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03060184z z0 CITY OF CUPERTINO p F ly U1 3 y O j, $ — *rhe � «,� '+ •• ^, •�'' •'. BUILDING DIVISION PERMIT CONTRAC*TOI2INkORMATION.•. VIM,x emll ADDRESS: STEPHEN & CASSIE HANNA PERMIT "°03060184 OWNER'S NAME: IT F, CAqqTP. HANNA PERMIT ISSUE DATE 7/ 2 $qTF,PT-TRN E: _ SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFD BLDG ELECT PLUMB MECH O O LICENSEDCONTRACIOR'S DECLARATION I hereby affirm Thal I am licensed under provisions of Chapter 9 (commencing Job Description with Section ]IXMy of Division 3 ofthe Business and Professions Code, and my license is in full fo... nd effect, Liccnac Class Lk.0 BATHROOM REMODEL Date PINAL.ED EL T'SCrunractsirDECLARATION ARCHITECTS DECLARATION' understand my plans shall rte used es Whim recnNs DEC,] 7 2003 L¢cnacd Pmfcaio..I OWNER -BUILDER DECLARATION -. - 1 hc¢hy aRrm that 1 am exempt from the Contractors License Law for the ' following mason. (Seetiun 1131.5, Business and Proressions Code: Any city or county r' wpich requires a permit to LOOslmel, atter, improv, demolish, or repair any nructum N B�'��f1' prior to its iasmose. also requires lW applicant for such permit to file a signed Statement that he is licensed purruannn the provisions or the Conommr's Limns Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7")of Division 3 of the B usiness and Professions GWe)nr dust he is exempt therefrom and tW basis for the alleged exemption. Any violation or 32647063.00 inion 7031.5 by ury applicant far a Permh subjects the aP'H... 11. a civil penalty of not mom Iran fin hundred dollars (Ston). Number APN Nb Occupancy Type ❑ 1, as owner of the property, or my employees with wages as their tele compensation, will do Om wars, and die mrocti , is at intended or offered for '[a (Sac. 7044, Business and Professions Code: The Conlucmfs License law does not apply a an awmr of d Inspections pmpeny who builds of improves thereon, and who doeuuch work himmifor III his 102 - PIERS own employees. provided that men impmvcments tie not Intended or offered for sale. If. 103 UFER however, the Wilding or improvement is sold within one year of completion, the owner — builder will have the burden of proving Net he did not Wild or improve for puryom of 104 - REBAR ask.). ❑ 1. as owner of the property, am exclusively contracting with licensed contractors to 10 5 - ANCHOR BOLTS conatrocl the pmject(Sm. 7044. Business and Profession Co,10 The Co"baetorS Li. 106 — SEWER & WATER come law does not apply to an owner of property who Wilds or improves dimmer, and who mct ennuacts for such projects with a cunor(s) licensed pursuant m the Contractors 202 - UNDERFLOOR PLUMBING ens law. 203 - UNDERFLOOR MECHANICAL lAm azem der S.N. ,Bdk Pc (n this on z% 204 - UNDERFLOOR FRAME 0 IPE SATIONDrCLARA N 205 - UNDERFLOOR INSULATION Thereby moun nallyofperjuryoneofthefollowingdeclaratinm: 3O1 — ROUGH PLUMBING In and will maintain a Cenifieam of Conaenno relf-inaum for Worker's Compen. 302 — TUB & OR SHOWER n as provided for by section 3700 of the labor Code, for 0. puff ...re. of he work for which Nis permit is issued. 303 — ROUGH MECHANICAL ❑ 1 have and will maintain Worker's Compensation Insurance, As, required by Sermon 3 04 - ROUGH ELECTRICAL 37M of the labor Co ic. for the performance of the work for which Nis permit is issued. 3 05 — FRAME My Worker's Com pensalion Insurance carrier and Pot icy numbenrto 306 — HOEDOWNS Carrier. CERTIFICATE OF EXEMPTION PolicYFROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE 308 - SHEETROCK nr loss.) (This section need not he completed if the Permit is for one hundred dollars IS 100) 309 - EXTERIOR LATH 1 certify Nat in the Performance of the work for which this peoput Os issued, I shell not 310 — INTERIOR LATH employ any Person to any mannerm As m become subject to the Workers'Compensation 311 — SCRATCH COAT Law, a(Celifornta. Dela Applicant 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT. If, after making this Ccnifc.te of Excmptian, You should become subject to the Worker's Compensation provisions of On LaMar Code, you must forthwith comply with such provisions or this Permit shall W deemed revoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that there its construction lending agency for the Performance of tl¢wmk permit for which this is issued (Sec, 3(1)1, Co. C.) 504 - FINAL BUILDING ENERGY Under's Name 505 506 - FINAL ELECTRICAL - GAS TEST Lenders Add., I comfyve that 1 haread this applieetimn and mute that the .hove information is correct l agree to comply with all city and county ordinances and state laws relining to 507 - FINAL PLUMBING holding eonstnsdim,end herchy Amouiw representatives of this city res const upon the N FIN MEC CAL propcny fodemnify an purposes. above (We) nedAgree (We) agree or leve, indemnify and keep harmless Inc City of Cupcnino against Q 9 F liabilities. judgments,msu and expmtacs which may in any way accntc against said City ed. ce of the granting of this perm' 5 ( NG �r IC UNDERSTA AND LL COMPLY WITH A NONP INT Issued by: 5 C WORKS Date4_-'� v jPL C GUL ION .Re-roofswrco Type of Roof pelican on r ate RDOUS MATERIALS DISCLOSURE Will the appl nor future building occupant nom or handle haruduur mated.) as defined by the Cupeninr Municipal Cods, Chapter 9.12, and the Health and Safety Cook, moYtion ss532(.)? Na All roofs shall be inspected prior to any roofing material being installed. will the applicant fumrt building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove W.odnus I, contaminants; as defined by be Bay Area Air Qurliry Managemcnt all new materials for inspection. Oct? l ❑Ye. 'TCI Nu I have read the handus materials requirements under Chapter 6.95 of the Califor- niaHmlth Safety Cate, Secumu 25505'25)33 and 25534.1 undersand that if the Wilding does not nil, have a that It IVY respomitoily a nouly the ach,., of or ' t. re which is on a la amaearacenW,aP69X70 Signature of Applicant Date t' ow efm odneda , D, All roof coverings to be Class "B" or better CITY OF CUPERTINO ' e e^a Bu1LDwc DrvlsioN PERMIT CONTRACTOR INFQRMATI( BUILDING ADDRESS' STEPHEN J & CASSIE HANNA PERMITNo03060184 OWNER'S NAME: STEPHEN 7 F, (AqqTT7 HANNA PERMIT ISSUE DATE E: SANITARY N0. CONTROL NO. ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB0 MECH 0 0 0 LICENSED CONTRACTOR'S DECLARATION I Job Description p I hereby affirm that l am licensed under provisions of Chapter 9 (commencing with Section]gN)) of Division 3 of He Busi mss end I'mfesainns Code,and my license is FIN /A force in fullsera arta efRc'' License Lot. BATHROOM LE® REMODEL �Iri� ' DEC 1 7 20Q; Date Contractor ECL ARCHITECTS DECLARATION I understand my plans shall be used es pod, rccmda ' BUILDING Licensed Pmfcssional OWNER -BUILDER DECLARATION ' I hooey License Law for the .(firm that 1 ore cxampl from Nc Commas Co : following massa. ID3 5, Business and Professions Code: Any city or wanly winch requires Permit to construct,atheeller, Improve, or repair anystructure t priorm its censncc,alsorequires the applicant for ouchpermit tofIcs Law(stammem n e, also h Permit t that he the") provisionsnr the License Law(C Sq. Ft. Floor Area Valuation BecronicindwitPursuam 7tCo diones's (commencingwith ciefos]BOB) of Division oft he Businessand Professions CnJe)ser or Code) or Nat he is exempt Nerefrom and one basis for He alleged exemption. Any vitiation of 32647063.00 Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penally of APN Number Occupancy Type P Y YP nos more Nan five hundred doll.. (SSW), ❑ 1, a owner of tee property, or my employees with wages az Neir sole compensation, will do the work, and Ne swclue is not intended or offered for sale( Sec. 7044, Business and Professions Code: The Contraction's License docs iui —racPUUND dInspections Law not apply in owner of builds improves himself his 102 - PIERS property who or Hereon, and who does such work or through own employees, provided that such improvements us not intended or offered for ale. If. 103 — UFER however, Ite building or improvement is sold wilbin one year of completion, on owner. builder will have He burden of proving Nat he did not build or improve ter purpose of 104 — REBAR axle')' 105 - ANCHOR BOLTS to ❑ 1, as owner or Ne property, . B exclusively contracting C.d.:) licensed contractorsContractor's construct the project son. 7W. Business and Proteasisna code:)The conlraclors u- 106 — SEWER & WATER come law does not apply to an owner of property who builds or improves lhemon,and, 202 — UNDERFLOOR PLUMBING who contracts for such projects with a contractor(a) licensed pursuant the Connector's mm Law. 203 - UNDERFLOOR MECHANICAL lam exam our Sec. - .B&PCfo Ihis on o4a! 21 z� I 204 - UNDERFLOOR FRAME //, 'R' - PE SATION DECLARAT N 205 - UNDERFLOOR INSULATION Thereby firm un r nilly ofpedury°neofinefollowing decimations: 301 — ROUGH PLUMBING have Ind will maintain a certificate of Consent to self -ensue for worker's Comped- 302 — TUB & OR SHOWER . an, as provided far by Section 3700 of He labor Code, for He performance of the 3 03 - ROUGH MECHANICAL work for which Nis permit is issued. 304 - ROUGH ELECTRICAL ❑ 1 have and will maintain Worker's Compensation Insurance. az required by Seldom 37M of He tabor Cade. for He Performance of He work for which His permit is issued. 305 — FRAME My Worker's ComPemadod Insurance carrier and Policy number aa: 306 — HOLDOWNS Cartier. PolicCERTIFICATEOFEKEMMONYFROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (TTusection need not he completed ifthe Permit la for one hundneddnllars($100) 309 - EXTERIOR LATH or rat.) I certify Nm in the performance of Use work per which this permit Is issued, I shall not 310 - INTERIOR LATH employ any person in any manner so este become subject o lheworkers'Compena6on 311 — SCRATCH COAT Laws em Laws of California. DataAppl 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: If, after making this Ccnificam of Escmption. you should become subject to the Worker's Compensation provisions of the Usher Code, you most mrlhwi th comply with such provisions or this permit shall be deemed revoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affmm Hal Here iso construction lending agency l Of Performance of 504 - FINAL BUILDING ENERGY the work Lendber'sNrwhichthispennilisissued(See.3891,Civ.C.) Lumber's Name 505 - FINAL ELECTRICAL Lenders Address 506 - GAS TEST I certify He11 have mad this application and diva that He show iws cmutinn is all City and eaanly coneeL 1 ogler to wmand and SLa4 .Ws calmingdruthe 507 - F I NAL PLUMBING rnminse'CS herebyauthortmreatiws of Nis city to corer upon the hominy FIN CAL shme.ngcodsuud pmKnd shove-(Weiagre Properly forinspectionkeeppurposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against 09 it FI liobilitics, judgments, costs and..pensee which may in any way seems against said City in conxyucee of the granting of this perm' .APPLIC 5 kaNW UNDERSTA AND LL COMPLY WITH A NON -PAINT Issued by: 5 ORKS Dale 5 URC EGUL ION . Re -roofs Type of Roof " 7 Si nemrca ApplicangqfO cooarc i(A DOUS MATERIALS DISCLOSURE Will the appy Ise, future building occupant stmc or handle havardW, material as defined by the Cupertino Municipal Cc&, Chapter 9.12, and the Health and Safety Code. SoYCa 25532(a)? All roofs shall be inspected prior to any roofing material being installed. /,q(I�No If a roof is installed without first obtaining an inspection, I agree to remove the applicanlol future building occupant use equipment ordcvicm which i0Will t hazardnua air coulaminanu az defined by He Bay Area Air Quality Management all new materials for inspection. triol O Yea No (have read Nc has ousmaterials requirements under Charon 6.95oftheCalifor- u'sHealH Safety Cadc,Sectiona255115,2533eM25534.1umuntanciHmiflhc building does not 'courtly haw Hal'I is a y responsibility, les nndly the occupant of He Ire m whmh a b m l d to auamcaofacemnc.1,af �Can pa ey �0� Signature of Applicant Date e27 b All roof coverings to be Class "B" or better owner .,Wti a 6ifu nal OWNER -BUILDER VERIFICATIODO 1. (Check one) I or my immediate family (parent, spouse or child) will perform: • A. s All the work authorized by this permit B. _ A portion of the work C. _ None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. _ A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to be performed • 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (rev se side). ` Property Owner's Signature: / DaW 6 Z 7 - Job Address: f �LF%�� DCS/ ca, Permit # O`7� 0 Department. I 1 51 CITY OF CUPEIZTINO AY OF CUPERTINO 0 PERMIT APPLICATION FORM ►1 03c) � N # Q � Date: � 2 Building Address: Owner's e: I9h a #: Z53-(-713 Contractor: License #: Contact: Cupertino Business License#: Bu g Permit Info: Bldg lect Prm,;��ec Job escri ion: esid al 04*;(rcia Sq.Ft. Floor Area: $/Sq. t.: - Cost of Project: = Occupancy Group: r Type of Construction: Boiler > I OOK to 500K Btu 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 > 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 <= 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 BMITIGATCComm. Housin Mit. Fee BUILD G L 1of3 em" CITY OF CUPEkTINO ATY OF CUPERTINO • PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING 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 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 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 Furnace > 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 2 of 3 CITY of CUPERTINO 6 CITY OF CUPERTIA PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3 I� U • F` ce4 ) A P. Art)." -77" J SUBMITTAL .#1 A.5Il'Ro µ "e ariv W �;r�D ..-�, nsa;,d sp,xiiicaiwn�itlsun' �s",BPI onpi m �a y �chandl es an�fters It na or �o riul to m� written permission, an some wdhont of pnpertinrl: ic is ba;,dmm ng o tti s14 an a mitt Pov td o en t 1t<e sta..p� , Held to P . ;PP�ial ur Q�dinance or. �t anY CdY .(c -T/vo Window I i 44 24" 0 %I FI. light/fan 6ekL1ceQ-)Dep2rloo 11 ss 35-1/2" �g7�J�J�i� i%0,/ 41" a 101"