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03100043 • CI'CY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR KINFORMATION• BUILDING ADDRESS: JK BAKER CONSTRUCTION PERMITN0.03100043 OWNER'S NAME: 2175 STONE AVE . #�11 PERMIT ISSUEDATE MARY KUA111 "E` (408) 882-0199 SANITARY N0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 ,00 LICENSED CONTRACatR'SDECons of CON Job Description YF Inas 70arrcm NalIamli he Dix un(Icr provision of Chapmr9(commcncing - p with Secdon]IXMI)of Division)of Nc Buairasp end Profession,Cpdn,asid my license is NmB,(nueanderre (' (���C FIREPLACE s Ia Z Linen lee Lie.M O/ Dale Contractor qF ARCHITECTS D' ATON I s k. IPundcratand my plans shall W used as public records 3 5b0 V i1 aL�, Licensed Professional V tto3 OWNER-BUILDER DECLARATION 3 J<F I he clay from that I am exempt fru.Ne Contractors License law for the o 00 following recon.(Section 7011.5,Business and Professions Codc:Any city or county S$ which requires a permit m constua,suer,improve,demolish,or repair any structure �^ poor ha in,issuance,also requires the applicant for such permit to Blc a signed staremem iso that he is licensed pursuant utheprovisionsofthe ConunckuhLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation 2 $ (commencing'with Section]WD)of Division]of the Business and Professions Code)ur I that he is exempt therefrom and be Was for the alleged exemption.Any violation of 3264 Section 7031.5 by any applicant for a Permit ubjects the applicant to a civil penalty of APN Number Occupancy Type not mon Nan five hundred dollar(SWOL ❑h As owner of the prepeny,or my employees with were As their ole compensation, will do the work.and the Npclum is not intended or offend for sale(Sec.70th.Business 101 — D d IDSpeCt100S and Professions Code:The ComtlaClor's License law does not apply to an owner of progeny who builds or improves Nemen,and who doessuch work htmulfor through his 312 - CHIMNEY REBAR & STRAPS awn employees,provided that such impmvcmentsate not intended proffered for sale.If. 514 — FINAL PUBLIC WORKS however,the building or improvement is sold within one year of completion.the owner. builder will have the burden of proving that he did not build or improve fur purpose of .[a I. 1-1 1,as owner of the property,am exclusively convening with licensed contractors to convect to pmject(Sec.7044,Business and Professions Code:)The Contract's Li- cense law does not apply in an owner of property who Wilds or improves themon,and, who contracts for such projects with a contracmQ)licensed pursuant to he Contractor's License Law. - ❑ I am exempt under Sec. B k P C for this mason owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty of perjury one of the following declarations: - C„ I have and will mainuin a Cwhficme of Continuo self-usure for Worker's Compte- Cotisi,As Provided for by Section 7]00 of the labor Crede,for the performance of Ne work for which this Permit Is issued. 1 ban and will maintain Worker's Compensation Insurance,As required by Section 3700 of the labor Code,for the performance of the with for which this permit is issued. M Workers Compeuationlnunna `reinnend Policy numbeism: mer. StfaFI"PTION ROMWO KERS' CERTIFICATE OF EX PTION FROM WORKERS' COMPENSATION INSURANCE (Thisuclionaced notbecompleted ifthe Permit Isforonehundreddollars$i0p) or less.) 1 comfy that in Nc parformepec of Ne work for which this Permit is issued.I shall not employ any proton in any manneuo As to become subject o Ih Worker'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Cenificate of Exemption.you should become subject m the Worker's Compensation previsions of the labor Code,you must �Z forthwith comply with such provisions or this Permit shall he deemed Invoked. ZO CONSTRUCTION LENDING AGENCY I hereby affirm that then in,construction lending agency for fie Performance of Y 7 Ne work for which this knits is issued(Sec.31197.CN.C.) , tl 0 Lender's Name z Lender's Address 0 1 certify that I have read this application and sum Net the above information is 1.F correct.I agree to comply with all city and county militaries and state laws relating to �U building consweroon,and hereby suthorim mpoormadves of this city to enter upon the 4 ehovamc e) nedSm to sa y for mnify an keep ho. (We)agree to Cove,andemneyandkap hay in wayacru Cupertinoagainst a5 p JN inconsequence fthecoming expenseswhichmay to any way scene against mid City `/ V z' t. APPLICAeNTcUNDERSTANDS Agranting of tND WILL COMPLY WITH ALL NON-POINT Issued by: Date Spq CERE ATIONS, / �/ IX is 4� b Re-roofs Igroame mfApplic nl/Cuntract r Data HAZARDOUS MATE ALS DISCLOSURE Type of Roof Will the applicant or future building cupanis.re or handle hamodous ankerial an defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety Cole.Section 15531(U] All roofs shall be inspected prior to any roofing material being installed. 0y. u Will the applicant o fwure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove h huzspous air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection. tell ❑Yck Ll Ihe.read thehv sus makcrials requirerants under Chapter 6.95 of dtr Califon ria Health h Safety C .Secduu15505.]SSJJ trod 25514.1 understand thuiflM huilJing does not currently hast a um4m raw it u my ofWasibikity at amity the menupant of the rtyuirtmcn wmm�muvubcmelpdrmlasuanCcoraCCNrcaeofO,a,.ey. Signature of Applicant Date A Y_U Owner or authorized agent Dae All roof coverings to be Class "B" or better .� CITY OF CUPERTINO CIT OF PERMIT•APPLICATION FORM CUPEkTINO APN# Date: 0 ? . S (� / 1O 3 1 1Z 03 Building Address: Owner's Name: Phone#: Contractor: License#: Contact: Cupertino Business License#: � 1 Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: t $/Sq.Ft.: Cost of Project: Occupancy Grou Type of Constructio : 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> 1000A ELECTRICAL. BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. HousingMit. Fee BUILDING 1 of3 . i•` - CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO 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 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 HeaterNent 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 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 2of3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEI,TINO 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 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Si s, 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 hisection 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 Mecb Permit Issuance MECHANICAL PPERMITFEE luinbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 7 r • i i n 1.•� • ' _— w ♦ n. ;! ii . : ►• � M r .•� 'i �� ',� Vii• 1 �' 7L .. ; rya . _:. :• - 44 3 A. 40 Is .. __ _ 3 7 3 I € n � • . qe �,•61 a ,i r s � : �_ �\ �_; `• ? ^ tea L i _ j ! lira • —1: � • .�� � '� .• i • i s i 4 s �— iiii •r C'7 i• ,r j ^ it II kA ilk 73 |\f �■ ■&� 7 | � : � . ' |f! In &- > § �q \ . . a : \ > \ -n 4A \ k -Mq r- Ln ` | n Ik tt ■ / . . « k \ 2 / ` rri CO rn , . § In *14 ,�■ % \ } `� © i � / |!%�;�§ �■%9 & _ } 2 l --- — ` 4 � �% " 03'A k\| , \ . ` . ■� _ § .