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05080197CITY OF CUPERTINOr.� ^�Tma�.�py `/'�&"moi.•`'! BUILDING DIVISION PERMIT ��s,��rr,.�p*£�p p ♦ 8 ONTT ! QT ORINPORMATION11 �;n£k v BUILDINGADDRESS: AM KITCHEN & BATH PERMIT N005 0 8 0 19 7 1100 ELMSFORD DR WS NAME: PERMIT ISSUE DATE GLORIA TURNER 1758 JUNCTION AVE UNIT D 08/22/2005 NE: SANITARY NO. CONTROL NO. (408)436-8151 ARCNITEC (ENGINEER: BUILDING PERMIT INFO B E P UMB M N LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby afnnn that 1 me licensed under provisions of Chapter 9 (commencing with Section 7(100) of DiWsion 3 of dm Busincas W PMicado ,Code. Wmy Hemen, Is in fall m force ! DaleLicense FRI 92 KITCHEN REMODEL ARCHnECC DEC O �•' 1 understand my plans mall W used u public mcoNs E�+, 0.2 LJ r ZOOrs Licensed Professional C Oat I Wrohy +Bite I am exempt m ConaraON from 11. exempt from Ule Cantractcc License Law for the u on following wawa. (Section Aommo Business and w. dcoom Cade: My oily m countyture which mqulroa • permit re L siler, imProw, demalbh, m rtpsig any urmwm pp w 5 3 0 0 0 �1 �� it it (f=•� A •.• y prior ws issuance, quires M Thar cnscdpaimrequire theappbamfor men permit m NCs, Law (Chapter Sq. Ft. Floor Area kl''�pVal on Code) or (commencing witpurmeatmlhepmvisiomofMtheBUwmOL4ndPmclaw(Code)or rM theeged excepton. II [1 VV My vi del W u asempl Mertfrom and Me bub for tise alleged exemption. My violation of that W is exempt thction erefrom and M basis f er Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mow than 0w handed dollars ($300). ❑ I. u owner of the property. or my employee wish wits u their win compensation, Required Inspections will do the work, and themoucture is not intended orortered formic (Sm. 7000, Business and Profesalam Cade: The Coatrsemis License law doe Out apply m an ower of q p property who builds or warrants thereon, red who does such wank himself or through his own employee, provided Mal such imp owments art rel Intended m offered for sale, IL however, the building or improwment Is mid within one year of completion, Me awner- buiidm will hon Ne burden of proving that he did net Wild or lmprow far purpose of ark.). ❑ 1. u owner of Me Property. am eeelusiwly contracting with licensed contractor m construct Me project (Sec. 7010, Bwinets and Rofesiots Code:) The Cwaactor's U- cense law doe nal apply ban owner of properly who Wilda or improwa ti moe, and, who commek fM mcll pmjecaf with a conlrClons) licensed pmmaN in the Contractors License Law. 1 am exempt under See. . B k P C for this mason r Date WORKER'S COMPENSATION DECLARATION 1 hereby aflim under penally of perjury ane of the following declarations: m and will maintain a Cen skate of Consent to self-itsum for WorkersCompen- tian, uprovided for by SeNon 3700 of tion Lader Code, (m the performance of MC work for which this permit is issued. l7 I haw and will maintain Wmkefs Compensation Insurance, u acquired by Section 371 of Inc labor Cade, for Me performance cruse wank for which this Permit b issued. My Worker's Cam mNan lmurata err and Policy number are: Cartier. Poliry Na.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ills section need nothocompleted If tic permit is Won, hundred dollars (5100) or Icx) 1 anlfY Mot in Me perfomence of the work for which this permit is Issued. I shall not employ any permn in any mannerm as to become subject to Me WorYeri Compensation Laws of California. Dam Applicant NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject in the Worker's Compclwdon provisions of we talar Code. you most faMwith comply with such provisions or this leech shall W decreed wwked. CONSTRUCTION LENDING AGENCY I hereby affirm Mat Mew is a conalrowma kadint awmY fm the perfumaha sir Me wank fm which this permit is issued (Sm. 3097. Civ. C.) Lendees Name lender's Addresa 1 certify that I haw need this application and sum that tine show information b Coma I a irm to comply with all city and county ordinances and scale laws relming to - Wilding construction, and hereby authorise wpreunuliM of this city in ale upon de above-mentioned property for Inspection purposes. (We) ata W raw, indemnify red lap hamlet Me City of Cupertino agaiml liabilities. Judgments, cofts and expenses which may In any way accrue against said City in eamequcnee of the treating of this pemiL APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT 2Z vp� Issued by9 Date O SOURCE REGU JJ Re -roofs */Z/� Siguwof i DD HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII or andlc l nd pant nfuture Wal Co e, Chanutow HealthSafer y the Cupertino Munitlpal Cath. Chapter 9.12 and the Ha1N and Safety defined by 25 32(a) Section xsss2(a)] yL'' Yuo All roofs shall be inspected prior to any roofing material being installed. If a roof 1$ installed without first obtaining an inspection, I agree IO remove Will the applicant or future building occupant we equipment or deviaa which cob hamawas air contealineats as defined by the Bay Arta Air Quality Management all new materials for inspection. District] f�� pYes i I haw mhdMe huardmu mmliaksequimments under Chapkr6.95 of the Califon - nu NcalM&SafclyCodc,Sectiou25505.x5533and255N.luMcrsund MI Wilding does Out currently haw a knot, that Itis my an mil, II m noM'y the oecupset of the regwmmcats which IPan afn Ccnirtule of cne,° ; Signature of Applicant Date �,,_ " ale All roof coverings to be Class "B" or better Owner or amharimd agent Dam I CITY OF CUPERTINO ' OI2IN UN BUILDING DIVISION PE Au ' ONT."2 BUILDING ADDRESS: AM KITCHEN & BATH PERMIT NO05080197 1100 ELMSFORD DR OWNER'S NAME: P®B.fff ISSUE DATE GLORIA TURNER 1758 JUNCTION AVE UNIT D 08/22/2005 NE: SANITARY NO. CONTROL NO. (408)436-8151 ARCHIECUENOINEER: BUILDING PERMIT INFO B E P UMB MUCH LICENSED CONTRACTORS DECLARATION Job Description I botchy afnm that 1 am lixmc i under provisions -rClufur 9 (commercial: with Section 700M ofDlvWOn 3 of de Business and Professions Cade. and my license is iLicensem d KITCHEN REMODEL fair Lk .# S B DamARfeed CHITECTS D 0 u am u I unmatend rmy plans slWhe l used W611c meorm / Licensed Profcmionat OWNER -BUILDER DECLARATION n mPl from be Cmtrutor's License Law far use 1 by air,. that 1 uae here O following =an. (Scum 7051.5. Business and Ptofessians Code: My City or county / .$ 5 3 O (] 0 u which requires • Permit m ennwuck atter, baprove, mmmish, or mlmfr any mans S^ price uits Issuance, alwrequires the applicant for suc111rnnllmrite asigned WmmenlValuation that he k licensed pumant an the pnevislam of the Carma's Lmenm law (Chapter9 Sq. Ft. Floor Area O� $ (commencing with Srsdon 7000)of Dtion 3 of the Business mad PtofeWons Code)or .. has be is manmpt tbnfrom and the bash far the alleged asrmptlme- MY violation of e f Occupancy Type Season 7031.5 by any Applicants for a permit "Notes the app0unl m a civil Pauly Of am mom than five hundred dollars (SSW} , the employees will do tion warkfand the�sOuny um is .1 or offered rmsale (Sc. 7044, ede as Required Inspections a: e Commerce, Llreofe law dues nal apply m an Owner of feans Cadat and PtoW Property who borlds or iceptoves thromm, and who deal sucb wing himulf ar Wmugb hit awn employme, provided that such improvements nom intended oroaeled forula If. however, the Wilding car Improvement a sold within mu year of mmphamm. that owner - builder will have the bond= of proving that M did not Wild nr improve far purpose of mass.). mansur Of am censed n 10 ❑mnsLtrurvct the ro ca (Sec. 70064. Business uW Profession; Cmi The CoCommuccises u cense Law does not apply in an owner of property who Wilds or improve Ihemon, and, who convect, for so bb projects with a conuacmr(s) licensed pummum to the Contrscuts Lkanu Law. Imesam tender Sc. . B d: P C far this moon cr Data WORKERS COMPENSATION DECLARATION I hereby aRmm under penalty of perjury one of the following declan0ans: .am will maiawn • ctedfsaleaf Comet mself.insom In, warker'a Compere am. as provided for by Seniors 3700 of de labor Code, far the pmarmana of the work for which Nis permit is Issued. ❑ 1 beve and will maintain Worker's Compensation Insurance, as required by Section 37M of thc L 1m, Cade, far the perfomatma of the work far which this permit is IOWA. . My Worker's Conn nsadon Inwnnce er and policy number n: Cards; .�V Policy No.: , CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ' CMisse muendnotbaampkmdirih Mmitisfaronehmdmddo0au(5100) or less.) I certify that in the Performance of the work for which this permit is board, l null net employ any perm in any manmrso as to become wbjeet se the Wonkm'Compensation Laws of California. Dam APPtiesnl NOTICE TO APPLICANT: If, after making this Ceninum of EaemPtion, yon should became wbjoe, or du Warker'a Compensation provisions of tie labor Cade, you am ,Z forthwith comply with such provisions ar this parmil that be doomed mv0tr4 ' 0 y CONSTRUCTION LENDING AGENCY I hereby grim that them is a construction lending aScacy for the Performance of > tion wars far which this penis Is issued (sec. 3077. Civ, C) QUndoes Name lander', Addmu 2 1 eanify that 1 have mad this application and state than the above Infonmadm is cont 1 agree in comply with all city and county ordinances and sou laws relating m upon the Wilding construction, and ba eby mNodm repmseaudves Of Nb city in come LIi abuve-mantiarud Ptolemy IN impaction Purposes. (We) agme to save, indemnify and kap hamlets the City M CuP ration against V2 liabik)des,judgment, casts and expenses which may in any way Oars. agalnstaatd Cly 7 in eawequcnm of the trammg of this Permit. Fl APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date le/_2 2 6-r SOURCE RPAU TI , Re -roofs Type of Roof Signswm of ApplianUCcoamcur 1h HAZARDOUS MATERIALS DISCLOSURE Wit the affluent or future building occupant sum or handle nvardous material as dcnnci by the Cupmim Municipal Com. Chapter 9.12. W de Head, and Safety Cam. Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes If a roof is installed without first obtaining an inspection, I agree IO remove Will the applicant or future building occupant use equipment or devices which anvil harardous air cmumimnu a mncd by the Bay Area Air Quality Management all new materials for inspection. Diwmt7 ❑Yes I have mad the hmandtma mm rtais requircmenu under Chapter 6.95orthe, Califor- nixHealth B SafuyCom, Scomns 25505.25533 and2353e.1 undersand that lfde building docs not cumally have aunanc Nu h u my res nsihllitym notify the occupant of ue ragmmmenuwnzh n at pdo ofa CsNnam of 9"'Pa"91 Signature of Applicant Date All roof coverings to be Class "B" or better owns urwmomraa em Dam �� c�rwi>drs • 2, NL:cv^crJd+i�. 0 SUBMITTAL 1 ECEl D AUG 2 2 2005 C -A lYoB� z�7 _ set�g ]PLOT PLMS Cmpm ails DA'a BLDG. Drr'r. , wr,iKildto UPACCORDNImCM 0, ERTlNO CODES TORDINANCES ATE_ IONEU_ ans d specifications MUS' his set ( ob at all times and it is ui x kept on the 1 changes or alteration wful to make allya[ ission tn' n same wlthou, w �tten V a tino. bu..dm3 Dep•, city of Cup 'ecificatia Ua slamP nG ci ,h s plan nit sV HAIL NOr be heal to Vomit or taoe he Bron. oproval of n Tviotatioof any V Dov City Ormnonce or )[ate law. n CUPERTINO al CITY OF CUPERTINO PERMIT APPLICATION FORM o-�-nE,ol Q 7 APN # 3 / C. o U Date: Building Address:_ Mailing Address (if different from building address): Dr (100 - Owner's Name: Phone #: on al tS G -r �� L57-- t Y Contractor: V.f�ti t �� License #: Sl 38 3s Contact:� qq r( Phone: �� Cupertino Business License#: t.JacL Fax: afb$ 2n6 -??47V Boiler> 500K to 1M Btu Building Permit Info: Bldg [$- Elect Plumb Mecb — Job'Description: Residential Commercial ❑ Sq,Ft. Floor Area: Sq.Ft.: MECHANICAL d Cost of Project: Occupancy Group: 5,.3 00o YZ3 Type of Construction. Please check this box if the project is a v f✓ second -story addition: ❑ Pro'ect Size: Standard.Q Large ❑ Major ❑ Hotel and Motel Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK 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 L-A 1of3 t 17 ��