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04100039�%z OC W st n� �u 5vrei his a;.LLl- Oa �pC ep� y=v _Z> zl=-c CITY OF CUPERTINO ` INFO � TIOO� '. BuanlNc DIV] PERMIT �hCONTRACTOR r ., . ..i•'. ... BUILDING ADDRESS; - -_ PERMIT NO.O 410 0 0 3 9 21583 LA PJAYA CT OWNER'S NAME: PERMITISSUEDATE - HANNA 6a YEHUDA 13AMNOLKER JE: SANITARY NO. CONTROL NO. ' ARCHITEC (ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION sCil Job Description p I hereby affirm that l am licensed under provisions of Chapter 9 (commencing - - "" with Section 70fifirDivision Softhc Business and Professions Codc:and my license is —"• _.._ _ -.------.---_.__-_ ...�- infull force and effect. DEMO (E) POOL License Class op Dam Contractor ARCHITECT'S DECLARATION 1 understand my plans shall he used as public record - Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 em exempt from the Contractor's LicenseLaw for the - -- ' following re n. (Section 7031.5, Business and Profcssioos Cade: Any city or county - which requires a permit In consumer. alter, improve, demolish, .1 repair any mmcmre prior t. its issuance. also septums the applicant for such permit to file a signed statement Sq. Ft. Floor Area - Valuation that he is licensed pursuant to the previsions of the Commusua License Law (Chapter 9 - _ (commencing with Section)000) 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 35k�1�➢3Qit816er00 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penahy of not more Nan five hundred dollars (5500). - ❑ Las owner of Ne progeny, or my employees with wegeaaz their sole compensation, , Required Inspections - ' will do the work, and thestrucmre is not intended or offered for sale (Sec. 7W, Business and Professions Chile: The Conmemes License Law does net apply to an owner or property who builds munitions Thereon, and who doeesuch work himselrorNrough his own employees, provided that such improvements arc notintended proffered for sale. If. - -- - - -- -- however. the building or improvement is sold within one year Or completion. he owner- -- ' builder will have the burden of proving flat he did not build or improve for purpose of sale.). X 1, as Owner of the pmpeny, am exclusively contracting with licensed contractors to comhoct the project (Sec. 7044. Business and Professions Coee:) The Conuacmr's Li , cense Law docs not apply in an owner of property who builds or improves Ihemon, and .Oho contracts for such projects with a eonmcmr(s) licensed pursuant to the Contractors License Law. o lam =gEyiptun er Sec. _.B&PCfpr Nia ��aan(�onaa ter - - 1__,5%?R'S'e MPENSATION DE' KATION 1 hereby aRm under penalty of perjury one of Ne following declarations: .. Pare and will maintain a Cerificare of Consent to self -insure for Worker's Compen- as provided for by Section 37M of the Labor Code, for the performance or Ne ._ work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section , 3700 Orth, Labor -Code. for the performance of the work for which his permit is issued. - My Worker's Compensation Insurance carrier and Policy number are: Cartier: Policy No.: - CERTIFICATE OF EXEMPTION FROM WORKERS' ' COMPENSATION INSURANCE (This section need not becpmpimed face permit is formic hundred dollars (SIM) or less.) I certify Not in the perfummnce of the work for which this permit is issued, I shall nut - employ any person in any manners. az m become subjcn to the Workers Compensation - Laws of California. Date - Applicant NOTICE TO APPLICANT: If, arm, making his Ccnilie, m of Exemption, you should become subject to the Worker's Compensation previsions of the Labor Code, you must = forthwith comply with such provisions or this permit shall he deemed tooled. UCf1ON LENDING ngagerAGENCY dou Omm agency for the performance of 1 hereby affirm Nat there is sed (Se.constructionlending Ncwork for which this permit is issued (Sec. 7097, Civ. f.) tender's Name Lender's Address 1 certify Nat I have mad this application and state Nat the above information is • correct I agree to comply with all city and county ammonites and sure laws relating m building construction, and hereby authodm rcpresommins of this city to enter upon the shove -mentioned property for inspection purposes. (We) agree to save, indemnify and keep harriers the City Of Cupertino against 6' j liabilities.judgment, costs and expenses which may in any way accmc against said City . 6 in emvequenee of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date URCEgEGtILA'[IOII I ��I`�I� 6' Re -roofs Type of Roof Signal of plpllliica'In�U\CMntractooe Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant store or handle ha:andous mammal az defined by the Cupertino Municipal Codi,, Chapter 9.12. and the Health and Safety ode, Section 25532(a)? All roofs shall be inspected prior to an roofing material beim installed. P P Y S g ❑Yom �Nn . If a roof is installed without first obtaining an inspection, I agree to remove Will the mpheant ter future building Occupant sae equipment or devices whim t in'nodous air contaminants m dcfmcd by the Bay Area Air Quality Management all new materials for inspection. stria? ❑Yes ANO Ihav mad! Ne hevardoes mamrialsrcyvircmenm under Chapter695 of the Calif.r- iia Health & Safety Cade. kefons 25505,25533 and 25534.1 understand Untrue building does not cmnrmly have a roan, Nal it is my responsibility m nmur, the axup., of Ne mquircplearldit Must PP missuance of a ccmfi of0c m ey. Signature of Applicant Date j rJ _-� OI All roof coverings to be Class "B" or better XT�/ - O oar Brd 1irtbrir. agem Dame ' CITY OF CUPERTINO N '' BUILDING DIVISION PERNM INF.ORMA BUILDING ADDRESS: PERMR N0 04100039 04100039 -3583 LA 12LAYA 21PERMIT :R'S NAME: nUE DATE HANNA & YEHUDA BAMNO KER PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description . . I bereby affirm men 1 am licensed under provisions of Chapter 9 (commencing - with Section ]DIM)) of Division Suture Business and Professions Code. and any liven. is in fall DEMO (E) POOL Ceanaerr«I. License a.Class LI[.R Dam. Contractor. ARCHRECTS DECLARATION - I understand my plans shall be used as public recmds ' Licensed Pmressinnal S OWNER -BUILDER DECLARATION 1 from the Contractor's License Law for the 1 hereby affirm ore exempt Code: Any city m county county following tines..enni(Section ]031.5, Business andnsu, altea improve, h permit t or repmr any tatuaure demolish, h, which requires a permit tit sires the far permit file iu i nhovisio � s of Contra Licrom Law (Chapter � that heiab<en.dpmrsaamttomeprm„ei.nsarmecmnnraetoesLicen.Law(chapter9 that he ensed p niman, he me Sq. Ft. Floor Area alua[ion (commencing with Section ]WO) of Division 3 of the Business and Professions Code) or _ mat he is exempt therefrom and the bass for the alleged exemption. Any violation of Occupancy Type $.ion]031.5 by any applicarl for a permit subjecu me oppliwm to a civil penally of&31b816er00 not more man five hundred dollars (S500). 01, as owner of the pmperny,or my employees with wages as Meir sale comperealion, ' Required Inspections q P will do the work, and Ure ancoe is cut ntended or offered for sale (Sec.]Oba. Busincss " • w dors nal apply to an owner of and Professions Code The Contributes LITLa Vopeny who builds mr improvcv thereon. and who does such work himself or through his awn employees, provided mat such improvements are natimended muttered forsalc If. however, the building or impmvemenl is sold within one year of completion, the owner. ' builder will have me burden of proving that he did not build or improve for purpose of sale.). �I 1, as owner of the progeny. am exclusively conwaing with licensed emmucters la comtmm the pmjecl (Sec. 7044. Business and Professions Codc:) The Convenors Li - crone Law does not apply to an owner or property who Wilds or improves thereon, and ,Fho contracts for such projecu with a contractor(s) licensed pursuant to the Cancelloes License Law. lame In unser Sca� . B & P C for do a (_ter(J / /I� Dam _ ' R'S' MPENSATION DFEfG KAT ION I hereby affirm under penalty of perjury ane of the fallowing aeclamlionen Ihoses ono will for Warkefabe f37M of Latom Cradc. In, of die as pmvidctl far by Sccuon l]BO of Jre Labor Code, for the pctformance of ds forSectionthe F work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of me Labor Code. for the performance of me work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE t (This section need not W completed if the Permit is formic hundred dollars (SIM) nr less.) I certify Wan in she perfmmancc of the work for which this Permit is issueo, l shall non employ any person in any mannerxsslo become subject o she Workers'Compensation Laws of California. Date Applicant - NOTICE TO APPLICANT: if, after making Nis CeniRcau of Exemption, you should ' of the Unit Clue. you most became subject to me Worker's Compensation pmv1110m e ,Z ronhwith comply with such provisions or this perms shall W deemed rewkea. O rnCONSTRUCTION LENDING AGENCY I hereby aRfm than there is a construction lending agency for me performance of > the work for which this permit is issued (Sec. 3897, Civ. C.) QLinda`s Name Lender's Add., 1 certify mu I have read this application and sum ohm me above information is f" cored l agree he comply wim all city and county arm ... .a and state laws rchoing on me U building construction. and hereby someone reprexnutives ofmis city to color upon L21 above.menniuned property for Inspection purposes. harmleas City of CuNnino against AAA G (We) agree to save, indemnify and keep the y liabilities, judgments, cosi and cxpemses which may in any way accme against said City z, in conscmimee of me granting of this permit ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE ED LA}S'10 i A l\ l\ l� Re -roofs Type of ROOF Signore of pplicamiCommetor Das HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant stare or handle hemodous material dcIII d by the Cupertino Municipal Code. Chapter 9.11, and the Health and Safety roe, section 25532ta)'All roofs shall be inspected prior to any roofing material being installed. ElYes gNu If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant rex equipment or devices whim Coll ha'modrus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District] ❑Yes Dallo I have mail the hannicus ma¢rialsrequi¢mcnts under Chapierri.95 of ore Califor- muHcalthB Safcly Codc, Secumts 25585.$533 and x5534.1 indcrstarto thairdm Wilding or Dors and currently have a tenant mat it is my responsibility no notify me, occupantthe reire nA n, maslW enpdmrlafseman<emae<ttirwtoara<anancy ga `�/�I Signa[ureofApplicant Date Y _>_ All roof coverings to be Class "B" or better �{ !! Owner I fir ascan Das U U ¢K W N w lr Y F- W a- 0 CL CL W I 2 w Q O F- 0 O 2 CL F U LU R { .0 I U GC CITY OF • CUPERTINO 4 CITY OF CUPERTINO* PERMIT APPLICATION FORM APN #� /�/ sa / !� Date: - Building Address�/� j1 y Maili i ui i dress (i g address): / Owner' Name: 1' Ker o #: Contractor: SIC Cit cov,s4rulc�lo✓� License #: Contact: Phon� Nt7$— ,�\, Ye[Ak10IA 6amnolk2�Fax: 58d- iii Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description Residential ❑ -G� P `�((•efnnineicial ❑ Sq.Ft. Floor Area: 7 $/Sq.Ft.: Cost of Project: 7 Occupancy roup: Type of Construction ` - Please check d the project is a second -s tory addition: ❑ ,_ Project Size:Stan Large El Major [I BBOILER5 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 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 � •2733 1 of 3j / qq ��- CITY OF CUPERTINO WITY OF CUPERTINO' PERMIT APPLICATION FORM 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 Pb)g 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 Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > l 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 2 of 3 CITY OF Y-1 inrnrlwir-% WITY OF CUPERTINO* PERMIT APPLICATION FORM 3 of 3 0) Quantity Fee ID Fee Description Fee Group 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 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 Change BUILDING 3 of 3 0)