06070199 CITY OF CUPERTINO , $' a+yO+�, '
BUILDING DIVISION PERMITvlv?�.Ltea�Q `liT,L"� �0
tea, a3+,x^ ,vi??� 1 sa ,A+7&WT
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BUIIDINO ADDRESS: v VEGA PERMITN0.O6O7OI99
20352 GILLICK WY
OWNER'S NAME: PERMIT I SUE DAIS
ARTURO VEGA 07/28/20
06
E: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMO MECH
t� 1
X00 LICENSED
CONTRACTOR'S DECLARATION Job Description u I h,mby affirm Love I am licensed under provision of Chapter 9(commencing
in'ullll fmx f70M)of Am (�1Nnon7o(dm Business andProfession,Code.Wmylicena is KITCHEN REMODEL NON .STRUCTURAL
uconmaasa Lic.0 -
i Dam r
Connsm
Iy- ARCHITECTS DECLARATION
i eT U I umcmand my pow Nall be usW u public moods
8G 0,mum ftffwmmnal
a3 OWNER-BUILDER DECLARATION ,
1 i I 1 ncrehy alarm that 1 am wempt from the Contractors License Law for the .
00 following moan.(section 7071.5.Business and Professions Cam:Any city at county
j39! which requires a permit m cartemet,slmr.improve.demolish.or repair my Rruttu m $8000
•zi prior m its 4smmc,also requites C,applicant for such permit he Om a signed sutemanl
8
that lsislicensed formed,mthe provisions ofthe Commutes License Law(Chapta9 Sq.Ft.Floor Area Valuation
8 (commencing with Section 7000)of Division 7 of lust Business and Pmfwions Coast)or
that he 4 exempt therefrom and the basis for the alleged emmp0on,Any violation of
Section 70713 by airy applicant for a permit subjects the applicant m a civil penally of Occupancy Type
net mom Nan Ove hundred dollars(SM
❑.t u owwrof tiie pmpwy,m my ttmpiayen with wgw u dick mm compensadw,
w d Profession
C d e;The tumtsmez License
Law ed apply
W s1.Butlneu Required Inspections
propertyand Pm(eWPw Gado:The Dailammr{Lkell6e law does cot apply ir an owmr of 9 P
mem who .p miml" Maroon,andsobametstenworkbi ofremthroughs,4
ownemployer,provideddesamuimpssold wit amml leadedmolfetec fm axle U.
however.the Ono,th gea Mrs of prom 4aold within oro year ari m rove fors.pse manes,of
builder with Nva tiro hvrdan of proving that K did nm idle m Improve(a purpose of (1��7�'
sate.). c tl AL
L u ower of the property..B exclusively contracting with )need sucamears m Ary D
construct the pmnot ply 7014,owner
of am property
whdoas cmc:)»m Ceoem es.u.and
^fglfb pfut7'L'
causewho c law caw not apply c an owner of property who hdWa or ImPmw Comm.ane
who coronets for such projects with acontrecmr(a)licensed punwnt m the Canemmra
License law. Pvsl
❑Tom uempt on tt 9ea Data mIld, .'V ��� ZUOu
was
Data
WORKER CO SATION DECLARATION
T hereby alarm under penalty of perjury,am of the following declamations:
amend will mdnWn•Certi0namal Cowem m self-lecture for Worgers ComPem `v`V•J ttjsss UII htJ I,t�+v
n,u provided for by Section 7700 of the tabor Cattle.for the performance of the
work for which this permit is inure.
❑1 have am will maintain Workers Compenwion Wenn.u mquired by Section
7700 arum Lamm Code,fm the pttfmmance of the work foe which this perch is Ismael. .
My Workers,Compewuioo foursome carrier and Policy number am:
Canter, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M completed if the permit Is forme,hunddedmilare(510(1)
otiose.)
1 unify that In Lost perfort of the work for which this permit Is 4m,d,I"I not
employ any pmmn In any mwmrpp /dfi9breesia bject to the Workers.Compensation
Laws of California.De•0,• (/�/LR 22
A,�Plkma � - —
NJTICE TO APPLICANT:If.%nor ttuting Quis Cerribwm of Emmplian,you should
become subject te the Workers Compensadan previsia,of Use Later Cmc,you mow
v,O fanhwilb comply with Such provisions Or Cis Permit Mill be dccmed revoked.
Z H CONSTRUCTION LENDING AGENCY
t:. 1 hereby a riime thou them 4 a emiwaTim lending agency for die pulcommea of
a> the wale for which this permit 4 issued(Sm.7097.Cir.C.)
aQ Lemdera Num
7 Z
Lenders Address
U Q f certify that I neva mad Ws appiiwien and sum the the above information 4
Lis F correct.I agree to comply with all city and county ordinances and Nam laws relating W
Q U building construction,and hereby utnodm reptesematives of this city to enter upon dm
Lkl above-mentioned property for inspection purposes.
W (We)agree to save,indemnify and keep hamsters the City of Cupertino against
rat Cn Iiablll0u,judgments,casts and expenses which may in any way accrue agalnaamid City
U,x In consequence of the grinding of this Pstmlt. {±
"-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE=716Z
E��ULrrTIONS.
,rG„f� , �� Os Re-roofs
Signature of AmlianlfConeamarr a�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fmure building occupant store or handle haallow material
as de0nstd by f Cupertino Municipal Code.Chapter 9.12.and tic Halth and Wary
Cam,sermon 8552(.)7 No All roofs shall be inspected prior to any roofing material being installed.
)1T 0 you
Will the applicant or fuaare building occupant use equipment a devices which If a roof is installed without first obtaining an inspection,I agree to remove
hemolous air contsminants u Jutland by the Bay Arm Air Quality Management all new materials for inspection.
u ct7 ,[
Oyu .SLN
su
1 have mad the hoaNnus muteda4 requir,mems under Chapmrd.97ofine Califor-
nia Health&SafayC d%Sectiau 25505,25533 and 8574.(understand Nati(the building
does not currently have a mnanL that It Is,my responsibility m unity die occupant of Cc
neRulmmmnaaw bmwtbcme minunaafaCcrtimamafOa Signature of Applicant Date
02a — ®lazom All roof coverings to be Class"Bt'or better
Owner or wtharvmd agent g
CITY OF CUPERTINO �' ^iia• >?r" �'� `'' "�'"
BUILDING DIVISION PERMIT .CUNTRC'�ORI1Q
BUILDING ADDRESS: ARTURO V EGA PERMIT NOO 6 0 7 019 9
20352 GILLICK WY
OWNER'S NAME: - PERMIT ISSUE DATE
ARTURO VEGA 07/28/2006
E, SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHI?ECTYENCINEER: BLDG ELECT PWMB MECH
0 0 0 0
Z LICENSED CONTRACTOR'S DECLARATION
1 hmm Nam
eby affirm 1 licensed under pmvidm oof CluPly 9(nemmcaMl Job Description
6 with kfall�farteanE�e1foct. nJofNeBusinrmam!PmfesuamM
Code,amylkenmis KITCHEN REMODEL NON ,STRUCTUR.AL
Z
LicaClass Lk,
Is
Dam Conuaewr
ARCHITEC77S DECI.URA71ON
Q lundersand my Plans.hall be red n public recnNb
�U
{� Licensed Pmfesdonal
t3
OWNER-BUILDER DECORATION
0 I harchy aRw(Section n 1 am exempt from tPr f snuactah LiAny taw for the
1 o fallowing tensa.amoutRn I.S. .area.borrow.
Prow.dons 1i Coda:Any air s retwayectme $8000
j
i which rtquima n Pamir w connneL Wm.improv,demolish,ri mpdr nY mucrum
pdawiu issuance.also mquirta the aPPliunr for such permitwfikasigned swcmpt Valuation
D thu beds Ikenspd purcam w the provision of the Comment License taw(Chapter 9 ESq.Ft. Floor Area
:9 (commeming with Section 70D0)of Division 3 of Ne Business and Profpdam Cnde)m
.
that he k esumFt themfrmn and Ne bask for ma alleged esempdan Any victlWun of
Section 7031.5 by any IPPlinnt for a permit subteen the APPlkant c•civil Penalty of Occupancy Type
.or rmc Uta 0w hundred ddlart(SM
o 1,as owner of tic property,or my employees wish vales so their cin emnpamtion,
will ao the watt and the sauttme is not intended suffered her sale(Sec.7DµBmbsess Required Inspections
and Profeadom Cade The Commences License Law does ml apply w N owner of q P
property who bold,cr improve+thereon,motorist does.uchwork himself a Ihmugh his
ow employees,provided that such imPmommanu em not Intended manned fmaak.If.
Mild r the building errdes of pmsul kaold within atm yen mea ec'm Imon.Ne owe ar9
builder will haw tite burden of proving Nn he did wt Oink a tmprwe(a purposed v,
rain.)./
1,u awns of the Sec.70 mea exclusively sand combatting with license eommuel e
construct..La d project(Sec.seas,anoNmandn,who he Come)The.decuse.Li-
come law dons nm apply w%owner of proper,who med p or Impmws 0mep,led, O
who contracts for such prokcu with a canuactor(q licensed pvauenl a the Contranoh
License law. jo
I.eumpt undo SeeBd:PClm Nk uan
Owner 2������� Date
7�370 /r WORKEHS COMPENSATION DECLARATION
1 hues, M.under penalty of pmjmy arc of the following dedamume
1 law and will mdnWn a CeniOmm of Comem a nH-insum fm WarnesCarmen-
0()
an,u provided fur by Section 3700 of me Labor Code.for Ne Performance of she
k for which this pmm11 is usned.
I haw and will malnuu Wormer Compenwion suunnaas required by Section
of Ne labor Code.far s e perforr.^�-dNe wrk fee which Nin permit k Issued.
Wasters Compensation human mania am Policy number sm:
Carder'. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This aec0on need not he completed If the permit Is froom hundred dollars(SIn(r)
m ler.)
Ir;cm( Not in the Performance of Ise work its which she penob is finned,1 Sul am _
employ any person in my nn gAbccom� llbjeelwNe WartM Compensnioo
Laws of Calillmia Dau �aw-�
Appllonl
NOTICE TO APPLICANT:If.after raising Bill Cedncate of Ewmption,yw thmlm
became subject to tite workers Campcm.don provkimu of Ne labor Code,You moo
O forthwith comply wish such providom or this permit shall be deemed rtwked.
�= CONSTRUCDON LENDING AGENCY
t Ibeeby ofRmlit ,Vert is a cotulmNen Waling armor far use pafamaacuf
'> Ute wart for which Nin permit is issued(Sec,3097.CN.C.)
I 0 Lenders Name
z Lembse.Add..^
)0 1 mrdly met I haw end No application W atom Nn Ne shove infolmatiun k
H correct.I alms to comply with all city and county on immv and sum Im minting w
jU building construction,and hcmby.uthodw mpmsenounct of Nis city to enter upon the
r W .hove-mentioned property for impcctian interposer.
(We)agree to now.indemnify and keep harmless the City of Cupertino sgdmt
t i;n IiWIIItieAJWlmpu.ensu old ops•^•whichmayinanYwayaess, aphmmid Gty
)z in consequences of dm gr on ial of this permit. -7- Ct^
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date GG2
SOURCERUES LOTIONS.
�„ del '®s Re-roofs �1�--'—
Sllnmureeof AmplicanUConlmeer- bato
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding ocoup.m A.urhandle hasudom maWial
n dunned by Ih Cuperltna Municipal Cods.Chapter 9.11 and the Health Most Way
Sees.25532(x)? L All roofs shall be inspected prior to any roofing material being installed.
CY. pD No
future building assassins use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
Will tin applicant or
r11 hwadous air conumimnts n defined by the Bay Asp All Quality Mrum all new materials for inspection.
District? 18i
❑Yes 18 No
I haw most she hnartlmumwrkkmquimmew under Clupeor 6.95 of Ne Collins.
M.HcalNb.salmyCode.Sectines75505,25533 uv115534.T uMemand NuirNe bokinl
dao let cumntly haw a tenant.Nu it k my responsibility In nmifY use aCCupinl of the
ragdmrenuw hentmbeme wissumcaar.cmdrtpte afaaP�`' Signature Of Applicant Date
���� '^— � /� All roof coverings to be Class"B"or better
Ower err suthor'usd a cm
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36936010 . 00
DATE ISSUED. . . . . . . : 07%28/2006
RECEIPT # . . . . . . . . . : 35423
REFERENCE ID # . . . : 06070199
SITE ADDRESS . . . . . : 20352 GILLICK WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ARTURO VEGA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ANJALA MANGAL
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : ARTURO VEGA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
• TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---- - ----- ---------- ----------
BENERGY PERMIT FEE 147 . 96 71.. 02 0 . 00 71 . 02 0 . 00
BPERMFEE VALUATION 8 , 000 . 00 147 . 96 0 . 00 147 . 96 0 . 00
BPFIXTURE UNITS 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BPGAS OULETS 1 . 00 5 .40 0 . 00 5 . 40 0 . 00
BELEC200 METERS 1 . 00 29 . 43 0 . 00 29 . 43 0 . 00
BPLANCHK PERMIT FEE 147 . 96 197 . 45 0 . 00 197 . 45 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BREMFIXT NO. FIXTURES 6 . 00 7 . 20 0 . 00 7 . 20 0 . 00
BREMRECEPT NO. OUTLETS 16 . 00 19 . 20 0 . 00 19 . 20 0 . 00
BSEISMICRE VALUATION 8, 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 602 . 57 0 . 00 602 . 57 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- - - ---------- ------------------
CHECK 602 . 57 1103
TOTAL RECEIPT : 602 . 57
T
�QQ CITY OF CUPERTINO
CUPEI�F PERMIT APPLICATION FORM
APN# 2� ,�_� ^,OI� Date:
Building Address: 2 D 3 5 2 I L L) C WAY Mailing Address (if different from building address):
. C- U (2EK71wo CA 9SG14
Owner's Name: AR -r U R 0 V E'G R Phone #: 40 9 - p7 9-t+2 3
Contractor: L I USS RD'S ENT IAL C'pA/SrKualnAl License #: e- l 7525
Contact: �68 - 205 , 0 79& Phone: Cupertino Business License#:
Fax:
Building Permit Info: y N Iq b—Mo.�EL , /Ut)N - S7 -
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Descrip io
Residential Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: t� K Occupancy Group:
2 - -3
TA�ofConstruction: Please check.this box if the project is a
second-sto addition: ❑
' Pro'ect Size: Standazd' Large ❑ Major ❑
QuantityFee 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 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 Svcs 600V<= 200A ELECTRICAL
BENERGY 71 Energy BUILDING
BENERGYADD IEnergy Add Multi BUILDING
BEWESTIGA I Investigation fee BUILDING
1 of3
T
(� CITY OF CUPERTINO
CUPEkTINO
PERMIT APPLICATION FORM 9
QuantityFee ID Fee Description Fee Grou •
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housin 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 Storm/Rain Water PLUMBING
BPTRAP Kitchen Tra PLUMBING
BPVENT Alt of Drain &Vent PLUMBING •I
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
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREM13USWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
MABREMNRAPP 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
I BREMRESAPP Remodel Res Appliance ELECTRICAL
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