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CITY OF'CUPERTINO
BUILDING DIVISION PERMIT
'CONTRACTOR INFORMATION`
BUILDING ADDRESS:
MIKE CHARON
PERMITNO05080215
19315 CALLE DE BARCELONA
OWNER'S NAME:
PERMR ISSUE DATE
MIKE CHARON
19315 CALLE DE BARCELONA
08/23/2005
E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
L ELECT PLUMB MECH
0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm Nal I am Iimnsed under provisions of Chapmf 9 (commencing
with Sttuon 7000) of Division 3 of the Business and Professions Cock. and my license is
infull force and efr«a
REPLACE STUCCO W/SIDING @ E. & S.
License Class contr
Damactor
REPLACE 2 DOORS, 2 WINDOWS
ARCHITECTS DECLARATION
1 understand my plans shall he used a public records
Licensed Prokanional
OWNER-BUILDERDECLARATION _
I hereby affirm that I am exempt from tie Conuacmrs License Law for the
fallowing mason. (Section 7031.5, Business and Professions Code: Any city or county
which mquines a permit m convect, army, improve, JemnliO, in repair any structure
prior to is, issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pufua^t to she provisions of be Contractors Licase Law (Chapter 9
Sq. Ft. Floor Area
Valuat 6 5 0 0
(commencing with Section ]000) of Division 3 of the Business and Professions Core) or
that he Is exempt themfmm and the basis for Be alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a Permit subjects the applicant o a civil Penalty of
not mom man rim hundred doll.. (S500).
37504005.00
(n� pp pp�� fI Ido
t(� I, u owner of the property. of my employers with wages a meir sole carpi oration.
ezw
It .t%'\ II in\ A fl a \A
. t' v�,t/.
Required InspectiOns.4i
'willdamcworkandtheswnumumtimmndedmoRerodfors (Scc.7M.BusiM..
and Professions cmc The Conuamra License Law dere net apply W in owner of
property who builds orimpmvra daemon, andwhodoessuch work himself or thmugh his
own employ=. provided mat such impromme^s ax nor intended or offered formic. If.
however. the building or impmvcment is sold within one year ofcompletiun, the owner-
rq
builder will have Be burden of proving that he did not build or improve for purpose of
y (c
eek.).
it
theexclusively confessions with licensed mnuacm. i.
❑ h a owner of dais
0 1, as
r,� p p
I t,.[! If 't t1 B
(Sec. ]Oars, Basica. and Professions Core:) The Cexamse
ms prof Sec. Tproperty,4 , B Li.
®fj
\\\UV�j
Ilj�1J\ tu' (Ij�
cons, Law docs not apply to an owner of pmpcny who builds or improves daemon, and
IYI]
who commas for such projects with a mnsecmr(s) licensed pursuant to the Contractors
License Law.
❑ I am cxcmpl u, B At P C for moa..on
Owner If /y, Done
WORKER'S COMPENSATION DECLARATION
10 1 hereby in. order penalty of perjury one clubs following declmatioa:
1 have and will maintain a Certificate of Consent to self-insum forWorker's Compmo
sation. u provided for by Section 3700 of On Latin, Cmc, far the performance of he
work for which this permit is issued.
rl I have and will maintain Workcri Compensation Imuranm, as required by Section
37M of me Labor Code, for the performance of the work for which his permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This xenon need not tic Completed if the permit is formic hundred Collars (Slip)
of Icm,) I
1 certify mat in he performance of he work for which this permit is ismed, I shall no,
employ any person in any manner an u m become subject to Be Workcri Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If. after making his Certificate of Exemption, you should
become subject to one Worker's Compensation provisions of. the Labor Code, you most
fmhwi lis comply with each provisions or this Permit shall be deemed revoked.
ONmtom ING
1 CONSTRUCTION
1 hereby a iso lending agcnry for he performantt of
Ws hem iso co leading
1
h olhi (Sec. 30
work fur which hu pcnmit 0 i and (Sec. 3097, Civ. C.)
Lenders
La
LenderAdds Address
1 certify that I basic read this application and sum that the above infortnaim u
'
cormeL 1 agree to comply with all city and county ordinances and sum laws missing to
budding conmvction. and hereby andaon7a mpresenri of this city to enmr upon this
.hove maroon pra,eny for onommuon purposes.
(We) Igrte to mvc, indemnify end keep humle.. the City of Cupertino against
j liabilides,judgments. costa and expenses which may in any way a ease against midCity
in consequence of the granting of his permit.
' APPLIRST SAN WILL COMPLY WITH ALL NON -POINT
Issued by: Date
()
S URCE R UI( ONS.
Re -roofs
Type of Roof
�
/`D�&C
Signuum of Applicam/Conuactor
HAZARDOUS MATERIALS DISCLOSURE
Will he applicant or future building occupant store or handle hazardous material
m defined by he Cupertino Municipal Code, Charter 9.12 and the Health and Safety
Cork. Section 25532(.)?
All roofs shall be inspected to an roofing material bei.
Y being installed.
r-1 yes ❑Na
prior
P P g
If a roof is installed without first obtaining an inspection, I agree to remove
Will the a locant or future building ecce am use equipment
cap 6 P a imam tat devices which
our ha>ardmm air contaminants u Jcfincd by the say Arca Air Quality Management
all new materials for inspection.
Disuia?
❑Yes ❑No
1 have mad he hamedous materials requirements under Chapmr6.95 of tae Califon
nia Healh & Sarciy Cade, Sections 25515. M533 and 25534.1 understand that lithe building
docs not currcmly h a tenant, thin it' my responsibility m nutity the mcup.( of Tisa
u
,quiremc who ftxpletpro i.uanmafaCetificaeofOccupancy.
Signature of Applicant Date
f�.
All roof coverings to be Class "B" or better
Owrier or auhorimd agent Date
0
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CITY OP CUPERTINO �'
PER
"�" bra �L 1 ° `� �ro_ s '
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Ru1Lo1nG nrvlslory
.& ,a,, 1-1-,, .w,< . .N -
BUILDING ADDRESS:
MIKE CHARON
PERMIT Noo 5080215
19315 CAE DE
—
OWNERS
OW NER'S NAME:
PERMIT ISSUE DATE
CHARON
19315 CALLE DE BARCELONA
08/23/2005
PHONE:
SANITARY NO. CONTROL NO.
HItLCT/ENGINEER:
BUILDING PERMIT INFO
L ELECT PLUMB MECH
G 0 t�
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm the I am Iiccacd umh:r provisions of Chapter 9 (commencing
with Scaion 7M)) of Division 3 of the Business and Pmfcssio o Coact and my license is
mmuforce and effect .
REPLACE STUCCO W/SIDING Q E. (& S.
Date Class contuacmr
REPLACE 2 DOORS, 2 WINDOWS
ARCHITECTS DECLARATION
1 understand my plans shall he used as public records
Licensed Plofelfamal
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following mann. (Section ](131.5. Business and Professions Core: Any city or county
which requires a permit to construct, Minn. improve, demolish, or repair any orunme
! prior to its issuance. also acquires the applicant for such permit to File aligned statement
Law 9
Sq. Ft. Floor Area
Valuatreii500
that he is licensed pursuant to Ne provision of nine Contractor's License (Chapter
(cmnmencing with Section ]fIDB) of Division 3 of me Business and Pr"femians Code) or
that he is exempt therefrom and Ice basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars 5:500).
3 7504005. 0 0
t� 1,aownerof Ne property, or my employees with wages az their sole comycnsation,
Required Insections's
9 P
will do Ne work, and the swcwu is not intended or offered for sale (Sec.]6W, Business
and Professions Code: The ContractorLicense taw docs not apply to an owner of
progeny who builds or improves Herron. and who does such work himself at through his
own employees. for sole.Ir,
not ear
uipmvidcd prsuchimprovementsase of completion.
builder Ne building orimprovementf,m,missoldwithinutteyear of completion,Pa
.
o.of
builder will have Ne burden of proving thea he did nnl build or improve for purpose of
sale.).
❑ J. rwner of property, exclusively contracting with licensed contractors i.
stns
construct the project (Sec. ]u44, Business and Professions Cade:) The Convenor's Lid
ct 70d . B
c Law does fnot apply r man owner aorprepcny slicesedporimgrova thereon,and
who convects far such pmjacas with aeonvacmr(s) licensed pursuant to the Contracmrs
/
License Law.
B & P C for this rcazon
G
o
❑ ! am uemp, u/Iger
21A/^
Owner � A� Doe Ela,34s
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Cctificutc of Consent to self -insure for Worker's Camino-
-
az pmvidcd for by Section 37W of the Labor Code, for the perpr mmen of the
a for which this permit is issued.
1 have and will maintain Worker's Compensasitn Insurance, as required by Senior
3700 of the Labor Code, for We performance of Ne work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am
Came,: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This edict need not accomplcmd Bonn permh is Torch hundred dtllars (SIIXI)
of loss.) t
1 certify that in the pcouroi of the work for which this permit is issued, I shall nor
employ any person in any former so as to become subject o pre Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker Compensation provisions ofthe labor Code, you must
7 fonbwi Or comply with such polvoima, or this Permit shall br, deemed revoked.
n CONSTRUCTION LENDING AGENCY
tat at re is a construction30 lending agency for the perfortts nanof
I herebyththe
Ne work fur whichch this pemtit is issued (Soc. 309], Civ. C.)
Lenticrs
Lenders Add Aaares
j.1 certify that 1 have read this application and state that be above information is
^ cored 1 agree to comply with all city and county ordinances and Soon laws relating to
building couswaion, and hereby authoriae representatives or this city In enter upon the
ahmvemcntioncd property for inspection purposes.
1 (We) agree to save, indemnify and keep harmless the City of CUpcnino against
liabi licks, judgments, casts and cspcnscs which may in any way accmc against said City
Z in eonexquenec of the of this
granting permit.
^ APPLICANT U RSTf S AN WILL COMPLY WITH ALL NON -POINT
Issued by: Date V -'
�/n i
Re_roofs
Type Roof
Signature of Applicent/Comuanor Datt
HAZARDOUS MATERIALS DISCLOSURE
of
Will the applicant or future building occupant ame or handle hazardous material
as, defined by the Cuperti an Municipal Code, Chapter 9.12, and ,he Health and Safety
Cedc. Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
If a roof is installed without first obtaining an inspection, I agree to remove
Will thea lieantorfmvrebuildin tutee utOrdeviceswhicn
pg d by the
mit M1aarJnus aircomaminanuarcfncJ by the Bay Arca Air Quallsy Management
a Air
all new materials for inspection.
arias?
❑Yes 0 N
1 have read the hazardous materials c(loinemen0 under Chapter 6.95 of the Califon
nil Health S Safety Code, Send. 23M, 25533 and 25534.1 undemand that if the building
Jots not currently haat, a recon, that itis my responsibility m nastily Ibe Occupant of the
gU12mC QWlow ourltbe lune to i nurse er a Certificate of occupancy
Signature of Applicant Date
V l/
All roof coverings to be Class "B” or better
owner ur2tnorn<d agent D„e
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® CUPEIJTINO
0 0
Assessor's Parcel Number
Name of owner.c! 1 ry a 9 ( CV ISA rs A
Project address. 1l qg >/I�s Ca I III 'P �a �p w�e � Lute-Kl)
t'V`
Contact person. tb Phone. -�7,l08 31 S /0,
Fax. H1F aa? 7jan
Net square footage of lot.
Square footage: First floor:
Second floor:
Garage:
TOTAL:
L
Existing
r'0 '30
Are there at least two 10 foot by 20 foot clear spaces inside the garage?
AIs privacy protection planting required for the project? Y
On what floor(s) is work being done? —�i r 54.
Brief description of work. BAUivt4 QYiS�t�G<o iF
lJe2 n�
Proposed
'ea wtk
Code editions: 2001 CBC (Y - N)2001 CFC (Y - N)2001 CMC (Y- N)
2001 CPC (Y - r>)2001 NEC (Y - N)
Effective ll/1/02 Wdr� �j�, 5 4yv W 1� 1
iN�,4wtu�t
C-ok s4l vd"s.
Plan Review Process Work Book Page -8-Revised 4/28/04
CITY OF
CUPEkTINO
`CITY OF CUPERTIN#
PERMIT APPLICATION FORM
v_� v,�o z(('
Ir N#
;1P v c+�a�'-
Date:
o f
Building Address: Mailing Address (if different from building address):
BAPPLOTHER
Owner's Name:
!x, 4 %
Phone #:
�4`b *3/�/0
1,
Boiler <= 100,000 Btu
Contractor:
License #:
Izo (�u,vIvr6 u,
MECHANICAL
Contact:Phone: A&g 3(,; -in
/e19
Cupertino Buse s License#:
(Vii CvI- al .1 Fax: 22 - 7030
BBOILER4
Building Permit Info: .
Bldg Elect ❑ Plumb ❑ Mech ❑
Job Description: Qa,v;tvAl 0� Siyccor .4p npj�'W S d,�y eas� S>o elc�osu.t. Pkcinp
Residential 0� in)L z Commercial ❑
Sq.Ft. Floor Area:
Sq.Ft.:
Cost of Project:
Occupancy Group:
BCONSTAX
Ind/Off/Comm/Quasi
Type of Construction:
Please check this box if the project is a
r a Q)', r,or Wkl(S
second -story addition: ❑
ro'ect Size: Standard ❑ Large ❑ Ma'or ❑
Hotel and Motel
C.
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
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
�# 3,0w
1 of 3 7
CITY OF
CUPEkTINO
*CITY OF CUPERTINO
PERMIT APPLICATION FORM
Quantity Fee ID
Fee Description
Fee Group
BMISCELL
Miscellaneous Fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
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
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
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 cfm
MECHANICAL
BREMAIRHAN
A/C Units <= 10,000 cfm
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
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
E.
2 of 3
afflil.
CITY OF
CUPERTINO
IPITY OF CUPERTINO
PERMIT APPLICATION FORM
Quantity Fee ID
Fee Description
Fee Group
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
Swiftuning 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 Issue
PLUMBING
PPLBG
Plumbing Fee sq foot
PLUMBING
PLLONGRNGC
Planning LR Comme/ Multi-Fam
PLANNING
PLLONGRNGR
Planning Long Range Residential
PLANNING
ZADDCHG
Address Change
BUILDING
•
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