Loading...
04010097 CITY OF CUPEWHN0 BUILDING DIVISION PERMIT s CONTRACTOR INFORWfION BUILDING ADDR17SS: PERMIT NO.04010097 4010097 7-97 KTRWTI\T IN ER'S IF. PERMIT ISSUE DATE HARVEY C RFCKMAN PRONG: SANITARY NO. CONTROL NO, ARCHITEC-DENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH 0 0 0 0 u o o LICENSED CONTRACTOR'S DECLARATION U U 1 hereby afarm that I am licensed under proviainns of Chapter i(commencing Job Description ;ca,u with Section AIIgBin fall force and ec Division 3ufthc Rosiness anJ Pmfcssi^nx Cada.mid my license is m E2° t. o Date etas Lick KITCHEN REMODEL L=� z F w Dam TS DECLARATION L�a.� ¢¢ ARCHITECTS DECLARATION Si a a 1 understand my plans shall be used as public menrJs AUG 2004 eau ;pv~i Liccnmd Profcsslonal i < OWNER-BUILDER DECLARATION <y I hereby affirm that 1 am exempt from the Container's License Law for the ©,r^ i 00 following neutron.(Section 0113 L5.Business and Professions Core:AnIG Nam y city nr county J f� ILI pS�n k m which requires a permit at construct,aper improve,demolish,or repair any structure priann its ismance.alsn requires tlo,applicant forsuch permit to lileasipned statement £gso that hcaflecnxed pursaantl^mcprn.ismnannhecomraewrs Lecnsc Lsw(Chaper9 Sq.Ft. Floor Area Valuation xi— (cammuncingwllb Secaou Wai of Dwixime3ofine Buxmessand Prnrexsmns Coddar ,5R dtl he is exempt thnefmm and Ne basis for the alleged exemption.Anyvid.6,an of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than me hundred dollars 0300). 3_'AVNMl0tgr0 0 Occupancy Type El I,as owner of the property,or my employees with wages se their sole compensation, will do the work,and the structure is not intended proffered for sale(Sec.7W.Business and Padmoions Cade:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves eerenn,and who does such work himself or through his own employees,provided that such improvements are nor amended or offered forsale.If, however the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving Nat he did not build or improve for purpose of sale.). 1,as owner of the propcny,am exclusively cantmelin6 with licensed comments to onsaun the Indoor(Sec.7044,Business and Professions Code:)The Contractors Li. cense Law dimes not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuit an to the Contractor's License Law. of..a e�mp/t under Sec. ,ry ,B de P C f/or his reason cr IV�II A/ Jai .C.49 if/AQ / "In lipWORR COM LN A ATION 1 hereby affmn antler penahy of perjury one of she fellnwin6 declarations: I have and will maintain a Cenificatc of Consent to self-insure for Worker's Credit®r ammo,as provided for by Section 37W of the Len,Code,for the terform race of the work for which this permit is issued. ❑I have and will moialain Workers Compensation Insurance,is requital by Section 37W of the Utm Code,for the performance of rhe work for which this pemtil is issued. ' My Werkei s Compensation Insumna carrier and Policy number am: Cartier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be orm lleed it the permit is faro.hundred dollars($1(10) ,or Im a.) I certify that in fi o performance of the work far which this Permit is issued,I shall not employ any person in any manner sit as to become subject to the WorkersCompcmoor Laws of California.Date Apllimmr NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should Neurone subject to the Worker's Comlcnsnion provisions of Ibc Labor Code,you must .J O forthwith comply with such Imvisimus or this fammil shall he deemed nevoked. z " CONSTRUCTION LENDING AGENCY F 4 l hereby affirm that there is a moratorium lending agency for the performance of a > the work Int which this permit is issued(Sec.3097,Civ,C.) 44Q Lender's Name 2, z Lender's Address U O 1 certify thin 1 have read this application and stat the,the above information is CL H comet.1 agree to comply with all city and county took ounces and stare laws relating to 0 U building construction,and hem by someone reprawmarives of this city to enter upon the {S7 shave-mcmioned property for osts and inspection expenses purposes. �y (We)agree to save,indemnify and keep harmless the City of CupcnEu against UZliabilities,jnce of the granting of this esmit. may inany way accmc againstwiU City U z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date SOU EGULATIONS. Re-roofs ,iifgmmrc or Ap icaro Commorm Tax, HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicam ser future building.ntpant store or hand to bxvarduus material as depend by the Culcnino Municipal Code.Chapter 9.12,and the Health and Safety. ntle,soros 25532601 yes N.a�`'l All roofs shall be inspected prior to any roofing material being installed. Will rbc applicant nrfmu c building occupant use cyuilmenl or devices which If a TOOT 15 Installed WIIhODC first obtaining an inspection,I agree to remove emit moss nus air commumants as defined by the Bay Area Air Quality Management all new materials for inspection. District? G Ycs "Xo I have read the Imvanlousme aids requirements under Chalerh.95 of the Califon nia Harbh dl Safcty Calc,Sections 25505.25533 and 25534.1 understand had If the building does not currently have a Ittenl,del it is my mspnnsihililY m ily the meupant n(the requiremcns which mutrt lx met IF or to issu cc of a Cmdfcato occupacy. Date �� O Signature of Applicant Owner rantherivedson[_. Dal All roof coverings to be Class "B" or better CITY OF CUPEWI'INO lea, " 77 "0.. ` 44 BUILDING DIVISION pig CC)N„ QAC C.OY> INI ORM: J BUn.DING ADDRESS: PERMIT NO,04010097 OWNER'S NAME: PERMIT ISSUE DATE OHARVEY CH7CKMAN III NE: SANITARY NO. CONTROL NO. ARCIIIT[C(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH _00 LICENSED CONTRACfOR'S DECLARATION p 1 hereby arum mat 1 am Bernard ower provisions of chapter 9 aommemcing Job Description Z� with section]IXx0 of Division 3nf me business antl Promssinnx Cnde,antl mylicenx is T in full force and effect. ^� '� License Class » KITCHEN REMODEL �y Z^, Date Contra., ! �C� ARCHI'ILCT'S DECLARATION 1 understand my plans shall be used as public records JyU �C l ;m0, Licensed Professional /Q' J OWNER veraBUILDER DECLARATION /t( a8 1 hcrchy affirm on I oro eBruia from Ihe Coume Co e:A.,c Law for the HC following rc a permit t ]11)15,Business antl Professions Code:Any may nr tenure K m which requires a pcnnit w construct,nlmr,improve,demolish,Or repair any.arunum poor it)its issuance,also requires the applicant for such permit It) a signedsmmmenl that he isEncased rmsuammmsl epronentoflb,Camram.rsLicenseLaw(Chapter9 Sq.Ft. Floor Area Valuation 0p (commencing with Section 7")of Division]of the Business and Premonition Code)or y mat Be is exempt therefrom and me basis for the alleged exemption Any vinlatina Of Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 251,9NVY61DgF0 0 Occupancy Type nm more than five hundred dollars($500). L sa owner or the property.or my employees with wages as aheir.sole compensation, will do the work,and the structure isnot intended or offered fo...In(Scc.]BW,Business and Professions Code:The Conttacmr's License Law does not apply to ea owner Of Required Inspections percdy who builds or improves(hand ,and who does such work himself or through his own employees,provided that such improvemems are not intended or offered for sale.If, now ever.he building or improvement is sold within one year of cam planar,the award, builder will have the burden of proving that he did not build or improve for purpose of sale.). 1,as owner of he property,am ealusively mountedng with licensed contractors 1. onshun the project(Sec.700,1,Business and Professions Code:)The Contractor's Li. ase Law docs not apply to an owner of properly who builds or improves thereon,and who conhnne,rot such projects with a eomracmr(s)licensed pursuant to the Contractors License Law. ❑ I on,eaaturptt under Sec. )� /� fI ,B At P C far this not .Ow cr l 1 / I N -1 / 4 ri iOh' / Date WOR CR COMP EN A t ATION I hereby off tat I1 nJer penalty of perjury one of me followingieclaratimm: ❑I haus and will maintain a Cenifcateof Consent to elf-insum for Wurkcr'sCompen- smioa as provided for by Section 37W of the Labor Code,far the perfomamm,of the work for which this pcfmit is issued. ❑L have and will maintain W.rker's Compensation Insurance,as mqui,cd by Section 37W of the Labor Code.far me pnormarmen of the work far which this Permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Carrier, Palley No.: CERTIFICATE.OF ERGMEP-ION FROM WORKERS' COMPENSATION INSURANCE Ghia scdion need not becomplcud Buie Permit is for one hundred dollars($IIXp or Icss.) I certify mut in the performance of the work for which this Permit is Bound,1 shall not employ any person in any manner so as to become subject o the Workers'Compensation Laws of California.On ' Applicant NOTICE TO APPLICANT:If,oHcr making this Certificate of Esempaion,you shun Id uncomic subject la the Worker's Compenimion provisions of the Labor Code,you most .JG forthwith cam ply with such provisions or this Perm it shall rte deemed invoked. Z CONSTRUCTION LEND ING AGENCY ar--I 4 I hereby affirm that here is a construction tenth ng agency for me Performance of (Y. > Be work for which this Permit is issued(Sec.3fN7,Civ.C.) - W� Lender's Name _ a zLender's Address CJ 0 1 cmnify that 1 have read oris application and sure mot the above information is correct.1 agree to comply with all city and county ordinances and stale laws timing to pU building coiswctimt and hcrchy autnnrimm,emenurivrs of this city a ionic,.,an the W above ratudoned plurally for inspection purposes. (We)agree to save,indemnify and keep harmless the City Of CupeninO against r N Iiabilitics,jmlgmems,enact and sarcasms which may in any way acme against said City U Z in consequence of the granting or this permit. ^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date SOU C EGULATIONS. h/ 1i 60 Re-roofs gnaama of A, inamiCtoo er., 11 lbacc HAZARDOUS MATERIALS DISCLOSURE Type of ROOF Will he applicant or future building ueacupunt stere or innate harartous material u dcfned by the Cupertino Municdral,Code.Charm,9.12,and the Health and Safety. Code,Section 25532W' All roofs shall be inspected prior to any roofing material being installed. ' ❑vex 40 Will the applmant ar mI.a building acu.ranl use equipment p,devices whichIf a roof is installed without first obtaining an inspection,I agree to remove emit hacmduas at,enomminano as depend by ate nay Arra Air Quality Mawgmnem all new materials for inspection. District? ❑Yee . I have row the huvanluus materials rcyuir romrs under Chipler 6.95 more Calif., Bin Health.P Safety Code,Scotto.25505,25533 and25534.1 understand that if the hoilding does not currently have a tenant,that it is my responsibility to il'y the o nnimat of me requiremcnts which must M mel Prior a isuoncc of a Cenifca_mo Occur. cy. Signature of Applicant Date v �. {l1ovt� z ar ownmaraum.rieedant DaAll roof coverings to be Class "II" or better JA�1 2004 fir•----``^� � 271,1 -� 13 n L _i2 —T� — i _ 1/1MSESE 1 .2 s4 ti s f4W�CVEN i'•I LF 3 24 -4 I I - a• 9L'PPER 2312 42 {3 n-uPER J314 422 Q II ` i2 PER 4!iia 42 18 ' sy I C"'t 13 PER .iu Ira 42 13 / 14-W PER FILLER J 1212 13 I& PER �4'' �� rL-..,L"( rCiw ell�fl . r', n t( 7 l ;1�� 71 /' t.;.lL'bifi et ll��t LJ�yi'-L! T- r 16 ia {——ul.z —4—_- -n_--._-_,C- !`1 a..^ai,�:Si I'Q" ----------13/12 -'---_--- —=°--J J '2`r +'. ibe c tS- r,. I ) 3HFY^;al thF )>L�` 4;:L q eI,rcuiee eeS ve vec 7k.t �,{ r jj 1 Z-e oCDc�S L✓C-r e t� w..—�A o,I"} ( i ' Ijif. ti� � �.\, C�'� � ,;"� . IGI�lC' i5 -`t 6vi,'ww.>Jv✓� S'1>` t4itr� v J vL), �cI c t`�4 �woYec�. I�1 c� v 5oc✓r- Floo lan o' CHECKMAN N39456 1/5 KITCHEN Room 1 Novemer 17, 2003 ,,.'acs .,; 0.0 n v2 as v2 23 i/2 15 112 k--3431/4--� 201/2 —�1�-271/2--_{� 4 f�--31 /4 1 1/2 — 41 1 1/4 1 1/2 1 1/2 1 1/4 30 1 1/4 1 1113 21/4 1 1/2 28 i/2 1 /1 Cabinet Report 1 Cabinet Name Width Height Depth A C 1- A 2212 6 '24.-: 2-BASE 32 36 24 ' 3-BASE 123/4 36 24 &UPPE OVEN 31 1/4 �95 1/4- 251/2 8-UPPER 37 24 -24 9-UPPER 231/2 I42 13 10-UPPER 30 . 26 13 11-UPPER 133/4 42 13 m m it/4'RECES3ED BOTTOMS o va C, 11-� �m yp y� J/pp'1ppb�1A 211 2004 5 � . 9 1/16 1 0 -- F 1 91/16 i L 1 1/2 1 1/4 1 1/4 1 1/4 1 1/4/4 1 1/2 1/ 1 1/4 + 3/--- k-22 19 112 3219 2/2-41 3/4I 38 /4 201/2 57— 137 1/2 44 1/2 i r CHECKMAN N39456 1/5KITCHEN Room 1 November 17, 2003 Ah 1 f � � 721414 3 i/ 3/4 3 4 40 1 1/2 1 3 1-- H-1]21/4 82 Cabinet Report a inet ar Width H-ei-gFt pth 5- A 381 24 6-BASE 36 36 24 7-BASE 22 36 24 12 UPPER 2]1/4 42 18 13-UPPER 331/4 42 13 14-UPPER FILLER 40 12 12 13 12 115-UPPER 20 42 13 11/4-RECESSED BO MS 1 1/6 RECE I0 BOTTOMS 5 5 oDDo TILT TRAY s s 6 1/8 c� JCI �r-211rz -�pN4 112 11/4 11/4 1121 �r 312 /4 381021211—�y--2q �,�---3394--•��F-191/4 -A, k 30 'I'--2` 122 82 202 12 - F17, 2003 4 Wall 3CHECKMAN N39456 1/5 KITCHEN Room 1 Novem O ER-BUILDER VERIFICATI N 1. (Check one) I or my immediate family (parent,spouse or child) will perform: A. All the work authorized by this permit B. ✓ A portion of the work C. _ None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. All of the work . B. ✓A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to be performed IC 2 Ct l h N bi.0 A I-211 — S 2qti c UTe s e oar u� ac�< MA ® 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer(see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be performed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Signature: y l Date: job Address: ` —//'C //v I Permit# D �$ Any chanties to the information provided on this form shall be submitted to the City of Cupertino Build Department. City of Cupertino Building Department CITY OF 10300 Torre Aven CU PEI�TI NO Phone (4oB) -3 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family,and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensatio rAft contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S. Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors'State License Board in your community or at 1020 N Street,Sacramento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper ITY OF CUPERTIN CUCITY TYOF O PERMIT APPLICATION FORM o -2 Date: /Building Address: ( ,� -7 5 `Owner's Name: Phone#: A kZ cHE- c AN 996- 3� 3 Contractgr: e ' Licen #: Contact: Cup rtino Business License#: Building Permit Info: Bld Elect Plumt MCCh Job Description: _ i Residential h1 k#+-r- Q N L� - Co erci Sq.Ft. Floor Area: $/ q.Ft.: Cost of Project: Occupancy Group: Type of Construction: G/ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> l OOK 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 B.ENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee �B(UIILDING 1 of 3 7 �+ c ITY OF CUPERTINC* CUP TYOF O PERMIT APPLICATION FORM Adek Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res 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 Cbeck Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING 7<1 BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backtlo 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 cfin MECHANICAL BREMAIRHAN A/C Units<= I U00 cfm MECHANICAL J BREMAPPLI Appliance lnstall 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 MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BRENC RAP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 ?F ✓ ° ITY OF CUPERTINCO CITY OF PERMIT APPLICATION FORM CUPEkTINO Qu ti Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 BSW1M Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary B I dg 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING BMISCELL Building Misc Fees BUILDING 3 of 3