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05080082 CITY OF CUPERTINO BUILDING DIVISION PERMIT ;0 RACT0R INFORMATION „ BUILDINGADDRESS: VANNI BROTHERS CONSTRUCTI orf"005080082 915 FERNGROVE DR OWNER'S NAME: PERMIT ISSUE DATE BOB & MARY KIRBY 914 HYDE AVE 11 2005 JNE; SANITARY NO. CONTROL NO. (408) 253-7028 ARCHITEC(ENGINEER: BUILDING PERMIT INFO t BO ELECT PLO MEOCH lOp LICENSED CONTRACTOR'S DECLARATION j w I hcmby affirm that I am licensed under provisions of Chapter 9(commencing Job Description ;<u, with Section 7M)of Division 3 of NC Businessand Profcuinu Code.and my licenm is oy inmOfomeandeIf e �y8' 200AMP BRAKER/WATER LINE TO GREENHOUSE j Z L¢cruc CI�r cmunscon, N MiY' ARCHfECT*S DECLARATION I understand my plans shall tie used As public rcenrtls JaU say Licensed Professional $ OWNER-BUILDER DECLARATION i<7 1 hereby affirm Nat I am cattail from Ne Cnnuacmrs License Law for the -o O following moon.(Seen..7031.5,Business and Professions Calc:Any City or county <m which requires a permit In construct,alcor,improve,demolish.or repair any structure 4 prior m its annotc,also mquima the,applicant for such permit file a signed statement ii`o that he is Retained ...a,to me provisions of me contractors Limns Law(Chapter9 Sq. FL Floor Area Valuation eh (commencing with Section 70D0)of Division 3 of the Business and Professions Code)or y Nat he u exempt IMmfmm and me bun for the alleged cumptien.Any violation of Section 7031.5 by any applicant far a permit subjecut the applicant in a civil penalty of art mom man five hundred dollars($soB). r Occupancy Type ❑I,As owner oftk propcny.or my employes with wages As their sole compensation, will do me work and the structure is not intended oroRered Actinic(Sm.7(l Business and Professions Code:The C.nuacar's License Law does not apply 1.an owner of Required Inspections property who builds or improves union,and who docs such work himself orthrough his awn employees,provided that such improvements are not intended or offered for sale.IL however,the building or improvement is sold within one year of completion,the owner. d_t builder will have she burden of proving that he did not build or improve far purpose of a� E)1. a as,me,p of On See 704,.Business udus Add contracting Cod;)Theed Tntracross i- censtroct tie pane.(Sec.n in arafand property who Cade:)The Contractors Li- ecus Law docs rnot sualeply a an owns o(propenY who builds or improves demon.and who ctunmcu for such projects vin aeonuactpr(s)li mond pursuant m tie Contractors L' Law. Iameampt.hou'..e. � ,B&PCfotnismuon Owner Dale WORKER'S COMPENSATION DECLARATION 1 hereby¢Rum under penalty of perjury ane.fine following declarations: I have end will maims).a ConfC.m.f Cnmdm to self-insure for Worker's Crmpcm ' 7'31'W.f uces,u provided for by Scioto 3700 of the labor Codd,for tie performance of the rk for which this permit is issued. 1 have and will maintain Worker)Compensation InsursnT,u required by Sceti.n tie labor Code,fo tie ptRomarn.of the work for which this permit is issued. y Workers Compensation Insurance carrier and Paliry nmberrtier: Policy No: ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('This section need not h completed Htie permit is fortune hundred dollars($100) Ices.) I coni fv mm in the performance of the work for which this permit is lamed.I shall not employ any ham in myth beWlp bjcm to the Wmkers'Compensation Laws of California.Date -s p�-Y� Applicant .4 .l4 NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to tic Worker's Compensation provisions.f tic Labor Code,you most .J C-) forthwith comply with such provisions or this Mornilshall be deemed mv.ked. Z ') CONSTRUCTION LENDING AGENCY 'rw� l hereby from that there is a crao.uon kndin6 agency In,me performance of a 7the work(ter which this potion u issued(Sec.3097,Civ.Q fz10 Landcrs Name a Lender's Address az U 0 1 certify that I have red this application and sum tan on,above information is (L F^ correct.I agree to comply with all city and county on inane¢and sum laws relating to O V building construction,and hereby eumome representatives of this city to enter upon the r W above-mcnomicd propcdy for inspection pugwses. (We)agme to save,indemnify and keep harrnleat the City of Cupertino against F'rary liabilities.judgments,Cosa and espmucs which may in any way see=against said City U in consequence of me granting of this Tcmit. ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Datef— SOURCEREGULA Re-roofs -�` Signature of Applicaro Comr ctor Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will On applicant or future building occupant aim or handle hverdous material As defined by tW Cupertino Municipal Code,Chapter 9.13,and the Health and Safety C.Jc.Scnion 25532(¢)?� All roofs shall be inspected prior to an roofing material bei. 71 Yea Q . P P Y g g installed. Will the applicant or future building Occupant use cquipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hvmdnu air contaminants as dcfned by the Bay Area Air Quality Managcmcnt all new materials for inspection. 7DIShol?❑Yes ,S. 5,MS55WidingHrulth&ently Code,tendon.255 u5, ity res J25534.Ito wdfMmazifuc Wilding notcurtcntly have a tenant.Nat itumy respxansihilitY m roufYted occupantoftheuimmc .wwh/hicnm.tr pnrmirs . tur,certrT pratapam. Signature of Applicant Date caner or authori'reJ agent new All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue Cupertino CA 95014 aaw�\ Telephone(408) 777-3228 SCITY OF Fax(408)777-3333 UPEkTINO BuildingDe artment JOB ADDRESS: PERMIT # 9/5 FerN r-oVe. -Dr • O�—O e 2 OWNER'S NAME: Zd56 K,� b y PHONE # 60-5--S1.5-7 GENERAL CONTRACTOR l// tj'M,,��, ,7 FAX # AS-3--2o,-,? I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following ' ormation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting ® Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile � Owner/Contractor Signature Date J n� CITY OF CUPERTINO o S--o&-c-6,f L CUP TYOF O PERMIT APPLICATION FORM N # 27S 3 q OS� Date: p_! 1- OS— Building Address: Mailing Address (if different from building address): Owner's Name: Phone #: (fah Contractor: License #: Awl,v 5-3-22-9 8 Contact: Phone: Cupertino Business License#i C,/ / Fax: 183 o-7 Building Permit Info: Abp rc kc4,c�/ op air<o lees $ w"�� ! ^e E'4'54"`f 1imkSP• Bldg ElElect E� ' Plumb 8" Mech ❑ Job Description: Residential [' / —' Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 4/0 ed Occupancy Group: Type of Construction: I L;Ja-te-r V Please check this box if the project is a second-story addition: El ro•ect Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K 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 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 Flee 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING tof3 3 -- 72- � Q-- CITY OF CUPERTINO cl OF PERMIT APPLICATION FORM CUPEkTINO Alk Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb 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 Re i e Of Fixtures PLUMBING BPSEWAGE. Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo 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 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace 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 Ap liance ELECTRICAL 2 of 3 �!Lfi�affla CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEIZTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmd] 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 Inspection 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—" —Plumbin-PesmifIssue PLUMBING -- PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3of3