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02020101t Si irV I , CjLTY OF CUPERTINO 2-� 2 CITYOF PERMIT APPLICATION FORM CUPERTINO APN # Fee Descop#on______------ e: a-eLo Build,i.ng`Addres MECHANICAL BBLDGFEE 1 Bldg Permit sq. foot I 'Tr E U PEEn CAA ASo Owner's Name: % 1 Phone #, BBOJLER3 Contractor: AT License =U1DE9.&A-1)rA)At- Vjvj4EL�,) E��, i Boiler > 1.75M Btu Contact: Construction Tax Phone #: 104 Is) do &19,M�F-m Applicant/Contractor: Hotel and Motel MAM r Constax Resi ol ile '13d�k Permit Info: 'ELECTRICAL BELEC1001 Elec 600V > 1000A (Bldg 7�,Iiiiiiiiiiiiiiiiiiiii' ..Elect Plumb Mech �Scription: BENERGY BUILDING Residential: R FL40 bEL aPy Commercial: Sq.Ft. Floor Area: 313 1113 13 $/Sq.Ft.: Archit6ct/Engineer: Valuation: 3 Type of Construction: Occupancy Grou. Fee ID Fee Descop#on______------ Fee-grox�p BAPPLOTHER MECHANICAL BBLDGFEE 1 Bldg Permit sq. foot 'BUSS ILDING Is", M-4 ME' I <= 100,000 Btu ME HANICAL BBOILER2 Boiler> 1 OOK to 500K Btu MECHANICAL �M BBOJLER3 Boiler > 500K to 1M Btu AT MECHANICAL i Boiler > 1.75M Btu I U-mewn.-IrLm Construction Tax 104 Is) 4Lmm &19,M�F-m Hotel and Motel Constax Resi ol ile Elec 600V <= 1000A 'ELECTRICAL BELEC1001 Elec 600V > 1000A ELE TRICAL BELEC200 Elec Svcs 600V <-- 200A BENERGY BUILDING Mul I 313 1113 13 I of 3 1 �i? CITY OF CUPERTINO BUILDLNG D"10N PERMIT BUILDING ADDRESS: 19872 MERRITT DR OWNER'S NAME: 13ALTUSIS IVERSON PHONE: ARCHITECTIENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,yait my license is in full forced ff License class Lic. Date 7 - ;M_ Contra" 'ARCHITECT'S DECLAIWITy— I understand my plans shall be used as public records Licensed Professional OINNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such.permit to file a signed statement- that tatementthat be is licensed pursuant td the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) orthat he it exempt therefrom and the basis for the alleged ex6mlitibij. Any --at c of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ,of.. more than five hundred dollars (5500). 0 1, as owner of the property, or my employees with wages as their sole compensation, will do the work. and the structure is not intended or offend for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property Who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for purpose of sale,). 0 1, as owner of the property, am exclusively contracting with licensed contractors to constructthe project (Sec. 7044, Business and Professions Code:) The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. 0 1 am exempt under See. B & P,C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 1 hive and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.. 0 1 have and will maintain Worker's Compensation Insurance, at required by Section 3700 of the Labor Code, for the performance of the work for which this permit is pohe C 0 F EXEM COMPENSATION Cf Policy N Mths section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance, of the work for which this permit is issued, I shall'not employ any person in any matter so as to become subject to the Workers Compensation Laws of California, Date ---------------------------- Applicant 'NOTICE TO APPLICANT: If, after making this Certificate of Exemption, —y...b..Id Z become subject to the Worker's Compensation provisions of the Labor Code, you must CC forthwith comply with such provisions or this permit shall be deemed revoked. Z ** CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which his permit is issued (Sec, 3097, civ. CJ Under's Name_ Lender's Address 1 certify that I have read this application and state that the above information is correct I agree toith all city and county ordinances and state laws relating to building contraction; authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against U &O3 liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence the 'ng of this permit. T UNDERST S L COMPLY WITH ALL NON -POINT Signature oNAppficamMorttfactorDate A 0 A RiALsDiscu6suRE Ed. Will the applicant or,furtme uilding occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code: Section?SS32(a)? 0 Yes' ;Wo Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as de edbythe Bay Area Air Quality Management District? 0 Yes I have read the hazardous materials requirements under Chapter 6,95 of the California Health & Safety Code, Sections 25505,25533 and 25534. 1 understand that iftbabifilding does not currently have a tenant, that it is my responsibility to notify the occupant of thexequi is w must be met prior to issuance of a Certificate of authorized �age- weer or authorized age PERMIT NO. INTERNATIONAL KITCHEN E ;viii_ GE 02020101 APPLICATION SUB DATE 1175 E HOMESTEAD RD 1 02/26/2002 SANITARY NO. CONTROL NO. BLDG ELECT I __:J it Description BATH REMODEL/CHANGE WINDOWS. l IERMIT INFO PLUMB MECH 0.3 103 - UFER Required Inspections 104 - REBAR 105 - ANCHOR BOLTS 313 - SEWER & WATER .106 202 - UNDERFLOOR PLUMBING 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION '3 0 8 309 EXTERIOR LATH, -31' 0 INTERIOR "LATH" 311 SCRATCH COAT 313 ROOF NAIL 501 FINAL ELECTRICAL ENERGY -502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY, 505 FINAL ELECTRICAL 506 GAS TEST. 507 FINAL PLUMBING 508 FINAL MECHANICAL 509 FINAL GRADE 510 FINAL PLANNING 514 FINAL-PUBZIC WORKS Issued by:_,. Date Re -roofs -Type of Roof ..-All-roofs shall, be inspected prior to 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 source regulations. Z_ > Signature of Appli4 Date -1 All roof coverings to be Class "B" or better OFFICE