03050069 CITY OF CUPERTINO "' '� ' '�'' -"°t'' ' `
BUILDING DIVISION PERMIT �DT$OR`I�NF..O�RMATI(.
BUILDING ADDRESS: MARK PEYSAKHOVICH PERMIT"°.03050069
'INA/1 OWNER'S NAME: PERMR'IN5/2 O O 3
RK PEYSAKHOVICH U7 1
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uo0 LICENSED CONTRACTOR'S DECLARATION lob Description
—y�u C I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p
U with Section10M)of Division 3 of,he Business and Professions Code,and my license is
'endmmumaeanderrea. REVISION—IN HOUSE USE ONLY
S l2= License ClassLic.g
—1 Dat Comrater NO NEW PERMIT ISSUED ORIG. 403040070
IT
ARCHECTS DECLARATION - r
�a< I undersand my plans shall he used as public rmnrds
�aU
;o t, Licensed Professional` 3 OWNER BUILDER DECLARATIONenc
1 hereby
.(Ones that
11. exempt from Jr Cessions o License Law for my
X p o following recon.(Section IIDI.S,Business and improve.
to Professions Code:Any city s mean
Km which reyuir=ac,also to necnnnruepplic improve,h Perlia firepairnayswcua
HIa thatpoorhe itscensed c,.arcquircs theapplicantfor sucCmars our', (censele a Lis,ned
that he is licensed puruenuothc pmvisinns of the Comrcmr's License law(Chapmr9 Sq.F[. Floor Area Valuation
Z (commencing with Section 70(30)of Division 3 of the Business and Professions Code)or
y Thal he is exempt therefrom and the basis for the alleged exemption.Any violation of 0
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of APN Number Occupancy Type
not more than five hundred dollar(5500).
Ol,as owner of the Property..,my amplay.with wages as their sole tap
mensalion. 32658074 ' OO
will do the wart,and the structure is not intended or offered for We(Sec.7044,Business 94�7�
and Professions Code:The COnlratOY.License Law it =not apply to an Owner of 101 — FOUNDAReal d Inspections
pm,any who builds or improv=thereon,and who does such work himself or Ihmugh his
own employees,provided but such improvements are not inwndcd or offered for sale.If, 102 — PIERS
however,the bulking or improvement is sold within one year of mmpkidim.the owned
builder will have the burden of proving Our he did not build or improve for purpose Of 103 — UFE R
sale.)' 104 — REBAR
❑ I.as owner of the ympeny,am=elusively contracting with licensed contractors m 105 — ANCHOR BOLTS
construct the project(Sec.704.Business and Pmfesdom Code:)The Cownwrar's Li-
cameLawdoesnaupplytoanOwnerofproerywhoWildsorlmpmv=Ncmon,and 106 — SEWER & WATER
LicCnul .for ouch projects with acohtrumrtallianseeparsuamrothe Convnfa
. o ' 202 — UNDERFLOOR PLUMBING
❑lam=crept under gee ,B&PCfor Nis reason 203 — UNDERFLOOR MECHANICAL
Owner Daw 204 — UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
Ihereby arrmtunder Penalty ofpOrur,One,ofdue following declarations: 205 — UNDERFLOOR INSULATION
I hive and will maintain.CcnlBeareOf Coosem mselr--insure Tor worker's Compcn- 301 — ROUGH PLUMBING
..tion.as provided for by Section 3700 of the Labor Cade,ror the pedormanm of the 302 — TUB & OR SHOWER
work for which this permit ishoused. 303 — ROUGH MECHANICAL
I have and will maintain Worker's Compen=don Toon e,as mquiad by Section 3 O4 — ROUGH ELECTRICAL
37W of the labor Code,for the cormmance of the work for which this permit is issued.
My Wormer Compensation Insurance comer and Policy number am: 305 — FRAME
carder: Policy No.: 306 — HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 — INSULATION
(This section teed not be completed ifthe permit is for one hundred dollars(SIM) 308 — SHEETROCK
or less.) 309 — EXTERIOR LATH
1 ceniry that in the perfnntrance of the work for which this permit u issued.l shall nut 310 — INTERIOR LATH
employ any person in any manner m u m become subject m the Wmker'Comns
peatin
o
Laws Of California Dam 311 — SCRATCH COAT
Applicant
NOTICE TO APPLICANT:IL after making this Ccnificam of Exemption,you should 313 — ROOF NAIL
become subject to the Worker's Compensation provisions or the Labor Code.you most
�Z fonhwnx
idicomplywithsuchprovisionsOrthisPermitshadeemedmynked. 501 — FINAL ELECTRICAL ENERGY
Z res CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
-F.`. I hereby affirm tat them is a construction lending agency rar the perforprewc,of 503 — FINAL MECHANICAL ENERGY
W > thew;rkfor which this permit isissued(See.3097,Civ.C.) 504 — FINAL BUILDING ENERGY
(D o L emor's Namc
CL Lenders Address 505 — FINAL ELECTRICAL
U O 1 canary Nat 1 have mad this application and sum that the above information u 506 — GAS TEST
(y F' coned 1 agree to comply with all city and county okinances and state laws relating to
Wilding construction,and hereby audemi're repoesenutives Of this city mchwrupnn the FINAL PLUMBI G
U above mentioned property for inspection purposes.
a. (We)agree to save,indemnify and keep harmleas the City or Cupertino against O 8 FIN L
.F. h liabilities,judgments,costs and ex,enaes which may in any way acerin against said City 5 1
U z of too granting of this
APPLICANTnsequenccUNDERSTANDS AND TWILL COMPLY WITH ALL NON-POINT Issued by51 A NG Date
SOURCE REGULATIONS. _
Re-roofs
HAZARDOUS
Signuum of Appli= Dam
HAZARDOUS MATE RIALS DISCLOSURE Type of Roof
Will the a Cu,panrnr(Muni building leecupanl stow of handle Health a material
Is donned by Ne Cupenino Municipal Code,Chapwr 9.12,and the Health and Safety
Code.Section 25532(a)7 All roofs shall be inspected nor to any roofingmaterial beim installed.❑Ye ❑Na
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.nit hazardous air contaminants as defined by Ne Bay Arca Air Quality Management all new materials for inspection.
D'nrict7
C]Yes [D No
1 have mail the hazardous materials mquirements under Chapter 6.95 of the Califory
ria Health&Safety Code,Sections 25505.25533 it 25534.1 umkrsand dw if Ire Wilding
it=not currently have a wham,that it B my responsibility Or huffy the occupant or the
requimmcha which must be met prior to issuance Or a COdfi=w Of Occupancy. Signature of Applicant Date
Owner ter ardimized agent Date All roof coverings to be Class"B"or better
Alz
—
_„� zi
RECEIVED
MAY 1 b 2003
' g �
T y ;a-IPPRf VED
ER T;;;. ;ill`.'M' G .�l"aA1Ca3
1 � .F.iiEci�
T;'S l:;et of f/ISL„ atld specliicatlal7s I�,i�JS.�I
k ct rn lite jub at af!times and itis wz
��' utul to ma!:e any chsmges or, alterations
mz i^;i f gut v;rii±en pormissicn: f[on3
hui:ding L'ept., City cf Cape,tina.
P s!a,,a,ng of this plan and spcdficationg
wif be he;d tip iLcmllt or. to be, a2
a' p •reset of t;c eiofalouf any provW00"I
Oft'Vtl 00tate Tari.
a
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1 2003
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• .Remodeling the loft in 20676 Celeste Cir.
The next new components for privacy and noise reduction will be installed
-The new Folding door 36"by 80" will be installed.
-The partition sliding Low-E glass with the grid window 72" by 48" surrounded
by the partition drywall will be installed on the 2"by 4" wood frame from the
floor to the top of the loft opening.
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1
atom C%Y OF CUPERTINO
CUPEYTITY OF PERMIT APPLICATION FORM d3 5 v �6l
bA
N # � �m � Date:
l7
Building Address: 0676 Ce toe ' -0 C c/SC�
Owner's Name: Phone #:,, 3rd- 0
Contractor: License #:
Contact: Cupertino Business License#:
Zd
dng P rmit Info:
Elect ❑ Plumb ❑ Mech ❑
b Des ption: Q
Re ntial EJV J T 1' " k `�Com l __
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction:
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
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 <= IOOOA ELECTRICAL
BELEC1001 Elec 600V > IOOOA 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
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cr *rY OF CUPERTINO i
L...
°n OF PERMIT APPLICATION FORM
CUPERTINO
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
J 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 c&n MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation ofFumace 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
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un - 'S CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkjT NO
Quantity Fee 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 Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Sips,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 Inspection 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
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