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03070120i y0z flz ?11 '3w 05 �WyZ6 6�$ 4 CITY OF CUPERTINOew BUILDING DIVISION PERMIT CtONTRACTTR INFORMATION.,; BUILDING ADDRESS: CUPERTINO KITCHEN DESIGNS PERMIT NO 03070120 OWNER'S NAME: 10562 S DE ANZA BLV P"R""T Lssue DAra HONE` (408) 257-4900 SANITARY NO. CONTROL NO. RCHITECTIENGINEeR: BUILDING PERMIT INFO BLDG EIF.LT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I xreby afOrm Nal 1 am IiecosW under provisions of Chapter 9 (rommcndng whh5 iso ]an(O of Divlslon3of lhNness and professions Code, and my license is radcffen. TCHEN REMODEL D`moIfo Lu.r Gao4r,3 ADD 68 Q. - Dale- Co robe, AR LARATION ' mh used as public records an plana a Licensed Pmfc nal OWNER -BUILDER DECLARATION O 1 hereby tum that 1 am eaempt from Ne Common's License Law for the following reason. (Section 7031.5. Business and Professions Code: Any city nr county ' which requires a permit to conwuct. alter. Improve, demolish, or repair my someone - _ prior m its boomee, also requires the applicant for such Permit to Ne a signed mtemcm that he is liccmod pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area uatlon (commencing with Section 7 WO) of Division J of the Business and Profession& Code) or % Oat x is exempt therefrom and the wish for tx alleged exemption. Any vioh kno of 34214049.0 APN Number • dupancy Type Section 7031.5 by any applicant for a permit subjects the applicant an a civil Penalty of not more than fate hundred dollen ($500). ❑ 1. as most of the property, w my employees with wages as uses sole compensation, - OUNDA6nn err @?Jd Inspections will do the work. and theawnure is not intended or offered for We (Sec. 70414, Baseness and Professions Code: The Contractor's License Law doe nm apply to an owner of --_' property who builds or improve themon.and who ddensuch work himulf orthrough his 10 2 - PIERS own employees, provided in such improvements are not intended or offered foruu.If. 103 - UFER hmever, the building or improvement is sold within ore year of completion. the Owner. builder will Nos the burden of proving Nat he did not wild or improve for purpose of 104 - REBAR .e.)' 105 - ANCHOR BOLTS ❑ h as owner of the property, am exclusively contracting with licensed contractors to eomwet the Poulton (Sec.Trust. Business and Professions Code:) Tho Contneurt U. 106 — SEWER & WATER come law does not apply to an owner of property who builds or lmprovu thereon, and 202 - UNDERFLOOR PLUMBING who convects for such projects with a contractor(.) licensed pursuanto tx Commences License Law. 203 - UNDERFLOOR MECHANICAL 0 l am exempt under Sec. .B&PC for Nls mum 204 - UNDERFLOOR FRAME Owner TION 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLAR I hereby an. under penalty of perjury ane of tbe following declunionc 301 - ROUGH PLUMBING Ihavemdwulto inaCcnirinwofConwntmulf-insumforWorker'&Compcn- 302 - TUB & OR SHOWER on, u provided for by Section 3700 of the Labor Code, for me lerfomsncc of the 303 - ROUGH MECHANICAL rk for which this Permit is issued. 304 - ROUGH ELECTRICAL ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section performance of the work for which this permit is issued. 37W of the labor code, tepppr 305 - FRAME ���Ix Mr wnrkee��Tmg.,nCia�f1�F: r/u .d Ticynumxrae: 306 - HOLDOWNS oaoo4ro-aro? prrier:9 rdatwaci(i EOF :+ ¢r FROM CERTIFICATE OF EXEMPTION FROM WORRERs' 307 - INSULA'T'ION COMPENSATION INSURANCE 308 - SHEETROCK (TTls section need not N completed if the permit Is for one hundred dollars(SIM) 309 - EXTERIOR LATH or less) 310 - INTERIOR LATH I eenify mat in the performance or me work for which this permit is issued. I adult not employ any person in any counter an as to become subjecuo the Workers'Compensation 311 - SCRATCH COAT Laws of California. Dau Applicant 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT. If. after making this Cenifiuu of Exemption. you thuuld become subject to the WoAcr's Compensation provisions of the Labor Code, you must foMwi lit comply with such prnvisiona Or this Permit &hall be doomed revoked, 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby arErm that them is a constrocion lentlinS.gncy our be perfmmanwnf 504 - FINAL BUILDING ENERGY the work for which this permit is issued (Sec. 3097, Co, C.) Under'sName 505 506 - FINAL ELECTRICAL - GAS TEST Under'sAddress I certify Nat 1 have read this application and slate that the shove information is 507. - FINAL PLUMBING correct. I agree to comply with all city and county ordinances and m c laws relating to building construction, and hereby amhorim repreumallvu of LisCity 10 enter Upon me FINMEC ICAL above-mentioned property for inspection purposes. City Cupertino 0 9 FI (We) agree to save, indemnify and keep harmless the of against liabilitiesjudgmcuts, costs and expenses which may in any way accmeagainst said City in comeeq nee of the gnming of this perm it. - 'A CA UNDERSTA ND WILL COMPLY WITH ALL NON -POINT 5 Issued by: 5 NG C WORKS Date - d� 50 RC R GULATIO? Re -roofs 1�1 1^Lest SlgramocofA lican tenor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material a defined by the Cupertino Municipal Code. Chapter 9.11, and the Health and Safety Code, Section 15531(a)? Oyes I All roofs shall be inspected prior to'any roofing material being installed. If 8 roof IS installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant uuequipment or devices which it hazardous air contaminants a do fined by the Bay Area Air Quality Management all new materials for inspection. trier? ❑Yee No I have mad the hauNrms materials requirements under Chapter 6,95 of the Califor. nice Hcolm aft ty Cndc,Sns 13505,25573 and 25534.1 understand wi nd OU if thlding dors not cu tly he a u That it n my respons hihity to nouly [be occupant of the r ts i mala permiavanceoflccrtl0nteofOccupancy. Signature of Applicant Dale \�7-gs-03 All roof coverings to be Class "B" or better owner or authu ted aget � am CITY OF CUPERTINO 63676 ( Z o cirvOF PERMIT APPLICATION FORM CUPEfIaTINO W PN # Fee Description 6 BAPPLOTHER Date: 6 Building Address: I BBLDGFEE fMailing Address (if differdrit fr6rdbuilding address): 0 2-40 DuOoq h Boiler <= 100,000 Btu MECHANICAL BBOILER2 Owner's Name: ( MECHANICAL BBOILER3 Boiler> 500K to IM Btu Phone #: Contractor:h ISTD MECHANICAL License #: MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Contact: BUILDING Pho e: 550 upertino Business License#: BUILDING BCONSTAXH F BUILDING BCONSTAXR B e it In BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V > IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A Bld E ec44 Energy P1nt Mec escription: BUILDING BINVESTIGA Investigation fee BUILDING Residential ❑ Comm. Housing Mit. Fee BUILDING /1 o Sq.Ft. Floor Area: $/ .Ft Cost of Project: 9) %u �j Occupancy Gro Type of Construction: ! Please check this box if the project is a / second -story addition: ❑ D Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK 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 lnd/Off/COmnV uasi 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 4 as y 7/ I of /� 2 i V 7 6 45 Y6 CUPE(,TINO CITY OF CUPERTINO PERMIT APPLICATION FORM 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 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 Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Stonn/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 Fumace 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 I Power Device/Apparatus ELECTRICAL • 2of3 ag0'. CITY OF CUPERTINO PERMIT APPLICATION FORM CUPEkTINO Qu i Fee ID Fee Description Fee Group BREMRECEPT Rep 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 BREMTHEATR Theatrical Ligbting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Seb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSVaM 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 .k. u.. 3 of 3