03030077 CITY OF CUPERTINOz
BUILDING DIVISION PERMIT , ' ' 1 t
BUILDING ADDRESS: CUSTOM KITCHENS & BATHS PERMIT NO.
OWNER'S NAME: 581 CALPELLA DR FEWITLSS A
OF AN CHARLES 7 AND MARINA (408) 829-0078 SANITARYN .3/14 2OL NO.
ARCHITEC IBNOINEEW BUILDING PERMRINFO i
BLDG BISCT PLUME MECH
t�
D LICENSED CONTRACTOR'S DECLARATION
E ly I bmcby&firm the I we licensed under provisions of Chapter 9(comme,ming Job Description
wlm Satin 7000)x1 Give,3 clean BudPm(cWmu Code a/mylipenmb
i Liceem 1x.11✓` ' 7/'/ RE '
�!A
Dam Nn r �$ /COUNTERTOPS/APPLIANCES/SINK
1 ARCNffECT3 DEC RATION
I g� Memand my Dt,m Meal be uan u puM1lic rncorda y� Llcuued Professional 2 1al 2003
OWNER-BUILDER DECLARATION
p o following maws.(Section affirm a703.5 Bt I se u rcu and Profession,Coca:Mytht frome the Commerce,UMW s m OW fcouor n y BBmRdrrw��w�.�,�
S which requires a permit n contents,alta.knphve,demo)aa h, mpe1r any enwum BUILDING
aSn prior an W lsmanm,also mquires the applicant forsoch permit to rile a signed state
@ayyC< that he Isllrenmd prrmamto the provision ofmo Commutes hese law(Cheptu9 Sq.Ft.Floor Area $10181 ion
C 3.$ (eammencing with Section 7000)°(Division 3 oftlm Business and Profaflons Code)or
33
that he IS Cochin meretmm and do but,fee the alleged exemption.Any vi°latin of
SSoginn703�3
1nw any
epi dollars(g3d0it abjau the applicant an Ma civil penalty or 3 4191B�r 0 0 Occupancy Type
0 Luownerorftpopmty.amyemployeswuhwageutbehwanmape im,
will do the work and the structure Ismtlntended gartered Asses(Sm.70/1,Budrcu101 7�f7�
and Pretender,Cede:The CommitteesLxnm law dm not apply an in,war or — FOUND Jjd IDSpCCIIODS
properly who build,or impotent mermn.and who does such wort himseltor through his 102 - PIERS
own employees,provided that inch Improvements son not intended or offered for sale.If. 103 — UFER
her ew,the building or Improvement t,old within one you or completion,the owner.
builder wild have Use burden of proving the he did ant bWW or Improve roe purpose of 104 — REBAR
sola).
0 I,as own of the property.m exclusively contracting with Ecmdacd comactm,an 105 - ANCHOR BOLTS
comtmct the project(See.7041,Business and Protudmu Code:)The Contractors LL 106 - SEWER & WATER
came law dm,act apply an an owns of property who build,or improve,unman,and, 202 — UNDERFLOOR PLUMBING
who comsee foe such projects Mm a eontnemr(q licensed puaaman the ConuaaarL
ddmlaw. 203 - UNDERFLOOR MECHANICAL
lamaaemptunderSm .B&PCfartial,rtuon
204 - UNDERFLOOR FRAME
Owner —WGRKERSCOMPENSATIONDEC RATIN 205 - UNDERFLOOR INSULATION
Ibereby aGim orderpensigotpujury. fotanwing decWulonm 301 — ROUGH PLUMBING
.wand will mdmena ceencam orcansem w oirdaem fgwohefscompm- 302 — TUB & OR SHOWER
aides,a provided for by Satiun 3700 of the Labor Code,for W pedmm
manof me 303 - ROUGH MECHAN I CAL-
work for which this permit is Wad.
01 how and will maintain Workces Compenetion lmusoca,as required by Section 304 - ROUGH ELECTRICAL
3700 oftin Labor Cade.for do perfmmanm or me want for which this permit Is loved. 305 — FRAME
MyWertees Compensation immune carrier and Policy number me' 306 — HOLDOWNS
prrirr. Policy No.:
CERTIFICATE OFEXEMPr10NFROM WORKERT 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
mICIA)(Omsection road set bewmpfemtl aim permit Is for one hundred dollars($100) 309 — EXTERIOR LATH
Igutty Nati (omarce of tin voA ror which this permit is in"IdWl not 310 — INTERIOR LATHemploy 2" ymauner umlrf ewbj eanunwod: pewuon 311 — SCRATCH COAT
Laws of Cali Ca .
313 - ROOF NAIL
eTo UCANnIf,after makdng flearCenfildine or Exemption.you should 501 - FINAL ELECTRICAL ENERGY
me
subject an the Worker#Compensation provision,of the Labor Cade,you most
.JO foMwithcomply with such pmvWmBm
northpeWhallbedeemedrawked. 502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
.. Thereby anlmthe room baeonsuucdonlending agency for the performance of 504 - FINAL BUILDING ENERGY
0 �weak r,regkhWspamut,arvn(sea3wLCh.c) 505 — FINAL ELECTRICAL
Lembes Address U Z 506 - GAS TEST
"Q I caNry,mal l Mw mad this application and sun msl me above InfomWn t,
r'� camslµrtemwmand With all city and=only°Ntiegeawd tun lawsrelatingupon n 507 - FINAL PLUMBING
p[V^ building mtl hereby othorize
pUrp representatives of m4 ehymennr upon me FI19C
CAL
fJJ ahmo-(We)*m to roperty
feeoeemnify an kwp sL
a (We)agora n sow.indemnify and tap humlea Un City of Cupertino agdmt 0 9 F I a 43
y IIMIIWe;judg eawandupoamwM1mhmay 1.myway amusagalmtWdCity 5 NG
V 7 inwmegte gnndng°ftNa pemiL
F7 APPLIC ERSTANOS ANO WILL COMPLY WITH AI.L NON-POINT Issued by:5 WORKS Date
SWR R CATIONS. ^
f/3 Re-roofs
S mal pplleantrCohsctor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
VAR the aCupertno Inn Wal Coaaupanteroseor and thdle h Health mSmsid -
u defined by earl Cupertino MUNctp,i Code,Chapter 9.11.antl the Health and Safety
Cade,Semon 25332(.)7 AN. All roofs shall be inspected prior to any roofing material being installed.
ts .
VAR dm applicant or furor°building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hap7aNna dr contaminants u dcflmd by the Bay Am Air Quality Management all new materials for inspection.
Diwlm7
p Yes Vfu
I hive mad do harem om mum4h mqui mm°nu mder Oupmr 6.93 of do CCIi fon
ni.HolthBSafuyCode,Somom253W,25333u425334.1.WivuW 1fdn wiWng
does amccm ,wenn thanitt,mym 11,1lb f tinoccupantofdu
req n few ant"°sum ofa CeNfrcamoSignature of Applicant Date
iv�3
Don
All roof coverings to be Class"B"or better
Owner nvoda ant
OTNC•Y OF CUPERTINO PERMIT APPLICATION FORM 3 J7
• CUPEVINO
APN# G Date:
Building Address:
G D
Owner's Name: Phone#:
kWhAl 1? 2 9-Cb7
eff
ontractor: License#:
Contact: Cupertino Business License#:
[s
Building Permit Info:
Bldg Elect V] Plumb Mech
Job escription: .FX/S774J& 4C,461POrS COvtiTE!/ A /
Residential R Commercial ❑
Sq.Ft. Floo $/Sq.Ft.:
Costroject: Occupancy Gro
Tof Con ction:
i
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/OfFComm/ 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
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit:Fee BUILDING
7 ?
1 of3
CITY OF CUPERTINO
CUPE(,TINO PERMIT APPLICATION FORM
uanti Fee ID Fee Descri tion
BMITIGATRFee Grou
Res. Housin Mit Fee BUILDING
BMNEWMULTI New Multi-Famil Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bld s MECHANICAL
BNEWMULTI Multifamil Res ELECTRICAL
13NUCOM M New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCONM2 New Comm Plumb PLUMBING
BMJMULTI New Multifamil Res PLUMBING
BNUSFD New Sin le Famil Res BUILDING
BOVERTWE Inspection Overtime BUILDING
BPBACKFLOW —Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bid Permit Fees BUILDING
BPFIXTURE Phi Fixture PLUMBING
BP GAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interc for PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
13PLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re !pe Of Fixtures PLUMBING
BPSEWAGE Sewa a Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
WENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pi e PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Rein ection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAMHAN A/C Units<= 10,000 cfm MECHANICAL
BREMBUSMBUSBREMAP A fiance Install MECHANICAL
WAY Remodel Buswa ELECTRICAL
BREMFIXT Li 1LU1 Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFCTRNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc A aratus ELECTRICAL
BREMNRAPP Rem Non-xes:Appliance ELECTRICAL
BREMPOLE Pole/PlatfOrm Fixture ELECTRICAL
2of3
i
CITY OF CUPERTINO
Cl"OF
CUPEf�TT INO PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch& Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT R air/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
EEO 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 I ;
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 of3
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FCIfTY OF CUPERTINO t 'r�'•< . .aI" o
Ed
DIVISION PERMIT WONT,�CIR�TNF'UR'M'A"�I'O.
1NOADDRESS: CUSTOM KITCHENS & BATHS PERMIT NO.
R'S NAME: 581 CALPELLA DR PERMIT&10AV
a. (408) 829-0078 SANITARYN O OL NO.
ARCHITECT/ENOMEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p
LICENSEDCONIRACnderp DECLARATION - IOb DeSCTi nOn
rd 8 1 ion 7 aro.that I am licensed under provWon of Chapter 9(commencing P
with S.Ilon 7IXll)or Dlvlslon3ofthe Bonin OPmrcssinm Code and myllpemch
In full forte If ea
Leeoso Lre.r REPLACE CABINETS/COUNTERTOPS/APPLIANCES/SINK
FFF Dam Con r
pQ As;"IbuCrS OEC RATION
SSSS p��'a++ty7 uMerwnd my plw.Mll Est urA As public nmNa
k wD Licensed Professional �2
y OWNER-BUILDERemeordDECLARATem �/
1 hereby ani.that I em exempt from she fessions Co Licence law for 1M
p O following regmason(Sectors 7 ort Business and Profession Code:Any Eby st county .
$ which mquIssuance.permit re cnuawc4 ppth,impmw,de ermit,ri e sig any nr.turo
pnonnIts slicenedursurequlmnheapplicant forsofthe such Contraroei Live=
signed
thnhebeingwiit pSccIImtothopmvivhkm3 Ne Conlrsuessand stria.(Chepmr9 Sq.F[.Floor Area $1�J.✓al� lOn,
$ than a Is exe exempt
um,fro 7000)n e Butson 3 the al emincasand pmfn y VI Code)der
Net he b uempt shemfrom and the bub for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant In a civil penally of 3 h Hud VorD zr 0 0 Occupancy Type
not mom Nan Bw hundred dollars(5500). O+J+a�i� 1C'
C 1,As owner of the propeny,Or my employees with wage,As their sure m
eompeatlon,
will do the wmkAnd meawnurtts.twmndeEmoffered fmWeCIZ7044,Business 101 - FOUNDI}W-j6Wd Inspections
and PmbYlnN Code:TM Comealm s Limine Law 600 not apply w an mvner of
property who builds otimprumthemananawhoaoeaauchwmthimuHorwtaughhis 102 — PIERS
oweemployoes.provided thatateh ireprowt.nts art nm intended mraQered fmssie.u' 103 — UFER
horewr,dust wildingm improvement Is mid within oro you ofcmnpleton.the nwner-
builder wB have we burden of removing that he did out bold m improve fee purpose of 104 — REBAR
sale')' 105 — ANCHOR BOLTS
❑I,As owner of the proper%am neclusively comnartng wish Ilcmtsed contncmn m
construct the re jen(Sec.70a4.Business and Protrusions Code:)The Con Tec m's u- 106 - SEWER & WATER
come law doe,not pply to an owner,of property who builds or impom dmmon,and, ZOZ — UNDERFLOOR PLUMBING
who contracts for such projects with aconvamor(s)licensed pursuant w dm Contractors
LLLAO.Law. - 203 - UNDERFLOOR MECHANICAL
I am exempt under Sec. ,B g:P C fm this mason
204 - UNDERFLOOR FRAME
WORKERS COMPENSATION DEC7ARAnoN
. 205 — UNDERFLOOR INSULATION-
IherebyafnunderpetWlyofperjurym e , folbwing deeluatlom: 301 — ROUGH. PLUMBING
have and will maintain a CeNfieam of Couenl eo self-Imus fm WoheM1Compen- 302 — TUB & OR SHOWER
andnn,as provided for by Section 37M of the labor Code.for Be performance of the - 303 - ROUGH MECHANICAL
work for which this permit Is Wood.
❑1 hew and will mainWn Wmkch Compensation,Insurance.u required by Sean 304 ROUGH ELECTRICAL -
3700mfmclabmCade,for dm performance of the work fm which this permuisRAW . 305 — FRAME
My Workers Compensation Imurance omiu and Policy number art: 306 HOLDOWNS
Caller. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(Thmuctionmed not becompleted mhepermt is form.hundred dollars($1010) 309 — EXTERIOR LATH
orless.)
1 ctnify sun I rw.anec of the wort for which thin permit Is Issued.I shall nm 310 INTERIOR LATH
!.maws of cera a manneraJyaswbFrp7pm avjlj�l to the worku[C penation 311 — SCRATCH COAT
9ppygan, a V 313 - ROOF NAIL
=Object
P LICANT:If.afermaking Irccn m
t ofExemption.you sh.Id 501 - FINAL ELECTRICAL ENERGY
me subject to the Worker',Compensation provision of she labor Code.you a=
�z forthwith comply with such pmvbine,or this FAMILmall ton doemmrevoked. 502 — FINAL PLUMBING ENERGY
rO CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
;4:M 1hamhy.M.rend¢mlucontuuctanlendinggemTfor the performanceof 504 - FINAL BUILDING ENERGY
C: live wor
k for which this permit b Issued(Sec.309'1.Civ,C.)
wQ Lan
aersNune 505 - FINAL ELECTRICAL
Centers Adam,+
Uz 506 - GAS TEST
O Q I certify sun 1 how mad this application end rots that the show information
ng b
^+ railingIagreectcomplywithallcityarmcepou resnNinancesane,umbwrupontw 507 - FINAL PLUMBING
SV" buildingronswcllon.aneherebyaumori2mpmsenutimofsuisdlymenmruponthe FIN MEI CAL
gi7 shove-(We)are to save(In In Indemnify
an keep h,.
Iy.�h (we)rime Int taw,inecmmry and keep ha.lnu me coy or Cupertino ae•Int � 0 9 F'1
it,n IIabIIllle,,jud6 .costsmdsapenseswhich may InAny way acc=againslaidCity 5 NG
t.
U 7 1.o' o DERSTIANDSIAINU WILL COMPLY WITH ALL NON-POINT Issued by:5 C WORKS Dale
G SOUR R LATIONS.
3 �3 Re-roofs
S rtof ppllcnavcn ase. Dam
ZA
HARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store orhandle huudom matutsl
u denned by de,Cupertino,Municipal Code.Chapter 9.13,and the,Health and Safety
e,s.umn 25532(a)7
MN.
All roofs shall be inspected prior to any roofing material being installed.
Suction
Will em applicant or future Wilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It ha'umous air contaminants as defined by the Bq Are,Air Quality Management all new materials for inspection.
istricl7
❑Yea A4u
I hew mad the hazardous materials requirements under Chapter 6.95 ofthe Califor. '
nia Health&Safety Code,Sections 25505,25533 mil 25534.I undcatatn mu if the talking
does not cu. sew a sun that 111,my maponlMllly f the Occupant of she
req n u pdan
orwlssuccofaCerlt"' ' an i Signature of Applicant Date
owner o moved agent 41 Dom All roof coverings to be Class"B"or better