02020076CITY OF CUPERTINO
BUILDING DIVISION
'A ' "-- • - - - `- "- " " -• "•- - -• ,.
CONTRCTQF;MORMATIO "
PERMIT
S
In ILDW G ADDRESS:
PERMIT NO.
10296 A ALPINE DR
02020076
OWNER'S NAME:
APPLICATION SUB DATE
BAYARD S. HOLMES
02/21/2002
iONE:
1
SANITARY NO. CONTROL NO.
ARCHITECUENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u I." _; L 7 L.1
LICENSED CONTRACTOR 'SDECLARATION
1 hereby eRrm that l am licamed under pros isimw of Chaper 9 (commencing
Job Descri Description
p
3 with Section 70001.1' Division 3 m,he Businessand Pmfnziom Code.md my license
KITCHEN
REMODEL
I, e, full forte and effect.
'R 'I3
[ Clus Lio. rt
Data
a Date
SDECLA
ARCHITECTS DECLARATION
i 1 underhand my plans shall be used as public records
JUL 2 5 nu
j Licenud professional
OWNER- BUILDER DECLARATION
- I hereby affim that I am exempt from the Contractor's License Law for the
following reasons. (Section 7031.5, Business end Professions Code: Any city or county
I LDI iNlG
which requires a permit m conswcl, alter, improve demolish, or repair any sbunure
$10000
prior to its issuance, also requires the applicant forsuch permit o file a signed statement
that he is licensed punuan( to the provisions of the Contractoes License law (Chapter 9
(commencing with Section 7000),at Division 3 of the Business and Professions Code)
I. gIQ [
'23,2:15 'Ij U- 7t
Valuation
or that be is exempt therefrom and the basis for the ellegcd dcmpti.n. Any violation
_
U,;.V (J'•1
of Section 7031.5 by any applicant hour a permit subjects the applicanuo a civil penalty
of not more than five hundreddollars(s5BB).
10f1PNNpMr1&DATION
Occupancy Type
❑ 1, as owner of the "Pony, tar my employees with wages as their sole compensation,
..will do the work. and the structure is not intended or offered for aule (Sec. 7044,
Business and Professions Codc: The Conimcior's License Law does not apply to an
103
- UFER Required Inspections '
owner or property Who tudds or improves thereon. and who vas such work himself
or through his own employees. provided that such improvements are not intended or
104
— REBAR
Offered for seta If, however, the building or impr.m
veem is sold within one year of
idmple0on. the..• ner- buuaer ww have thewmen ofprovingmal haaidnmwad.r
105
— --
— ANCHOR BOLTS
mp,ovemrpmpoa.f.1c.).
106
—..SEWER & WATER
0 : as owner of the propery ore exclusively contracting w6n licensed aced. to
202
- UNDERFLOOR PLUMBING
Lomwn she project (Sec. 7044, Business end Profess ns code:) Thc Concoaor's
iana law does not apply m an owner of property who wads or improves thereon,
2 03
— UNDERFLOOR MECHANICAL
and who concocts for such.projecls with a contractor(s) licensed pursuant to the
Convectors License Law. -
2 O4
.. ... - .. .
— UNDERFLOOR FRAME
❑IamezcmplundaScc. BRPC for this reamn
205
— UNDERFLOOR INSULATION
Gaunt, oat`
ORKER'S
W COMPENSATION DECLARATION
301
— ROUGH PLUMBING
I hereby idlinn under, pemh tot
y or do, e oOhe following declarations:
302
— TUB & DR SHOWER '
303
— ROUGH MECHANICAL
❑ 1 have and will maintain a (,•er11EC Section n 37M Consent It a Lab us for Worker's d
.Compensation, as for by Section 3700 or the Isba code, for the
304
— ROUGH ELECTRICAL
orkfoe
perfomtance of the work fa which Nis permit ix issued.
305
— FRAME
❑ I have and will maintain Worker's Compensation Insurance, as ryuiroxi by Salina
306
— HOLDOWNS
3700. the Code. for the performance of Ire work roe which this permit is
arker
assure. M W.Reti Com saGOn Insurance artier one Policy
.._..,......-
_icy .......... ... .... ....
307
— INSULATION
Policy NO.:
Camicc ICERTIFlCAIION
...
308.i':=
_
''SHEETROCK., "'
OF'
l= 1:,. RTIIC EXEMIMONFROMWORKERS'f
z, s
t... •..._..,'3'091`"`EXTERIOR'=LATH
COMPENSATION
' SATION INSURANCE
' .:(This session hem not x completed if the permitrsfor oat hunend donut
.
310,
: =' :INTERIOR LATH
(sloB)ar leeea
311
— SCRATCH COAT "
,. ...
I e ;I m Ws pe or Ina for an I
313
= ROOF NAI L
-']-' in -1nce
as us
Compel employ any person in any manner m as to wcomc eubj<m s. the Workeri
bcc- subject ct 1.'h Woke.
Compensation Iowa f C
oilifomie. Date
5 01
- FINAL ELECTRI CAL'ENERGY
Applicant
NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you should
502
— FINAL" PLUMBING ENERGY
become subject o the Workers Compensation provisions of die labor Cede, you must
forthwith amply with such povirions or this Permit shun be deemed remkm.
503
— FINAL MECHANICAL ENERGY
.
- .504..
-- ..FINAL BUILDING ENERGxt
chat JSereisaloNIENDINCACENCY
- '1 this there is d donswmon lending agency for the pei(or..
505
- FINAL ELECTRICAL
rkfor'which
Lor workforwhichthis pe 'rtnitis issued (S«.3097:Civ.CJ
' .1<nd<ra Name .:' - .._.__..: ... � -. ... _ ,.. �.. ._
._ ,Sp 6,
— GAS TEST
....
Landar"'A lase
507
_
— FINAL PLUMBING .•
1 certify that 1 have read this application and sum that the above iMomtadon is
mammal.
508
— FINAL MECHANICAL
l agree to comply with all city and county ordinances and stale laws relating
to wilding conswaion; and hereby authorize representatives of this city to enter upon
509
— FINAL GRADE
"aawve- memiohed property forimpasioo purpoue. -
(We) agree to save, indemsdfy aIM keep hamdcss he City of Cupertino against
510
— FINAL PLANNING
Be"ait judgvents, cos¢ erM expenses which may to coy way accrue against said
City in ton eau ice of th e gaming of this penrat.'
514
— FINA P C WORKS
T
APPLICANT UNDERSTANDS AND WILL COMPLY Wfni ALL' NON - POINT"
SOURCE REGULATIONS..
Issued by:
7.
Date
Slgnature of A,phcmVCmma1t.r - '. -. Date ...
,, '.
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE :
"
�iW11 the epplicepsafumrt wJaing- acupart store an handle hazardous maleriy
defined
Type of Roof...
.
u by Cupertjgo Municipal Coda. Chapter 9.11, and she Health and Safety."
Code Sat n 35533001
'• 1
s -, { ':.
6ii
,nitWllthe an mmorl narts wddmg ace Bay Air Quordemceswhich
hazardous e'v ronteminanlsudcfinm by the Hey Ma Air Quality Management
roofs shall respected prior to any-roofing material being installed. _
If a roof is installed without first obtaining an inspection, I, agree to remove
g p
s1nc°
❑Yee ono ..
'f'
all new materials for inspection. Applicant understands and will comply with
_
all non -point source regulations.
is
1 have dad the Safety Code. materials 505u 5533 a under 4. 1 an 6.95 of the
5
Cilifomilt o Safety Coda 25505., and 15534. 1 that
s have to ity to e0ed
- if the building O d oultor evm which .in ba dw it is my responsibility of m fificay the
it is
"occupant of Ire m7uirtmchls xhicti mutt be 'met prior issuance of 6 Cenifu¢ of
Signature of Applicant
Date
All roof coverings to be Class "B" or better
"Owncror authomed egcno' Dne
_.... _ OFFICE
I
351
122
8615}
I32
45 --
351 — 42,1 183
70} — -
175 112}
9
— 112 21 30 ---L 21 -,' 24
1 BV-
36 111 24 —f 18 f- 30- �12�4 33-
BSS36R
W2136L W3030 W21
112
S 0 ,DISH.24 B18L O O BR
12
2 - -'-
2
0
IRIL14- Yaps
711
711
341 313 —t
125}
S�gMITTA�
#�1
Re Flt
B36
W3636
W3848
W1., d36
UT3624X90
36 33 36
36 —1 -6 38
117 b1I�1�1°"yFIG
3 24
3
601
3
24 3
313
653 6531
1 13.01
57}
183 nv nwcr..w „m rur rm OR
_.C_U_ P EiT710 " 1JDEamS ( A�W6 ORDINANCES
This set of pl r sv specifications MUST
be kept on th job at all times and it is un
lawful to male any changes or alterations
on same without written permission from
the building Dept., City cI Cupertino.
The stamping of this p:cn . nd specifications
SHALL NOT be he'd t, 1c.mit or to be an
All dimensions & size designations eVPt
given are subject to verification on THE This is an original design and Oust
Job site and adjustment to fit job HOME DEPOT not be released or copied unless
conditions, applicable fee has been paid orjob
order placed.
Designer
Designer
uesign : 12/05/01
Date 12/05/01
122}
UPFlCE ....._ _ .. .. ... _._. ._. -.._ ...
CITY IDF G DIVISION
CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS:
PERMIT NO.
OWNER'S NAME:
APPLICATION SUB DATE
BAYARD S. HOLMES
02Z21/2002
'HONE:
SANITARY NO. CONTROL NO
ARCHITEC`UENGINEER:
00
BUILDING PERMIT INFO
U
BLDG ELECT PLUMB MECH
i
LJ LJ =1 1—]
h i
LICENSED CONTRACTOR'S DECLARATION
1 hereby 1 licensed
Job Description
P
affirm that am under provisions of Chapter 9 (commencing
t-m
g�
with Seai.7000)of Domino 3 of the Bueinessand Professions Code and my license
is inmd force and effect. e
KITCHEN REMODEL.
w a
Licenu Class Lic. N
a m
0
Date Contractor
ARCHITECTS DECLARATION
�
1 undemmnd my plane shall be uxd as public recoms
.0
License) Professional
LL
OWNER- BUILDER DECLARATION
m
1 hereby of tam Nat 1 am exempt from the Contractor's License Law far the
?G
following mason. (Section 7031.5. Business ad Professions Ca de: Any c." ormentry
which q a permit t construct, h improve, demolish. n or repair any eauaur<
$10V
3�_If.,h
-
fw su hpe',License
rs' Leo gnbe
lrr0• s F[-Ft
"al
Valuation
1mviliapplicant
(homed al aw(Chtemem.
lawlChpmr9
fWeC ,sand
n7WO)
ram <aCng ms a ]ram rD b. 3 nn Business dxempumareanyvi lase)
Pr
or that lie is exempt (here(, li a,d the for We axe option Any violation
vs•r,"ry
CO x.? �326150'TO1h0,0 ;r•�l"..'.' " °' *;
-of Section 7031.5 by any applicantlorr permit aubjeeu the applicammacivilpmnlry -
tiler subjects he
ear no, more than fi,e nanarea aanae rssoul.
APN Number
.,... •;0 Occupancy Type
Property. yeisP r b pen,
o Las owner oflhe ert.orm bees with wages as their sole compensation.
101 - FOUNDATION
,
-will nc� workessio the is nor intended
d'or offered for sale
'to
- - - - - - - - - -- I
Required ItISpeCh011S : , " .
103 - UFER
'Business one ode: The t.,, Law sces not apply m an
Who Case: The Contrucmrs apply an
hillsor
ownc
owner o en, improves ,and w
rugproperty em videdTai thereon,
rel,iandwhdnts such work tendedor
or Through his own empbyces . Provided mat ma, imp,vemmn.. are no, intended orREBAR-
�ona �year -
"- -� - "-'
L(fcied for shle.lf however. the building or imP�avcmdm is sold within of
-- -- - - --- -- -, -- - _ ..................... .... ..___..._..._.._..
completion. the owner - builder will have the human of proving that he am not build or
105 - ANCHOR BOLTS ;
> <
improve for purpose of sale.).
- -.._.. -- ---- --._.. _ .--- -_— -I
:aeawner often p(Sec.7 ante mortars (L
- .._...106 - SEWER & WA i
- - -- - -. TER-- r- _..._..._`- -- --
_.
License( me project (Sec. moan Beninese and
Business and coe<o The Contractor
it :: :..' : P'.:':- - ;-
2 0 2 - UNDERFLOOR PLUMB ING
"
-
;; _
License La soy whion.
wd« anforsucmajects, oit ,cietywmowild:or ;parriameson.
onvacrs for. such projects with a.commaor(s),licensed pursuant.to. the.
andwho.`sueentt
. -.__ __..-.. 203 - UNDERFLOOR MECHANICAL " x
olva<mr aw...
me
a xc t order So, ''' ' ' & P C for this mason
204 - UNDERFLOOR., FRAME -- - -_ . _..-- --..__ ---- ...._...._..._...
♦(
--
ti tii�u- ,,':.;
205 - UNDERFLOOR INSULATION
Own, KER'SCOMPENSA"ITONDECLARATION
301 - ROUGH PLUMBING
" "' 1bomb a ro under , Noayyofpeijuryaneaf ,hc following declameone,
302 - TUB & OR SHOWER
�0
1 nave and win mrdnli n'a'Cendicam of Consent to self -;mare tar workers
303 _ ROUGH MECHANICAL
Compensation. as pmviaca for by section 3]00 of the Labor Code, for the
304 ROUGH ELECTRICAL
-
performance of the work for which This permit is issued.
305 - FRAME
-
01 have and will maintain workers Compensation mmmric`a, is required dy section
3]00 of the labor Cod, for the performance of the work for which This permit is
306 - HOEDOWNS
' beMyWorkers ,ca pe__rnlnebra a aPdfiyou x
307, INSULATION,_
cal: u',1 `I L.: Pdfirry
-
k.. {�tvC730Bk- v,SHEETROCK�ef,s;'.
ICERTIFICATION OF. EXEMPTION FROM WQRKERS
.. .. ..
T - _ COMPENSATION INSURANCE
EXTERIOR _LATH_,,;,_„
" " (Tnesa;bnneaanoibecLmplema f 'he permit is far one hunwmdd.11.
310'—`INTERIOR ` LATH -
IsI.I rleeel, . ,
-- 311 - SCRATCH COAT
This c t . 'eeLea L
n d6yany th on in anemmer 1 ' k r m, object
ml at c ply any R nY moon r so as m become bjen te the workers
_:- ..
313 - ROOF NAI L L : s, { l.. ., I (: -
C
Comp<nat Laws orcalr:paa,
.'Apple t ..
501 - FINAL ELECTRICAL ENERGY
NtYlrkj APPLICANT If, ref( making rn Cm re, (Fame( you
.__.._. ._ .. _.__
502 -- FINAL -- PLUMBING ENERGY
z
�
you rold
become s mcbo�m( 'miwuch sc Provisions p ashall W< Law Craft, over
comply pmvtsinns or this Peoria shall bed d m okcd.
503 - FINAL MECHANICAL ENERGY
_ .. ... -
' CONSTRUCTION LENDING AGENCY -
_ - - - -- 504-=- -FINAL--BUI-LDING' ENERGS - --
'c IIT ,by ffvn That thercn LnalruaLnlendingagencjlforth performance
505 - FINAL ELECTRICAL:
ae wink hch This permit i ssued(Sec 309`,Ci, C) ' •
t
,Q
_.
- -- -- 506-- GAS-TEST -- .
z
Lnar Aadrc a
-
507 - FINAL PLUMBINGir n
'F
I«rofy that I have 'mad this application and state that TrWee information is
'ouricci. I agree (o, comply with ell <try and county ordinances and state laws
508 - FINAL MECHANICAL
.p
. relining
tohaaingconswaio, midhembyaumoriuiedaseaaevesormis city to enter upon
509 - FINAL GRADE
the above namianed property for im,,caion purposes._
IL'
(We) g msaw tlm'fyadk plo-A srheCty fCpent egemst
510 - FINAL PLANNING
W
Z
liabilities 3 dg (s.. cot J pe s which may in any w y < gains( said
city uqe
514^- NA
<arth g rW ;p ,t
A L ANTUNDERST DS N ICE COMPLY WITHALI, NO P NT
P WORKS
I
s v RHCU T'dH�
Issued by Date
L YI D
'....'...
ignamre a! prcanocontia< r- .:, .....' ,. •. ;. Dace...
HAZARDOUS MATERIALS
Re -roofs
„ DISCLOSURE
wh appl cant or f ore Wilding 06.1 t ,ore or handle hL dais material
Type Of Roof
as defned by rh CPen M P Code Chapter 9 12 a J the Health and Safety
._.. ._ _ .. _..__ __ .., __ -__ _
;
Cbde S t o 5553 >(e)
.,r fJY 1. xT
, .
f R'T v
i
_ r %( + t a {
All roofs shall be inspected poor [o any roofing material being installed.
wn to applicant a future building p m use equipment devices which
am na r def ed b The B Area A menu
Y Y Quality M na e
If a to is installed without first obtaining an ins ecuorl, "Pagree'to remove
g P
D "'" t - _
0 Y<s Nn
all new materials for inspection. Applicant understands and will comply with_
r.
all non pbtnCsoorce regulations " _
h mad me _'
req l
n p the
C 1 f m H< lth & Safe Core. s125505 25533 and d 25534 understand Wat
'foe
WVldngdoes o, chic dy ha tenant, that tism fY the
b1 ry no
occu mendicant whmh mu a met prior to issuance of Cenifica,e'of
"
T
r -
Si nature of Applicant
g alt _ . PP i ... Date
_.. .._.., ..._... ... -_
All roof coverings to-be-Class "B" or' better '
Owner ar au area ase t Da,e .
UPFlCE ....._ _ .. .. ... _._. ._. -.._ ...