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04100165 CITY OF CUPERT[NO BUILDING DIVISION PERt� sCONTRACTORINFORM,�ON BUILDING ADDRESS: PERMIT NO, POSSIBILITY KITCHENS 04100165 OWNER' AM PERMIT ISSUE DATE PRWT 1NG913N AVE SANITARY OLNO. Mop RT T Q PHONE: (408) 924 9294 ARCHITECT/ENGINEER: BUILDING PERMIT INFO. BLDG ELECT PLUMB MECH 0 0 0 .Oita LICENSED CONTRACTOR'S DECLARATION 00 lob Description i u F I hereby affirm @a 1 am licensed under provisions of Chapter 9(commencing aZu, with Section IIl(XI)nf Division 3 of the Business and Prefcssians Cndc,end myliccnsc is ,p9� in full(aura ane effect. r9ltl License Cl. Lies KITCHEN REMODEL LI"w Dau Contractor ^f toARCHITECPS DECLARATION ne I Understand my plans shall be used as public records a APR; 1.2 2005. e.t; Liecoscd Professional =0< OWNER-BUILDER DECLARATION v<S I Wool anion that I am exempt from the Contractors License law for the s p o following reason.(Scene.V21.5.Busin=s and Profcctio=Code:Any city or county ING K m which requires a permit to construct.alter,improve,demdieb,or repair any structure ',;w prior to its issuance.also requires the applicant for such permit to file a,signed statement t�'< thatheislicensedpursuanxrtheprovisionsoftheCarburetor'sLienselaw(Chapter9 Sq.FL Floor Area dal o (commencing with Saction 7")of Division 3 of to Business and Poressinns Cade)or y _ Nat he is exempt therefrom and Bre basis for the alleged exemption.Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of ,ppr�7�].�,.,�er Occupancy Type not mare Nan five hundred Odors(S500). 3 l�7 C I 10t7 . 0 0 ❑1,ss owner of the property,or my employe=with wages as their sole compensation, wig du the work,and Ne structure is not intended or offered for sale(Sec.7044,Business and Professions de:The CoContractors License law does not apply to an owner or - Required Inspections progeny who buildsor improv=thereon,and who does such work Limealf or through his Own employees,provided that such improvements art not intended or offered for sale.IL however,the building or improvement is sold within one year of completion,the owncr- Wilder will have the burden of moving Nat he did not build or improve for Purpose of sal.). 1,as owner of Ne property,em exclusively contracting with licensed contractors to emutroct Ne project(Sec.]Odd.Business and Professions Cade:)The Convacor's L4 c=ue law dors not apply to an owner or propeny who builds or unproven thereon,and who contracts for such projects wit a contractor(s)licensed pursuant to the Contractors License Law. / I am exempt idcr /� B h P C for this nuson r "/„v'I� Date ,WORKER'S COMPENSATION DECLARATION '/�/ I '-.Vthere aflnm under penalty ofperjury arc of Ne following-?ewurnho^s: J 0 I have and will maintain a Certificate of Consent to selfinsum for Worker's Compete satum,as provided for M1y Section 3700.(On labor Code.for the performance of in, work for which No is peni,is issued. 1 have and will maintain Worker's Compensation Insu mac,ss required by Section OO of the labor Code,for enc performance of the work for which this permit is issued. y Workers Compensation Insurance carrier and Policy number am : Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORK ERS' COMPENSATION INSURANCE [This section need not be completed Hthe permit Is furor hundred dollars(SIM) carless.) 1 eengy Nat in the performance of the work for which this permit is issued.l shall not employ any person in any manner so az to become subject to the Workers'Compensation Laws of Cal i fnrnia.Dae Applicant NOTICE TO APPLICANT:It..ltcr making this Ccnificau of Exemption.you should become subject to the Worker's Compensation provisions Of the labor Cndc,you must .JZ forthwith comply with such provisions of this permit shall W deemed revoked. z CONSTRUCTION LENDING AGENCY (-. a I hereby affirm Nat dere is a convection lending agency for the performance of 0: Ne walk fur which this permit is issued(Sec.3097,Cm C.) UJ 0 Umber's Name, =z Lenders Address U 0 1 certify that I have read this application and Vatic that the above iofoonadun is ' e, F curmct.I agree to comply with all city and county ordinances and sure laws Misting to 0 U an..nmentioned omni heabyauthoris representatives of Nis city to enter upon the G anove(W)ogre progeny for finemnify an Nkeep bo. (We)agree m save,indemnify and keep hay in an enc City of Cupeni to against nF.fq liabilites.judgments,cosrs and aspens=which may in any way accrue against sold City U 4Sign ” ' pe. ,. r-h D WILL COMPLY WITH ALL NON-POINT Issued by: Date ,2G Re-roofstramnr tala HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or forum Wilding occupant store or handle hmardous material u defined by IM Cupertino Municipal Code.Chapter 9.12.and the Health and Safety ColeElyoos 25532001 1rn All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building Occupant use equipment or device;which If a roof is installed without first obtaining an inspection,I agree to remove crit haaardnos air co.mminanyrs u' Jcfired by the Bay Area Air Qualdy Management all new materials for inspection. Distrix? 1 u ❑Y= I have mad huvardnas axis requiramrnn under Chapter 6.95oftheCaiifor- LcaIthd<S y ,Scc 05.25533 and25534.I understand thearthe building not cu d hit is my responsibility to nutty the occupant of the mgaiomca M g(cr�e 0liys.ance.f a Cereficauor lJccmpsoc, Signature of Applicant Date Owner ora th 3.cJagcm y Dau All roof coverings to be Class "B"or better JSpa L 1033EC-iYLtC� CGrtLu�'K�C�' Gt�i r l • -] Gly+ LILTY eltaiI OC30 U VY L CMU L" 36" 2490 fZC+�SCV < -%, WR361HEF D ✓� _ � D BE 15 ' �S4i Gugdl BD12 .3 W 27 ' �3SFoSr� .3 18 0VCA (22A 1013 N DI H. 1 2 114 W36 P 9 �16RR 7 1383 RK RRE 15 3 � ,�✓IC-C6 N� j BD12 B NLw 1r�\KVSv'r�j 3 214 26 �C S/Zf (ate B9R 3LSA6R Lt N< "ra f,qK•(b 11 24� 21 pV Ec) 09 r Wtt�+ AA ,6 28 n (� s c PccKcr bcc PSA,I a and SPasttias actd tt isVN 65 75 KD �P `o Y nSes °G�ssioc� OW 36 attn 373 B,TT] A wllbant WCC 0 0°ps��tXO S� rna. nt its Pian d�n°m S ;dyldmp p�oP an ba held anY. S SG',a N�..1na v1o1aW°�c Z� 6 32 681 - 1031 6010BACe Design: 02124104 D gno. ,mansions 8 size designations THE This is an original tlazipn and must Scale: Date 101174 n era subject to venfication on not be released or copied unless kMpier sq *.-aba and adjustment to in job HOME DEPOT Dilma Morego 1 1 applicable fee has been paitl or job D 10199 E.Estates r. condRmns. order placatl. Designer CupeNno,CA Ixm278 c I i O i ' � W I � � © d m a C n C v x U fh M s U N O ONU- / \� 6 W O Q 2 W C ® � m 2a d J ®®® o 'n E m d two x` � � U N ' M Eo EQUIRED c v t o N N O O d d C v v O N a = n yyy�����, n�• C N O � \J N 7 a W i LLI I N O I I N � N I 0 C C NC a 0 1 c a m � i N U O I 9� d > d N d E N a U N N C N C d N C N v Ed ' a ® N I I `I L O ---- N _moi i I d c I i II �I - N C • nN J a a % CX, T I I a r o :41 Q a m w w U N N Q y 0 w a I � C ,`a_ o nEora i c c 4 c v n m w c a a L O v a. M N nr� s R IRE® a a a m L r I F C a Oi . 1 J N �00000 ❑ ❑0000 Cl i ❑ 0 N a ❑ ` l! , Cl ® T TZ 0 o ! ® M N o a m o C a c c � mm �= M c a a O o i E m 2 .2. > n cI Q ma U'. , III , I I ! I � II � c I 3 0 I u xc • � � mN Ji . � ❑ ai o yl O NAV m Q d W U a o t o Q c m m aO) � o ' J O n tk\1 N a w y U � N O q C � L o a a gt N N d p N Vly O 6 a a Q ED I I I• \ O li W W Q I [h of t _o I I c o o a c 0 0 rn m � ` o i a _ y i a N o E � U J �a� o J N N C N• I w v m CI i a c M , 01 I CCS- OCITY OF CUPERTINOP c� , CITY OF CUPERTINO PERMIT APPLICATION FORM (: G APN # 3/ Date: (5 D �s—a uilding Address: Mailing Address (if different from building address): - . EST-IqT�.5 bA Owner's Name: I Phpne #: 2GD ChP( 11Mfl- Kore11 arK . s-o s—D Contractor: License #: o r 1 i- Poss;bi-,�1T �t . Contact: Phone: Cupertino Business License#: F*x: V0 9)7.2 2,0 Building Permit Info: U /� Bldg/3 ' Elect Plumb ]L� Mech ❑`�/� ` _T•ob Description: Residential mme ial Sq.Ft. Floor Area: S/Sq.Ft.: t Cost of Project: > (^ U C7D j Occupancy Group: _ Type of Constructs n: ✓ Please check this bol i project is a —� y — — — ---"— second-story addition: ❑ Project Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 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 ® 1 of 3 / (� 1 aUTfl *CITY OF CUPERTINO* CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL 14 r BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTRVIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING _ BPCESSPOOL Cesspool PLUMBING .tV f 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 rinUer/Backflo PLUMBING _ ___ BPSTORM _Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING 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 BRENLkMIAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL 2J BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > 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 • 2 of 3 (Q WITY OF CUPERTINO* CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, 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 Insection BUILDING BS WIM 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 Issue PLUMBING —=— — —— —PPLBG--- — Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3 of 3 •