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
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�!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
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