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04040049 (2) CITY OF CUPERTINO � CTOY2 INk'l1RM ""N BUILDING DIV-3ION PERMITimisa BUILDING ADDRESS: PERMITNO. KOBETSKY CONSTRUCTION 04040049 ER'S NAME: PERMIT ISSUE DATE NE: SANITARY rMTIZOL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 00 LICENSED CONTRACTOR'S DECLARATION Job Description U C I hcrchy affirm that 1 son licensed under provisiosu or Chapter 9(commencing pt whhSacthn70(g1)ofDiviaion3offtBox,. asdProfessions_Code' and mylacuseis �p qS Lfull�d`B`a L� X147 MS BATH REMODEL FQpUQ& D FDate yg I i�e.r�_Canvacw—r ATIO e n' I undcrsund my plans mall he uscUDis tic mco0rtls JUN 2 12004 C w Licensed Pm(cssional S OWNER-BUILDER DECLARATION O��D�� I hcrchy affirm that 1 am exempt from the Contractor's License Law for the O o following reason.(Section 7(13 1.5,Business and Pholmsm.Code:Any city m thorny S; which¢quires a permit to ennumoa,eller,improve,demolish.m repair any structure iy prior m jUdeuance.also requires the applicant for such Permit to Tile a signed statement 869 that he is licensed pursuant o Ne provisions of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area Va1D h ❑ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of Semon 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of 3�I1_yl Jtgro 0 Occupancy Type net more than five hundred delta.(9S00). ❑1.as owner of the property,m my employees with wages as their ma compensation, will do the work.and Ne xvunure is or intended 000Remd forsale(Sm.70MA,Business - Required Inspections and Pmfesaima Code:The Contractor's Licence law Ems not apply 1.an owner of q P property who builds or improves thereon,andwhodoessuchouta himself orthrough his own employees,provided that such improvements are nolimended oroRerad broods.If. however,de building or improvement is sold within one year of completion,the ewncr- builder will hove the burden of proving that he did not build or improve fm purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed cenitacmrs to conmme the project(Sec.7(tM4,Business and Professore Code:)The Cootraem'a Lt. come law does not apply to an owner of propeny who builds or improves Ihemon,and, wvpo eonlm et for sun projecus with a conVHclrra)licensed paraumt to the Contractors License law. emewanplumarSea ,B&PCfmthismazon er Dale WORKER'S COMPENSATION DECLARATION I hereby afitm under penalty of perjury one of the following declaralmut. have and will maintain a Certificate of Concent to self-mme for Wmlmr sCompce- n,as provided for by Section 3700 of the Labor Code,for to performance of the work fm-which this permit is issued. ❑1 have and will maintain Worker's Compensation Bnormca,u required by Section 3700 of me labor Codc,for the mofmmance of the work for which this Permit u issued. M or pensyioa I upnce artier and Policy Tatum me: ERTIFICATE0 EMPPI�11` OM ORKERS' COM SATIONINSURANCE (This section need not bechmpleed lithe permit is throne hundred dollars($100) or less.) I certify that in the performance or the work for which this permit is issued,I shall nut employanypc rain any m,nCra asmbccomc subject to the Workcn'Compeniellon b O APPLICANT the Work I(,afterpens Nis Cedprovisions of of Exemption,you should b h coral to the Worker's Compensation this provisions of the roodLabor Code,you mull ��{ forthwith comply with such provisirm ho this permit shall be dcemctl revolted. 7 CONSTRUCTION LENDINding-1CY 1 hereby whafrum that mart is s c d(So..nn lending egenry for the per(ormanm of 7 the work for which this permit is issued(Sec.31197.Civ,C.) 7 Q Lenders Name Leader's Address Q1 terrify met 1 have read this application and sure that the about Information is F' correct.1 agree to comply with all city and county oNimmeas and sale laws relating to �U building concoction,and hereby aotbodrz representatives of this city to enter uponthc, LSt shove-mentioned progeny for inspection purposes. (We)agree to saw,indemnify and keep harmless the City of Cupenow against w h limilides,judgments,eocu and expenses which may in any way action,against mid City 7 in consequence of the grooling,of this permit. r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PQINT Issued by: Dat SOURYmT ULATI NS" Re-roofs SpplicmUContmemr D tcHAZARDOUS MATERIALS DISCLOSURE Type of Roof e applicant or future building mcupml store or handle hazardous mamriai athe Cuperrinn Municipal Code.Chapter 9.12,and the Health and Safety c25532(a)? All roofs shall be ins ected nor to an roofin material beim Installed. C�r P P � Y g ge applicant or future builtling mcupanl tau cyvipmenl ter devices whichIf a roof is installed without first obtaining an inspection,I agree to remove s air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. rX ®No I have mad the hazardous materials mquiremcnts underchapter 6.95 of the Califor- niaHealth&Safety Code,Sections 25505,25533 and 25534.1 understand that If the building docs not cumently haw a¢rant that it is my responsibility in nod I the occupant or the mgviremcros hichmust/bcmet tioroi amteor.Ceriflemoroccult . Signature of Applicant Date rtherized stem Did, All roof coverings to be Class "B"or better LCCA- ITY OF CUPERTINCO z ® CUP TYOF O PERMIT APPLICATION FORM APN# �J � ✓ �� Date: Building Addr 3 d iJe C'. Mailing Address (Jaifferco from b ilding address): Owner's Name Phone#: Tuck 4 T ,� /a , vcgp) ?916-01V4112 Contractor License#: i �1ikc Ko 6efJ� 806 Contact: Phone: 66'0 ZYB G96v Cupertino Business License#: NII,,e. KobP-trk Fax: JZ /7137 Building Permit Info: �T Bid Ele Plu McCh' ❑ Jo Description: Residential ❑ m ❑ Sq-Ft. Floor Area: $/Sq. t.: Cost of Project: � 60 Occupancy roup: r ype of Construction: Please ch e project is a Necond- nry addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permit sq. foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM 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 BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 '��. �13 ZF ITY OF CUPERTINO@ PERMIT APPLICATION FORM ® CUPERTINO Quantity Fee ID Fee Description Fee Group BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Ins ection Overtime BUILDING BPBACKFLOW Atmos beric 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 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 BRENLUMAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> 10K btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BRENINRAPP 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 BREMSIGNAD Rmd] Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL 2 of 3 Zak- CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 ® � 518 v �- tions Mu 5'4 fica Qnpta. 1„p A:a:t timz Of alteca T amll :Y L a, �m�ss� - Rj tactulto gut w itten ono, same with' �- of uPe iti s an wt., a d sP� a --- the building of this Plan it of The stamP� a held to any Prot \ aNALI NOo be violationo` M 19PIova1 18 City O�dmance � Co zo Master Bathroom - (bathroom 1 ) 0 ppR 08 2m 56 5'6 oily OF CUPERTINO SUILDING ®EpARTMENT Jack and Trish Taylor 10333 Krista Ct. Cupertino, CA 95014 Master Bath - Existing 518 545C) M CO -64 Master Bathroom (bathroom 1 ) 66 ,i 66 , RV D APR 08 2CC4 CITY OF CUPERTINO Jack and Trish Taylor BUILDING DEPARTMENT 10333 Krista Cg. Cupertino, CA 95014 Master Bath-New