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02100018�0 ZU 0Z�: :WZa. LLO tua'n0 ad 6 zz a d U4. 0 U CITY OF CUPERTINO Oforthwith .�. Q7 z Q (, U W 2 r4 BUILDING DIVISION PERMIT �, ONTRACTOR INFORMATION: '.. eulLppgA813ESCOLBY AV MARTIN LLOYD H AND JULIE PERMrrN412100018 N�§RAPIN LLOYD H AND JULIE B APPLICATITT)"I'ZV 2 0 0 2 ONE: SANITARY NO, CONTROL NO, ARCHITELTMNGINEER: BUILDING PERMIT INFO SLOG ELECT PLUMB MPAII a LICENSED CONTRACTOR'S DECLARATION F I hereby affirm That I am licensed under provisions of Chapter 9 (commencing KITCHEN b Description REMODEIi. with Section]B(1(1)of DiviaionJof he Business and Pn+fessinns C.Jc, anJ my license is in full force and effect. FINALE® _ Limmo Cress Lic.M Dare C'SDECr ARCHITECT'S DECLARATION MAR 1 8 2003 I understand my plans shall be used as public records U D]tJ � Licensed Professional j OWNER -BUILDER DECLARATION i I ,(firm that 1 cusine from the Contractor's License Law the BU'1 cu O following reason. (Section ]Bistro Business and Professions Code: Any city at county naso I yl�J3J1/�6�1,1�Uy demolish, .r repair any structure which rcyuires a permit re construct, the almq improve. for a poor uitsissuancgalso d,I. the lhostaimaoffor such PermiuLNcse Lawd araremem (Chapter that netslicensed pSectio 9~2.8 0A16i0 Valuation (commencing with Section 7")ofDivisioofNCComsinesandProfssio J of The Business Professions Code) or $ that he is exempt therefrom and Ih bazar for Ne alleged exemption. Any violation of and de, pt Section 7031.5 by any applicator far a Permit subjects he applicant to a civil Penalty or NNPIERS Occupancy Type not mom then fn hundred dollars ($5fKd. 102 ❑ I, u owner of the property, or my employees with wages az Their sale compensation, will do the work, and the structure is not intended or offered for sale (Sec.]044, Business and Professions Code: The Conuanols License Law does not apply to an owner of 104 — - REBAR Required Inspections property who builds or improves Thereon, and who does such work himself or through his own employee. provided Instance improvements am not intended oroffeend forsale.If. 105 — ANCHOR BOLTS however, the building or improvement is old within one year of completion, the owner. 106 SEWER WATER builder will have du burden of proving Nat M did not build or Improve for purpose of - & .It.). 202 - UNDERFLOOR PLUMBING 01. as owner of he property, am exclusively contracting with licensed conmcmm m 203 - UNDERFLOOR MECHANICAL construct Ne project (Sec. 7044. Business and Prefeuions Code:) The Conum ar'a Li- meuLaw does not apply toanowner ofpropertywho buildaorimprownhereon.and. 204 - UNDERFLOOR FRAME who contracts for such projects with a commuctor(s) licensed pursuant to the Connector's License Law. 205 - UNDERFLOOR INSULATION lam exam under Sx. .B&PC ser a awn 301 - ROUGH PLUMBING ncr Date log 0a 302 - TUB & OR SHOWER WORK'S IP SATIONDECLARAuQp1� 303 - ROUGH MECHANICAL uaina enaltyof 304 - ROUGH ELECTRICAL andwill ai ofCoyoncaf If-in.o ., ,arCsCa: I have end will maintain a CeniOcam of Cnnunt toself-inaurt for WorkersCompen- safi.n, as provided for by Section 37W of the Labor code, far the performance or the 305 - FRAME work for which his permit is issued. 306 - HOLDOWNS ❑ I have end will mainmin Worker's Compensation Insuranm, az inquired by Seedino 307 - INSULATION 3]00 of the labor Cade, for Ne performance of he work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: 308 — SHEETROCK Carrier: Policy No.: 309 - EXTERIOR LATH CERTIFICATECOMPENSATIONINSURANCE EMPTION FROM ORKERS' 310 — INTERIOR LATH (This median need nut h completed if be permit is Enron hundred dollars a LFT) 311 - SCRATCH COAT .'less.) 313 - ROOF NAIL I comfy that in thc perform eof the work far which This permit is issued. i shall not employ any person to n*! To h o h' cI Inc Wn kers'Compeasmion 501 - FINAL ELECTRICAL ENERGY Laws o(Califoroia. Date 502 - FINAL PLUMBING ENERGY "paths NOT I APPLICANT. It. ser,jrtghu2enifcateofEempuon,youshould 503 - FINAL MECHANICAL ENERGY hcome su jeer to the worker's co eati.n provisions of the latair Code. you muse comply with such provisions or this Kraft shall h deemed revoked. 504 - FINAL BUILDING ENERGY 505 - FINAL ELECTRICAL CONSPRUCT10N LENDING AGENCY I hereby of orn that there is a construction lending agency for the Performance (if 506 - GAS TEST the work for which his Permit I.issued (Sec.309],Civ, C.) Lenders Name 507 508 - FINAL PLUMBING - FINAL MECHANICAL LcndersAddress I minify hat I have road his application end state the, the above information is 509 - FINAL GRADE coned I agree to comply with all city and county announce and state laws relating To building construction, add hcrehyauhrnmenmpresenutivnaofgas city menterap..rhe 5 FINAL PLANNING shove-menuoncdproperty 14 FIN�RKS (We) agree to use, indemnify and keep harmless The City of Cupertino against osts antepenson eswhichma inconempundeofhas costs and expenseswhichmay in any way attruc against acid City of This permit. Aconsequence APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT UNDERSTANDS Issued by: C.aC Date SOURCE REGULATIONS. V V Re -roofs Type of Roof f Srgnaru AFplinn onuacmr Duke HAZARDOUS MATERIALS DISCLOSURE ill the applicant or future building occupant store or handle hamud.us arsenal defined by the Cupertino MunicippI Code, Chapter 9.12, and the Health and Safety be, Secure 25512a)? ur / All roofs shall be inspected to any roofing being installed. Dy. prior material If a roof is installed without first obtaining an inspection, I agree to remove Will he applicant or future Wilding occupant use equipment or devices which craft haeardons air common az fined by the Bay Area Air Quality Management all new materials for inspection. Carrier? ❑Yes No Ihavereadthehaae c) smaunalsrequirementsunderCMpur6.95ofdieCalifor- niaHeath&Safety Code,ScedomBY)5,255J3and25534.lunderrand Naifhc Wilding docs ser currently haw a unapt, hat it is my responsibility To Why the northeast of he m yuiremenlswhichrrusTbeetp' joissutrcaofaCenifcamofOccu cy Signature of Applicant Date /6 a 0 All roof coverings to be Class "B" or better Owner r Thoriscdagent am i L 4 w U S J CITY OF CUPERTINO I -' - ' .. �-° a: _� � • BUILDING DIVISION PE( IT ,CONT"R TOIt,'W TION:', BuIL1)IgA8RJFsCOLBY AV MARTIN LLOYD H AND JULIEPERM"N(02U1B0NA0�0/18 DWMRAPIIN LLOYD H AND JULIE B APPLICAT11 vc/ 2002 NONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO • BLDOELECT PLUMB MECH 0 0 0 LICENSED CONIRACfOWS DECLARATION Ihereby affifm the, l am licensed underprovimmw of Chapter 9(commencing with Section 7")of Division 3 ofthe Business and Professionsd Code.mmy liana is KITCHEN REMODBIib Descripfl0$�� in full forte and effect License Class - Lie. a MAR 1 8 2003 Dam Contractor ctor ARCHITECTS OFDE10th 1 understand my plain shall W used u public rscoms ®® BUIL6./Ir License) Professional DECLARATION Oat 1 hereby .(firm Net 1 lam exILDERempt License Law for the exempt from the Camas tl 1. following mown.(Secdun 7 onalm Business and lore Coca: Any city or county Co $300 which requires permit re sure improve, de slur. nt fmw, o,ermitt at repair any n the statement primmits issuance,also requites the inion of for workpermitto Nessigned naumem Nath is licensed pursuant the provisions of the ComncmM1 License law (Chapter 9 3)1a.Er2.8%ob8AI@0 Valuation (commencing with Section 70010 of Qivision 3 of the Business and Profession, Code) or Nat he B essmpt from and Ne buss for the alleged exemption. Any violation of Section 7031.5 by any applicant for i permit subjects the applicant to a civil penalty of live dollen -N Occupancy Type nmom than m (($500).N 102 - PIERS ❑ 1,atawrcr or Ne pmpeny, or my employees with mgesat NeB sob wmper.ation, will do the work, and the structure u notine tiled moffe sad fors de (Sec. 7044, Suriname a� profession. Coda: The ConOa lad's Ucense law does nal apply m an Owner of 104 TifFER - REBAR Required Inspections propertywho Wlldsm es Improves thern, and whodoeswch work himselfor through his awnemployen.pmvidedthateucbimprmemeetsareretlnt woRem fwale.IL 105 - ANCHOR BOLTS however, the Wilding or improvement U sold within orc year of completion, the owner- Wilderwill have theWiden of proving dw N did Out Wild Or improve fm puryos of 106 - SEWER & WATER "le). 202 - UNDERFLOOR PLUMBING 01, u owner of the property am exclusively coreacting with licensed contractors to 203 - UNDERFLOOR MECHANICAL construct the project (Sec. 7044, Business and Predications Code:) The Communes Lt - ansa law does not apply In an Owner of pmperty who Wilda or improves Nemon,and, 204 - UNDERFLOOR FRAME License Law. for such projects with econmcmr(s)IlcensW punuantmNe Conuaemfe 205 - UNDERFLOOR INSULATION ❑jun s=ere under Sec. ,B RPCfor is son 301 - ROUGH PLUMBING own D.m l� 0� 302 - TUB & OR SHOWER WORK^'S fPiSAl10N DECLARAn�,prl 303 - ROUGH MECHANICAL I hereby alRrm under pendty of perjury ane of Ne Toll ng lantions: 304 - ROUGH ELECTRICAL 01how and will maintain a Cemficam of Consent or ssl6imum for Worker's Camper. ssdon, n provided for by Section 3700 of the Labor Code. for Ne performarm of the 305 - FRAME work for which this permit is issued. 306 — HOLDOWNS 0 1 have and will maintain Worleces Compensation laments, m required by Section 307 - INSULATION 3700 of the "WrCode, fee the performce anof Ne work for which We permit is lured. My Worker's Compensation Insurance carrier and Policy numberam: 308 - SHEETROCK carrier: Policy No,: 309 - EXTERIOR LATH CERTIFICATEWORKERS' COMPENSATION INSURANCE 310 — INTERIOR LATH (Ibis section nced not W complcmd if the permit is for one hundred dollars (51"0 311 - SCRATCH COAT cruse.) 313 - ROOF NAIL 1 certify that In the performs c of the work for which this permit is issued, I shall not employ any person In n smWo b'n 1W WO Kari Compensation 501 - FINAL ELECTRICAL ENERGY Laws o(Crthfomie. Dau 302 - FINAL PLUMBING ENERGY Apph ,(/� 503 — FINAL MECHANICAL ENERGY NOIR )0APPLICANf:If. tail? t g is-Cmiricauof ernptmayou should become m ject m Ne Worker . nsadon prevision, of lam, Cade. you mint forthwith comply with such Pmviaiom or this permit shall W deemed revoked. 504 - FINAL BUILDING ENERGY 505 - FINAL ELECTRICAL CONSTRUCTION LENDING AGENCY I Wtehy affirm Nat Bert i ... 0.0on tenoing.gtcy for tW performame of 506 - GAS TEST the ,it for which this permit is issued (Sec. 3097, Civ, C.) Lender's Name 507 508 - FINAL PLUMBING - FINAL MECHANICAL Lenders Address 1 certify that I hive reed this application and me that the aWve information is 509 - FINAL GRADE correct. I agree m comply with all city and county ordinances and stain laws relating to building construction, and hereby authorim represenulives of this city to crier upon the 5 FINAL PLANNING liabVe-mentioned(ant purpowhich es.may 14 FIN �,]j 7i,QRKS (We) agree m save. indemnify and kap harmless the City of Cupertino against udgmpmpmly expenses encs O nu, costa and expenses which may In my way aceroc qaW t aid City in consequence ofD granting of this permit A APPLICANT APPLICANT UNDERSTANDS A D WILL COMPLY WITH ALL NON -POINT Issued by: 11/. C.ae Date SOURCE REGULATIONS. Re -roofs Type of Roof 3 Stgnau Applean onoacmr DA. HAZARDOUS MATERIALS DISCLOSURE dl the applicant or future Wilding occupant atom m handle haaardom material u defined by Ne Cupertino Munici 1 Code, Chapter 9.17, ono the Hcdth and Safety Coda. Section 75537(x)7 Y" o 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 the applicant or future building accupam use equipment or devices which ,mit haramous air contaminants seideflood by the Bay Aree,Air Quality Management all new materials for inspection. District? OYee No I hew read the h=ramaus memrialsmquimmen. under Chaper6.95 of theCslifor- nia HCalthR Safety Code, Sccdom 75505,25533 wd25534.1 undersand thaifthe Wilding once not currently hew a monk NM it ismy msponsibility, m noddy the Occupant of Ne uiremenu which.,O IN etp' W Luuanm ofa Ccnificauofoccup ,yo Signature of Applicant Date 16 a All roof coverings to be Class "B" or better owner r thorimo agent m OWNER -BUILDER VERIFICAON 1. (Check one) I or my immediate family (parent, spouse or child) will perform: 95D14� • A. ✓ \O All the work authorized by this permit B. _ A portion of the work U C. None of the work D � r 0 2 2002 If B or C is checked, complete 2 or 3 below. BY_. 2. A state licensed contractor will be hired to do: A. _ All of the work B. _ A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to be performed • 3. �/ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. rev,..Phone Number.• of work to be performed I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). Property Owners Signature: Date: '97 Job Address: 14 ll 3 rOl iN'I � � dd(/T' Permit # %P / Anv changes to the information provided on this form shall be submitted to the Citv of Cupertino Build 0 Department. • City of Cupertino Building Departin CITY OF 10300 Torre Avem CUPERTINO Phone: (408)777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owne'r-builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself; you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permit's for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensative contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations understate law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. . Information about licensed contractors maybe obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, • City of Cupertino Printed on Recycled Paper an CITY OF CUPERTINA, CUPEf�TINO PERMIT APPLICATION FORM N#:. 3Date: Fee Description Building Address: Owner's Name: mar L , 7�✓ Phone Contractor: Ll�Idi,- L License#: Contact: Phone # pplican Contractor:1 Lin a V �1 d Fax #: 3 -9 v'� 9 uildip Permit Info: - Bldg Elect Plum Mech Job cription: Residential: mmerc Sq.Ft. Floor Area: /Sq.Ft.: Architect/Engineer: Valuation• Type of Construction: Occupancy Group: F 2 QuantityFee ID Fee Description Fee Group BAPPLOTHER Other Appliances 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 ELBCTRICAL 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 BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Famil Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME 1 New Comm Electric, ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3 3644 44 74� 288 18 _t 17364 8J7 —� 33 f 82} 18 58 36 t }� 36 12 1 9 95 127 23 i 130 — 724 391 18 53 35 —f- 94 3666 I 561 �16 14 3,6 — W R3618 E 1 B36 36" REF -3D 30 — 30 — 39Q _ W303 18 BD �n r R 18 D �J BPPS30 0 2 2002 U '� H. OCT By a R UjjB1 18 18 3 B18 30-30 i 67 9 02B27Wff 3218 30 2136 �' 27v,�'Ii� 12 12VJIli THE Oif'1' 2 169 �I,rr and spaaflcaf l)" M'JSi b at all times an'. Is um ny changes o an,Tadons 103 103} written pern.'z" from City of Capert'1 0. 1. S th s plan and specifications ht d to permit ^ be an . laGon of al V Pr v _a or islono aF1'iC:y�d=S�te 6. All dimensions & size designations This Is an original design and must given are subject to verifica0on on HOMET THE not be released or copied unless job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. Jl� /Ylst✓� i7 x/'0'/483✓ Co /by Aq- 32'.. 30 86 24 ® IIoVAC... ® ZZoVAC. vv©. Sw 1—L cIJ :maximum Design: 09/05/02 Date : 09/19/02 Designer