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04020094 CITY OF CUPERTINO BUILDING DIVISION PERMNif` BVIIDING ADDRESS: CRAIG CUMMINGS PERMITNcb4020094 OWNER'S NAME: PERMITISSUEDATE E: SANTTARY NO. CONIAOL N0. ARCH=1ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Op LICENSED CONTRA=R'S DECLARATION JobDescri tion F 1 Wreby Minn than 1 sero li¢need under provisions of Chapter 9(commencing P with Seeton7")of Division 3 of the Business srW Professions Code.and my license ? in full fores end effect. 9'n I msclata Um.M MS BATHROOM REMODEL N� Dam Contractor 4< ARCHITECT'S DECLARATION 2 1 understand my plans shall be used as public rttmda aU G t; Licensed Professional g OWNER-BUIIAER DECLARATION f 1 hereby affirm that 1 am exempt from Ute Cmwctofs License law for the 00 following mount.(Seetion 7W 1.5,Baines and Prefersiou Code:Any city of county m which require a Permit to consuucL elms.improve,demolisA or repair any structure thetdo Pdormslimuwenitcep.aNlsanLm mr.M w0liNeOntffomrsuchpierW..mla4aiganwed(Cnl•m^pmmor9n Sq.Ft. Floor Area Valuao (*mmcncingth Suellen 7000) Division 3of Bunessand ni Cocke)of Nat heis excerpt Mnfrom and she basis for 0n,alleged exemption.Any viobYm of section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3 5 ib��0 Occupancy Type not mom Nan Eve hundred dollars(SSW). O 1.u owner of Die pfopmy m my employ=with wage u thch slc emnpeuadm. will do the wwLaed Ne snuctumunmintended uraRehedforsale(Sec.]Ose,Business Required Inspections bu and Professions Code:The Conuacta't Liceme Law dom eqcs not apply an owner or `Z property who ilds or improves therern,andwho doessuchwmY himselfortiuott nhis own employees.provided that such impronormnu sm nm inaendcd moRe s!for ale H. however.Ne Wilding or improvement issold within one year of mmpletim.the owner. Wilder will ban the Wrden of proving that he did not build or improve for purpose of cote.). ❑L as awmr of the pm.7 am exclusivelyand cmuacUng with licensed monYacmrs on i. construct d project(Sec,to C4,Business and property who ns Code:)The Cmuacmfs Lid / wtae law dors nm apply m an owner of property who milds of improves Hereon.and / who mnuaeu for such mojeeu with a emvacmrts)licensed pursum on the Conuum/s !SL se Law. )Ln �t— WORKER'S OM�SATION UECLARA—XJPCfw(is main Ow 1 hereby affirm under penalty of perjury orte of the f ng declar bore: 1 have and will maintain a Certiheam of Convent to self-mme forwohsYscompen cation.u provided for by Section 3700 of the Labor Code.for the Performance of the wort for which this permit is issued. ❑I have and will maintain Worker's Compcncotim Inmmnce,m hequimd by Section 3700 of He Labor Code,for the pertomance of the wort for which this Permit is issued My workch Commutation Incurso e eanim and Policy number am: Carrier. Policy No.: CERTIFICATE OF EKEMPDON FROM WORKERS' COMPENSATION INSURANCE (This auction need not beeompkmd lithe Permit is for one hunched dollars(SIM) re,loss.) I eerdfy that In the perfomame of the wort for which this Permit u issued.I shall not employ any person in any manners at at Income abject to the Workers Compensation Laws of California.Dam jtppli., NOTICE TO APPLICANT:If.afar making this Certificate of Eaemption,yon shmld become subject to the Worker's Compensation provision,of the labor Code,you most O forthwith comply with such provisions or this permit aball W deemed mNd rvm :y CONSTRUCTION LENDING AGENCY I hereby of am Nat Hem is a mn,trucetion lending agency for the Performance of me work for which this Permit is issued(Sum.3097.Civ.C.) ALeneces Name z Lcmm,'a Add. C 1 codify that I lave and We application aed sum WI the above information is roma.I agree in comply with all city and county ordinances and sum laws elating in building censwction.and hereby southern mi mususam of this city to corm upon the a�7 abo n-mentioned property for inspection purposes a fY (we)agms in cove,indemnify and tech harmiran the City of against s against y inconstswe ceofth,core and eapcmewhich mryin any way accrue against said City / z in conscgucnec of the granting of this permit .•w APPLIC U ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR R G ONS. I SiindinderdrApplstaill0icanessum-14� TIp�DG-2 Re-roofs HAZARDOUS MATERIALS DISCLOSURE " Type of Roof Will the applicant or future building occupant nom or handle hazardous material at deflned by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety Core,section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. E]Ye *5o Will the, rear or future Wilding tan If a roof is installed without first obtainingan inspection,I agree to remove OP d Wnr use equipment of devices whiten P gre It ick? us sir conuminanu u defined by Nc Bay Arta Air Qualify Management all new materials for inspection. District? ❑Ye Ee. I ban reed the baaNms materials hequisemenu under Chapterri.95 of IW Califor. nu Health&SatmyCede.Section,35505.25533 and 29534.1 understand thatifthe Wilding does not s.Tqtll a unarm Hat if u my miponnhility m notify the,aceupmt of the reyuihe nuw roc f Wmerpridr Hissuanaofa Certificate or 0"y. Signature of Applicant Date z ter or authorivcd agent Dam All roof coverings to be Class "B"or better • hPPROVED TR ACCORDANCE WITH THE CITY Ofl CllPERTINO C DES D NANCEB 111 L�T ;FEIB C.1 i 4 �I� — SIGNED This se};j —,,,,,aps and specifications MUST PA Ot hP un lawful� make any changes or alteration on sera without written ermission frorr __ the burning Dept., City of Cupertino. o y The r=ping of this plan and specifi ations C N SHALCSOT be held to permit or to be or. s �j approvaof the violation of any provision, ro 4 ww-Ov Ordinance or State Law. N c ca m J U) U) U N w o Q `� Z a F- f 1 W }fsy fi 100 • N r N V m �Z4 O T 7 CL H O X o a a o a CN U) p� .c m c >- L E O 7 N U (� 0 o I J N N m 0 3 • U t r—-- i IA .1 to f • 103, � / b O w � I • I_ Oc' ii o O CNjai Urn C Becu r 200 U cu _ U) N N - O m m () 0 co 0) O U LL O% J F] J C E E Z cU -.L OFF M W U m cu ® OE . m N co O J C m O Z - -------------- ------------ ---------------------------------- --------------------------------------------------------- N 3 O .. as <<s aq�n *ITY OF CUPERTINO * o 0,-2-o CITY of PERMIT APPLICATION FORM •CUPEkTINO APN # ?;%-J � Date: / Building Addres : Mailin ss (i differen from building address): Z203y 13gkt tcV I Owner's Nam Phon #: l�'�!Ci (!S J,�t M 1,U C, S Contractor: License #: Contact: Phone: 2,5-2_7gyg� Cupertino Business License#: 62AI G Cc-,.�.t,u w G 1 Fax: 7 -&$;V 7 $uilding Permit Info: Bl Elect � Plumb ( Mech Job Descripti Residentia Co erci Sq.Ft. Flo Area: $/Sq.Ft.: Cost Of Pro.) . Occupancy Gro (G� ; Type of Cons ction: t Please check thF ox if the project is a 11second-stor 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> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1 M 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/ uasi 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 BINVESTIGAInvesti ation fee BUILDING BMITIGATC Comm. Housing Mit. Fee F BUILDING 1 of3 �s 3 . 73 SAM fITY OF CUPERTINO UP OF TYO PERMIT APPLICATION FORM 'QuantityFee ID Fee Description Fee Group BNUCOMME New Comm Electric ELECTRICAL BNUC0NIIv1IN4 New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTWE 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 rinklerBackflo PLUMBING BPSTORM Stonn/Raln 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 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM13USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BRENSFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace > l OK btu MECHANICAL BREMBEAT 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 Rept], 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 2 of 3 `.0 PTY OF CUPERTINO CITY OF PERMIT APPLICATION FORM J CUPERTINO . Quantity Fee ID Fee Description Fee Group BREMTHEATR Theatrical Ligbting 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 BSPECLU Special Insection BUILDING BSWIM Swimming Poo] BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electricals foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3 ITY OF CUPERTINO "W�-'V BUILDING DIVISION PERMIT ;'T�C--O"N'TRAI�CToI,R-�INFOiiM,&,TION"",' ILDINGADDRESS' CRAIG CUMMINGS PERMIT 14020094 kk,o 21AM Ry Gip R*S NAME: FERMn ISSUE DATE rp�nkTr, rTTMMTNrq Q�11 2,12 ONE: SANITARYNO. `��L NO. ARCHITECT(ENGTNEER: BUILDINGPERMITINFO BLDG MECH tf pn LICENSED CONTRACTOR'S DECLARATION I WrOhy affirm that I am located under pocrisions of Chapter 9(commencing Job Description ;N wi��Uon7�)nrDivi�on3of�B��wW�f��C�.�mylicenwis in full force and effect. Liecose Class-Us.0 MS BATHROOM REMODEL L E L13 Dow Cost., ARCHlTEC`rS DECLARATION I understand my plains mail he mind as public records JUN 2 4 2004 is Q �t; Licensed Professional �0� OWNER-BUILDER DECLARATION �z I hereby amorn des,I an,exempt from ft coneachoes License Law por the BUILDING ii:a following reasion.(Section 7031.5,Business and Profossions Cods:Any city or county which requires a Permit to construct,almr.impom,e.demolish.or repair any structure l-,c. prior an,its issuance.also requires On applicant for such Permit to filh,a signed somentent mat M is licensed pursuant to the prowisions or 0.Cmunclor's Let.LOw(Chapter 9 Sq.Ft. Floor Area VaIA�90 0 0 a (conomensing wiffiSOction 70)))of Division 3 of the Business morl Profissamis Conic)in hot he is exempt thernefrom and the bases for don alleged caternpim..Any mlml im of Sccoon 7031.5 by my applicant For.permit suilijects the applicant 1..chdi rearair,of no,ourre than fl.hundred dicillass(M). 3 5AEFMunb9ID 0 Occupancy Type 0 I.uow=offtpmpmy.wmy=pjoymwi�MrAu��wlemmpe=don, willdo On we&-end the structure ism,intended orufficind forage(Sec.70,14,Business and Proofesions Codc:The Contractor'.Lt.Law does.1.11,W an manc,of Required Inspections property who Wilds or fimpoorest themon.and w1boducesuch workhorculf in throngs his own employ=,proo,idcd that such impornments runnot intended croffered for sals.If. how,..Obc Wilding or mpno�cmmr I.sold withi.m.year.1'completion.On build,,will he.On bod.of pomvi.,tho,he did tron Wild or i.p.for purpose Of satc.). 0 1.as owner of the pmperty�am exclusively contracting with focused comment.to construct On,parefca(Sec.7044.Business and Profiessions C:!.)The cromencones u. cemse Law dons not apply to an Owner of property whit Wilds or improwes thencon.and, who contracts for such pirjects with a commumr(s)licensed pursuant to On Connsaactoes L ace L, . ans node, B&P C fee Or, on r A Date WORKER-SCOMITNSATIONDECLARATIO :50jdectarathirs. �ution.as providcd for by Section 37W of the Labor Code.for due Performance of the 11 weak fee which this Permit is issund. I in 0 1 w and will maintain Worloor's compensation Insurance,as required by Section "',On LasWr Code.for On peffincroure.1'On.&to,which this .i,is named. My ii Compensation Insuranco carricr and Policy number mc: center. -Policy No.: CERTIFICATE OF UEMPTION MOM WORKERS' COMPENSATION INSURANCE Cods flim ndmo hic completed ifthe ptnerift is rmmic hundred d.tl.($IW) Or Wat) I Certify that in me perforrarce of the work for which this Permit is isound.I chair not employ any person in my mother so,as or become subject to On Worlers'Compensation Laws of California,Date Applicant NOTICE TO APPLICANT.If.after making this Ccrificam of Exemption.you should become subject so the Worker's Compensation Provisions of on,Labour Coun.you most 0z forthwith comply wife such porivisions,Or this Permit shall lic denoted oc�nkcd. z C CONSTRUCTION LENDING AGENCY I hereby airtnot that them is a construction lending agency for the performance of the work for which this Permit is Wood(Sce.3M,Cv,C.) Undoes Name Lender'sAddroust z U C) I corlify that I hove ad this application oil show in.,On mu�information is L� come,.I alptic to comply with 01 city and county ordinances and seem laws relaung to 0 Wilding constriction.and hereby summon opresentati,nes of this city to cnanr upon the b.,n-monnioned propeny for in,cedon purposes. (We)agree W sa..bull and keep haroulcer the City of Cconninit a I.' get i,, liabilities,judgments.costs and expenses which may in my way see=against=it City U Z in consequence of the granfing o(this Permit. A 'CA UEP�ERSTANDS AND WILL COMPLY WITTI ALL NOWPOINT Issued by: PPLnR G ;DNS. Dat OUR A I Re-roofs (�7 SiteratibriffA,plitantrCconerictm% �)"`Dnac HAZARDOUS MATERIALS DISCLOSURE Type of Roof Allmilks will or future building occupartslon,or handle hamodon;material Round by -I--Municipal Code.Chapter 9.12.andi On,Health and Safety cienimic"'F C n Y. AIT. All roofs shall be inspected prior to any roofing material being installed. 'Y Will the applicant or future building Occupant use,equipment or&vi=which If a roof is installed without first obtaining an inspection,I agree to remove ' 0 mjE hazardous air contaminants as difined by me Bay Area Air Quality Management all new materials for inspection. "a L District? Let C3 CY. I ban noted the require==under Chipter6,95 often Carron- 0, _ re not fic.111,&SalllyCedc,Scetion,25M5.25533 and 25534.Itoolcomand thatifft Wilding wo is r it. 4 Oat it is my nexperoothly no nodry On ex,upor,of On no,- fly h a hoom on mar me Oro, ey I. me in torecirmwouisman"Ofaccrofficase Signature of Applicant Date ermi.tWo'c age.. 70 net or authod7zd agent All roof coverings to be Class "B"or better