04070023 CITY OF CUPERTINO
'AXCT 0 nC%
BUILDING DIVISION PERM O XON -4
T RjNF0,1KM N
UILDING ADDRESS: SULLIVAN CONSTRUCTION PERMIT NO04070023
9385 GREEM100D DR
OWNER'S NAME: PERMIT USSUEDATE�
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NER S NAME:
I - L
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KEVIN & ALEXANDRA KASIK 960 OPAL
SANITARY NO. CONTROL NO,
ONE:
(408) 247-2147
BUILDING PERMIT INFO
ARCHITECTIENGINEER: SLOG ELECT PLUMB MECH
is
nat, LICENSED
co
ICENSED CONTRACTOR'S DECLARATION Job Description
to❑ U
I berb,tiffilin the'I ton licensed order provisions or Chapter 9(Ionamemn't"ll
iWw Seen y)r, of,.,..
with Liccnu .n fDivisioyof BusumusandiProfessiotmCouk.ime! B
.wm tiff paress.. ,g
iffiSection: )a live
LjS -13 REMODEL KITCHEN/2 SATKRMS/GAS PIPE TO RANGE
Due-Ccothelor
ARCHITECTS DECL`
p-/ lundcra an.s]bill W te.odes � 2 pd�ltiv.t
,.r Licensed PreMsaltimm
04NER-BUILDER DECLARATION
eI
I Moth,offine Out I.m exempt remost the Contractors License Low for the
0 following icatim.socumn 7(31.5,Business and Poxfossimm Cmlc:Any cUYm county $25000
E which requires a Formil It,Christi alter,improve demolish.ore any structure
poor to its hounnoc.also notitures,the applicant forsuch permit to rile aoilined statement
that he is licensed pursuant to the prOvoloses of the Commactur's Liecrise Law(Chapter 9 Sq.Ft.Floor Area Valuation
1-C mmanionem,with section 7110(1)of Division 3 of the B.domeorid Poffossi-na Code)to
Na'he a exempt ths.firmin and 00 Were;for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant 10 9 Civil penalty Of er0 0 Occupancy Type
mat mom than rim hundred dollars(S500).
0 1,as owner ofthe property,or my employees With wages ad their sole compensation,
will do the mod,and doo,truettim is notbructided or offered forsam(Sec.70".Business
and Professions Code:The Contractor's Larxime Law does not apply to an Owner of Required Inspections
property who Wilds or improves thereon,andwho doessuch work himselfor thomigh his
Own employees.provided Oat such improvements we not intended arroffered forstalks.If,
however,the building or improvement is sold within one year Of completion.the moom'
Wilde,will have the hard.of moving that he did mil Wild or improve for porpmeas of
aalt,.).
1.as owner of the property.am exclusively connecting with licensed ounexactoes to
mmwc the project(Sec.704,1.Business and Prumssimis,Code:)The cmus.tr'.Li.
more Law does not apply to an owner of propony who builds or irommms shirrimn,and,
who contracts for such projects with a citintraCeiros)licensed pitionsima 10 Ove Contractor's
License Law.
0 1 amexempt Under See B&P C forr this Mason
own. Data-
WORKER'S COMPENSATION DECLARATION
AmI hereby affirin under Penalty of perjury one Of the fallowing decurallons:
IWO I have and will maintain a Cenificate OfCOMCOL M self-uresur,for Worlatescourripsn.
isatimi as provided for by Scotian 37W of the Ube,Corm,far the refftimmexam of the
nwork in,which this permit is issued.
0 1 have and will maintain Worker's COMerounion insurance,as required by Section
37w or the Labor Code,re,Use performance of do,work for which this Permit is issued.
MyWmkoesCm.
c .jo
RTIFCATFOPEXEMPTIONFROM WURKERS*
COMPENSATION INSURANCE
(This section need not k completed time permit is forchic hundred dollars(SIM)
or Irs..)
ce carticr and Policy number art: ,�
I o,off,out in 0.Nff.....r
the work far which this Permit is issued.I shall mU
employ.,person in any manner so U to WOmom subject to the WOTImot'Cisairentathan
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:if,iffle,making this Cenificat,Of Exemption,you should
become subject to to Worker's Compensation poevisions Of me Couir Code YOU Most
Z forthwith comply with seen Provisions or this permit sbull he'deemed mmla.d.
zo CONSTRUCTION LENDING AGENCY
`Z' I hemb,Uffion on,derm iso emearestinn lending ag,mo,to,he 11frotionce of
> the work for which this pi,pand is issued(Sec.3097.Civ.C.)
IA Q Undoes Name
lender's Add.
Icoolly that I have mad this application and state that the above inforoustimn is
U. Co.".,agree to comply with all city and county ordinances and seem laws muting to
building construction,and hereby juderam,mpre,culative,of this city to enter upon the
CSl tuotwo-oventioned property far inspection purposes.
(We)agree to an.indemnify and keep harmless the city or Cupertino against
liabilities.judgments,costs and expenses which may in any way accrue against said City &3,
U Z in consequence of the gronong Of this permit. Dille
APPLICANT UNDERSTANDS AND WILL,.COMPLY WITH ALL NON-POINT Issued by:
TR
SOURCEREG
sign me I - r - "// , Re-roofs
pplicamUCentraCtor Dam
HAZARDOUS MATERIALS DISCLOSCR Type of Roof
Will the applicant or future building Occupant store or Me toteam..,insucri.]
as defined by the Cupon.r.Muh C' 'I Code Chapter 9 12*and the Health and Safety
m be Health and Issued by
Re-roofs
Code,Section 25532(a), Safety All roofs shall be inspected prior to any roofing material being installed.
Oy. ;;No If a roof is installed without first obtaining an inspection,I agree to remove
Will the irphe future building occupant use equipment or desises which
,,mi,li.,,ammux air room
tied by the Bay Area Air Quality Management all new materials for inspection.
District?
Oye, Zry
0
i have rest the
'an
niz�l"SdetyCWc.�cdom25505,25533�d25534.lundcmwdmat ir0c building
Se
jdl�' not currently have a wriant,dist it is my rcsfainsibilsty,to notify the nesupsol of the
rxxpuiocommu�,� Ihich es at W I yflendiummociffac'nife...f Y.. Signature of Applicant Date
::d All roof coverings to be Class"B" or better
winter or..th.6.d agent Do,
N
• • Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
CUPEkTINO
Building De artment
JOB AL DRESS: RMIT#
0 3 ?S 0�/o
OWNER'S NAW: M R cq' W 02� r= S, " }� P P NE # yv Y - D 4/7
GENERAL CONTRACTL, L L ,' l� FAX #
I am not using any subcontractors: �M GI _ 7 -6 -O!/
Signature Date
Please check applicable subcontracors and complete the following information:
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
-0 llgr-/Coniractor Signature Date
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OWNER Mr. & Mrs. Kasik
ADDRESS 19385 GREENWOOD DR.
CUPERTINO CA. 95104 ®�
• JOB DESCRIPTION
KITCHEN
A. REMOVE EXISTING CABINETS AND INSTALL
NEW CABINETS AT EXISTING LOCATION.
B. UPDATE,ELECTRICTAL 7'O MEET CURRENT CODE REQUIREMENTS
SEPARATE CIRCUITS FOR DISHWASHER,MICROWAVE,AND '
GARBAGE DISPOSAL,TWO SMALL APPLIANCE ELECTRICTAL CIRCUITS
NEW RECESSED LIGHTING FIXTURES AT CEILING
•
FLUORESCENT LIGHTING INSTALLED BELOW UPPER CABINETS
C. INSTALL NEW GAS PIPING BETWEEN MAIN METER&OVEN RANGE
NO PLUMBING CHANGES SINK BASIN IN SAME LOCATION
MASTER BATHROOM
A. REMOVE EXISTING TILE AT SHOWER WALLS&FIBERGLASS SHOWER PAN&� PROVED
INSTALL NEW SHOWER PAN& PAPER WIRE,&CEMENT AT WALLS. C�• ANCE RH C QF
B. INSTALL ONE NEW ANTI-SCALDING PLUMBING FAUCET AT SHOWE�t
C. INSTALL ONE NEW SAFETY GLASS SHOWER ENCLOSURE CUP F II _S
D. REMOVE&INSTALL NEW LOW FLOW TOILET
E. REMOVE&REPLACE 2 VANITY SINKS&CABINET&INSTALL NEDIyj
F. INSTALL NEW GFI OUTLET
SIGN
This s 1 ans and sus MUST be
HALL BATHROOM kept on the job at all IIIIYW and III le Unlewfld
A. REMOVE EXISTING TILE AT BATH'T'UB WALLS& INSTALI.NEW PAPERtWLR�'+,changes of altefet=On NMI
&CEMENT AT WALLS. PhDU1 wnitefl permissbn hWe 8111Id111®
B. INSTALL ONE NEW ANTI-SCALDING PLUMBING FAUCET AT SHOWER
C. INSTALL ONE NEW SAFETY GLASS SHOWER ENCLOSURE DP,panment, City of CUpertln0.
D. REMOVE& INSTALL NEW LOW FLOW TOILET Toe stamping of this plan end ane
E. REMOVE& REPLACE I VANITY SINK&CABINET& INSTALI.NEW3.iALL NOT be held to panda Or t0 be 8111
F. INSTALL NEW GFI OUTLET
a•,?royal of the violation of arty provisions of
wq City Ordinance or State Law.
n• 111131 j
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OWNER Mr. & Mrs. Kasik
ADDRESS 19385 GREENWOOD DR.
CUPERTINO CA. 95104
*CITY OF CUPERTINO
CUPCITY OfERTINO PERMIT APPLICATION FORM p (._ 7 L
F
Datress:13S5 Mailing Address (if different from building address):
�r�e�e�t�l 10 . .
Owner's Name: Phone#:
Contractor: 3p I I \ License#: 4/53736
Contact: Phone: a �r?-J t k7 Cupertino Business License#:
30� :l i/th Fax:Cfl( 3 l S LI15- f
Building Permit Info: I'-1L( -'T&71
Bld (� Elect (� Plumb E Mech ❑
Job Description: ' %t�,h ✓n cu/ qas prpe w eypr, lv
,/
Residential t� RtKoc( 9� �� Z- v4/00*qommercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Dpp Occupancy Group:
Type of Constructi Please check this box if the project is a
• second-story addition:
Pro'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 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/Comnl/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
BELE 200 Elee Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
• BINVESTIGA Investigation fee BUILDING
#-
i of 3
Ccs;
OCITY OF CUPERTINO�
CITY OF PERMIT APPLICATION FORM
CUPERTINO
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 Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
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
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Li htin Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace > I 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 Appliance ELECTRICAL
2of3
i
CITY OF CUPERTINO*
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Sips 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 Insection 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 Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
CITY OF CUPERTINO "
BUILDING DIVISION PERMIT t�CONTRACTORIIN'P'URMATIONg,
BUILDING ADDRESS: SULLIVAN CONSTRUCTION PERMIT N004070023
19385 GREENWOOD
OWNER'S NAME: PERMIT ISSUE DATE
KEVIN & ALEXANDRA KASIK 960 OPAL DR_
SANITARY NO. CONTROL NO.
E:
(408) 247-2147
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ace, LICENSED CONTRACTOR'S DECLARATION
o0 Job Description
w❑ 1 io affirm that 1 am licensed under provisions of Chapter Y(commencing
�iW with Sauo )�of Division fthc Business Professions Code.end myli cnu is
in r.0 rnmc mDg3T=m. �0 ° L�S373 .� REMODEL KITCHEN/2 BATHRMS/GAS PIPE TO RANGE
n i3? Ltenu CIo!_ O� Lie.N
Zg, Da¢ Conlncbr
✓� \\ ARCHITECTS DE7";
I undcra)aoJalTy plana spell he uxJ y pU Cords
JyU I
a,y Licensed Professional J
OWNER-BUILDER DECLARATION
<� 1 hereby affirm Net 1 em exempt from she Contractor's License Law far the
K20 following mason.(Section 7031.5,Business and Proreasiona Calc:Any City or county
-6.1 which rtquirm a Neenh m CO .,.arm,,improve,demolish,w repair any svvmum
pow or its issuance.also mquime,the applicant forsuch pcumit m rile a signed statement
that he is liccnud pursuant to the provisions,of Ilse Contractor's IJn�Law(Chapter 9 Sq. Ft. Floor Area Valuation
�Fa (Coomendng with Section 7")ofDimino 3 of the Business and Profesafors Code)or
i $ that he u exempt therefrom and the base,for she almSc l Gumption.Any violation of
Section 7031.5 by a"applicant for a permit subjects the applicant m a civil penalty of 3 7af1aNQft1er0 aar eir Occupancy Type
not mom Nan five hundred dollars(5510).
❑1.asOwner,of theproperty.on my employees with wages as their ole compensation.
will do the wort and the structure is not mandod on.ReuA for sale(Sec.7044,Business Required Inspections
and Raressions Code:The Conuacwrs License law does trot apply re e an—1 of q P
property who bui Ids or improves thereon,and who docs such work himself or through his
own employees,provided that such impuaamenu are not intended at o@red for sale.IL
hmmwr.the building or improvement is Sold within one)es,of completion,he ownco-
builder wUI hese the Wide..f proving(hash did.1 build w improve fon puryasc of
a4.).
h as Owner of she property,am exclusively contracting with licensed contractors an
Consumer die project(Sec.71W4,Business and Profcssiom Cade:)The Contractors U.
Came,taw does not apply to an owner of property who builds or improves dtm.n.and
who Contracts for such pmjccu with a centractor(s)licensed pursuant to the ContracwYs
License taw.
1 am aaempt under sec. .B k P C for Nis scaaon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hemby afEno under penalty of perjury one of the following declaredom:
hst and will mdntam a Ceeufcate of Common to u1f-insure far Waher'a Compem
on.as provided fm by Section 3700 of the IaEor Code,far tit perfoonana of the
work for which this permit is issued.
1 have and will maintain Worme,Comperism..Inamence,as oequind by Section
3700of dte labor Code,for the penformanc,of the work far which thus permit is bound.
My WorkeYs CompensationjSenttr nce artier and Polity number au:
'cr �� ! ws'I Poi —"'v
' CERTIM ATEOF Pn FROM WORKERS'
COMPENSATION INSURANCE
(nissectionnecicwt be complmed dthe permin is for one hundreddollars(5100)
or loss.)
I certify thm in den performance of the work for which this permit is issued.)ahall not
employ any person in any manners,as to become object to the Workers'Comper ation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ccnifint of Exemption.you should
become subject re the Wma.r'a Compm urrim poi of the Libor Calc,you mmt
.J Z foMwith comply with such provisions or Nis pwmitahall he deemed revnked.
ZO CONSTRUCTION LENDING AGENCY
F..N. I hereby maim ohm titre is a construction lending agency for the performance.!
a> the work for which this pmmit us 097
issued(Sec.3 ,Civ.C.)
WQ Landtfs Narre
Z tender's Addm..
(�Q I certify than 1 have mad this applicauon and sot thamnniu
t the above Infon is
E, Correa I since to comply with All city and county ordinances and sure laws relating to
�fJ
buildingconstruction,toan .inde indemnify
aauthonxmprouniles, of this OfCufy to nmrupnndt
�U above-mentioned property for inspection purposes.
tigy (We)ague to cast,indemnify and kith hay in m the City of against against
h liebilities.judgmens,,costs and expcnsm which may in any way accrue against avid City
U Z in coneequenec of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL.COMPLY WITH ALL NON.POINT Issued by: ate
SOURCE REOTIONS� //
C/ r/01 /GXe5� Re-roofs
Sign rc hpunnuConmctor Data Type Of Roof
HAZARDOUS MATERIALS DISCLO
Will the applicant.,future building occupant atom or lasioHn hazardous mound
as defined by the Cupenino Mumu al Code.Chapter 9.12,and the Health and Safety
ode,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
El Yea
11 Will the applicant or!wore building occupant Sou equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air contaminants as de d by the Bay Area Air Quality Management all new materials for inspection.
vitt?
�Ycr
I have read the hanolousmatrials requiromenu mdc,Chptr6.95 of the Califor.
nia Health 5 Safety Code,Secd.m 8505,25533 wd 25534.1 undemmnd thwif the building
Vas not curtently hurC a Inmos Nat II is my rmponsihility 10 nntif the occupant of the
requirements yrhich slN ct wissuanccofe C=nifntof cup y Signature of Applicant Date
All roof coverings to be Class "B" or better C1_/
wncf r authorized agent Dam