so ce r lations.'- A Ig Slg atur f Appll t _ Date All roof coverings to be Class `B" or better