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05070070 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRAC`TORINFORMATION'` ','. n ,sr 74,...d%t d&ta hsgp n BUILDING ADDRESS: ""NO) 5 0 7 0 0 7 0 10';64 T)FMPqTP.R AV OWNER'S NAME: PERMIT ISSUE DATE JOE & ELAINE FENS E: SANITARY NO. CONTROL NO. - ARCHDECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH yoo LICENSED CONTRACTOR'S DECms of CON Job Description y VZ C I hereby storm that I em f ft Bo under,previsions of Chapter 9(commencing P ^<d null fora and of Division 3ofthe Bpiness f Code.and yImpact s �q= License Cl Lie. a Z REMODEL MASTERBATH/HALLWAY BATH 2ND FLR �onDate CCH imummUWATICN LUMBING/ELECTRICAL/MECH/NONBARING WALL z� &y It 7/12/05 ARK CONST PAID FOR BUS LIC �a uy 'Lk d fnicamol - O OWNER-BUILDER DECLARATION in i<I 1 hereby uffrm that 1 am exempt(rum Rs Conuacmr's License Law fur the ZOO following mason.(Sectiun 70 31.5,Business and ProfuWons Code:My city or county which requires a permit to construct,alter,improve,demolish,or repair any stmemre FZsprior our issuance.also requites thcappbcant for such permit m fila a signed antcmcnt that he is licensed pursuant to the provision of Ne Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation ,H S (commencing with Semon 1000)of Division 3 of the Business and Professions Code)at e g_ Nat W is exempt therefrom and the bests for the alleged exemption.Any violation or 10 8 8 1 Section 1031.5 by vry applicant for a permit subjects the applicant to a civil penalty of ane APN Number Occupancy T mat roma Nan five hundred dollars($e(n). P Y YPe Ej I,as owner ofthe pmpcny,or my employees with wages as thairmlc compensation, rsa�a B m f GY n Fixecar FFZN will do the wart and the swcsure is not intended aroRered for We(Sm.IDU,Business ism and Professi.p Cade:The Comu¢tor5 Licerae law doe:mat apply 1.an awn,of Required Inspections property who builds.,improves dNere.....d who doessuch work himselfor through hu B D Y Vab tis...x0^.4 own employees,provided that such improvements are not intended or offered for We.If. however,the building or improvement is sold within ane year of mmpledon.the owner. buildar will bare the burden of proving this,he did at Mild or improve fur pc,..of / G nos sok.). I,as owner of the pmpeny,are exclnimly mnlnning with licensed conwcmrs to rrrr�� rtrt p ��555 ffsr Y. p vv tl construct the es not apply in in Bovine'and my who Cade:)The Convectors rad {I B {S ry y NS 5 const law dap not apply m an owner Business who Wiida or improves thereon.and �l��/�('v''Q 41I�H Q who contracts for such projects with a convacmr(U licensed pursuant to de Contractors Lkcnx law. ❑ 1 am exempt under Sec. .B k P C for his moon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affrm under penalty of perjury am of Ne following declarations: I have and will maintain aCertificate of Consent to selPinsum for WofkersCompen- sation,n provided for by Section 3100 of the labor Code,for the pedurnanm of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Immune.as required by Section 37W of Ne labor Code.for the pi,darronam of the work for which this pemtit is issued. My Workers Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section aced not he competed tithe permit is for one hundred dollars($IBB) or less.) 1 certify that in the performance of the work for which this permit is issued,l shall not employ any permn in any man soh tom uhjccu.the Workers'Compensation Laws of forma.Da Applin a NOTICE R�PCIFANT,if,after making this Ccnibc.le u(bilmul ou should become m l to the Worker's Compensation previsions of the Labor Code,you most .,O faMwith comply with such provision or this Permit he deemed revoked, Zvy CONSTRUCTION LENDING AGENCY (-. 1 hereby alarm Nat them is a mostruetinn lending agency for the peromnance or CL'25the work for which Nu Perron is issued(Sm.3091,Civ,C.) W�Q Lendcr's Name Z Lender's Address V O 1 certify that 1 haw mad this application and state that the above information is D,F cancer,1 agree to comply with all city and county ordinaries and sure laws relating in 0(J building construction,and herN by activation w,eprasentatiaes of this city enter upon the W algvCmentimmul property,for Inspection purpoYi gy (Wc)agree to save,indemnify and keep harmless Nc City of Cupertino against h Ilabilihes.judgments.mon;and expenses which may in any way&cern against said City t.)Z in consequence of the graining of this permit, ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date URCE R ATIONS. atom arA _ Retroofs tg pp ma inHAZARDOUS MATERIALSDISCLOUE Type of Roof Will the applicant or future building occupantxmm orlc haradous material as defined by the CLpenino Municipal Code.Chapter 9.13, n Nc Health and Safety Code.Section Zs5320p1' All roofs shall be inspected prior to any roofing material being installed. ❑Yes ku 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 split M arams air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? Dyes u I have mad the hero nus materials mquireplenu under Chapterri.95 offs Califon nu Health 6 Safety Cade,Scmom25505,25533 ard25534.1 intonational thxtirthc building d not curtcntI base a tenant that it u my responsibility m rwdfy the occupant n(the r cyimmcnts ni plaatbcmetptiorRriaraaneoraCeni11 rOcmpan Signature of Applicant Date ct_� 7 / b o ortO tithonk :goal Dale All roof coverings to be Class"B" or better i CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRAC`TORINFORMATION'` ','. n ,sr 74,...d%t d&ta hsgp n BUILDING ADDRESS: ""NO) 5 0 7 0 0 7 0 10';64 T)FMPqTP.R AV OWNER'S NAME: PERMIT ISSUE DATE JOE & ELAINE FENS E: SANITARY NO. CONTROL NO. - ARCHDECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH yoo LICENSED CONTRACTOR'S DECms of CON Job Description y VZ C I hereby storm that I em f ft Bo under,previsions of Chapter 9(commencing P ^<d null fora and of Division 3ofthe Bpiness f Code.and yImpact s �q= License Cl Lie. a Z REMODEL MASTERBATH/HALLWAY BATH 2ND FLR �onDate CCH imummUWATICN LUMBING/ELECTRICAL/MECH/NONBARING WALL z� &y It 7/12/05 ARK CONST PAID FOR BUS LIC �a uy 'Lk d fnicamol - O OWNER-BUILDER DECLARATION in i<I 1 hereby uffrm that 1 am exempt(rum Rs Conuacmr's License Law fur the ZOO following mason.(Sectiun 70 31.5,Business and ProfuWons Code:My city or county which requires a permit to construct,alter,improve,demolish,or repair any stmemre FZsprior our issuance.also requites thcappbcant for such permit m fila a signed antcmcnt that he is licensed pursuant to the provision of Ne Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation ,H S (commencing with Semon 1000)of Division 3 of the Business and Professions Code)at e g_ Nat W is exempt therefrom and the bests for the alleged exemption.Any violation or 10 8 8 1 Section 1031.5 by vry applicant for a permit subjects the applicant to a civil penalty of ane APN Number Occupancy T mat roma Nan five hundred dollars($e(n). P Y YPe Ej I,as owner ofthe pmpcny,or my employees with wages as thairmlc compensation, rsa�a B m f GY n Fixecar FFZN will do the wart and the swcsure is not intended aroRered for We(Sm.IDU,Business ism and Professi.p Cade:The Comu¢tor5 Licerae law doe:mat apply 1.an awn,of Required Inspections property who builds.,improves dNere.....d who doessuch work himselfor through hu B D Y Vab tis...x0^.4 own employees,provided that such improvements are not intended or offered for We.If. however,the building or improvement is sold within ane year of mmpledon.the owner. buildar will bare the burden of proving this,he did at Mild or improve fur pc,..of / G nos sok.). I,as owner of the pmpeny,are exclnimly mnlnning with licensed conwcmrs to rrrr�� rtrt p ��555 ffsr Y. p vv tl construct the es not apply in in Bovine'and my who Cade:)The Convectors rad {I B {S ry y NS 5 const law dap not apply m an owner Business who Wiida or improves thereon.and �l��/�('v''Q 41I�H Q who contracts for such projects with a convacmr(U licensed pursuant to de Contractors Lkcnx law. ❑ 1 am exempt under Sec. .B k P C for his moon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affrm under penalty of perjury am of Ne following declarations: I have and will maintain aCertificate of Consent to selPinsum for WofkersCompen- sation,n provided for by Section 3100 of the labor Code,for the pedurnanm of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Immune.as required by Section 37W of Ne labor Code.for the pi,darronam of the work for which this pemtit is issued. My Workers Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section aced not he competed tithe permit is for one hundred dollars($IBB) or less.) 1 certify that in the performance of the work for which this permit is issued,l shall not employ any permn in any man soh tom uhjccu.the Workers'Compensation Laws of forma.Da Applin a NOTICE R�PCIFANT,if,after making this Ccnibc.le u(bilmul ou should become m l to the Worker's Compensation previsions of the Labor Code,you most .,O faMwith comply with such provision or this Permit he deemed revoked, Zvy CONSTRUCTION LENDING AGENCY (-. 1 hereby alarm Nat them is a mostruetinn lending agency for the peromnance or CL'25the work for which Nu Perron is issued(Sm.3091,Civ,C.) W�Q Lendcr's Name Z Lender's Address V O 1 certify that 1 haw mad this application and state that the above information is D,F cancer,1 agree to comply with all city and county ordinaries and sure laws relating in 0(J building construction,and herN by activation w,eprasentatiaes of this city enter upon the W algvCmentimmul property,for Inspection purpoYi gy (Wc)agree to save,indemnify and keep harmless Nc City of Cupertino against h Ilabilihes.judgments.mon;and expenses which may in any way&cern against said City t.)Z in consequence of the graining of this permit, ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date URCE R ATIONS. atom arA _ Retroofs tg pp ma inHAZARDOUS MATERIALSDISCLOUE Type of Roof Will the applicant or future building occupantxmm orlc haradous material as defined by the CLpenino Municipal Code.Chapter 9.13, n Nc Health and Safety Code.Section Zs5320p1' All roofs shall be inspected prior to any roofing material being installed. ❑Yes ku 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 split M arams air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? Dyes u I have mad the hero nus materials mquireplenu under Chapterri.95 offs Califon nu Health 6 Safety Cade,Scmom25505,25533 ard25534.1 intonational thxtirthc building d not curtcntI base a tenant that it u my responsibility m rwdfy the occupant n(the r cyimmcnts ni plaatbcmetptiorRriaraaneoraCeni11 rOcmpan Signature of Applicant Date ct_� 7 / b o ortO tithonk :goal Dale All roof coverings to be Class"B" or better i crry of cuPE4CQ)NTRACTnR,INFORMArIQN BUILDING DIVISIONSION PERMIT ,rte;,• 4,;'m a• ,�%».tee' „a%c ;�na'ci"� �i 5070070 PERMIT BUILDING ADDRESS: � N%V PERMIT ISSUE DATE .ER'S NAME: JOE & ELAINE FEN SANITARY N0. CONTROL NO. - PHONE: BUILDING PERMITINFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH o O LICENSED CONTRACTOR'S DECLARATION Job Description y u C 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing 6Zw wiNSccdon]Wo)of Division 3 ofthe Business ofcssmm CoM.and ay lmc aaeir M in full form andeffcct kjC� Z REMODEL MASTERBATH/HALLWAY BATH 2ND ELF. -z o Data_ ata Cl LUcCom.YracsorLUMBING/ELECTRICAL/MECH/NONBARING WALL �'+ ARCHITECTS DEC• ATIO 7/12/05 ARK CONST PAID FOR BUS LIC KI undo my plans shall Ac umd public rcmrds 3LL r. On 'Licn d mfcuinnal Our I am exempt U rept(r DECLARATION n o I hereby maso affirm on 11. exempt from the momm�al Co c:Any Law for the _o O following mason(Scehun](1]L5,Business and Pmfminns GWe:Any city ter emumy . $ which requiissres a permit m consumer,cher.improve,demolish,or repair any slruclum prions ill uamm.ah requires the applicant for such permit to file a signed statement Sq.Ft,Floor Area Valuation ��Sa "Zi" 'nuant mme pmvlsimm Ffthe C.mr.1c1.l_iCCsCLaw(Chapmr9 IO88I FO p:ommencing with Scetion]f1W)nf Divixion3 nRM1c Busincsx and Professions Cndc7tar S i�j 3 thm he is exempt thcmfrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicansfor a permit subjccu the applicant to a civil Penalty of APN Number not mom than five hundred dollars(5500). ❑I.Far ownef of the property,or my employees with wages For their sole compastoralism. will do the work.and the Structure is not intended or offered for sale(Sec.]B4a,Business Required Inspections end Professions Code:The Contractors License Law does not apply to an owner of Impenywho ebuilds orimproves Hereon,andwb^due ssuch work himselforthrough his own cmploychilding of pr ve est iss ments id widorene ears of intended for owner, Wilder Ne building ar impmvemem is xmld within one year of completion,the ore of builder will have Ne burden of proving tut he did Wl Wild as impure for purpose of sal.j ,not p ❑1,as owner of Ne progeny,am exclusively contracting with licensed Contractors,to cense La theproject(Sec.Wad,Business and rty who Code:i The vesdim dimmer.and eche taw docs not apply je an owner of protons who builds or improves Neuron,and whaces for sucM1 Projects with a contractor(s)licensed pursuant m the Contractors t Licence Law I am exempt timer sec.. ,B&P C for this reason V\ Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: El 1 have and will maintain a Cenificam of Commit,m self insure for Wormes Compen- sation,as provided for by Section 3700 of do labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3701).f the labor Code,for me performance of the work for which Nis permit is issued. My Worker's Compen alien Insurance Carrier and Policy number am: Carrier. Policy Ne.: CERi1FICATE OF EKEMPITON FROM WORKERS COMPENSATION INSURANCE (This section need not hce^mpleted if the permit Is fortune hundred dollars($I(1B) or less.) 1 certify that in the performance of the work Our which this permit is issncd.l shall not cmployanypermninanyman� rob tom ubjo3mdm Wmkms CnmpcmuLicn Laws of 'form Dat Applin t NOTICE P 1 A :If,aftm making this Ccmrica¢of Excmpu ou should become so IF m the Worker's Compensation provisions of the Labor Code,you must ,J Z forthwith comply with such provisions or this Permit shall be deemed revoked. Z '—' CONSTRUCTION LENDING AGENCY I hereby affirm Nat Nem is a eorsom,m m lending agency for the perfurmance of a Ne work for which Nis permit is issued(Sec.3097.Civ.C.) W Lender's Name 0Lcndu's Address V1 certify that 1 have read this application and sure Nat the shout information is ,r correct 1 agree to comply with all city and county ordinances and sate laws raising to V building construction,ane,Inde nify and rep homeless s tocs of this city Cuportef upon the >C'U above mentioned pmtery for inspection onfoses. (We) ,mem save,indemnify and keep harmless the City of Cupertino to City F'� liahilitiu.judgmcnu,cos4 and catenses which may in any way acerve agates said City C.)Z in cmucqucncc or the gtanhng of this pumiF Date F-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: URCE R- ATIONS. v "7 t U Recroofs ig attire of Apt insnuConuumr m HAZARDOUS MATERIALS DISCLO U E Type of Roof Will the applicant or future building occupant store or Ie hazardous material defined by the Cupertino Municipal Code.Chapter 9.12,an the Health and Safety ode.Section 25532(a)'1Yet All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future banding Occupant use equipment or devices which IF a roof is installed without firs[obtaining an inspection,I agree to remove emit honrdons air conuminanu as dinned by the Bay Arca Air Quality ManagemenL all new materials for inspection. Di titer? 0Ycx I have read the haasdous materials requircmcnu under Chapkr6.95 of Oc Califor- n is Health&Sammy Cedc,Secuone 25515,25533 and 25534.1 understand that Eft Wilding d tcurtcnit haveatenant Natitismymspomihilitymnotrythesa p Lofthc W i¢mcnuwniyt,mnvbemetJ /pr_T t'\Ic�ra�c3e` rr4fcamorOc<ttp,nsr Signature of Applicant Date '-' �'tj�t t�1n-t vN lyb\A�L't' �(� � , All roof coverings to be Class"B" or better i ®. co rfl � i IS cc) r r4 i � � a x 1 OD f g r C= o ® tt� LA el- CA Cj J \ &ammnl CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO � � 567667� APN # ! (/ �fp/ Date: 7— O� Building Address: 7 Mailing Address (if different from building address): o J Owner's Name: Phone#: —' Z - 6 Cont ctor: License #: (� Z Contact: Phone Slo Cupertino Business License#: Fax: p _p Building Permit Info: e� (� b vL. ]d Elect ) Plumb Mec Job Description: Residential NCommercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: /D Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project-Size:-Standard Large ❑ - Major ❑ -- - -------- Quantity— ----- - ---- Quanti 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 IM 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 Energ Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3