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03050001 CITY OF CUPERTINO "'^°� �� f "�' `' ' ' "- BUILDIN,DIVISIOFy PERMIT ', � 1 E2'f2Q"5°D9ALUSTROL CT CLEAR OAK DESIGNS PERMIT No03050001 IYN;; STANLEY AND EILEEN 1723 B ROGERS AVE 1/2003 i NE: (4 0 8) 436-5448 SANITARY NO. CONTROL NO. ARCHITECTIENGiNEER: BUIIDINO PERMIT INFO BLDG UM lm 1— �� oo LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby a(Rrm that 1 Me licensed under provisions of Chepmr 9(Commencing with Smilon7=)of Dlvision3ofthe Banal Pfrp�ranzt.qCod�gOen�dmI�ylicensela �- mflif dmfea l � JTCL` KITCHEN REMODELWINDOW CHANGE R'4 Liam----- �- tae.g i� Dam contractor POCKET DOOR 09MA,Um-93 fq.. ARCHITECTS D N `� - ?a hmdenund my plane shall Mused blit wwDd+ `� 2 R 2003 0 Lucnsed Professional OWNER-BUILDER DECLARATION E 1 hen,by affirm on 1 am exempt Iron the Cssions o License taw for Ne BUILDING 1:0 o following moron.(SOcuun 7(171.5,Busi"^••and Professions Cade:Any city or county B U I LDI I� G u�$ which requires a permit to constroci,elms Improve,demolish,or repair my sucetum F poor 0 its Issuance.also mquims the applicant(or permit m Rle a signed statement �< that be la licensed pursuant the provisions of the CommcumS Liverec Law(Chapter 9 Sq.Ft. Floor Area Valuation €th (commencing with Section 7000)of Division 7 of the Business and Profession,Code)or that he Is exempt therefrom and the basis for the alleged exemption.Any violation of $20000 Section 7071.5 by any applicant for a permit Subjects tin,applicant to a civil penalty of APN Number Occupancy Type DMI more than shothundred dollars(3500). 01.as owner of the property,or my employees with wages a their mm Cooperation, 35603012 . 00 will do the work and he auction,is not intended or offered for rate(Sm.7044,Busimes; q d Ins ections and Profteadone Cade:The CwMwme3 Lbceme Law does not apply m T I'O an owner of 101 - FOUNDAp property who builds or im proves theraW and who does such work himself car through his .=Play.,provided that such improvements areaminmndedorofferedfor We.IL 102 — PIERS however,Ne building or improvement is sold within ane year of completion,Ne awuer- builder will have the burden of proving that he did not build or improve for purpose of 103 - UFER Wo). 104 - REBAR ❑Las'Owner of the property,em aselwively contracting with licensed contractors to 105 - ANCHOR BOLTS construct the project(Sec.7(t14,Business and Professions Code:)The Continence&Li- censeLaw does not apply toan Owner of property who Wilds or improves Obown,and. 106 — SEWER & WATER who conesctsfor such projects with a conlnemr(A licensed persoam tothe Cormacks s LicenaeLa.. 202 - UNDERFLOOR PLUMBING ❑I ME"empt untler sx. BkPcfor this sawn 203 - UNDERFLOOR MECHANICAL et Data 204 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION Ihereby alntmunder penalty ofperjury amofthe following dWarumns: 205 - UNDERFLOOR INSULATION .I have and will maintain aCerdfictm ofConsentto sel&Inmm far WorkeesCmrPen- 3O1 — ROUGH PLUMBING Milan,M provided for by Section 7700 of the Labor Code,far the performance of the 302 - TUB & OR SHOWER work for which thispermiiisissued. 303 - ROUGH MECHANICAL ❑1 have and will maintain Wortrfs Compensation Insurance,as required by Section 7700 of the labor Code,for the performance of to work for which this pmmit is issued. 304 — ROUGH ELECTRICAL My Worlmes Compensation Insurance carie-and Policy number am: 305 — FRAME cao( / Po"— 306 - HOLDOWNS •� GP.RTIPI COMPENSATION JR NMC ORKERS' 307 — INSULATION (This Doctor Coed notbecompteted lithe permit is farow huhdmddolim(5100) 308 - SHEETROCK NOIL) 309 - EXTERIOR LATH I certify that in the performance or the workrM which this permit is issued.I+hall not 310 - INTERIOR LATH employ any person In my manner sou m became subject the Workeri Compensation Laws of California.Dam 311 - SCRATCH COAT Applicant NOTICE TO APPLICANT:IL after making this CeniOcam of Exemption,you should 313 - ROOF NAIL become Subject to tin,Worker's Comi emsetion previsions of the labor Code.you marl .JO forthwith comply with such provisions or this Permit shall xwarned mvnked. . SOI — FINAL ELECTRICAL ENERGY ?. CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY p...y. I hereby affirm Nal them is a eomracdon lending agency for the Performance of 503 - FINAL MECHANICAL ENERGY Me work for which this permit is issued(SEC.3097.Civ.C.) 504 - FINAL BUILDING ENERGY D7 Q Lender's Name D7 Z Leader's Add. 505 - FINAL ELECTRICAL Uo 1certify that Ihaw mad this application and sum dust the ebe"Information is 506 GAS TEST ' IL FCorem.1 agree to comply with all city and county ordinances and sure laws miming in o building construction.and hereby amborim representatives or this city ut enter upon the FINA PLUMBI IG Wmow-amakmod property for Inspection purpose& 0 8 FIN L (We)agree to save,indemnify and keep h+mdc s the City of CupWim against / yliabilities,Judgments,cats and expenses which may in any way actors against said City 5 U to APPLICANTeof the granting of UNDERSTANDS ANDWILLWILL COMPLY WITH ALL NON-POINT Issued by NG Date SOURCE REGULATIONS. st a LaA,.O �� Re-roofs Sig store of ApplicanUContractor am HAZARDOUS MATERIALS DISCLOSURE Type of Roof _ Will No applicant or futoro building Occupant sorra or handle haamours material u dell"d by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety de,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes Dom the applicant car future mtuamg«sponte roc equipment or devices which 'If a roof is installed without first obtaining an inspection,I agree to remove ire havardnus air canuminanu es defined by Ne Bey Arce Air Quality Management all new materials for inspection. District? ❑Yeso I have mad the hwardousmmcrialsmquimmcnuundcr ChepmrA95 of the C+lifor. ria HcolN&Safely Cade,Sections 25505.25533 and 75534.1 ucdersmnd NNI(tim building docs not curtenlly have a mnan4 Net it u my responsinility m the ac meal of the mq mmenuwhichmostbeMELPrior totuuanceofa@rti0cam0 mPaney. Signature of Applicant Date owne-a-mthonMa a col Dam All roof coverings to be Class"B"or better CITY OF CUPERTINO �sa^ir� 01� BUILDING DIVISION PERMIT ;; .. xV7.. I�!Jiv'C ^ez B&IIE`4`N?'PD9ALUSTROL CT CLEAR OAK DESIGNS PERMIT"°03050001 TqfW; STANLEY AND EILEEN 1723 B ROGERS AVE �R r` Mnl/2003 PHONE: (4 0 8) 4 3 6-5 4 4 8 SANITARY NO, CONTROL N0. ARCHITECTIENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 p LICENSED CONTRACTOR'S DECLARATION Job Description Y 1 hereby affirm that 1 un licensed under provisions of CNp¢r 9(commencing < with Suction 7=)of Division 3 of the Bud Pr'Qfculom Cc&.andmyllcenmis � � mf ill it III. `C T � � KITCHEN REMODELWII C) Sgb Lm.u.,O .art 5 L LM.g z Dam can actor n t ._c POCKET DOOR plan. biomed TI N SEP 2 4 2A03 3 ''1'Ondcrsund my plana NJI be used arpillbli.records atad Liccnmd Profeuional OWNER-BUILDER DECLARATION BUILD= M m 1 mossy aRbm that 11.exempt from the Conlncroo e:Any Law for the i aO fallowing mason.(Section 7031.5. .alter. and Pm(essiou Code:Any city art county $R which inquires a permit m conurun.altar.wprove,demalith,or rtpalr'anY auucwro 'nprior m anceala its issu , u requires the applicant for such permit m rilea atgtmd atstament i- poor,hu rte I.limited raiment m the powinum of me conaaemra ucc�Law(Chapter 9 Sq.F[. Floor Area Valuation K O (commencing with Section 7000)of Divinon 3 of the Emmaus and Proleuiom Code)of that he 1.Section 70715 Ey airy applicant(w pCII11I NbJttle the applicant pn11CN11a [IYiIption.My iP.'mRy O( $20000 APN Number Occupancy Type not mom than raw hundred doles,(5500). 35603012 . 00 n I.isownerofthepmperty,mmyemplo)eeawiNxguuftVMICwmpenaadon. wtlldotbewark,andme Nucturthnminwndedarofer fmuie(Sm.70M,Busiaaa dIDS cations and Professions Cade:7yn Contracmes Lim, ran m Law dam t apply an owner of 101 — FOUNDAT I'ON p propenywho Wildaar improves themomand wwdoessmh workhimseifor Waugh his own cmpinymts,providrd that such improvements am not toward maRered for sale If. 102 — PIERS however.me wilding or improvement is sold within oro year of compladon.me owner. Wilder will haw the bndm of proving dust he did not bald or improve for purpose of 103 — UFER ; Wla.> 104 - REBAR 0 1,vii owner of W property.sm normatively cometh.&with Hamad amtractm,In 105 — ANCHOR BOLTS comma the project(Sec.70m,Business and Professions Code:)The Contractors Li. cause law does not apply in an moor ofpmpwy who wilds or improves themon.and. 106 — SEWER & WATER who contracts formula pmjccm with aconuanor(a)Earned punoint m tits Conu 's ento License taw. 202 — UNDERFLOOR PLUMBING D l am esempt under Sem .Be PC res this memo 203 - UNDERFLOOR MECHANICAL Fraud Dam 204 - UNDERFLOOR FRAME WORKERS COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION I hemby a1Rtm under porosity of perjury one of the following dmlaradons: Dlhaw and will maintsin sCarnfimm of Cament m self-Insure fm Worker Caropen- 3O1 — ROUGH PLUMBING sailor,u provided for by Section 3700 of the labor Code,for One paRormma Of me 302 — TUB & OR SHOWER work for which this permitislaned. - 303 — ROUGH MECHANICAL 0 1 haw and will maintain Worker's Compemadon imumna,as required by Section 304 — ROUGH ELECTRICAL 3700 of the labor Code,for The performance of the work for which this parent(la hued. My Worker's Campetuation Inurume canine and Policy number art: 305 - FRAME Can �`�^9fL` -�Pa"C' - 1 306 - HOLDOWNS J CERTIFICCOMPENSATION NSIR N EORKERS' 307 - INSULATION Crisis auction sed not W completed ifine permlt is far one hundmddallan(SI00) 308 — SHEETROCK arta°`) 309 — EXTERIOR LATH I certify shut in the performance of the work for which this Permit Is Issued.I,hall not 310 - INTERIOR LATH employ any person in any mmarm m in become subject to the Worked'Compensation Laws of California.Data 311 - SCRATCH COAT Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should 313 - ROOF NAIL become subject o W Wonmes Compomadon provisions or the labor Code,you must .JQ forthwith comply wwsuch pmmrevoked, 501 — FINAL ELECTRICAL ENERGY z`" CONSTRUCTION E"oNCAGENCY 502 - FINAL PLUMBING ENERGY F+^N" IherebyaRnommilarelucomtmNm,immullrnrthcrerfenommeuf 503 - FINAL MECHANICAL ENERGY rGD the work for which this permit IsIssued(Sea.3097.Civ.C.) 504 - FINAL BUILDING ENERGY W Q Lendeis Name Z) LerdersAddmss 505 - FINAL ELECTRICAL UO 1 ratify that I haw read this pplicNon and,uu that the above Infomudun is 506 - GAS TEST I,F correct.I agme in comply with sit city and county adinmers and rote laws relating in O V building cammction,and hemby aumadse representatives;or this city in enter upon me FINA PLUMBI TG W above-manuaned property for Impecdon purpose, It O 8 F I N L (We)agree to an.indemnify and keep harmless the City of Cupertino against I n„y fiabilides.judgmerWcos,and caucuses which may In any way same against said City 5 / U 4 in APPLICANT eor the jimmml of UNDER5TAN0g RIND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date SOURCE REGULATIONS. J tat 2 Lea n G11�a� Re-roofs Si mum a(ApplicandContracmr � am 'ape of Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future wilding Occupant I'm at handle hanomin material as da ncd by the Cupertino Municipal Cade.Chapter 9.13.and the Health and Safety Cede,Section 15532()7 All roofs shall be inspected prior to any roofing material being installed. O Yes IETO If a roof is installed without first obtaining an inspection,I agree to remove Will W applicant or future wilding occupant use equipment ordevica which ' emit hoard..air contaminants as dNncel by the Bay Area Air Quality Management all new materials for inspection. Dialrict7 ' ❑Yea (. [haw read the hoardnusmucrialerequlrtments under Clupter 6,95 ofma Califor. nia Hmlm&SafctyCode,S =25505.25533ud25534.1uuuuuu��dentsnd mulflM willing dea not amotly hew a tenant,than it 4 my respondhillty W aavpan,or dm mq'mmenu which muse be met prior ro issuance of a CenlOcateo enpsray. Signature of Applicant Date 4E, U All roof coverings to be Class"B"or better Owns aautharimd agent Dam r�- ATY OF CUPERTINO • ci!o'l' 6 lruY CUPEFPERMIT APPLICATION FORM S APN# G Date: Building Ad ress Owner's Name: Phone#: �C Contractor A , S Li ense #: Contact: cbcx�AV� Cupertino Business License#: Building Permit Info: LJr .Bldg 0' Elect Plumb Ef'— Mech C� Job Description:: �— Residential 3'-- C � Sq.Ft. Floor Area: r ^O q. Cost of Project: J�, �(! Occupancy Group: r ;oldco Type of Construction: t_ FAOM L-Y Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING 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 BMITIGATC Comm. Housing Mit. Fee I BUILDING z � 7 "' 1 of 3 (� r• �s �TY OF CUPERTINO C'TMO PERMIT APPLICATION FORM CUPEI�TINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING 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 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAMHAN A/C Units<= 10,000 efrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> 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 2 of 3 f I an CITY OF CUPERTIA CUP TYOFINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 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 Insection 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of ? ..b g��r 8JS , moo: J. pC� � � p c4�i v c o y L Wp •. y' "r�Q- Zi m i O OLY m a 3 �^ v a c ,�NNlv�lWCn• 9i o noL a c m v dF EE of,gf P S }� V (3iI ' J N ZZ ,gyp � c_ rJ sp - - LLO) la — �k 1, _dam ♦. L- ; ,��I :�: d cn :Uli Qroo ;z= VE � r o m zt� � M O N d T Q� P � 08 _ cn C Fd ' E S o esu; i eon —'— ez—! a-; ��i 1•y. J LO V � 1L� � �� ,pI pp C:¢`)^ C •C O•I 4�''tN►.i...iw g C �v ZO - 40. o� N • 1 -e � -- •