03060116 CITY OF CUPERTINO
BUILDING DIVISION PERMIT • tsCONTRACTOR INFORMATICS
!v'.^#:,::tam.,._.,..re 1:::'�4x ✓u..,. ;;�.^ 'xS.Y�.. .�%;;�t+a. �e?
BUILDING ADDRESS: PERMIT NO.O 3 0 6 0 116
OWNER'S NAME: PERMrf LSI]€f7jA �]/2 Q Q 3
SANITARY NUO.` CONTROL NO.
ONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION Job DesCllphO❑
fP line by affirm that I am licensed under provisions of Chapter 9(commencing
`Zw `fish 5cctioO(1J10)of Division Sof the Busittet�gtd Professions Code.and my license is
In feces tome err=e I -11 L' /- j�j REMODEL KITCHEN & 3 BATHRMS
4 Z Liccnu Class j Lk.N '
^ Da ARCHITECTSD mr RA 1 — CONTRACTOR: CANNING CONST. ��
a 1 underaund my plans shall w used hlic records �./
Liu
s u. Liccnrscd Pmfcssional
`to 5 OWNER-BUILDER DECLARATION T/
1 Wrehy arfirm Nat I am exempt from the Contractors Licenx Law for the 777Ti=�ai
�aZ Q
M2-71 O fallowing reason.(Secuun 7(131.5,Rosiness and Rofcssioa Code:Any city or county
m which requires a permit m coarabra alter.improve,demolish,m repair any structure
�< iriot to its issuance.also requires the applicant for such permit m file a signed sommcnt Valuation
lls he is licensed pursuant to the provisionsor NC Contractors License law(Chapter9 Sq. Ft. Floor Area
Yom (commencing with Section 7")of Division 3 of the Business antl Professions Code)or 100000
E5§ Nat he is exempt therefrom and the basis far the alleged caemptinn.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant a civil penalty or APN Number Occupancy Type
not more than five hundred dollars($500).
Q I,as owner of Nmpen
=property,or my employees with wages as their sole cosation, 36217054 . 00
will do the work.and the swcture,isno,intended aralf=radWaal.(See.7B4n,Buaioers Required Inspections
and Pmficanons Code:Th,Comractors License law does not apply to an owner of 101 - FOUNDATION
properly who wildsm improver thereon,andwbo docxsuchwork himself or through his
awn employes,provided that such improvements are not intended oroRercd for sale It. 102 - PIERS
however,the building d,improvemem is to within one .of cumpkdon,the owner, lO3 - UFER
builder will have the burden of proving that hm bu
Ito did not or improve for purposeof
tam.). 104 - REBAR
❑h as owner of the pmpcny,am exclusively contracting with licamed anuacmrs to
construct the pmjcet(Sec.71j4a.Business cad Professions[ode:)The Contractor's Li 105 — ANCHOR BOLTS
come law does not apply to an owner ofpmpcny who wilds or improves Hereon,and. 106 — SEWER & WATER
who contracts for such pmjecm with a conmcurat)licamod pursuant to the Coavactoes
License law. 202 - UNDERFLOOR PLUMBING
0 l am exempt under See. ,B&PC for this ma:an 203 - UNDERFLOOR MECHANICAL
Owner Data 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
Ihereby anirmunder prnauyofPaduayamorNarauawingdeaaration,: 205 - UNDERFLOOR INSULATION
I have and will maintain a Cetunate ofConsen,to saf-imum for WarkeesCompcn- 301 — ROUGH PLUMBING
cation,as provided for by Section 3700 of the labor Code,ear the performance of the 302 - TUB & OR SHOWER
W
ork fur which this Kmati:issued. 303 - ROUGH MECHANICAL
1 have and will maintain Warkprs Ca d basal on Insurance,as required by Sccuon
3700 of the laver cadc.r«Ne peHaamana arth=work for whim this permit is is:aea 304 - ROUGH ELECTRICAL
My ofthe U1 ,Code.for mmrembrounceofth Palicynumwrate 305 — FRAME
mer. S:Phil <o;4P PoliFy7�1 � ° �C••02.
306 - HOEDOWNS
CE0.TIFICATE OF EXEMPTIONFROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
(This section need not Weomplemd inba Permit is for one hundred dollars(SIM) 308 - SHEETROCK
"fleas.) 309 - EXTERIOR LATH
1 certify that in the performance,of the work for which this permit is issued.I shall not 310 - INTERIOR LATH
employ any person in any manner so as at become subject the Workeri Compensation
Laws of California.Date 311 - SCRATCH COAT
Applicant
NOTICE TO APPLICANT:If,after making this Cenificare of Exemption,you should 313 - ROOF NAIL
become subject to the Worker's Compensation previsions of the Labor Code.you muse
]z forthwith comply with such pmvitimaorthis pant itshall wdeemed revoked. 501 - FINAL ELECTRICAL ENERGY
z: CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
I wmhy affirm that them is a construction lending agency for the Performance of 503 - FINAL MECHANICAL ENERGY .j
Y > Ne work 0s,which this pemthisissued(See.30n,CN.C.) 504 - FINAL BUILDING ENERGY I
1 Q Lander':
Name
Landers Address 505 - FINAL ELECTRICAL
DZ
;)C) 1 certify Nat 1 have rad this application and state Nat the above iormsnasiun is 506 - GAS TEST
correct.I agree to comply with all city and county ordinances and state laws relating to -
U building contraction,and hereby autnome representatives of this city to enter upon the FINAL PLUMBING
tea anov matian re property ran indemnify
purpose:. � 0 8 F I L
y 6 (We)agree to save,indemnify and keep harmless Ne City or Cupertino against
N liabilities,judgm .costs d expenses which may in any way aceme against said City A
jz 'tn eonmquenee r e gr?g or iy"bit. NG Dale i
.r APPLICANT U DE S KND WILL COMPLY WITH LL NONPOINTIssued by:5 / J -
SO RCE R IA //Z
(jJ Re-roofs
Si at rc o(ApplicanatConuesqdef ate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future wilding occupant atom or handle hausedous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 355320)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya XNo
If a roof is installed without first obtaining an inspection,I agree to remove
turn the applit,otorfor..building occupant are egmpmeatordevRce which
emit l mardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District
❑Yes �No
iha JN av Nnus mamrials reyuimments unJcrChapter 6.95 of Nc Califon
nialdcalrn S cry od.Secd' 25505,25533.d25534.1undcrsmnd Nmif Ncbuilding
docs not a nil be s tc}Knt,Nm it is my respnnsiM1ility to Badly Nc u:cupant of Nc
regal, c :w�eh a et ...toi..anmoraCCNfwtcofOcup '/�t
Owner or uthori'rcJ agcm Signature of Applicant Date
a ' pate All roof coverings to be Class"B" or better
Tr�l /�l�C�n/ �wloDr�L
IN p,Dr,;DRDR P RDINPNCFS
GU �GTINO o0'; �
DPTE " � MUST
$!GPlEU o pjan and sVeciiiratwns
This set bat all times and it is un.
pe kept on the chanteS or alterefoQ
law�tul to make at written Permission
wlthout . -4 cupertmo..
n nn • . I 1 ou next: .r ecm�dc,t�
the uu" : .b1 r�io • to De
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ads rr U es and it is unaf
i This et of P b-at al,tion
ra d i� I O �f� r� p° YePt o the 1 eS or alterations zt;
L'1 12 ako a v Bhang from
id�+,ful tom —rii,;,, permission
."" 00 I r \ D ori sarrre v}ri�w�JifXOt Cupertino.
c 4 I the b0109 m e PN and WecificbeoeR
, y I
',JUN 1 \263 THe staidRm� Ir i to Permit or to
NbT be ViP d rovisionr
B 3tIF1L• vial,tion
of any P
4„lt Y ?pPfb'eii of the
ne ;e or state Law.
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CITY Of.
IN fr,i.CG"P. ange
'ITWDTORDINANCE
R N CES
C'UPERT DATE
SIGNEDeciicationa Mug,it Ur
This sot of It unpo kept on1stimeor 9ltes and and tratlonslawful to m
on same without written
C t e of Cupertino from
Jr`
the building Dept., Y
r — The stampi.g of this plan and specifications
l O permit or to be en r:r
jI L4 .. f�_ SHALL NO be held to
-- `' g�pioval o the violation of any P
rovlelon9
ij at anyY'' w,
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s�efications MUST
set of o{ahs et .4limes and d is un
ch it or afterations
Invl{b ton�9ke anY ermission iLoln
Z;tHoUt Bbl Ott
Cupertino.
t e I U{It1i�zti,, dept"- i ecrf{cation'
t a §4§ .`fi� 4his I Ian a t 0 m't oc to ba e9
® tha Viol on of any P-Lovisifluv
LAWA
3teY.C1�.OLdm lu S�
JUN 1 7 -003
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Il ; ,
- C*Y OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
APN# � � P— Date:
i
Building Address:
Owner's Name: Phone #:
,�OMJnro Tr�l
Contractor: License #:
Contact: &q EE 64,V41W6- Cupertino Business License#:
GS0-7Y0-/6d1
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential ® er i 1 �
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
/dO A 3
Type of Const ction:
REMdD�L r Gil/ � .3 ,Qi9-➢'i6�/Zo0 h,S"
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
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 > I OOOA ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
Eat BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
® �, Z Z18�
1 of 3 $ Z 3 I 7
t
"- CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
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 Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
Bp NT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
J BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BR.EMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
I BREMHEAT Heater Installation MECHANICAL
BREMMHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
2of3
SCITY OF CUPERTI ,
CITY of PERMIT APPLICATION FORM
CUPEkTINO
Qw0ty Fee ID Fee Description Fee Grou •
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 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 Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,XyCONTRAQ0R`,INFORMATION:`"
BUILDING ADDRESS: PERMIT NO.03060116 3060116
02 12,9ST-1-VAL OR
OWNER'S NAME: PERMIT I5segAJ� 7/2003
7/2 O O 3
E: SANITARY NO, 1 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O o LICENSED CONTRACTOR'S DECLARATION O O O
Z C
[be In arcum Nat I.m Rcemd under provisions of Chapter 9(commencing Job Description
<U with Scctioq)g10)of Division3of NC BusinGs�gd Profusions Code.end myliccnu is ,17
in fall forceclr(derree 1 /C /- /Q3 REMODEL KITCHEN & 3 BATHIMSG�
�,t2_ Late.Claes Lk.• aq
�-; Da Co CONTRACTOR: CANNING CONST.
Qq ARCHITECTSD RAuntie
8 U I understand my plans shall n used untie records Mq 7a
Licensed Professional 2004
3 OWNER-BUILDER DECLARATION S
qy 1 hereby alRnm that 1 am exempt from to Camrecmrs License law for the sB`•YY�Ip
5cc following aamo(Sealon703IS.Businesamal Professions Cade:Any city or comny
5 si� which requires a permit to canurum,aper,improve,demolish ar repair'any,ssmcture
prior m as issuance,also requires the applicant for such permit to file a signed summon
�Z< that W is licensed pursuant to the provisions of the,Commuter's L,cnse Law(Chapter 9 Sq. Ft. Floor AreaValuation
Yl-3 (commencing with Section 7000)of Division 3 of the Business and Profusions Code)or
4 _ that he u exempt therefrom and the basis for the alleged caemption.Any violation of '$100000
Section 7031.5 by any applicant for a permit subj.0 the applicant to a civil penalty of APN Number Occupancy Type
am mom Nan five hundred della.($500).
❑l,mawnerafthe proprny,or far employe.wit.wagesu thetrmm eompeva0on, 36217054 . 00
will do be work and the auucmre is rent intended or cffmcd for We Sac.7014,Businw gg
and Professions Code:the Contractors Liana law does net apply to an Owner of 101 - FOUNDAT 1 ONd Inspections
property who builds or improves thereon,and who doesmchwork himself or,[rough his
Own employees,provided Natsuch ireprovemenu art not intended or offered forsale.If. 102 — PIERS
however,the building or improvement is said within ane year of completion.the owner-
Wilderwill have she notion of proving chat ndid non Wild orimprove far purpose of 103 - OFER
sale')' 104 - REBAR
01.as owner or the proptny,em exclmively contracting with licensed contractors to lO5 — ANCHOR BOLTS
aestmct the project(Sec.7044,Business and Professions Cade:)Tn Contractor's Li
came Law dors not pply to an owner of papery who Wilda or improves dtereon.and' 106 - SEWER & WATER
who La mfarsuch projecprojectswith aconuaam(s)liamed purswnttothe Contractor'sw. 202 - UNDERFLOOR PLUMBING
Alam exam..nod,See. .B e P C far this reawa 203 - UNDERFLOOR MECHANICAL -
owner Data 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
Ihambyarntenunder peWtyof eduryeve ordwfollowing declarations: 205 - UNDERFLOOR INSULATION
73jW
aeand will maintain a cenifieme of Co..".self-inaum far workers Co.,.- 301 - ROUGH PLUMBING
,u provided for by Section 3700 of the Labor Code,far the pcohmeam.of dm 302 - TUB & OR SHOWER
for which this Permit isissumL 303 - ROUGH MECHANICAL
ave ant will maintain Worker's Cempcuation luurana,as required by Section
of the labor Codc,for oc performance of the work for which this permit is issued. 304 — ROUGH ELECTRICAL
orkcrs Cit caNnsauon insurance carder and Policy number are 305 - FRAME
t. �; RIE <014PPolifyl�a�/ " 2—' 306 - HOEDOWNS
CERTIFICATE OF EXEMMONFROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
Trhu satiannerd not hecomplmed iftbe Foot,is future hundred delars(Slmn 308 - SHEETROCK
orlcss.) 309 - EXTERIOR LATH
I eerily that in to performance of the work for which this permit is issued.I shall not 310 - INTERIOR LATH
employ any personan
in any mor an u to u
become subjeco the WorYeti Comnstio
pean
Lawscatiromia Data
Applicant 311 - SCRATCH COAT
NOTICETOAPPLICANT:If.after making Nisvisinsof of Exemption,lyou should 313 - ROOF NAIL
became subject ro the Workers Coons ort is previsions of the Labor Code,you mus
�.Z rorthwitheomptywith mmprovi:into orth,Permit shall bedeemed rewpma. 501 - FINAL ELECTRICAL ENERGY
Z CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
I herchy WTmmthat"ere iso construction leraingegency far to performanee of 503 - FINAL MECHANICAL ENERGY
1S> Unwork(Or which lhispc[mi[isissucdJScc.J097,Civ.C.)
Lenders Nam. 504 - FINAL BUILDING ENERGY
y Q
j z L rod tsAddms 505 - FINAL ELECTRICAL
1 cenlry that I have read Nis application and sure that he above inrormadon is 506 - GAS TEST
Corea I agree to comply with all city and county eminences and sum laws relating to
U building convection,and hereby moron representatives of this city to enter upon the FINAL PLUMBI G
Y U above-mentioned property for inspection purposes
(We)agree la saw,indemnify and keep harmless the City of Cupertino against 0 8 F I L
rA liabiliti206
cuu expense which may in my way accmc against said City A
J z APDL 0 [ gOf D WILL COMPLY WITH LL NON-POINT Issued by:5 NG Date/
Re-roofs
Si m rta(ApplicmVC.mou, Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hawdous material
as dapped by the Cupertino Municipal Codc.Chapter 9.12.and the Health and Safety
Aillil6ads,Section 25532(a)T
0y. XNo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building=upon[use equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
vamnus air contaminanu m natural by the Bay Area Air Quality Management all new materials for inspection.
7.1th
[3Ycs k.'N.
the th v sus materials mquircm.nuunderChapter6.95oftheCalifor-
S .ty Secs 25505.25533.d25534.1undc.mndthmifth.Wilding
ot u np by m,that it is my responsihiliiy.nouly the occupant of the
c w ch mm rimuoissuatmo.faemific.teofOceup Signature of Applicant Date
r or eutnrimcd eg.n[ D,� All roof coverings to be Class"B"or better