04020095 CITY OF CUPERTINO �sswEFav��
BUILDING DIVISION PERMIT �jCONTRAC�TOR INFORMATION .
N_#
BUILDING M JAMES H. SMITH 1E11ITNO04020095
NiJX�.iZT AVE
R'S NAME: PERMIT ISSUE DATE
ONE: SANITARY C NTROL NO.
ARCHrIE-CT ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I� I�
+�
oo LICENSED CONTRACTOR'S DECLARATION
Ym I ionby anion that 1 am licensed under previsions of Chapter 9(commencing Job Description
<Z�
with section kmby Ianion that I m licensed
um edLnde eMPisions of hapten 9 my(cam uchchncense s
^n in toll forte and erz«t
^ in
12zq Dae�Cl� Lim.0 DRY ROT REPAIR /
q W ARCHITECTS DECLARATION j
0 nt 77U I uMcrsunJ my Plaru shall be used u public ranrds
LL GLicensed Professional DX
a.05 OWNER-BUILDER DECLARATION
99 1 hereby.Rem Nm I am exempt from be Conoactah License Law for the
i O O following reason.(Section 7031.5.Business and Pmfeuions Cade:Any city ar county
which requires a Permit to construct,alter.WPma,demolim,or minor any nmctun
Fi< prior to its iammee,also requites thcapplicmt for such permit in Rlca signed statement
huheis liansW Purmanuothe provision ofthe Canmcmr's Liansc ixw(ChaPter9 Sq. FL Floor Area Valuation
�$ (commenting with Section TODD)of Division 3 ofhe Business and Professions Code)or
ey
that he u exempt therefrom and Ne With fm the allcgad emmpdoo.Any violmion of
Section 7031.5 by any applicant fNm a Permit subjects the applicant w a civil penalty of � P
not mon Nm five hundred dollen(5500). 3 ,y,eitO O Occupancy Type
']P
e
❑I,u owarof the the
stoic ar myempleyas wimwagd Wash.v rote eompewtiess
will do uta work.and the mono¢is intended Liccum eLaw dos not.(Sec.too44,Bulinus
And property
wh obu Code:The Contractor's License Law dates or apply 1f an owner of Required Inspections
property who Wildsa i d Out such impr mments Amandwhocknnot int wok himseeredWaugh his
owneer.the uiprovidedmatsuchimprovementsare not Intendedmolfered for We. r.
however,me building or improvement is sold within oro year of impletion,he owas-
Wildtt will have ecu burden of proving that he did not build or improve for purpose of
talc.).
El 1,As owxr of the pmpcny,am exclusively contracting with licensed contractors to
construct me project(Sec.7044.Business and Profusions Code:)The Coutsmtm's U. .
ante Low doe not apply ro an owner of property he builds or improves them,and.
who contracts for such projects wire a eantra or(s)lianud pursuant o the Communes
rase Law.
Am eefrlpt under Sat. ,B if P C for mu tenon
WORKE 'SCOMPEN ATIONDECLA ATION
1 hereby eriirm under pointy of perjury one of the following decluauom:
,i ban and will maintain a Certificate account m self-insum rat WalmesCompen-
unnk f u which
It fa by Section J]00 of me Ichor Cade,for the pertarmame a)the
wok for which Nis permit is issued.
1 have and will maintain Worker's Compensation'soutane.u required by Section
3TOOof me UW rCode,fmmepertormartcearthewokforwhichroilpermitisissued.
My Workers Compensation Insurance camicr and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not becompleted time permit is formic hundred dollars($100)
or len.)
I anify that in the performance of the work for which this permit is issued.I shell not
employ any pawn in my manner so As in become subject to the Workers'Compensstion
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:If,after making his Ceniocate of Exemption,you should
become subjat to the Worker's Compensation provisions of the I bnr Code,you must
,JZ foihwith comply with such provinces or this Permit shall be docmed nmkcd.
'z OCONSTRUCTION LENDING AGENCY
..� 1henb a1Rrm mat then is mommetinn lending F Y 8 garter'or do,Perfomtana of "
Q' me work for which on.permit isissad(Sat.309'f.Civ.C.)
CWj L A LendersNam(
Z) Z Lender's Address
J C) 1 anify hat I have mad this application and sure One me above information is
by P coned 1 agree to comply with all city and county omirunces and sure laws relating W
O U building eonsuuetion,and hereby suthomm nprexnudver of his city to enter uppn he
onal
r W shove-menudgmah.Pcny for l expenses
purpowhich ms
9L (We)agree to save,indemnify and Feep harmless he City of Cuperono.gamut
Z
liabilities.antram cn¢easmmd es thio which they in any way eccmc against mid City
U,Z in cmnseganc<af he granting of this Permit.
APPLICANT UNDERSTANDS ND WI COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGULATIONS.
_A
iG to a pplicm/Conmi
V-44ni C2 Re-roofs
HAZARDOUSMATERIALSDISCLOSURE Type of Roof
Will me applicant or future building occupant store a handle havudous m.terial
0ned by he Cupertino Municipal Code.Chapter 9.12,and the Hcalm and Study
.Scctimn 25332(a)? KNI All roofs shall be inspected prior to any roofing material being installed.
❑Y
Will the epplcmt of future Wilding occupant use,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
O,t hazardous air contamin`ants.a.s dcOncd by the Bay Area Air Quality Management all new materials for inspection.
Dyes �o
1 have real the baaardnumatcrisis mquiremeu under Chapter 6.95 or me Calier-
niaHcalihikSafelycode.Sections23 5,2553 d25534.Iunderstentumi)mc Wilding
docs not canon ly have.enm4 that 14 in uihiloy to dry occupans or me
require i rete W u be met a la i s or Caul fo panry. Signature of Applicant Date
Owonu'n ee agent g
All roof coverings to be Class"B"or better
eek
P
OF CUPERTINO • '"?"sr "" ••>" '-` '- ' �a`''',
LDING DI VISION PERM •SCONTItAOR TNFORMA N
4d ib> i' a�
ADDRESS: JAMES H. SMITH PERMITNOO�IOZOO9S
NAME: PERMIT ISSUE DATE .
17q
SESANITARY itP42"2C NTROL NO.
ArsCHITECfrENGINEER: BURRING PERMMINFO
BLDG ELECT PLUMB MECH
0 0 0 0
o0 LICENSED CONfRACIDR'SDECLARATION
w Job Description
FC 1 hereby affirm that 1 em liceucd under provisions of Chapter 9(commencing
zw with Section 1")of Division 3 of NC Business and Pnfession Code.and my license is np ll
>> Limn for¢r, erten DRY ROT REPAIR FUNA,RL EEE
gjZ in fuller Class Lic.N
t-a Dam Contractor
ii ARCHrmcrs DECLARATION
C< I understand my plans dull he used ss pantie ramiAUG 3 _ 2004
6D
G t; Licensed professional
5 OWNER-BUILDER DECLARATION eo
1 hereby affirm Net I sm ucmpt room the Conlrnetra s License Law for the BUILDING C 0 fullewmg mown.(Section 70313,Busier.•are Professiau Cade:Any city or county B I IN
which requires a Permit to emmbosct alcor.bnpmw,demolish,or repair any sounum
2pdor m its issuance,alae require the applicant farsuch Iermitio Ble a signed statemcot
prior
slicensed Purmsntto Ne previsions oftWCossicmr's License Law(Chaptcr9 Sq.Ft.Floor Area Valuation
t• (commencing with Section700()nf Divislon3ofthe Busmessand Profusions Cele)ur
$ "I M is exempt therefrom and Ne basis for the allged uempdoo.Any violeian of
Section 7031.5 by any applicant fora Permit subjau the applicant m a mil permity of 3��@rp 0 Occupancy Type
not mom Nan fisc hundred dollars(5.500). .
❑I,u owner of the property.or my employes with wage u their sole compensation.
will do the amrk.and tiresomeness linos unleaded mmffeed fusale(Sce.70th.Busied". Required Inspections
and Professions Cie.The Cmuaetm's Lica.Law doe not apply m e an owner of q P
property who but Ids or improves thereon,and who does such work himself or through his
own enployes,provided We web improwmeru tae not intended or offered far sale If,
however,We building or improvement is sold within one)ear of completion.We owaer-
builder will have the burden of proving dust he did not wild or improve for purpose of
sale.).
❑1.as mine of the property,am excluiwly cWhosto ng with licensed contactors on
cocoon th project(Sec.7004,Business and Pm mentis Code:)M Contaeors U-
cove taw does not apply in an owner of property who builds or amp enc,thereon,and,
who contracts for such projects with s conoacter(s)licensed pursuant to We Conuacmta
uelaw.
am exempt under Su ,6 A,P C for Nis moon
WORKE 'SCOMPEN ATIONDECLA ATION _a
I hereby affirm under penalty of perjury one of the following declinations
fth..and will maintain aCertifiem of Consent o self-insure for Worker'.Compen.
as provided for by Section 3700 of the tabor Code,far the performance of the
for which this permit is issued
❑1 have and will maintain Workers Compemadon Luurance,as required by Section
3700 of the Labor Code,for the performance of the wort for which this Permit u issued.
My Workers Compensation Insurance carrier ant policy number art:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisseelim recd not 4 complewd if th permit is fmo schundmddollars(5100)
to lea.)
1 certify that in the performance of dre..,it for which Nis Permit is issued,I shall mm
employ any person in any manner w as to become subject so than Workers'Compensation
paws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenifuem of Esemraim.you should
become Subject in the Workers CmmPeuatimn pmvisioma of the,Labor Code,you mux
0 foMwith comply with such provision at this permit In deemedvah
recd.
CONSTRUCnON LENDING AGENCY
y > Thereby affirm dust there fi a construction lending agency for the Performance of
dte were for which Nu permit u issued(Sec.3097,Civ.C.)
QLcreces Name
J z tender's Address
01 1 canary that I have one Nis application W state that the abuse inmm,atiun is
t" correct I ogre to comply with all city and county ordinances and sok laws relating to
U Wilding construction,and hemby authorise repmmnutiscs of this city be enter upon the
W above-mentimred property for aupscorm Purposes
4 (We)agree to row,indemnify and keep harmless the City of Cupertino against
fn
liabilities.judgments.cum and eapenscs which may In any way merme against said City
z in emu quenee or the Fm ring of this Permit.
APPLICANT UNDERSTANDS ND WI COMPLY WITH ALL NON-POINT Issued by: Date
SOUR 0.EGULA710N5. \
Re-roofs
rg taro ppliuMContncwr
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stem or handle h ma dons maumie
as defined by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Code.raY �No
Section 25531(a)7 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
Will he applicant m forum building oarrpanl sac Nutriment or rkvice which g
t hanotious air contaminants ss dcOned by Ne Bay Area Air Quality Management all new materials for inspection.
uictt
❑Yee
1 have mal the harardnu materials requvcments under Chapter 6.95 of Nc Califor.
nix HcaW6S9elyCoCc.Smtiau25 5.]SSJ 15534.I understand dust if the building
Ues not cuncntly hew a tenant that t
is my miM1ility w d(y c mcupant fir Nc
require en hic�i mus D<met o w issuan of CeroO of cy.
Signature of Applicant Date
Ow fir auih r0 agcm ac
TG All roof coverings to be Class "B"or better
City of Cupertino
Plan Check Transmittal
Permit# 03120081 Co 0'#
12700
Project ADDITION/REMODEL Plancheck# 3
Address 8061 HYANNISPORT FileDate 12/12/03
Owner POSADA
Description
Plan Check Status (attach comments and return to Buiiding.with pian.set)
Plan
Dept check# Date Due Date: Staff ...;:: Comment Date Ap royal?
BERRYMAN -3 2/5/04' 2/12/04' 'BERRYM
Planning 3 • : 2/5/04; ,2/12/04' , PETER':• Q
Public Works 3 2/5/04; 2/12/04. -JASON-;..
Fire 2 . : 1/22/04 1/29/04- . < . WES:;: - ,.: 1/22/04'
Sanita' 1 12/15/03 12/29/03 r :'CHIEN 1/6/04 ❑�
• _ Assessor •3 2/5/04'. 2/12/04: ' El .,,
Additional Plan Check Fee ❑ Hours
Planning Fees
Housing Mitigation Fee Amount
Heart of the City Specific Plan Fee Amount
•
,( - PITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
N 1137 Date:
Building Address: Mailing Address (if different from building address):
'd Ae#4PAET AVy6N0Ln Ctrl v fo (fsoi 1337 L AINoX k)4q SauArAte- 74 es 17
Owner's Name: Phone #:
S '3 R V 44,kE: 4as-Z45-6ZZf at_[ ¢1)8•'F31-a4.26
Contractor: License #:
Si L+F
Contact: Phone: Cupertino Business License#:
bw ooz__ Fax:
Building Permit Info:
Bldg`] Elect ElPlumb/6� Mech
Job Description:
Residential>qr Kmmercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Sq 5. Occupancy Group:
Type of Construction: Please check this box i e project is a
f:EPLACi_- DR*k01"5fLr99 "ib A b C 1G`ntr auiP 0006Suy
,rOr-OA second-story addition: ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> l OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS 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> IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Ener Add Multi BUILDING
BINVESTIGA investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
1 of 3
RTY OF CUPERTINO ,
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
eQuantity Fee ID Fee Description Fee Group
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 Bidg 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 Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL
BREMAUU- AN A/C Units <= 10,000 cfm. MECHANICAL
BREMAPPLI Appliance Install MECHANICAL s
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
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 I Remodel Signs, Marquee ELECTRICAL
2 of 3
aJzwrum
PITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Grou
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
13SPECIAL 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 Electricals foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicalsq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbin Permit Issue PLUMBING
PPLBG Plumbing Fees foot PLUMBING
ZADDCHG Address Chane BUILDING
•
•
3of3
-- - _ +
o �� /
C ,. I
H-H
F�CETVED U�cxo-j
n FEB 1 2 2004 wcw) (sae
asst
q �P l l Q C3
3;...,
i — 70 1►R ral r !7
4at'
COPY I
1@NFcN.r and "Pe
tot e tions MUST
Thit tot of ion „ t;t�e and it is un
410' 0` a. - r. alterations
ale ;� chars
lewtul to emission Iron,
on same w,thua w " of ppupertino.
Cepi., Ci y
the tiuo .1 of this plan and speI tD be, a9
��SgQt arse f5 the siomPina ermit or,to be ar,
1 �11{16L- NOT be held to P
��ptoVal of the violation of any PYOVItoo
tt enY.CftY.q�dinancQ oc 5to LOI8'
Gc6 TT Nlk