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05110151 CITY OF CUPERTINOra" ` ?w t' '+ BUILDING DIVISION PERMIT CON>t'R.a,C�1'ORINF'QRIAT fl c a.¢ bt^,•o ';.�..,. ,"+ ,_seat,--' ,np;§'�,rt i w.,n., BUILDING ADDRESS: HOME PROS PERMIT N0.05110151 679 (4ARDENSIDE 21, ER'S NAME: 'PERMIT ISSUE DATE JUDY COLEMAN 245 E LAS PAT-MAR I NE: SANITARY NO. CONTROL NO, 510) 440-1609 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG O PLUMB MECH O lop LICENSED CONTRACTORS DECLARATION JOb Description luj I humby aOvm that 1 am licensed under provision!of Chapter 9(commencing with Section 70M of Divium.3 oft the Buslatu aad Professmat Code,and my liceme u nmm11tmroand ertea KITCHEN REMODEL, ADD GAS LINE, n:mmc conumor �D NO STRUCTURAL 3 ARCHITECTS DECLARATION ta 1 undersnd my plans Mall W used as public accord! U Mp Licensed Professional M OWNER-BUILDER DECLARATION A2 1 hereby aures that I em exempt from the ConaumYs license law for de aO fallowing mater.(Section 7031.5,Business and Profession Cade:My city or county SI� which.qui.;a permit in commas•aler,harem,demolish,or repro my mumu. iy prima,its issuance,also requires the applicant feamch permit"Rleaalgaed Klement C that W is licensed pummr to the provision of the COnumme,Liceam law(Chaplet 9 Sq.Ft. Floor Area Valu1*118200 $ (commencing with Section 70DO)ofDivision 3 of the Business and Prefesdan Cada)or that ha h esemps tberesam and the bash tar the alleged ernmpdm My vlolwon of Section 70315 by any applicant fm a permit mbjecs that applicant m a civil penalty of APN Number Occupancy Type not mom than It.hundmd dolhn(swan.' 36232001 . 00 ❑L"Water ofum property or my employee with wages as th.mmle compensation. will do chat work.and thestameme Is mtimended"Offered fmaale(Sec.nw.Budrcas Required Inspections and Pmfefsiani Code:The ConKca's License Law dem not apply m an owner C of q p property emplohoWumAdedthat enimprmdwmawatahwmkhlmaalr"tMaasnhis Ownner.th buiprovidedthatveme Imps»emmuartne year aedoroffered for oler- WMws.thearmtheor MptawnmlhcoldwWinot year of mp.1 .theawmr- Wilmr vriB haw dm burden of proving that he did not build"improv fm puryom of ❑1,as owner of the property un emlmlvely co tuawng with licensed cenar.7om m construct the project(Sec.70".Business and Protevian Cade:)The Cwuacmrs Li- / cense law dean net apply an m owner of pm arr"ho butuds or impmws dremon,and. who comacs for such pmjects with a contrectas(O Ranted pomace m the Conlawmes '1 l ars law. 0 pun accept undo gee .B&PCfordm mann r Data O� WORKERS COMPENSATION DECLSRATION I hereby affhm under partly of perjury one of the following decimeterrs 7---,k am and will maintain+Cewfiestaaf Consent to self-Insure for Workers Campus. .as provided f"by section 37M of um Labor ease.tar the Performana of tiefor which this permit is ianmd. ave Nd w1II mY0ta111 WMfCN COrllpmlad011 In1aMR,as RgNRd by SCCIIOr of lire tab"Cade.far thO performance of the work far which this permit s W"d. odm!y Compensation Income:ossa and Policy neumber ate: , rGi Pi?if Policy No,r]/CISo-3N-%r CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section reed mtbocamplemd if de pends isforone hundred dollen(5100) or has) I certify that In the performance of the wart for which this Feats is load.)shall rot employ any person in my manrcrm as to become subject to the Workers'Companoum Iowa of California.Dam Applicant NOTICE TO APPLICANT:IL afmr making this CaniOom of Exemption,you should become subject to the W"k"'s Compeasasion provisions of the Lab"Cade,you moa .J 0 forthwith comply with each provisions or this permit shall W domed rewked. z 51 CONSTRUCTION LENDING AGENCY t" 1 hereby 41Rrm that dam is a commuted..Wading agency for the performance of a.�.r dm work far which this permit s issued(Ser.30107.Or.C.) GQ Lender's Nauru Z) z Lenders Address V Q 1 cmufy unit I haw lead this application W Km that the ahem Information is ;^ correct t&time to comply with all city and county on it mss and arum IBM relating In QSV^ Wildingcowmction,andherebyauthosimrepresentativesofthiscityusenmruponthe Lt7 aWw-mentioned property for Impaction purposes C (We)agree to on.indemnify and kap harmless the City of Cupertino agairm .w ti IIaMlides,judgmrnunso,eoses andexpewhich may In my way accrue against mid City V z In cuuequemu Of the Swung of this permit. 's h ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUgg��gg��R��GG L• Glu^. (� //�9� Re-roofs Signature of App anuu:ter s Due HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will um appliesnt Or futmc Wilding Oermpmlam tubowie ha'umons material as dented by the Caperton Municipal Cada.Chapter 9.12.and the Health and Safety .Section 25532(a)? / All roofs shall be inspected prior to any roofing material being installed. ❑Yes QNO Will the applicant or future building Oavpam use equlpmem or device which If a roof is installed without first obtaining an inspection,I agree to remove croft becardma air contaminants a defined by de Say Area Air Quality Management all new materials for inspection. Martell El Yes u 1 have mw the haasrdous marrials mquilements under Ciupter6.9tofthe Califs. nh Health&Safety Cade.SuctiOns25w5.25333 sW 23334.l understand thalf to building does now n ly haw a Vnm4 Nu it h my reryonsihility m ncdfy the oceupans of the .qui prior Signature Signature of Applicant Date owncr err mm agrnt Dow - All roof coverings to be Class"B"or better 06/07/2006 10:46 FAX 5104401616 HOMEPROS 12001/001 Community Development 10300 Torre Avenue Cuphoner(40 C77 95014 3228 Telephone(408)777-3226 LswFax(408)777-3333 SUPEkTINO Building Department JOB ADDRESS: r PERMIT # 2UC�-7f-t 6G1(Giev�. d-e l_.r. or//o/ -r/ OWNER'S NAME: Tv D, G'vjAe4, PHONE # f 510 4e-1 U •-(b Of GENERAL CONTRACTOR: fl-ung ro< FAX# (5w)V) Lit.l G-1(i 1(, I am not using any subcontractors: cp Signature Date Please check applicable subcontractors and complete the following information 61 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencirig Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wall aper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Owner/Contractor Signature ti Date � N 8 / daE U w 1 � a� �J�� :y� mgo r b; b 49•�� 2S-' � e.p 3 A � a m M �b ..,,T 62' d1i 1� 13- 36• 2d ry s a 24.DI314W 4DI3 SS C Ny.............................__......__...� r �a p � u y i r � YS C .Bl i $ cm II i� � fZIM O0�ffiW :y V .9e � .ae -- - .ee .£4 .Bl XIL 4:w S � ' CITY OF CUPERTINO CUPE(�TINO PERMIT APPLICATION FORM DS �S N# 3 b 2 .32- b Date: Building Address,: Mailing Address (if different from building address): U �G1 Gr�2v�5 G� 2 Cr Owner's Name: Phon #:. Tv�Z Cblewxne% Q; 0lyy.Z>-(6oC1 Co tractor: License#: Contact: Phone: C�lo) 1p0--1601 Cupertino Business License#: 1M y lcm Fax:(510 NqIbl� Building Permit Info: K �G KBwtO�e(1MJ1 j jaJ,m,)N vv� Bldg ❑ Elect 9 Plumb W Mech a Job Description: Residential F1 Commercial ❑ Sq.Ft. Floor Area: q.Ft.: ofProiect: Occupant GrOUD: Type of Construction: Please check this box if the project is a second-story addition: ❑ ro'ect Size: Standard 0' Large ❑ Major ❑ Quant ity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BB0ILER2 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 J BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING • 3213 ?- 1 of 3 3 J7 iffl CITY OF CUPERTINO cuPE o PERMIT APPLICATION FORM QuantityFee ID Fee Descri tion 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 MIXTURE PbIg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interce for 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 Tra PLUMBING 7 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 BREMfAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install hfCHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Li tin Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Re]o Fumace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREAENHOOD 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 BREIARELOCA Relocation of Hood MECHANICAL I BREMREPALT Repair/Alter Heating MECHANICAL J BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 No CITY OF CUPERTINO CU NO PERMIT APPLICATION FORM 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 BSEIDUCOM Seismic Commercial BUILDING BSEISMICRE IL Seismic Fee Res BUMMING BSPECIAL Special Insection BUILDING BSVTIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEIIIPPERA4 Temporary Bldg Permit BUILDING BTEMPSVCS Trmp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING . ELECTRIC Electricil sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance 1\IECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3