03030091 CITY OF CUPERTINO
BUILDING DIVISION PERMT 'C®N= URS
PE41
RMIT NO.
BUR-DINGADDRESS: VANNI BROTHERS CONSTRUCT ON
8 PERMrr muE dao 3 0 0 91
OWNEft'S NAME: 914 HYDE AVE
FALK ALAN SANITARY NO.U 3 N0.
(408) 253 -7028
ARCHITECTMNOINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j0 LICENSEDCONIRACIOR'SDECLARATION Job Description
i 1 hereby drum Nal I am limm ud under providwu a Chapin 9(commencing
with Sccdon7M(RofDlvuloa3orrk Budnusand PmfcW=Co ,.ndmylicenu4
mm�ma.nae@ KITCHEN REMODEL/UPGRADE
a? Limmcasss Lk.1
Dam Conn ..n«
ARCHf1EC1-B DECLARA]ION
I understand my num Nall k,4ed m public raordi
Littnund Prufcatlonal
OWNE0.-BUILDER DECLARATION L` "--
1 amby affirm Nat I am eumpl from the Contractors Liccmc law for dm
O O following reason.(Srcdon]11515.Bttdmst and Rormdons Ca&:Any city m county
o which requires a pem,it to consto4 almr.imPmw,demolub,or rePalr any awctum
prior b ire luvana.Jere requires Ne epplinnt fpr+«M1 permit m ...igned slammcm
?'< Nar;eisllcemcd Instant,to de pmvidom of the ConuauA Ldanse law(M-Imar9 Sq.Ft.Floor Area Valuation
�.° (canoe«ingwithSction]000)ofDivislon3oftkBudnessadPmfwionsCodc)« �� $40000
3 Nat k 4 exempt Nuermm an
Ne naso r«the dmgW camnPdan MY vlClai(mt of
SeNon]031.5 by mry appllunt for.pump subjecu de applicator o a civil Family or ��y� �@ - 0 0 ccupancy Type
not room Nan Bw hundred dollen(1500). - '
❑1,as most of the pmpeny,«my eroployem win wage u thak nem eompenullon.
Mudo New«t.na Neawnme4noNnmww«ortemd r«nm(s«.]B4a.Budrcs. 101 - FOUNI �tPC4I�'Inspections
aM pmr .1. Cads Tk Canuanors Llosamae Law dart Out apply man oww of
prup. whobull&orimpawNemun.and who damsuch wmkM1imselfortluou:Mire 102 - PIERS
.cols employees,pro Nm such lmpmwmmuam not inuamded or Offered f«ale If. 103 - UFER
bowu
av ,Ne building or Impmma
w .4 sold within.year of mmpledan.thcr
e own -
wndar will ban rite krda of moving that k did not build«impmse for Pulp=or 104 - REBAR
am.).
1,as owner or the property,am mcludvely contracting wills licensed eonuacmn to 105 - ANCHOR BOLTS
construct de project.(sec.70,14,Bmt«ss and Pmrmdnm Code:)The Conlnelura U- 106 - SEWER & WATER
coma law does no,apply It,an owmr of p opony wk bull&er Wprovm Ihemon.and.
who cnnuama for such pmjeets with a mouamr(s)Rosamund pursuant to the Conuaelors 202 - UNDERFLOOR PLUMBING
kana la". 203 - UNDERFLOOR MECHANICAL
tem enc du See B&PC(« a
3 204 - UNDERFLOOR FRAME
WORKERS COMPENSATION DSMARA m 205 - UNDERFLOOR INSULATION
M1meby affirm
umdar pmudly or P hry one of the foficall dedan0ons: 301 - ROUGH PLUMBING
❑ wand wmmdnwnacenlnas ofConammaiblmum f«woM1eraCompa- 302 - TUB & OR SHOWER
awork(oaw hchdthis permit is Wood. of Ne fab«Code.in
dm performaue of Ne 303 - ROUGH MECHANICAL
❑1 haw and will maintain Wo lurA Compnuadon Iosurano:,as,mquimd by Section 304 - ROUGH ELECTRICAL
37W offt laborCada.far tae parrmmu,ce or to work for which Nis permit 41swed. 305 - FRAME
Mr Wohda Compemadon Immurarue amu and Policy number are:
Carder: Policy No, 306 - HOLDOWNS
CERTIFICATE OF EX0vUrnON FROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
at 4se Into accurst need not k canplcud if de permit 4 for ore hundrW dollan(SIM) 309 - EXTERIOR LATH
1 certify that In the performance of Ne work for which this permit 4 issued.l shall not 310' - INTERIOR LATH
employ aro Papso.inanymanner a u m baome subject to the Workan'Cmopetuation 311 - SCRATCH COAT
laws of California.Dam
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If.akr making this Cenineam or Exemption,you should
baume erehjcl to the Workers Compensation pmvision.of the Labor Cud,you maul 501 FINAL ELECTRICAL ENERGY.
yZO rorchwiN erk comply with such provisions or this pmit"it dmmed rooked. 502 - FINAL PLUMBING ENERGY
CONSIRUCr1ONLENDING AGENCY 503 - FINAL MECHANICAL ENERGY
E4 I heohy vCrm hast alert is acomu cdon lendinS age«y for tk perfornm nm of
4 thmdm'.Nfor which Nispermhubound(Sa.31197,Civ.C.) 504 - FINAL BUILDING ENERGY
D,70 Under'sAdd 505 - FINAL ELECTRICAL
Z 4ndu'a Address
J p I cenKy Nal i law read this application and sum Nu the aft"iNormatia is 506 - GAS TEST
convct.l ague to comply with all city and county,mdiwees and stem laws minting to 507 _ FINAL PLUMBING
building concoction,and hemby autho lm mpmannudws of this city to enter upon the
�a .kw-mendomdpopety for impecdonpurpoms 0 4- F
FI L MEC ICAL
(We)egree to aw,indemnity and kmp hamdess Ne City of Cupertino against )O�9
N Iubilitim judgments,costa and uprnaes which may in any way eCme.:.last aid City
J2 In comequanceof de ranungof rids pumiL
APPLICANT UN STANDS AND WILL COMP WITH ALL NON-POINT Issued by: NG Date 17
SOURCE GU ONS.
y 2Re-roofs
eturtc Awi rt/Contramar Vol-Dano �
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ran applicant or future Wilding acuput tort or handle houdoua material ,
as defined by dm CupeNno M(�N�,
' al Co&.Chapmr 9.11.and the HcalN and Sdcly
Cade,El Yes 1553i(a)T All roofs shall be inspected prior to any roofing material being installed.
Will the epplicanl Tilding o cupadl uta equipment or&vias which If a roof is installed without first obtaining an inspection,I agree to remove
n ncom eir contaminaonned by tk Bay Am,Alr Qualify Magcmenl all new materials for inspection.
District?❑Yn Nu
I law mad tae hasardommamrudsrcquhn.undo Chapmr6.95 of NC Corm-
nisHoalth&SdcryCo4.Smiom15M.B533md]S53<.Imab dNuirRho Wilding
doe.not cunenlly les a conal Nat It la my responsibility m n dm«cup.,or Ne
requircmenu 'ch be mer pin not
of ,esm a ere cy.
Signature of Applicant Date
Ow or.nNoinrrd.gent ,m -ty All roof coverings to be Class"B"or better
4 tl ,•t� F ;W t +n- � + .k YT 1 _: 4A ,.�., '�v„y}yy
ems' t
F � ' 'Y LL.• � YJ��'a l'
O. o
In
j
tl
�� ,t ! '-� FW- 'd <n:`- . _.•gra 'a;w � c> a.
'.� � _• ,� � ,o�, � �,'� !t F'�r,�a vim°�e�� -0 .�. ., ;.
'♦ t
IYr -
7
e. J
� r i
1Trt��• r n � y4`HS �'`gin ' -
t��y�� .a �J(j� '' 4 ry ✓
r k"4
!-
17
i V. Y
r
F 4
M'7'� fin,-'''a L' • r ntir, `' " r$ .-i t 2 -�` � ��"�;.
e
j•
�TY OF CUPERTINO • ��
"T"oF PERMIT APPLICATION FORM
• CUPERTINO
APN #. O Date:
Building Address
B� `t Fn/cyAzotjr stly� c����r ��o
Owner's Name: Phone#:
1 Lgh! GL �ugl } P��'VK y06- -.4 �-6620
Contractor: License#:
Contact: Cupertino e s i nse#:
Nie ,+Nit!/ \14-mv) i5", kF/"
Bu' mg Permit Info:
d Elect Plumb Mech
Job escription: �r
Residential C- m c
Sq-Ft. Floor Area: /Sq.Ft.:
Cost of Project: Occupancy Gr
CSD ZS
Type of Construction:
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
BBOILERS 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 Svcs600V<=200A ELECTRICAL
BENERGY EnergyBUILDING
BENERGYADD. Ener Add Multi BUILDING
BINVESTIGA Investi ation fee BUILDING
BMITIGATC Comm. Housin Mit. Fee BUILDING
1 of 3
CITY .OF CUPERTINO
CUPE
""f�TCTINO PERMIT APPLICATION FORM
QuantityFee ID Fee Descri tion
BMTTIGAI-RFee Group
Res. Housin Mit Fee BUILDING
BMNEWMULTI New Mylulfi-Familly Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
13NEWMULTI UCOMME Multifamil Res ELECTRICAL
B New Comm Electric ELECTRICAL
BNCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamil Res PLUMBING
BNUSFD New Sin le Family Res BUILDING,
BOVERTEVIE Ins ection Overtime BUILDING
BPBACKFLOW Atmos heric Vacuum PLUMBING
BPCESSPOOL Cess ool PLUMBING
BPERMFEE Bld Permit Fees BUILDING
BPFIXTURE Phl 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 Re eat Fee 1BUILDING
BPREPIPE R__;__ ^r,- t PLUMBING
BPSEWAGE sewage Disposal
BPSEWER Sewers
BPSPRINPLUMBING
K Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen
BPVENT Tra PLUMBING
Alt of Drain 8i Vent PLUMBING
BPWATER Install/Alter Water Pi e PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAg A/C Units<= 10,000 cfin MECHANICAL
13REMAPPLI A liance Install AT,
BREMBUSWAY Remodel Buswa s
MEIN.l ELECTRICAL
BRE
Li tin Fixtures ELECTRICAL
BREM �FIRelocation of Furnace MECHANICAL i
BREMFURNOV Rel-Furnace> l OK btu
BREMHEAT MECHANICAL
Heater Installation MECHANICAL
BRENHNHOOD Installation of Hood
BREMMISCMECHANICAL
Misc A aratus
BREMNRAPP Rem Non-Res A liance ELECTRICAL
BREMPOLE POIe/Platform Fixture ELECTRICAL
ELECTRICAL
i
2 of 3
I
CITY OF CUPERTINO •
OF PERMIT APPLICATION FORM
CUPEkTINO
Quaudty 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 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
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 Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3
CITY OP CUPERTINO
JHUILDING
LDING DIVISION PERMIT '-aCONTRAC'COR INFQRMt1TION
.'3Y.+s<Ss '^t.��' .r. sz+Y _ ms 's -k,d. `-�A
PERMIT NO.
_
ADDRESS: VANNI BROTHERS CONSTRUCT ON
PERMIT ISSUE 16) 0 3 0 0 91
'AME: 914 HYDE AVE
FALK ALAN SANITARY NO. NO.
(408) 253-7028
BUILDING PERMIT INFO
ARCH ENGINEER: BLDG ELECT PLUMB MECH
'Z, LICENSED CONTRACTOR'S DECLARATION JOb De$CrlptlOn
F1 Muby affum Net 1 am lim=d under pmvW=of Chapar 9(commencing '
t5j wiNBecdonlIXA)ofDivuion3of Ne Buaineu and Professions Code.erdmylianx i[ r-0NA� . F,®
' mfull In=and effect.
License chis i sec.« KITCHEN REMODEL/UPGRADE
Z
ARCHr1ECTS DECLARATION ARATION APR 2 8 2003
t 1 undcntand my plans Nell he used as puhlic mcnNa '
s
Licensed Pmressioal BUILDING
OWNER-BUILDER im reptfrom
DECLARATION
1 hereby aka but 1 1. ,Business
from the CanttntCo e:A License law for the
jO following mann.permit
703L5,Busineas and w.demolish.
Code:Any city nr county
'vii poo o mqulms•e,also
re cores the alter,improve,h permit
t m repair any ned staucture
tement�y dombe its!seance,also requires dm applicsffor wehpmmitmiem. ow(Cekmcnt Valuation
amp Nu he is licensed pursuantNdu:pmvisloaortheConacmr'sLianalaw(ChaptuY Sq.Ft.Floor Area
-� (commencing with Section 7")of Division 3o(the Busincas and Profusions Conk)-1 $40000
that he]s ucmpt Nucfrom and the baro for the alleged exemption.Any violation of
Session 7031.5 by arty applicant for a permit obje n;the applicant to•civil penalty of p� _ 0 0 Occupancy Type
rat more than Rw hundred dollar(5500). _ _
1,u awns of Um prepr+ty.or my employees with wage u dclr sok compcnsstlon,
.111 do the,work and NeaWCWrelS unintended car offered rental.(Sec.701 Business 101 _ TPOTTTTr ss,�s�,,1rin$Inspections
and Profuilons Cuda:The Contractors Lit—Law does rot apply N on owner of P V NEW y.•O 13
pmpenywho hilldsor barrows themon,and whodoes such work himselforthmugh Ms 102 - PIERS
swnemployeu,provided thatwch lmprowmenu am novisioned orafferW foruke lL 1O3 - UFER
h..,.the building or impmwment is sold within one year of comPledon,the coma
builder will have the burden of prodng that be did not build or improve for purpose of 104 - REBAR
alcJ.
1,as aware of Ne property,am acksiwly contracting.1%licensed convectors to 105 - ANCHOR BOLTS
construct the project(Ste.70aa,Business and Prurearmas Cade:)The Contncter'sLl- 106 - SEWER & ' WATER
cease law docs not apply to an owner of property who builds or barrows theater,and,
who conuacufor such projects with.mntrxtor(U]!caused parson N the Convectors 202 - UNDERFLOOR PLUMBING
Licensee 203 - UNDERFLOOR MECHANICAL
axe t du Sec. .B&PCfm s
MT 204 - UNDERFLOOR FRAME
tl WORKERS COMPENSATIONDECLARA m 205 - UNDERFLOOR INSULATION
( hereby affirm under realty of perjury one of the following dcelnatioa: 301 - ROUGH . PLUMBING
in and will maintain a CanRcam ofConxnuo self-Nsure for Workers Cmnpen- 302 - TUB & OR SHOWER
anion,u provided for by Section 3700 of the labor Cock,for the performance of the 303 - ROUGH MECHANICAL
work for which this permit is issued.
p 1 hale and will maintain Workers Compensation Insurance,as moimd by Section 304 - ROUGH ELECTRICAL
3700 of the labor Cade,for rite performance of the work for which this permit is issued. 3 05 - FRAME
My workers Compensation I..=caner and Policy number art:
Caner. PolicyNo.: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION ROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(ITk section need not her completed it the Permit is for one hundred dollars(SIM) 309 - EXTERIOR _LATH
or less.)
employ mutiny that in thern in anymanne of as work for which Nis permit is lured,I shall not
310'. - INTERIOR LATH
Lowsoenyperso ymennnwasN become subject to the Workers'Compensatlor 311 - SCRATCH COAT
Lows of California.ia.Dow
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If,after making this Ceniftate or Exemption,you omm
become subject to the Worker's Compensation previsions of the Labor Code,you most 501 - FINAL ELECTRICAL ENERGY
Oforthwith comply with such r wisinsorNnpermitshallbedammedmwlad. _ 502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby aRrre that some its construction lending agency for dm performance of 504. - FINAL BUILDING ENERGY
7 the work fur which this permit is issued(Sec.3(1 Civ.C.)
4pLerdersName
Emotes Address 505 - FINAL ELECTRICAL '
O,z -
C) I cenfy that I how read this application and[hire that the above information I, 506 GAS TEST
correct.I agree N comply with all city and county ordinances and sum lows mining to
507 - FINAL PLUMBING
building concentration.and hereby authorize mposmatimes of this city m enter upon ftU ahowomentioncd property for inspection purposes. O - F I L MEC I CAL
yd (We)agree m sue,indemnify and kap harmless the City or Cupertino against O 9 permit. - F I
z
liabilities judgments.toss and upensu which may in any way accrue against aid City /ff/
APPLa1CwANTeUNNe STAt inNDSor IhisAND WILL COMP WITH ALL NON-POINT Issued by: 5 NG Date
SOURCE U ONS.
-Al7 2Re-roofs
oto.o App umi/Cmun ctor Doc I
.
HAZARDOUS MATERIAIS DISCLOSURE Type of Roof
Will the applicant or future building occupant store orhandle hasrdous material
ad by the Cupertino M(N�',
' el Cadc.Chapter 9.12,sd the HeJN and Safety
( Sa0on25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu WIII Nc applicant Tuilding meupanttau cyulpmcnl or devices whichIf a roof is installed without first obtaining an inspection,I agree to remove
.raNna.it m nsomm efined by the Bay Am.Air Quality Management all new materials for inspection.
rai=n
❑YesN°
I haw read the hsardas mamriallumnimmcnts under Chapter 6.95of the Cslifm.
nia Health&Safety Code,Sections 25505.35533 and 25530.1 undershind Nuif the adding
drcoycuimnomt ccnuunendya consNlomy mapopubdity w n hoccupant of the
h a4mel, f
Signature of Applicant Datea
ow aaNammdagmu - to -t�
arAll roof coverings to be Class"B"or better