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05020034 CITY OF CUPERTINOy BUILDING DIVISION PERMIT VCOLVTRACTOR NFORMATIO sat OUILDING ADDRESS: CRAFTSMENS GUILD INC PERMITNfb5020034 471 MIJIMP14, All NER'S NAME: PERMIT ISSUE DATE ONE: SANITARY NO. CONTROL NO, (408) 366-1000 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uo0 LICENSED CONTRACTOR'S DECLARATION JxQ? w❑ I hereby affirm Unit 1 am licensed umkr provisions or Chapter 9(commencing Job Descnption aW toI."Sachem,NN,of Division 3 ofthe Business and Professions Code.and my license is 5 ? Liren mxaand erre"' NEW CABINET IN KITCHEN License Class Lic.N �� {r nFp Dam ContracTSDE L FF ARCHlheuse DECLARATION n W� 1 understand my plans slWl be used as public,inertir '0 Licensed Professional /(JJs pyo® �af�g p or 3 OWNER-BUILDER DECLARATION d I hereby affirm that 1 am exempt from the Contractor's License Law for the ff// pr xxxtt� 00 following mason.(SccOm 7I31.5,Business and Profcosans Code:Any city or county �� $ which equines ennslNv, m a permit to et.arm,.improve demolish,or mini,any st uch m ��••" ,fZy prior to its Issuance,also requires the applicant for shch permit to file a Signed statement .� < that lmuficensedpursaanttomcpmvlaioatofftContracmrs,llanxLaw(cn.pmr9 Sq. FC Floor Area \Valuation ¢�� (commencing with Section 7000)of Division 3 of Ne Business and Professions Code)or Nat he is exempt therefrom and she buil for the illegal exemption.Any violation of Section 7031.5 by my applicant for a permit subjects the applicant m.civil penalty of 3 6 '0Itln1ye1ane 0 0 Occupancy Type ' not mom than fits hundred dollars($500). P Y YP I,u cower of the pmpcny,or my employees wish wages as their role compensation, will do the work,and the swmum is not intended or offered fondle(Sec.7044,Business and Profca4ons Cade:The Contractile.License Law does,am apply to an owns,of Required Inspections property who builds orimprow•s thereon,and whodoes such wart himxlrar through his awn employees,provided that such improvements me not intended oroffered forsala.If. however,she building ar improvement is mid within oa year of completion.Ne owncr- builder will have Has burden or proving that he did not Wild or improve for purpose of sale.). O 1.as Owner of Om property,am eaclusively contracting with licensed contracmm to construct that project(Sec.7044,Business and Professions Cade:)The Coatracmr't Li. cense Law docs not apply in an owner of property who builds or improves daemon,and who contracts for sueh projects with a eonaYt.A.)licensed puRWm Or due CanVactora Lice.Law. ❑1 an exempt ands,Sec. .B d:P C for On reason netDam WORKER'S COMPENSATION DECLARATION 1 hemby arson under Pe,aly of perjury one of the following declarations: lcol"Ly: M1aw and Peal maintain acsmfiesm of Consent ro rev-insnm for woneraeompen n,as provided for by Section 3]00 of the Labor code.for the Performance of the for which this permit is issued. haw and will maintain Worker's Compensation Insurance,as mquimd by Section of the Labor Code,far the oformarm,of the work for which this permit is issued. Workers Compensation Insunna eerier and Policy number ax: er. Policy No.: CERTIFICATE OF EXEMP ION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not W compl,md lithe Nmol is Foran,hundred dollars($1IX) or les.) 1 eenifv Nat in she Performance of she work for which Nis Permit u issued.I shall not employ any person in any manner an a in becomesubject to the Workers'Compensation Laws of California.Dam Applicant "/�' NOTICE TO APPLICA :If.after making Nis enificam of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Cade.you mot .J z forthwith comply with such provisions or this permit shall W deemed revoked. z"" CONSTRUCTION LENDING AGENCY I hereby arnrm that Nem is a construction lending agency for the performance of C the work for which this pmmit it issued(Ss,.3091,Cin,C.) Le.d.ex Name = z Undies Address V Q 1 cense Nn 1 howply read this application and sum Net Nc about information is ] / U coned 1 agree m comply with all city and county ordinances and sum laws r upon t e //A/,�✓fA S D V abowsgcnnawaion.and hereby aushorixrpose& tins of this City mcnmr upon she atwve-(We)agree in save for emnifyadpugwx. F c es,ju agme to rev,indemnify and kap hay in m Us,y ac of Cupcnsta against N incoires,juce of thecostsand expensesmit. may in any way urn¢agmnnssid City ^ •O� C)z APPLICANTeUNDERSTANDS Athis ND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. zI2 Re-roofs Signal..cofApplin � Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or(mart Wilding acupanl uax or noodle huardous mamrial u defined by tk Cupertino Municipal Code.Chapter 9.12,and the Health and Safety nue.SOYuon25532(x)? No All roofs shall be inspected prior to any roofing material being installed. Will she applicant or future Wilding occupant Use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit harzAous air contaminants at dcGned by the Bay Area Air Quality Management all new materials for inspection. DiWim? ❑Yes o 1 have mad the hsrndeus¢then.snaps rcmcnts under Chapmr 6.95 of Ne Califm- niaHcalNhSafsty Code,Secrons25A15,2553J and 25534.1 undersand Out ifft Wilding Nes not eurremly how a UO.ML Nat it is my responsibility to surly the occupant of the requirements which must ctpriara,faso.na ofd cemneam of Occupancy. Signature of Applicant Date () O/9nn S All roof coverings to be Class"B"or better Owner he i uNodrsd agent aDate CITY OF CUPERTINO m r ,, ✓} a„a��;'r H r' - 13UILDINGDIVISION PEAT C�NTRAC�TnRINF�ORi�CION " UILDINGADDRESS: CRAFTSMENS GUILD INC PERMIT"b5020034 71 (-nT.TTMPTTq ANT W NER'S NAME: PERMIT ISSUE DATE PHONE: SANITARY NO. 2 CONTROL NO. (408) 366-1000 ARCHITECfIENGINEER: BUILO[NO PERMIT INFO BLDG ELECT PLUMB MECH LOO LICENSED CONTRACTOR'S DECLARATION to❑ 1 Wool,affirm that 1 am Bcenxd under provisions M Chapmr 9(commencing Job Description ?W with Section 7000)of Division 3 argues Business and Professions Cods.and my llcmac is n urfosn rme reaand effect. 'o? in full friss Lis. NEW CABINET IN KITCHEN S z r p Dam Contractor 1 'n ARCHITECTS DECLARATION y W U I unQrsund my plans shall he taxed as puhiie records Cy Licensed Poloational OWNER-BUILDER DECLARATION +� F I scabby affirm that I am exempt from the Conlfacmr's License Law for the —O D following mason.(Section 7031.5,Business and Professions Code:Any city or county mwhich requires a permit to commodes,alcor,improve,demolish,or repair any Structure Poor to its issaaace.also prim es the applicant for Such(Mrmll to rile a Signed statement SiGthat beulicensed pumanuotheProvisionsOfdoeComnctes'sLicames Law(Chapter 9 Sq. Ft. Floor Are Valuation in (commencing with Section 7000)of Division 3 of the Business and Professions Cow)or _\ y that he is exempt motorman and the basis for she alleged exemption.Any violation of �7 Section 7031.5 by any applicant for apemitsubjects the applicant at a civil penalty of 36�IPYdiQkilr113C100 Occupancy not mare man five hundred dollars(3500). �� P Y Type 1.ar owner of the property,a my employees with wago or their sole compensation, will do the work,and theswcmm is not immoded or offered for salt(Sec.7044,Business surd Profcssimr Code:The Contractor's License Law does not apply to an owner or Required Inspections property who builds or impmvo mmcon,and whodnes such work himreif or through his Own employees,provided that uch improvements are not intended mattered for We.If, however,the building of improvement is sold within one year of complotion,the owner builder will haw gum burden of passing that he did not child or impmw for purpose of We.). 1,as Owner or the property.am exclusively contracting wish licensed connotation to torten the prolect(Sec.7004.Business and Professions Cade:)The Commator's Li- come law does not apply b an owner of property who builds or improves Merton,and. who comment for such projects wire a eomnerogs)licensed pursuant re the Contractors W1x law. am exempt under Sec. .B&P C for this reason Uwner Date WORK ER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following decimations: ❑T haw and win maintain a CnGfiam of Consent to self-insum for WorkersCompen- smian,as provided for by Section 3700 of the labor Code,for she performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,az required by Section 37110 of has labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This ecetion wed nor Ire complex d if the permit is for one hundmd dollars(Slpl) or Tess) I certify mot in me performance of to work for which this permit is issued.I shall not employ any pcm5on in any manner set ss m became Subject o the Workcrr Compensation Laws of California.Date Applicant NOTICE TO APPLICA If.-Tref making thucnificaa 0f FacmpIi00.you sh0uW become subject to the Worker's Compensation provisions of the Labor Code,you must .JO fmmwi th comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY [--�� I hereby affirm that there is a construction lending agency for the pereomaes of ai the work fur which this permit is issued(Sec.3097.Civ.C.) 1T7 Lendo's Name Lender's Address D V Q 1 certify that 1 howply mead thirty and coon and sola that she above information is 0 F carmen 1 agree m comply with all city and county wrfi ordinances and sum laws relating to QU alosamngeonstrsolproandM1emhyaumorixmpreunuti.rs of thiacirymcnurUpon tha fSl ahovc (we)agree to ertysave for inspection ar purposes. ,^y eWet)agree to save,indemnify and keep harmless w City of Cupertino against fg Iiabilltiesicroo o dr, ramand expenses which may in any wry secret against said City amon,of this ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2— - 0jSOUR[E REGULATIONS. Re-roofs Signature of Appl IcantaCbnlsutor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof will the applicant or forum building occupant store or handle haazmous mammal defined by the Cupertino MunNoicipal Code.Chapter 9.11,and dre Health and Safety ales l25532(.)?Y. All roofs shall be inspected prior to any roofing material being installed. Yon 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 emit hatardous air conuminams as defined by the Bay Area Air Quality Management all new materials for inspection. District? / ❑yes 1 have read she haxardaus materials reyuimmenu under Chapterti.95 of the Califon nice Holm&Safety Codc,Sadao 25505.25533 and 25534.1 underseud not doe building docs act currently haw a unam that it es my mires bility to notify thc comfort of me requirements whim must be, Igriartt5)manee of.cerdhcam or Occupancy' Signature of Applicant Date Owner or authari'rcd team �- ��" S All roof coverings to be Class"B"or better t am JOHN OU & ASSOCIA'T'ES CONSULTING STRUCTURAL ENGINEERS 1813 Oak Knoll Dr. Belmont,California 94002 Tel.: (650)592-7181 Fax: (650)592-1450 January 21, 2005 Building Department City of Cupertino Cupertino, Ca. Ref: 21471 Columbus, Cupertino,Ca. To Whom It May Concern: As the engineer of record for the last addition, I hereby certify that I approve the installation of a 4'-0"+- opening thru the wall between kitchen and family room. The opening is to have a 4x8 header. If you have any question regarding this letter please call me at 650- 592- 7181. Sincerely, John On, S.E. ., ✓ � 2�� 11 AL O CITY OF CUPERTIN# clik' NO PERMIT APPLICATION FORM 0S"�� CUPEI�TI ® -5- 4� 'L—(�3 Ct- O APN # Date: 2a d(� Building Address: Mailing Address if different from building address): 21 Lt7► Cv �-tt�T3(SS 6 . � - - Owner's Name: 4 4/'/1f� VPP,+t A 9u Phone#: Contractor: .d p ^A � G License #: -601 l/S 9 Contact: C� N !A•,Phone: < 08-34' It) Cupertino Business License#: I Fax: Building Permit Info: Bldg LerElect ❑ Plumb ❑ Mech ❑ Job Descriptio . a Residential L 7 Commercial ❑ Sq.Ft. Floor Area: 2 f $/Sq.Ft.: Cost of Project: Occupancy Group: 16 e of Construction: 1� /� Please check this box if the project is a 1 (XX second-story 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 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> 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 lof3 �/ CITY OF CUPERTIN(O UP TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 rinkler/Backflo PLUMBING BPSTORM Stoml/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING dh BPVENT Alt of Drain & Vent PLUMBING RW 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 BREMABUiAN 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 Furnace> 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 BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL 2 of 3 °C Ory. OF CUPERTINO On OF PERMIT APPLICATION FORM CUPERTINO • Quantity Fee ID Fee Description Fee Group 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 p EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL Q MPERMITFEE Mech Permit Issuance MECHANICAL 0 PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • • 3 of 3