05110126 CITY OF CUPERTINO rifr: :>" '� "3«*'^ •"
BUILDING DIVISION PERMIT C,''<StN rji . T�Q..
BUILOWO ADDRESS: FARKAS STANLEY R AND HIL �D-05110126
92 HOTJANDT?RRY 2T,
RS NAME: PERMIT ISSUE DATE
FARKAS STANLEY R D L Y J
NE: SAN FARY NO. CONTROL NO.
ARCHITECI'IENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Q Q
18'66 LICENSED CONDUCTOR'S DECLARATION lb Description
1 hereby affhm WoeBGn
am
t 1 licensed under provisions of Chapter 9(commencing P
E S with Sectloo70111,of Division 3 Of Lim Business ad Protesnmu Coda,and my licem is
m mfmltorteadmnee BATHROOM REMODEL
: ? Liam Clan Lm.d cards t)�w"g'.'
DaW-Contracts,
ARCHDECrs DECLARATION v RIVALED
a�+ I underead my pl ARCHll Ee used u Public r TION
s u6 Licensed Profcatianal
OW NERe sump ER DECLARATION
a S i Mreso .(Sect the 11. eumpt from the Cssam,C a Any law for the UN /_
p O following.moon.(Section 70713,Business and m.de ons Coda:Any shy m county me .7t/tV
S$ which mquirns•permit m constrOca aper,hnpaw,dpermit me a sig ed a omens M%000
Z'ta delurbitsissume0.alsurequim theappllant for suchpermitWiese signed moment
thmheuliccmdpursumt to the pmvisisl of dm Convince, License l.w(Chapmr9 Sq.F[. Floor Area I 'o
5 9 (co he eacareittl phSmion rem,ad
basis n3 themcgcdcamdon.Any nsCade)sir
S
and io u exempt tsay appli ad em Aper,for the subjects
Lh d asempdon.Any vialado or
Section 7031.7 five
acy red doll for s permit mbjeeu the app0ewn m a civil penalty of T CCU
not mom Nan fiat huntlrtd dollen(5700). '
❑Lasawnerofthepmperty,armyemployom with wagau theirs°lecompewdon,
wtUdothewwk,md Neavun°monotinundcdmoReredrorsale(Sm.7041,Buahev Required Inspections
and Pro"doer Cede:The Cm=oes Ucrnm Law does sot apply m an Owner of q P
property who hullds a improwa Vumon.and who dm,uch wart himself a through his
awn employees,provided Nn such imprew:mau art at intended connected Resale IL
however.the building or improvement Is sold whim oro year of mmpledoa.dm owns,
builder will haw tam burden Of paving dual he did rot build or ha num for purpose of
role.).
1.as owner of the property,an aelusively contracting with Heated com m m to
consmet the project(Sec.7044.Balsam ad Profissioa Cade:)The Comracw•s U•
mm law does not apply to an ower of papertywho builds or impta a t ers m,and
who contracts for such projects with a comranm(s)licensed pmauant to the Conaeroes
Lkem Law.
❑lam aempt er Sea ,BRPCfwthumason
Dae( I L7 U
1� C PE TION DECLARATION '
\ 1 hereby affirm under penalty of perjury an,of the following daW Wee
Ihaw anvolde for by Se CeNOau of Carom W mde.far the Workman Compeo-
salon,u proHtletl for by Section J700 W the Labor Cade.Iso the performance of Um
work for which Nb permit is issued.
❑1 have ad will maimsin Wormer Compensation Insesom,as acquired by Sectio
3"of the labor Code,for the perfoman of the work forwhich this permit Is issued
My W°rkees Compensation inseam carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSA71ON INSURANCE
(Thu reWo need not becomplemd!film permit is future hundred dollar(5100)
or mu)
1 certifv that In the penfamance Of Lou work for which this Permit u
a Wood13 tl at
employ any pe °°IamCampdon
LawnCifomaDso ymlw
NOnCnt
NOTICE TO APP :V Ort-A Of
1117.1ifthr making btrCcrifflum of Exemption,yed should
become subject to the W°rtefs Compensation paHsi°a of du:Laos Code,you mus
.J O forthwith comply with such provi,l°ns or this permit"I be demand revoked.
Z 51 CONSTRUCTION LENDING AGENCY
[+ 1 berehy"Bre that them It a construction Waling agency for the perfom.or
a> me work for which thus permit Is(surd(See.7097,CN.C.)
W Q Lendmaa Nona
z Latices Adarett
U O I certify that 1 haw red this appUutim ad mm eW the above IMomatlun u
w^ c°tmm.l agree to comply with all city and county estimates Wroam laws mining W
O IS.'J: buildingconsuucion,and hereby mthodm mpmamatiwa°f this city to rnmr upon em
W abuvo-mationed Property(a impatient Purposes.
Ly, (We)agree a am indemnify ad keep harrnka the City of Cupertino against
t�(A Iiabilidm judgments,cats and expenses which may In my my acerae against said City
U 7, In conmquenco of tiro gnnung of this permit.
APPLICAIIkl!kjjjj{Kt��UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE
-0 Y_ Re-roofs
sig Applian omrmm Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliaat co forum building oavprutmene orhandle havardons material
a de0ned by 0th Coliseum Municipal Coda Chapter 9.13,and tle Health ad Safety -
Smniat 75732(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will dui applicant or res m building Occupant m equipment a devices which If a roof is installed without first obtaining an inspection;I agree to remove
mit hwArdoa air cam olmats m dcOtmd by We Bay Area Air Quality Management all new materials for inspection.
District?
❑Ya 6gNo
I haw and the harrow,,r nMelsrequimmcnu undcr .Chapmr197°ftle Cillfo,
MAN HOW�Saf Code,ami°mu7aS.us33.d2553A.1°ndanundthwudn Wilding
dna not corm haw a mnmL thus It m my nes marihluty m odfy em ac UWE of the
re4.1man is h t met armissancofaCeN =_0
raawpmmy.�, Signature of Applicant Date
d' — co T 01 All roof coverings to be Class'B"or better
Ow' au Ori ad 4jenv Dam'
CITYOF CUPERTINO xP
Bull
DIVISION PER C(S = G1OR�Il a d
BUILDING ADDRESS: FARKAS STANLEY R AND HILL IT`J(D'05110126
S92 T4QT,T.ATTnV.PPV PT
WNER'S NAME: PERMIT ISSUE DATE
FARKAS STANLEY R D HIL Y J
ONE: SANITARY NO. CONTROL NO.
ARCHMCT/E CINEER: BUILDING PERMIT INFO
PLUMB Mn
.0LICENSED CONTRACTOR'S DECLARATION Job DeScrlptl0
IZI hereby affirm that,1 am Imensed too er pmv(sic m of Chapter 9(carom mcunj
<� with Salion 70(101 o(Divlalon3af tho Budneu and Profrsnom Gode,aM mylreensets
+<� nranmmeand affect. BATHROOM REMODEL JUN 6� ?UU6
jjj 1.1m.Client Lie.0
Dam useda pis BUILDING ARCXfTECi'S DECLSRATION
1 mberstanJ my phatu shall E rS u public ATION
)yU
aua Licensed Pmfcssioul
6� OWNER-BUILDER DECLARATION
SS 1 hereby anion that I am exempt freer the Contractors License Law for the
`c O following moon.(Scedon 7113 1.5.Business and Professors Cade:Any city or county
$ which requires a permit to construct,slur,improvedemallsh,or repair any suracmre $8000
_zi wPrior m its issuance.dm'requires tier applicant forsuch permit m Rle a signed sediment
€Q dhcIslicensedpunwb
nlNeprovis(onsofNeContractor'alxcnseLaw(Chapter9 Sq.Ft.Floor Area Valuation
(eenmouing with Borden 7000)of Owulita Jaf the BuilnessaM Prefe.,anm Centel Wlb
teat he is exempt therefrom and the basis fes aha alleged eaemptine.My viola dan of
Section 7031.5 by 4"applicant for a permit subjttu the applicant in a civil penalty of ———————S99?QMYeTUU Occupancy Type
not more thus five hundred dollars(ML
(j I,u owner of tith property.ser mY employees with wgu u their sole cempemadon,
will do the woh,and thesuumue ismainunded araRcred formic(Sec.70/4,Business Required Inspections
and Prefessk en Cade:The Coatrumra License Law,does fiat apply 0 an owner of q p
.pmpcny who buildsar(mpmses dances,and who dauswhwnrk himaelforNmugh his
awnemplayees.provided that such Improvenunu am not imeMed moRered fes 59L IL
however,dee building or Improvement.]amid within arc year of mmpleion.the awnu.
bulkier will have do books of proving that K did rot build art improve for Purpose of
sale).
11.as owner of the Property,am exclusively communing wish licensed cenuxmas to
comwat the project(Sec.7044.Business and Profession$Cade)I'm Conlreemes LI-
roma law does not apply m an owner of prepsmy'wha Wilds or Improws dartos,and.
who conuacu for such pmjccm with a eommun(s)licensed pursuant in the Contractors
ense
dUw.
❑Ion uemol ler See ,Bh PC fes u
this mne
was
C ' IPE TION DECLARATION
I hereby affirm under porosity of perjury arc of du following decuratians
❑I haw and will maintain a Cardfieau ofComenl m self-imum far W~1Campcn-
udan,u provided for by Sudan 3700 of the labor Code.for W Performance of the
work for which this permh is Issued.
❑1 have and will maintain Workers Compensation insurance,as required by Section
3700 of she Labor Code,for dm performance often work far which this permit is issued.
My Workers Compensation luueem carrier and Policy number am:
Carder. Policy No.:
CERTIFICATE OF EXF14 MON FROM WORKERS
COMPENSATION INSURANCE
Clhb section need mthccompicmd If the permit Is foray hundred dollars($100)
or less.) '
I certify that in the performance of the work for which this Farrah is issud.I shall not
empdoymypermninanl unarm bac ca bleelicthe'WWk<n'Compemation
Laws of California.Date
A (
NOIICE TO APP :If.ilh r ma 'n6' Nnesa of Eacmpmne,yes'ImuW
become aubjen m she Workers Campemadoo pmvidom ser 1M tabes Cade,you muss
O faMwile comply with such previsions this permit that be diamond evaded.
Z CONSIRUCIION LENDING AGENCY
Fr vrA-� Ihereby&Rrm that mem in$construction leadinggcuy for the nufurmanae of
ai> the work for which this permit Is issued(See.3097.Civ.C.)
GQ Lenders Name
7,Z Landers Address
V Q 1 certify that I haw read this application and sum shat the allow bJorreaden is
Iy corm"'I agree in
cmmplY with all dry and wary exothermaland Nu Taws relating m
lS.'! building construction.W hereby manda mpmsenudws of this city as umr mom the
[17 allow-reentiamd Property for Impaction purposes
(We)agree to saw,indemnify and kap har'nless the City of Capen)na against
`ccAA liabilities judgments.emu and expenses which may in any way oma against mid City
V t'+ APPLICUNDERSTANDS AND A ffin WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE �q+
V41�« [[—L3-Ul� Re-roofs
Slgnu Appliesn neaacmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or peace W Ilddng mseeput Adm a handle ha'=mw maadal
as deform!by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safty
Cade,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yesu
Will the applicant or fu mbullding meapant use cqulpmentormAe"which If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or f1
emit Imeardaus air cuuminuu as de0ad by the Bay Area Ah Quality Management all new materials for inspection.
Disuict7
❑Yes IS4Nu .
I have mad the hasaNaTTTss materials mquim menu undar Chopmr 695 of me Caliper.
niancalshBSar ycaia Sccdmu25505.35533and2553/.Iuetrsundthuifthe Wilding
Jac'not ccm I haw a unan'dot it h my mspomihilily m nodfy tie aaupmt of the
requiremeru h qry�L�met +ser lis issuauc ofa ecnineme of Ocapanry. Signature of Applicant Date
VL V <<^� to All roof coverings to be Class"B"or better
Ow' ran$ ori cd agccn� Dam"
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tr� a `t t;•a`t �'' �U �e�. `k�"`�i.,� Af'Y,t s''�y
bRESI°D:EN�TIA'LP;ROdEC � COwVESH'�EETgg - 'A;t�,`�,�
• � 11et v. u'�C � � � x��-1 r� � 4'", � MEN
Assessor's
xir1
CUPERTINO `� '�� a ��t�4 �".,;, m <d ��� � ?��,�u`' $n
Assessor's Parcel Number: C
Name of owner.
Project address.
Contact person. sCA Phone. 4 Fr-J-
Fax. IC, 2-
Net
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage: 7 i"
TOTAL: f
• Are there at least two 10 foot by 20 foot clear spaces inside the garage?
Is privacy protection planting required for the project? �N�
On what floor(s) is work being done? S/T
Brief description of work. R-c - 1^�,P P l 3��� ►rJ r7 w. — I1 oi4 -C�� T�
Code editions: 2001 CBC N)2001 CFC (Y -N)2001 CMC (Y-N)
2001 CPC (2)-N)2001 NEC N)
Effective 11/1/02
Plan Review Process Work Book Page-B-Revised 4/28/04
CITY OF CUPERTIN16 OS O a
CU
CITY OF
NO PERMIT APPLICATION FORM
14 N# *3(007- a61- 004- Date: 11 - Z 3-DS'
Building Address: Mailing Address (if different from building address):
S
Owner's Name: J Phone#:
Sou le L-0r - �-
Contractor: License#:
Contact: Phone:1jerp,ZS-7—GL(IoKupertino Business License#:
,Gley, Fax:
Building Permi fo: �j
,Bldg Ell, Elect ETI, Plumb Mech ❑
Job Description:
-Residential 0 Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
Cost of Proiect: Occupancy GrouD:
D;) D
Type of Construction: Please check this box if the project is a
�/ 0 1 second-story addition: ❑
*Qe=ctSize: Standard 4 Large ❑ Major ❑
Quant Fee ID Fee Description Fee Group
BAPPLOTHER Otber A fiances MECHANICAL
BBOILERI Boiler <= 100,000 Btu MECHANICAL
BBOMER2 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
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of