08050224 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
PERMIT NO.
Bu1L 2T.'ffriE CCLELLAN ROAD KITCHEN & BATH, INC 08050224
ER'S NAME: PERMIT 96UE DATE
W N
DONALD HALE 46560 FREMONT BLVD STE '407 05/28/2008
NE: (510) 440-1609 SANTARY NO. CONTROL NO.
ARCHI=JENGINEER: BUILDING PERMIT INFO
-BLDG ELECT PLUMB MECH
uOp LICENSED CONTRACT'OR'S DECLARATION Job DBSCLIpI100
r�V 1 hento,affirm Nal l am fi ensN M.
umh:r P. "of Chapter 9(comnn
meng
with Scedan mote)ofDivision 7oftheBusnas and Professions Code,and my llceraac a REPLC SINK FXTRS IN KTCHN&THREE BTHRMS
in fell fortpe War�e cffat .
j a�2 Lice 1 — r I.ic.6� -
FO Dau CSDECf '-'
e uuuy��� ARCHil W ad OEC A I
W< 1 understand my Plans shall ha feed ss Public records
B C Licensed Professional
5 OWNER-BUILDER DECLARATION
I hereby afro that I am exempt from the Comrxcmh License Law for the
❑o following mason.(Section 703 1.5,Business and Profesaium Cost;Any city or county
$ which requires a permit to connotes,alter,improve,demolish,or repair any structure
Z< prior to its issuance also mquirts she applicant for such permit o rile a signed sutemem
than ha is licensed pursuant ote provisions or NCConuaclor's Licsme Law(Chapw9 Sq.F[. Floor Area Valuation
x2Fa (commencing with Section 7(IfM))ofDivuion3ofthe Busimasand Professional Code)or $2000
that ha is exempt therfoam and the hue for the alleged exemption.Any violation or
seeable 70313 by try applimat fora permit subjects Ne applicam m a Civil penally ofN Number Occupancy
nM mase Nan fine hundred dollar atom. 3 5 7 19 OAH P Y Type
❑1,u awdss of Iha ryopeny,art ser wPloym with wages v tie'vselccmnpewdon.
will do the work,and the stmmum amet Wtended ar affcrtd(arsale 70
(Sec. 61.Bailout
tee Pmfewom code:The Conanswes Liarnse Law dam as,apply in an owdsf of Required Inspections
property who peri Ids ear i m poses theeom ane who docs sueh work hims0l er thmagh he
own employers,presided thasaueh improvements art not intended oraRered forssle.B.
however,tho building or improvement is sold within one year of completion,the numn,
builder will have the burden of pmAng that M did ore Wild or improae for purpose of
sale.).
(:3 1,as owner of the Property,am exclusively contracting with licensed Commotion In
construct the pmjca(Sec.7044.Bmincss and Preasiom Code:)The Conmazmrs U.
come Law docs not apply to an owner of propcnY who builds or impmw Merton.and.
who contracts for such projects with a conaamarD)licensed pursuant in the Commensals -
License Law.
❑I an exempt under See ,B k PC for this reason
ser Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penally of perjury arc of the fallowing declaradonc
astaI]Iham and will for
by eCutiOmte of Co Labor Code,fort a WoeareaCompo-
worle f u proh thi far by Section i700 of the War Cade,for the perfarmarm¢of the
wank for which this permit is issuN.
❑1 hoe and will maintain Worker's Compensation Insurance,as wired by Suction -
7700 of Ne Lsbar Cad,In,the per(mmanee of Ne work for which thispermitpermit is issm4
My Workers
r.8T?q emaagmJ�fn jcfand Paler A I Q��'W9 S
Cartier. YN UU 1kaCJ TCA (�{VEMPrI iry No.. _
CERTIFI CO OF EXEMPTIONFROM WORKERS'
COMPENSATION INSURANCE ,
mot semlun recd not W completed if t e permit Is foredo hundred doll=(SIM)
m le a)
I citify,Not in the performance of the work for which this Permit Is Wood.l shall raw
employ any person in any hounds,an u m become subject to the Workers'Compens tmal
Laws of California.Dau
A"ikum
NOTICE TO APPLICANT:If,after making the Cenifiute of Exemption,you should
become subjens m the Workers Campcmidon povisions of the Ishor Code you most
.J O forthwith comply with such provivom or Ne pammis shall be deemed revoked.
z vy CONMUCTION LENDING AGENCY
(•+ 1 hareby M.that Vert is a construcdom lending agency for the perform.of
Ri ti
the work for which the permit is issmd(Sec.71197,Civ,C.)
0.Q Landels Name
z Lenders Address
U 0 T certify that I less rod this application and state that the abase information is
IL ^ Comm 1 agree m comply with all city and county oNinames aha suer laws relating as
.�rV' building construction,and hereby amhorim¢presenmim or this city to enurupan Nc
yabmve-mentioned property for inspection purpmea.
(We)agree to sale indemnify W laep harmless tha City or Cupertino agunsl
to liabiliax,judgments.cow and telethon which may in any way accrue agalnsl said City a
t>m2 in conncquence of Iha]slung of Ne permit 1_
^ APPLICANT UNDERSf NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date J 2
UR RE LA SOY/
111M yo 5WORe-roofs
iglu of Applicap'Ca salter Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thc applicant er future building cecupentnort or handle hmardam meatal
as defined by tha Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
0"Ouon25572(a)? All roofs shall be inspected prior to any roofing material being installed.
0YmNo
will Nc applicant a future building occupant use cyuipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
crit harardnw air contaminants ss defined by the Bay Arta Air Quality Management all new materials for iiispection.
Divrct? -
❑Yns Nu
I have mal the hatardous materiae requireencnu under Chapter 6.95 ofthe Caller.
rte Heal"Safety Cade.Secum x15505,15577 arta 25534.I w st rsuM tea lithe,building
does. l Currently ham a lam.Uma it a my res onesi/ility u notify the asupem of de
umCurrentlyCurrentlym
rtnunt wmow spriortowe.of.CcrdrCCof_ Signature of Applicant Date
(22±r D,a' All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 357 19 060
DATE ISSUED. . . . . . . : 05/28/2008
RECEIPT # . . . . . . . . . : BS000004916
REFERENCE ID # . . . : 08050224
SITE ADDRESS 21737 MCCLELLAN ROAD
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DONALD HALE
ADDRESS . . . . . . . . . . : 21737 MCCLELLAN ROAD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : HOME PROS WINDOWS
CONTRACTOR . . . . . . . : JIM DAWKINS LIC # 26318
COMPANY . . . . . . . . . . : KITCHEN & BATH, INC
ADDRESS 46560, FREMONT BLVD STE 407
CITY/STATE/ZIP . . . : FREMONT, CA 94538
• TELEPHONE . . . . . . . . : (510) 440-1609
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- -------- ---------- ----------
1BSEISMICR VALUATION 2 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40. 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 82 . 08 0 . 00 82 . 08 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 82 . 08 #10200
---------------
TOTAL RECEIPT _ 82 , 08
•
0�o50�a�
«�_�� CITY OF CUPERTINO
CITY OF
CU
PERTiNO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # �/ ! lJ Date:
/o gBuilding Address: rnc ^ e1larRdC ^wfY V " ;D
V+
Mailing Address (if different from building address):
a 11 3-- rfloa yl o, 9�5w q
Owner's Name: Phone#: 409 3a2 J O —1
0
. Orw,A flal -(�
Contractor: Home PvoS Phone: 5i0 �o IU09
1" Fax: 440 Ra'a
Contractor License#: -I gD43U
Cupertino Business License#:,LLP 701 D
• Contact:C,VIS-01116 ByI� Vlo Phone: 90 440 t(9001.
1� Fax: "M `140 tt�3,-
Residential Commercial
Job
�Description:
�RtMCL Q, �'n� ����� l� W nl�1 1,0,
•�'` t' C.i' `
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B �L-3
Valuation:
2 000 Square Footage:
Project Size: Standard Q--'Iar e ❑ Major ❑
•
Revised 5/21/08
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1BTEMPPER Temporary Building Permit (good for B
30 days)
1 BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1 BBOILER2 Installation /relocation of ea ' M
boiler/compressor.over 3 horsepower,
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1BBOILER3 Install ation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to •
& incl 1,000,000 Btu/h
1BBOILER4 Install ation/relocation of ea M
boiler/compressor over 30,hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5 Installatioii/relocation of ea'boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P •
(per hour)
IMEETINGIHR Application Meeting B
CITY OF CUPERTINO
CUPCITYEf�F GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
,Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
1 FENCE>6FT Non-masonry, over 6 ft in height B
I FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
IFIREPLMAS Fireplace Masonry B
IFIREPLFAB Fireplace Pre-Fabricated/Metal B
1 FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
IFOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete)
3 of 5
St -
CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPEiZTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group )GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY)
1RETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSPIO Special Design, over 10' high (up to B
50')
I RETCRB< Gravity/Crib Wall, 0-1O'high (up to B
50 ft)
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft)
SIDING
1 SIDEST/BK Siding, Stone & Brick Veneer B •
(interior/exterior)
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<l0 SF Skylight less than 10 sf B
I SKYL>1 OSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
SO
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
4of5
>� CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPEkTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass B
door (ca 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
/ 1TRAVD0C Travel & Documentation B
1BUSLIC Business License B
•
5 of 5
Community Development
f 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
SCUPERTINO
Building De artment
JOB ADDRESS: �1 I-13 M W eA layj qd� PERMIT #
OWNER'S NAME:Dorojd iiwlp, PHONE #c5 0 tLa09
GENERAL CONTRACTOR: )eOrDS FAX # GLO 011 0 Gla d,
I am not using any subcontractorc.Y/_ _lA�{ Y��J `i"JU IA �09
Signat&e Date
Please check applicable subcontractors and complete the following information:
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 r�
-r V
Owner/Contractor Signature Date