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06020117CITY OF CUPERTINOa-a.�+�"'*'''^- CONTIt p'T )R IN 'OI.2MATIONa BUILDING DIVISION PERMIT ' w.„at? BUILDING ADDRESS: A & A PLUMBING PERMIT NO. 0602 O 117 864 KIM ST OWNER'S NAME: PERMUT ISSUE DATE WILLIAM RINEY 924 E FREMONT AVE 02/21/2006 NE: SANITARY NO. CONTROL NO. (408)738-8878 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH j LICENSED CONTRACfOWSDECLARATION Chapter JbDescrip tion o al 1 em licensed under provisions of 9 (commencing 1 hereby affirm that ` with Section7IXgB of Division 3 of the Business and Profession Code, and my license is i in full force and e �U �dl �� Licemc Class Lie.. GAS LINE TO FIREPLACE Dam Convenor �{?� ppp [,� As ECfS DECLARATION 1.1�., D shall f I UMcrnanJ my plans l h, used u public necnNs i F I At] f f3tl`'.'�a" { Licensed Professional f Oat I son UIIDER DECLARATION 1 .(Sero Net 11. exempt Toro tiro Convectors Licence taw fm the ^ d8 2006 following reason.(Swdon 7foJL0.Business and n, dernns Code: Any oily as county naso which tcyuirca permit re comwcl, altee improve, nr repair any swctuo It'1� 6� 10 0 h pumah, ' pale itsapumanta the he isiu anlfonuon=toitlUMawe a signed w(Ch em issuance, duet tim eslicevW puraant to the of dm canastorauannal,w(Chapm Sq. Ft. Floor Area q 'Va1118ti6ri c��''1 It (commencingwithffimf n]Ono)the badsionr of guineas endin 3 lent of Division vi Com) in i O NJ1 // Must he M aanmpt wenefrom and the buil for the nl,gcd exemption. Any Rotation of he Is Man al on. Any 1 �j �:/ * Occupancy Type Section 7031.5 by any applicant fen a permit subjects Ne applicant to a civil penalty of not more than five hundred dollen (SS00). ❑ 1. as owner of tiie property, or my employee with wages Is theb mit werpewdon, Required Inspections will do the work. and the structure is not intended or offered for Wm Uwc. 7044, Business and Prefeilons Catle: The Convenors License Law does not apply m an owner of Q p property who builds or Ice proves Ihercon, end who does such work himsel f or through his ownemployces, provided that such Improvements are not InteMetl cautioned for sale. If, however, the building or Improvement is sold within ore year of completion. the owner, Wilderwill have tie, burden of Moving that he did not build or improve for purpose of sale,), ❑ 1, as Owner of the property, am exclusively contracting with licensed contractors to comtoct the pmjecl (Sec. 7044. Business and Professions Code:) The Commences Li- , come taw does not apply in an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed purtunl m the Consommes License Law. ❑ 1 am exempt under Sec. . B & P C for Nis mason Owner Dale WORKERS COMPENSATION DECLARATION 1 hercbY elfrm under penslry or perjuryarc of dm following dslam4ou: 1 have and will awar.w a Certificate.(Consent toslGinsum for Workces Compen- ' sedan. In proviOcd for by Section 37011 of the Labor Code, for the Performance of the work for which Nis Permit Is issued. ❑ 1 have and will maintain Wmkers Compensation Insuranm, an required by Section 37013 critic Labor -Cale, for we PCdOMMM or Ne work for which this permit is cured. My Workerk�salion nsx�Wce carrier and Policy number m: Cartier. Poli No.: IA/ O(S� OE IFICATE OF EXEMPTION FROM WO KERS' COMPENSATION INSURANCE (This section need not be completed Iisic peamit 1. foranehundre l dollars (SIM) or Ma.) I certify that in the performance of Ne work for which this Permit is iuuad, I shall not employ any person in any memoir an Is an becom,abject in die Worker' CompensaRon Law. of California Dam Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should Nome subject m the Worker's Compensation provisions of the lahor Code. you most ' forthwith comply with such pmvinous in Nu permit shall be denied revoked. ' j CONSTRUCTIONLENDINGAGENCY I herm by frtthat mereinisis a• construction lending agency for tic Performanceof ' the work for which this permit is iurctl (Sen. 3097, Civ. C.) ' tenders Name , LeMera Mtlmu 1 wnify that 1 have read this application and sum that the about information is ' v correct. I agme to comply with all city and county ordinances and seem laws misting 10 building construction, and hereby situation repreanutiros of this city to enter upon me aMvcmentioned property for inspection purposes. (We) agone to ave, indemnify and keep hsrtnlea the City of Cupertino against j liabilities, judgmenu,com and tape. which may in any way acwm against and City ' in consequence of tic pouring of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date 2 SOURCER ULATIONS. Re -roofs Type of Roof V G5 �-L—i Signed. 7Appli..nw Dam HAZARDOUS MATERIALS DISCLOSURE Will dte applicant or future building Occupant stare or handl, hmmulous material an defined by me Cupertino Municipal Code. Chapter 9.12, and the Health ad Safety de, Swoon 25532(x)? ❑Ye �Na All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building Occupant use equipment or devices which It hanrdova air contaminants defined by we Bay Area Air Quality Management all new materials for inspection. WIn7 ❑Yes No I I have mid the huafdousmucrials oquiommut under Chapter6.95 of Bac Califon Health & Safety Cede. S,etiom25507,25533 ad 25334.1 understand wstifth, Wilding es not currently baro a mot. thin it is my repannhility, m notify the occupant of me uirements whi run be mel Poor tu issuance rete Certificate or c° Signature of Applicant Date ,� All roof coverings to be Class "B" or better Owner riaed oa.al agent Data f aClOF UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: VC/f K 'w� S/ PERMIT # g e5o OWNER'S NAME: I ,•G1-11 1Z,%- - PHONE # GENERAL CONTRACTOR: /V7e jy FAX # I am not using any subcontractors: 44� k - Signature Date Please check avvlicable subcontractors and complete the following information: Owner/ Contractor Signature Q-11-06 Date 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 Owner/ Contractor Signature Q-11-06 Date Yzt CITY OF CUPERTINO CUPCITY PERMIT APPLICATION FORM d 0 °.2 .PN # � 7 l %c ov b Fee Group Date: ( ' a � - 06 uilding Address: MECHANICAL Mailing Address (if different from building address): 64-1 K. I MECHANICAL BBOILER2 wner's Name: W, k\ , o 2 BBOILER3 Phone #: yyc -yeas Contractor,�ri�U /Yl ,G� , l /� License #: l Contact: Phone: Cupertino Business License#: 73 K- &V 71( Fax: BUILDING Building Permit Info: S ,_ fay.L ��(� . O Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: BCONSTAXH Hotel and Motel Residential I1 BCONSTAXR Commercial ❑ Sq.Ft. Floor Area: BELEC1000 Elec 600V <= 1000A ELECTRICAL Cost of Proiect: df Elec 600V > 1000A Occupancy Grouv: Y Elec Svcs 600V <= 200A ELECTRICAL V--3 Construc on: TLroect BUILDING BENERGYADD Please check this box if the project is a 4&(iS �C1 hC �(i1Ll, second -story addition: ❑ ize: Standard .� Lar e ❑ 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/Comm/Quasi BUILDING BCONSTAXB 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 L 1of3 33� CITY OF CUPERTINO CUPE"ZTWO PERMIT APPLICATION FORM QuantityFee 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 BP13ACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE PbIg 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 rinklerBackflo 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 Reins ecton Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMA-aUlAN A/C Units <=10,000 cfln 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 BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood NIECHANICAL BREMNIISC 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 L -A 2of3 . CITY OF CUPERTINO . 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 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 MPERMTTFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Foe sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING' 3of3