04030220 OFF-
CITY OFCUPERTINO -aw. v'ayx.�u4's 'd''� ' g.w �'� -r-
�Tts��.,,���� > 4.1VTRA.CTUR AVF® t1�fiAT n-*
BUILDING DIVISION PEl�lYll� .rte r � ,gN,„�, Y••.v� k�'d ,u df"4�;
---T4 03 022 0
BUILDING ADDRESS:
PERMIT ISSUE DATE
S NAME:
ALAN RENNINGER SANITARY NO. CONTROL NO,
PHONE
BUILDING PERM"'HPO
ARCHITBCrfENGINEER: BLDG ELECT PLUM MECH
' LICENSED CONfRACIOWS DECLARATION Job Description
YI hereby affirm thatI am UrCeaud under Pmuiamis or Chapter 9(commencing
L with Sethn7=)afDheimm Sof Ne Bows and Profusion Code,and my licweu
< infuldofcaand efrect. REPLACE 7 WINDOWS/2RM
agp Licemc Cl.0 Lm.+1
–� Dau: Comments—
ARCHrTECr-S DECLARATION
< I understand my plans shell W used as Public records
Licensed Profesdoml
OWNER-BUILDER DECLARATION
1 Wmby carr,.that I am exempt from the ConlactoYS License Law for the
Z O following won.(Section 101.5,Business and Profesdum Cade:MY chY of county 000
a which quires a Permit to trammel,alter,hnprme.demmlish,or repair any uneum
ANY primmits issuance.also mquifuthtmPlicantfor such Permit m...•..gondauument Sq.Ft.Floor Area Valuation -
<
drat M 1.Mussed pursuant in thepmvialoon of the Contractor's1.4,t.Law(Chapter
�S (commencing with Section 70D0)ofa"'. of use Buffets and Proreuio..Code)m
SSadmt 703is esl3Ey9"appIramomfoom enm BeIP�ermit wobxu+aNue applicant m:aHirpen:n fT 'p
3 71H'DII41f7tA)el0 0 Occupancye
rwt more than five hundred do1W503001
❑Las owty of U+e properY•ormY emPlmycu with wage�ss Heir sole compemation, .
wi0 do du work and NeSwnure Bnot intendsd oraRertd brook(Sa.7061,Bufneu Required Inspections
and pmfmdom Code:The Contractors License Law does nal apply u an owns of q P
pmperywhoWildscarimpmvm Ihemon,andwhodoessuchwakhim ffmt ughhR
corn employces.provided tlutsuch improvememsme ret intended moRerd for shit if-
imomm,Ne building orimprovement is sold within cam Seta of wmpl- on,the owner.
Wilder will have tiesrd
burden of proving that he did not build a Improm for Puryme of
me.).
1,he owner of tad property,am esdmiwly ctemaWng with licensed contractors to
construct the pmjm(Sec.7044,Business and Prof um."Cade:)The commutes s U. , 1�
come Lew does not apply u an oarm of property who Wilds or impmwa demon,and, EV Il—'I
who contracts for such projects with aemtMafs)licensed pursuant W do Committee'
LJcaak
c Law.
l em em oder ,BPCfor this ia rea
a Dsre I u7
W CER'S CO PNSATION DF RATION "
1 hereby union under is mlly of perjury arc of du following deGaWo
rns:
❑I hemand will mdnW n•CufiOate of COruWm to self-boune forWmmf`sCampm-
mion,as provided for by Sado.3700m the Labe Code,for the pertonnanco of the
work for which this permit is issued
❑I have and will maintain Wo ma S Compemation Insurance,as required by Section _
1700 of Ne Labor Code.for Ne performance of the more for which this Persil is Wood.
My Workers Compound.Imunoca artierend Polity number are:
Choler. Polity No.:
CERTIFICATE OF EXFMPTTON FROM WORKERS'
COMPENSATION INSURANCE
(Niasection used not W completed if 1W permit is faromhundred dollars(SIM)
toles)
I coolly that In the performance of the wort for which this Mrnlil is issued.)shall not
employ any Person in any manner an a b humnm abject to Ne Warkeei Compenmdrat
Laws of California.Dau
Appliemt
NOTICE TO APPLICANT:If.afar making this Certificate of Exemption,you Should
become subject he 1W Wohefs Compensation pmridam of the labor Cods.you muse
Qforthwith comply with such Provisions of this Permit hall W tamed rewleel.
Z;"" CONSTRUCTION LENDING AGENCY
.N. ", I hereby affirm Nal then u•conuruNnn lending agency for the perrommnm or '
y'> the.,it for which this permit is issued(Sa.3097,Civ.C.)
g1Q Lenders Name
z Lenders Address .
J O- N
I certify that I have fend this application and state u the man's information is
L eorreeL 1 agme to comply with all city and county Ordinances and awe laws re1Nng to
ft
building co).gran n,and ms.i.dbyauNofmrep lut less of Nis Of m-16-0 nnmt
0. .hove-mcotioned Property for malunion Pmlhd s
(We)i gra m Cove,indemnify and keep hsnntea Ne City of Cupertino d C"y
Co) Itabllities,jndgmenta.cases and expenw which may in any tx'SYamue agalmisaid Cily
jIn consequwu of the gemming of this permit. Date
APPLI NT UN STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
U G I NS.
Re-roofs
sig tum ofApplicho OrtUUt ate eofRoof
HARDO RIA
MATELS DISCLOSURE TyP
Will Ne applicant of in=Wilding ocouPantume or handle haYardaus material
defined by the Cupertino Municipal Code.mspon 9.12,and the Health and Safety
de,section 25532(4)' All roofs shall be inspected prior to any roofing material being installed.
❑Yes 14No
If a roof is installed without first obtaining an inspection,I agree to remove
Will Ne applicant or future building Occupant am equiPmml of devices which
coil hormdnm air crnumimnu as de0ncd by Ne Bay Ars Air Quality Management all new materials for inspection.
Disuict7
❑Ya 1914.
I hues lead the WaNtusff l cfalsmquirtmenu under Ch.Pmrd.95 of Ne Caifor-
fix HrallhBS f.,yCedc,Seed.25505.25533 and25534.lmderund thatlithe Wilding
does not currently ow a u that it b my responsibility m noufy the occupant or the
requimmen mus t"mmI uancoof.CcNOcau or Occupancy. Signature of Applicant Date
y _ S� ov All roof coverings to be Class "B" or better
u..n1u mad agent f Dou
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng : Sub: Blk: Lot :
APN . . . . . . . . : 32643074 . 00
DATE ISSUED. . . . . . . : 03/25/2004
RECEIPT # . . . . . . . . . : 24958
REFERENCE ID # . . . : 04030220
SITE ADDRESS . . . . . : 10649 NATHANSON AV
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER ALAN RENNINGER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1330
RECEIVED FROM . . . . : ALAN RENNINGER
CONTRACTOR LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . ,
• TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- -------- -- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 137 . 00 41 . 10 0 . 00 41 . 10 0 . 00
BPERMFEE VALUATION 8 , 000 . 00 137 . 00 0 . 00 137 . 00 0 . 00
BSEISMICRE VALUATION 8 , 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
BPLANCHK PERMIT FEE 137 . 00 116 . 45 0 . 00 116 .45 0 . 00
---------- -- - ------- --- ------- ---- ------
TOTAL PERMIT 295 . 35 0 . 00 295 . 35 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--- - ------------- ---------- -- --- - --------------
CHECK 295 . 35 1920
TOTAL RECEIPT 295 . 35
•
CITY OF CUPERTINO* 3 0 o
c'TM°F PERMIT APPLICATION FORM
• CUPEkTINO
APN # �� Date:
i
Building Address:
Mailing Address (if different fro uilding address):
I0(049 N0,4l SI Ave C,l (Ay%no , lA
Owner's Name: Phone#:
A1cn RtnA'n^IV L108- 7`1(o OY ttO
Contractor; , License #:
�c P
Contact: Phone: Cupertino Business License#:
Fax:
BuilldinPermit Info:
Bld ❑ Elect Plumb ❑ Mech ❑
Job Description:
Residential ❑ ommer i 1 ❑ V / l
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: `• J Occupancy Group:
Type of Construction: !J V Please check this box if the project is a
second-story addition: ❑
Quantity 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> IM to 1.75 M Btu MECHANICAL
BBOILERS Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/ uasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= IOOOA ELECTRICAL
BELEC1001 Elec 600V > IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housin Mit. Fee BUILDING
* 7s�
1 of � ��s�� 3 /�'
4WITY OF CUPERTIN040
CUPEIo PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTRvIE 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 rinklerBackflo 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 ctin 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 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 Remodel Signs, Mar uee ELECTRICAL
2 of 3
-- *CITY OF CUPERTIN(O
Cl OF
PERMIT APPLICATION FORM
'
CUPEI�TINO
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 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 afoot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
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_ . ALL. tr/NDo�F__Rfi(�bACEl�H.
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I I I yoRt�
Wltlfl_ MICCA,(�D „<t SgSStS iV.liYYC
tHaRIX WIPO
.. ai o rrya' rrwa . -sctoIwC, !.?r
HQRtzoNrn� I
JCI u r MaGLAS6 xy
. Dam, w,�vow>'HEaE�i wa:�- Ivor I ',flbR1$QNr'pl
_._. HE ITY UI wlNpav
- — -- —- --
_. ;DPER DES'AN -- -
;IGIVEU ecifitations MUS�4'""-"; I'
' - -- itris-set of pans and G
oe kept on the at all hmes endatls un:_
- -- _ es or altershon
law u to mate anYrchyng,
on-58ma 'wilhuut wrdtAn pe[Rllu fro I 6 XY
I
De t ICityot Cupertino
he building p nand spec!Ucetlon` 1 f(mPJ�v�/tAi'
_ pl .-
- The's
w/Npw�+
�HAII_N�7 be held t permit or to be at - -
weron
of
I pprovel of the vTohtt ot 'Mte
t ePv Cav Ordinance
I I
-sGO R.o - F-CUPL -11 NO
.MF
, NT
I
,
I
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i 1 I('
CITY OF CUPERTINO x /
a 0� r .
BUILDING DIVISION PERMIT CONTRACTOR T, NFFC 'ItMATION'c
BUILDING ADDRESS: PERMIT N00 4 0 3 0 2 2 0
19649 NATHANSON AV
R'S NAME: PERMIT ISSUE DATE
ALAN RENNINGER
PHONE: SANITARY NO. 9 CON1101.NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� E e l�
MLICENSED CONDedunerpDECLARATION Job Description
+�F 16creby(fi.f dot 1 3 fft Du under provisions of Chapter 9(commencingmy[I. is
iSy wlN Seorce nd.fof Dlvlaian 3of01e Businw cab ProfeWoru Code,end myliceve is
S� infm.Cla and erfec4 REPLACE 7 WINDOWS/2RM
?9 Dead Clue Lm.N
C' 7 Dem C.nUmT'SD DECLARATION
I undcrsund my path shall M used As public records
a U
C�S
Licensed PwfcsUonH
3 OWNER-BUILDER DECLARATION
I I hereby.(Seth on 1 1. exempt from me Contractor's License Lew for the
O O following reawn.(Semon 7(*1.5. t,aln=and Improve.
demolish.
e ons Code,:Any city os county
$ =bleb requires a Permit m ennauwc4 Anel,impmm,n pc o t,i,ri nasig any suunurc
t•�a pdorlomissuanum.alw rcqulrm lM applicant for such permitro fie uigned statement
ggTxF< that W is licensed perwem in the provisions of me Common'slJttnw Law(Chapter 9 Sq.Ft.Floor Area Valuation
S$ (commencing with Section 7000)of Division 3 of the Boom=and professions Code)Or
Wle
3 t Is exempt menlwm And me basis for me alleged exemption.Any violation of
Section 7031.5 by a"Applicant far a permit subjects the applicant in a civil penalty of 3 2aff 413,0iiiiMerO 0 Occupancy e
Win not mon NRm hundred dollars($500). _ P y Typ�
0 1,u owner Of the pwpeny.m my employvm wiO warm u thea role wmpenudm.
will do thewo k.And the someone is not intended oroDered forsam(Sec.7044,Business
And Pmfwlam Cade:The COnuem6 Liswe Lew dam not apply m m ower of a ??lied Inspect?s
propertywhob,pd i edthait thhimp. menu=nGtlhwork himW(mthrWerough his ,, I
ownemploy Wilding
Improvement
m rauchimpssold ntsartne year
ofdmOBcrn.the Owner.
buwemg 11 buildingmimprovementiswidwithinonsyear of romplefor the Owner.
builder will love tie burden of proving ren he did not bW10 or improve for puryoe of
role.).
I,m owner of the property,am exclusively contracting with licensed conoactons to
coastwct the project(Sec.7014,Business and Profwiom Code:)The Convecur's U.
cense law does not apply m an ower of property who builds or improves Ihemon,rod
who contracts for such projects with a contra loo(O lined pursuant to the Convector's
License Lew.
0 lam sae retie .B&PCfm this!assure
Dam 3 A
W ER'S CO ENSATION DELYEARATION
I hereby Alarm under penalty of perjury oro of the following declarations:
of
have and will maintain a Certifcam of Consent to self4mue for Workees Compen.
cation,as provided for by Section 37M of the labor Code,for the performance of the
work for which this permit is Wood.
0 I have And will maintain Workees Compe=tion Imunnce,ex required by Section
3700 of me Usher Cads,for the performance of the were,for which this permlt is Issued.
My Worker's Compensation Inaurame carrier and Polity number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisscotion need not In completed]irk permit is for one hundred dollars($10()
or fru.)
1 certify that In the performance of The work for which this permit is issued,1 shell not
employ any perwn many manner an as to become subject the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CcdiOcate of Exemption,you should
become subject to the Worked Compmsation provisions of the Labor Code,you mum
Q 0 forthwith comply with such Prevost.or this permit shall he deemed revoked.
'Z n CONSTRUCTION LENDING AGENCY' t
Fro I hereby affirm that then is a cemlroctlon lending Agency In,me lscrfumnamz of
0.v? the Aunts fur which this permit is issued(Sec.3097,Co.C.)
fxl Q Lender's Name,
a Z Lemme.Md.
U Q 1 certify mat 1 have red this application and sum that the Ahold information is
t[.P cartecL 1 agree to comply with all city and county ordinances and atm taws relining to
O U building conurumion,and hereby AOmodm reprwnutivca Of this city to enter mann me
W shove-mentioned pmperly for Impecdon purposes.
(We,)agree to Arm,indemnify and keep humlw the City of Cupertino against
!0.q Ilabilides,judgmcnu.casts And expenses which may in any way accmc against Wd City
L)Z In consequence of the grunting of this permit.
.. APPLI fs
vNT UN STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
U G 1 T NS.
Re-roo
Sig on of AppRean maracmr am
HA"RDOU MATERIALSDISCLOSURE Type of Roof
Will me applicant or future Wilding occupant same or handle ha ewdom material
^s defined by the Cupenim Municipal Code.Chapter 9.13.and the Health and Safety
.ScNe19 No zss3z(a)7
Dyes❑YAll 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
Unit hlyANOus air conuminants as defncd by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yea AN.
I ham maul me lmeardom materials oxhOmmcnv under .Chapu06.95 of thc utfor.
nu Heil &SafctyCOde,Secdom25505,25533 and25534.lundcaundmauifmc Wilding
docs not currently am A m Net II o my respomihility u nosily ItXI mcupant of me
nquimmcn It mum IpdarmissummoraCeNfcamofucupmcy. SignatureofApplicant Date
Quaffo All roof coverings to be Class"B"or better
unuthari'rcda col Dom