04020076 CITY OF CUPERTINO "3a' �'° '}
BUILDING DIVISION PERMIT CONTRA.GWR' r dl\ayl
BUILDING ADDRESS: PERII NG0 4 02 0 0 76
nlc;Av A17
ER'S NAME: PERMIT ISSUE DATE
JIMMY PAG
ONE: SANITARY Nth. CONTROL Nth.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+�00 LICENSED CONTRACTOR'S DECLARATION
1 hereby afftrm that 1 am licensed under provisions of Chapter 9(commencing Job Description
wiNSenion7 )o(Division 3ofte Bustnessanil Profosniom Code,and my license is
Nmnm a er a g ✓I.C. 7//(,3 7 KITCHEN REMODEL
'. n�� License %
CONTRACTOR: PRUDHON BUILDERS
Y ARCHITECTS DEFLA ATION
a 1 understand my plans shall he used u Public mmrda
is
rip Licensed Pmfcssiontl
g OWNER-BUILDER DECLARATION
E 1 hereby alfirm that I am exempt from the Contowtor's License Law for the
p O following mason.(Section 7031.5,Business and Professions Cade:Any city or county
S:00
'$ which requires a Permit to construct.elten improve,demolish.or repair any structure
prior to its issuance.also requires the applicant for such Permit to file a signed statement
Nat he is licensed pursuant to the provisions of the Contractor's Liccnse La
of 9 Sq.Ft. Floor Area Valli ti000
(commencing with Section 7000)of Division 3 of the Business and Profusions Code)or
But he is exempt therefrom and the buis for ft alleged exemption.Any violafion of
Section 7031.5 by any appliant for a permit subjects the applicant to a civil penalty of APN Number Occupancy e
not mom than ftvs hundred dollars(SSW).
P Y�'P
❑I,As owner ofthe property,in my employees with wages As their sole eooMudon, 36912013 . 00
will do the work and Code:The Cure is noHntanensoro mored Toroth(Sec.7046, wrier os
tad erofeuiom ldsoThe Conlruura License Law Ochs not apply ff an owner of Required Inspections
own employ .provi impravuch improvements
soaaschwmk himfferedthrough his
ownemployers,ping or i proviohimprotemauarcmyear ded ofcoro@red forristheo e,it. ��
Wilderhowever.thebuildinguta Wild
of completion,the of
Wilder will have the burden of proving Net he did not build or improve for purpose of
tale.). ^' 4t
❑1.as owner of the property.am exclusively contracting with licensed coommous to J�'Y
construct use project(Sec.7W.Business and Profusions Code:)The Contractor's I.I.
move Law duos not apply to an owner of property who Wilds or improv thereon.and, a'
who conlncufor such projects wiNacantnmor(s)licenxe puuantkthe Contractor's ' 4,/1*ZOO
rise Law, (�
exemptundm Sec. ,B&PCfar NHmadon -
er Date ��
WORKER'S COMPENSATION DECLARATION
I hereby arfrm under penalty of perjury one o(Ne following Oalvuions:
1 have and will maintain aCandfiate of Consent to self-insure for Worker's Compen-
mile u pmvitictl for by Sation 37W of Ne IaWr Code,fm Nc performuce of the
work for which this pennil is issued.
I have and will maintain Worker's Compensation Insurance,u required by SccOon
37W of the labor Code.for Ne performance of de work for which this permit is issued.
My Worker's Compensation Insurance tamer and Poliey�nsumberam: r�
Carrier. i7 f� Ft)N I "",Y v'ys`�'
CERTIFICATE OF EXEM4 1101,1 FROM WORKERS'
COMPENSATION INSURANCE
(pais sectlon need not he completed if the permit is foronehundred dollen($1 00)
or less.)
1 certify that in the performance of the work for which this Permit is issued,1 shall nm
employ any person in any manner an as to Wcome subject to the Workers'Compensation
Laws of California.Date
Applicam
NOTICE TO APPLICANT:If.atter making this Certificate of Exemplion,you should
become subject in the Worker's Compensation previsions of the labor Code,you must
,J O foMwiO comply with such provisions or Nis permit shall W deemed rooked.
Z^' CONSTRUCTION LENDING AGENCY
IWrehy ArB.Nat Neu is a construction lending agency for the Performance of
C> the work for which this permit is issued(Sec.309'1,Civ.C.)
V4 25 Lender's Name
D (sender's Address
U Q I ccr ify that I have read this application and sate that the Almon information is
ly F corrom 1 agree to comply with all city and county ordinances and sue laws mining to
Q V building conswction,and hereby authorize representatives of this city to cnur upnn the
W ahove-mentioned property for inspection purposes.
(We)agree m tau,indemnify and keep harmless Be City of Cupertino against
`v.t rq liabilities,judgmenls.casts ad expenses which may in any way accrue against mid City I/
U',L in consequence of the granting of this Permit.
APPLICANT U ERSTANDS AND WILL COMPLY W L ON-POINT Issued by: Date
SO 0. %ATIONS.
Re-roofs
9ti tare ofAipplicanuCondractorDataJ. HAZARDOUS MATERIALS DISCLOSURE Type of Roof 1
Will dm applicant ar future building oceupam smrc rehandle heureous material
fined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
da.Section 23532(a)7
[3 Yen XNu All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants u defined by IW Bay Area Air Quality Management all Bew ma enols for inspection.
District?
C]Yes �No
I have mad Ne hvaMnus materials requirements under Chapter 6.95 ardor Cxlifar-
nIaHA�Codc. 50S.25533 and 25534.1 understand N� lding
does it is my responsibility u nd0/y�/cNe uP tnYYNc
rC uirto ismance ora CcmRcak^r n C Si natureo pplicant Date
owner or aathariz[e agent DateAll roof coverings to be Class"B"or better
r
CITY OF CUPERTINO
MOLDING DIVISION PERM*
BUILDING ADDRESS: PERMIT NO04020076 4 0 2(]O,�6
OWNER'S NAME: PERMR ISSUE DATE
JIMMY PAG
NE: SANITARY NO. CONTROL NO.
CHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1� 1�
+,top
LICENSED CONTRACTOR'S DECLARATION
�2F 1 hereby affirm that I em licensed underderp provisions of chapter 9(commencing lob Description
r`$ with Secuon7 )of Diviswn 3af du Husinessand Profcuiuns Code.end mylicenx is '
O �,",'.° , ° `RSa are« 77G '3 )C> KITCHEN REMODEL
Dare f canuehm v I CONTRACTOR: PRUDHON BUILDERS-
ARCHITECI'SDEF ATION
IU 1 undcrstanJ my plans shall he used u public mcords
IN Licensed Professional
OWNER-BUILDER DECLARATION
0 - 1 hereby o0trm that I am exempt from the Conrecturs License Law for the
L,O following morn.(Section 7031.5,Business and Professions Code:Any city or county
22 which requires a permit m construct.elle,.improve,demolish,or repair any structure '
Sy prior to its i Us.,also requires the applicant for such permit to file a signed sumucat
that he is licensed pursuant in the provisions of the Contoular's License Law(Chapter 9 Sq.Ft.Floor Area Valut Qoo
y $ (commencing with Section 7")of Division 3 of the Business and Professions Coda)or
�.. that he is exempt therefrom and dm basis for Oar alleged exemption.Any vloladan of
Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of APN Number - Occupancy
notmoredun Ovehundreddallars(5500).' . Type
❑I,uownerofthepmpeny,mmyemployceswghwagesutheirsalecmpenudon, 36912013 . 00 - -
will do Ihewmk,and thermostatic isnotimended oroRered forsah(Sec.7r,14,Business
and Professions Cade:The Convectors License Law does not apply m an owner of Required Inspections
property who builds ar improvesthemon,end who does such work himself or ibrough his
awn employees,provided thaterch improvements are not nunded.1mrsred(.rule.If.
however,the building or improvement issold within one year of compledon,the owner.
Wilder will have the human of proving this he did not build or improve for purpax of
[:]1, PINALSO
❑1,as owner of the property,,B exclusively contracting with licensed cormsectors i.
conmrvat the project(Sec.7004,Business and property
whoWilds
Code:)The Canvumr's Li-
ceran whocamwdounotapply cm wish Owner afpot licenseddsmimprovu dmreon,and, JUN 0 7 2004
who Lace for such pmkcts with aconvacmr(s)licensed pursuant li the Continuum's `
License Law. '
❑larecumptunderSee ,B&PCfarthisreuon
Owner Data BUILDING
WORKERS COMPENSATION DECLARATION
I hereby affnm underpenally of perjury one of the following decimations:
have and will maintain aCenificme of Consent uxlf-insure for WwkcYeCompcn-
n,as provided for by Sudor 37W of Ne labor Code.far the performance of the
I for which this permit is issued.
have and will maintain Workers Compensation Imurana,av required by Section
of the labor Code.far the performance of the work for which this permit is Issued.
Workers Compensation Insurance eerier and PolignumIseeier'. t�� Fu Polic},yI
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This semiom need Out be completed if the permil is for me hundred dollars(SIM)
or leas.)
1 certify that In the pufarmanoe of the work for which this Permit is issued.I shall not
employ any person in any manner so as m become subject in dm Workers'Compensation
Laws of califomia.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become suhjttt m the Worker's Compensation previsions of the labor Code.you must
00 forthwith comply with such previsions or this permit shall be deemed raw°ked.
,z.t _ CONSTRUCTION LENDING AGENCY
[-, I hereby affirm that drum is a construction lending gency for the Performance of
Ni t>-t the work for which this permit is Wood(Sec.3097,Civ.C.)
WW Q Lenders Name
z Lender's Md.
t) I cenify that I have read this application and rum that the shots information is
{A cored.I agree to comply with all city and county ordinances and state laws relating to -
0 C..1 building construction,and hereby authorize mpresenudws of this city to enter upon the
W Hove-mendoncd property for iupection Purposes.
gy (We)agree to save,indemnify and keep Whelan the City or Clperhm against
IYJ liabilities,judgmcnu,costs and expenses which may in any way ucruc against mid Cily
f,z in consequence of the granting of this permit. r(
r.t APPLICANT U 15ERSTANDS AND WILL COMPLY W H L ON-POINT Issued by: Date '
50 RC -ATIL ONS,
-,-,. - ` E Lf
Re-roofs
ZZagime of Applicant/Conuacmr Dam /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will 0.applicant or future building occupant store°rhandle havNous material
as derined by the Cupertino Municipal Cade,Cbapmr 9.12,and the Health and Safety
Code,Section �Na
25572(a)?
❑ All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it horardnus air contaminants as defined by the Bay Arca Air Quality Manegcmcnl all new malenals for inspection.
vin?
❑Ycs ;Eq No
I have mvl the haaNausmamdals requirements under Chapter&95 ofthe Califor.
nia Health&S9cty Coda, donsM505,25533 and 25534.1 understand LWIfthe uiiding
docs na Curren Iy M1m�e meant that it a my msporm"u ty m na l the up t of the J �--
nequireme whbh. stM mel priormissuancc ofe Cenigcau of up c t� S g ature`of-HPplicant Date
Owner or authomed agent L D �/ All roof coverings to be Class"B"or better
OITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
N#
Building Address: Mailing Address (if different from building address):
/03 / CIAJ fldL=
Owner's Mame: Phone#:
51M 25<5-- tSl`i I
Contractor: License #:
Contact: Phone: 'Yoe)-317o -725"1 Cupertino Business License#:
'LS C—K 0, I Fax:
/Building Permit Info:
Bld Elect lumti" ---mei/E6�1rn7 /
JobPescription:
Residential C' Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project- Occupancy Group: r
� ao,vvi�
Type of Construction: Please check thiso the pxojfct is a
second-sto ry additi
uantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee (� BUILDING
1of3 1y ) 1 /0
r PTY OF CUPERTINO
CUP TYOF No PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
/ BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee. BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 c$n. MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation ofFumace MECHANICAL
BREMFURNOV Relo Furnace> I 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
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS I Remodel Signs, Marquee ELECTRICAL
2 of 3
tTY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEI,TINO
uanti Fee ID Fee Descri tion Fee Grou
BREMTHEATR Theatrical Li htin Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation S stems MECHANICAL
BSCBLVD Scb S ecific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL S ecial Ins ection BUILDING
BSWIM SwimminE Pool BUILDING
BTEMP Tpmnnrary.Power ELECTRICAL
BTEMPPERM 11 emporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC lectrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical s . foot IvIECH?,NICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE PlumbingPermit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
j
3 of 3
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APPROVED �
IN ACCORDANCE WITH THE 85-'-
CUP DES AND IN NCE9_ 31 =
s1 '
DATE 47 17-
SIGN 216
This set of it specifications MUST
be kept on the job at ail times and it is un'' 19"
lawful to make any changes or alterations 15'..
on same without written permission frons FEB 10 2004
he building Dept., City of Cupertino. All dimensions size designations given are
subject to verification onjob site and i2O This is an original design and must not be I Designed: 11/3/2003
e stamping of this plan and specifications adjustment to fit job conditions. eoicci=s released or copied unless applicable fee has Tinted 1aY3124
5;'MALL NOT be held to permit or to be ar been paid or job order placed.
- ` 03
[oval of the violation of any provlslonc
Qp,..
kit aw ry Ordinance or State Law. 1
1 .
Rustic pecan brkside raised Penn dwr