04060225CITY OF CUPERTINO
BUILDING DIVISION PER T °CONTMCTORRINF,O
ON.
Pn.. `. n^v4'o
BUILDINGADDRESS:
FISCHER PLUMBING & CONST
PFJ3MRNO04060225
20177
OWNER'S NAME:
PERMIT ISSUE DATE
LLYOD YAMADA
2766 SCOT1,1311M
SANITARY N0. CONIHOL NO.
NE:
(408)727-242E
ARCHITECT7ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� t�
LICENSED CONRACfOR'S DECLARATION
Job D
I hemby of n. that 1 am licensed under provision or Chapter 9 (commencing
wiHSectio97 )orDiision3ofthcll iec�!a� fctsiomC dmyliccnois
'"/
In ren rare
KITCHEN REMODEL
A�L'��" w�
SEP 0 9 2004
Damnw
ARCHITECTS DEC ION
�!
1 undersand my plans shall M used As purse records
BUILDING
Litm,sedPm,res,ianal
OW NERBUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Communes License Law far the
1 follnwing mason. (Section 7(n 1.5. Business and Pmfesamns Codc: Any city or county
which requires a permit to construct, alter, improve, dcmnlivh. or repair any stmeture
! prior or its issuance, also regours the applicant forsuch permit to rile a signed statement
'
Sq. Ft. Floor Area,
Valuation
thmMisliccnodpur,vanttot pmvisionsofNcConmcwr'sLimnmisw(c Ptcr9
l(commencing with Section 7000) or Division 3 or NC Business and Prormadma Code)or
. that he la exempt thcmfmm and IM basis for the alleged exemption. Any vinla4n, or
316&NMu'31Ber00
Occupancy Type
Section 7071.5 by airyapplicsnlfor a permit subjects the appbcant to A civil penalty of
not mom Nan fin hundred dollars (5500).
1, As owner of the properly, or my employees with wages As Neirsale compensation,
Required Inspections
q P
will des theworkand thoometum is notintended moffemd forsale(Sec. 7044, Business
and Professions Cade: The Con"coms License Law does not apply w an Owner of
property who buildsmimproves Hereon. and whodoessuchwark himselforthrugh his
own employers, provided thmoch imprwments art ominmmded MmEared tarsal. If.
however, Ne building m improvement is old within one year of completion. He Owner -
builder will haw the burden of proving Nat he did not Wild or Improve for purpose of
sale)
❑ I, as owner of the pmpeny, am esdusively vonlr,cting with licensed conmewrs to
construct the project (Sec. 7044, Bmineer and Pmfassiom Cade:) The Omustme. Li.
cenw raw does not apply to an or, of progeny who Wilds or improves Nemon, And,
who concocts for such projects with a conmaor(A) licensed pursuant o the COnOamfa
License law.
❑ 1 Am exempt under Sec , B At P C for this mason
Owncr Data
WORKER'S COMPENSATION DECLARATION
1 hereby af0m under Penally of perjury one of the following deelarmimn,
❑ 1 haw and will malmain a Comfcate of Consent w aelFinsum far WOMh`3Compere
by Sdon 3700 of dm labor Caere. for Ne perfarce maeof the
orlon, As provided to'ec
work for which His Permit is issued.
0 1 haw end will maintain Wcalme, COmpens.d.. Insurance, As mquimd by Section
37W of the labor Cantle, fa am parf mmane..r Or. work for which His permit is issued.
'
My Workefe/Cq� p exren I tisane co ser and Palic, n m ram: /
,
'
Cartier. /./ Polity NO.:
CERTIFICATE OF EXEMPTION FROM RS'
COMPENSATION INSURAN
Rhoosenion need not becompletW If the Permit isforone hundred dollar, (SIM)
or less.)
1 « nify Hot in the performance of the work for which this permit is issued. I shall not
employ any person in any mannero As w become subject w Ne Workers' Compcmadon
LA., of California. Date
Applicant
NOTICE TO APPLICANT: It, After making Nis Ceaifiate of Eaemption, you should
bocome subjal w the Workers Compenodan provisions of the Labor CMc, you mutt
:• roMwith comply with such previsions or this Permit shall Inc deemed revoked.
CONSTRUCTIONmmumelNDINGAOENCY
1 Mr Net Nem is lending agency for He performance of
cfrm
which s ed (Sec. 30
the, work for which this permit is issued (Sec. 3097. Civ. CJ
lander': Name
Iander'a Address
1 "Mfy that I law read this application and state that the show information is
comem 1 agree w comply with all city and county ordinances and state laws relating to
building construction, and hereby authonre mpmsem adves of this city to enter upon the
a above-mentioned property for inspection purposes.
(Wo) agree to son, indemnify and keep harmless the City of Cupertino against
liabilities. lodgments. costs and capemcs which may In any way accrue against said City
o<Q2
a in cansquence of the grating of this permit.
" APPLICANT UNDER STA D ILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGU TI 1
Re -roofs
Type Roof
ilima. o AppliaMCanmctar Dam
HAZARDOUS MATERIALS DISCLOSURE
of
Will the applicant or future building Occupant store or handle havaNOus material
.defined by the Cupertino Manic a't Codc. Chapwr 9.12. and the Health and Safety
Code, Section25532(a)7
All roofs shall be inspected prior to an roofing material beim Installed.
P P Y g g
❑res Na
11cbanding«anPAnl
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future a equipmentar devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
all new materials for inspection.
District?
❑Yes Mita
1 have read He haoadmms matmiab mquimments under Chapter5.95 of the Califm-
M.Hcalth a Safmy Code, Sodom 25505, 25533 and25534.I understand thmif the Wilding
'
does not eurmmly have A tenant. Nat is my maporibiliry m nodry do mEumrL of the
regmmments whichtb et Luu.,Orsecjcaw ar2r6-25-0po
Signature of Applicant Date
G
All roof coverings to be Class "B" or better
oifncry nborizcd agent Date
0
REC8VED
f r" jf irrl�
�..�� -7 251004
ff®
O 11131JIMING
F�
1 � %
I /
141!'PR
IN ACCORdANCE
D
CUP
CO
DATE \
/ SIGNE \enc
This et
ke; 1 jo
\O w4il0Ui �r
�•I r u n1:
T, t01No
N� 1=c,t,icAtr &,Ln4
THE CITU OF
s MUST be
I and It is unlawful
Aerations on same
tmm the Building
!no.
o en spec`,ifications
pea-mk4M>',
of a r?vlsr ns of
=;� -
69 r.+:1a.Gl 1o"
�G[m�dc-
o20 Iar4dr,�o�.
6r -or
LIVING ROOM
�JC/Sy'/%JE MOOR �Ii9 /�
tp (E)
Floor
Rece-m- v
DININJLJ*a�Poa
Remw VTV,QFcCJP9
Yl�IC�n7��+'lySSFU
/-3 !2 /1Gt
------------------------------------------= IKITGIIEN 1
0
0
i
r �
J _J
1 �
'15k BTU Gas Furnace _,
�I�
40 G. Water Wtr.
ENTRY
-",-----------------------------------------
OG/02/2004 11:42 FAX 408 7333 CITY CUPERTINO •
— r
CITY OF CUPERTINO
CUPEkT1N0 PERMIT APPLICATION FORM
n
[M 001/003
Fee
er <=100,000 Btu
> l OOK to 500K Btu
r?50 KK to 1M Btu
1M to 1.75 M Btu
filer > 1.75M Btu
instruction Tax
lJC -- nwu Lravwa..
i00V ¢=1000A
600V >1000A
es 600V c= 200A
1of3 �-II D7, 7�
06;22/2004 11'.42 FAX 408 77J333 CITY CUPERTINO •
CITY OF CUPERTINO
PERMIT APPLICATION FORM
a 002/003
uauti=BNUC0N2v2A
BOVERT]IvIE--tmection
BPBACKFLOW
13PCESSPOOL
BPERMFEE
i tion
us Fee
Mit. Fee
Electric
echanical
=NewComm
Plumb
Overtime
Atmospheric Vacuum
Cess ool
Bldg Permit Fees
Fee Group
BUILDING
BUILDING
ELECTRICAL
MECRANICAL
PLUMBING
BUILDING
PLUMBING
PLUMBING
BUILDING
1 BPPDCrURE
BPGAS
BPINi'ERCEP
PbIg Fixture
Gas Piping System Fee .
Ind Waste Interceptor
PLUMBING
PLUMBING
PLUMBING
BPLANCHK
BPLANCKADD
BPLANCKREP
Plan Check Fee
Plan Check Add Multi
Plan Check Repeat Fee
BUILDING
BUILDING
BUILDING
BPREPIPE
Re i e Of Fixtures
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSPRINK
Lawn S riukler/Backflo
PLUMBING
BPSTORM
Storm/Rain Water
PLUMBING
BP AP
Kitchen T
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
BREMAJRHAN
A/C Units <=10,000 ofm
MECHANICAL
13REMAPPI I
Appliance Install
MECHANICAL
BREUBUSWAY
Remodel Busways
EL]✓CTRICAL
/01/ BREMFI&T
Lighfing Fixtures
ELECTRICAL
BREMFURN
Relocation of Furnace
MECHANICAL
BREMFURNOV
Relo Fumace > 10K btu
MECHANICAL
BREMHEAT
Heater h3stallation
MECHANICAL
BREMINHOOD
Installation of Hood
MECHANICAL
BREN MTSC
Misc A aratus
ELECTRICAL
BREMNRAPP
Rem Non -Res Appliance
ELECTRICAL
BREMPOLE
Pole/Platform Fixture
ELECTRICAL
BREMPOWER
Power Device/Apparatus
ELECTRICAL
BREMRECEPT
Lkytl, Switch & Outlets
ELECTRICAL
BREMRELOCA
Relocation of Hood
MECHANICAL
BREMREPALT
Repair/Alter Heating
MECHANICAL
WS BREMRESAPP
Remodel Res Appliance
ELECTRICAL
2 of 3
06/72/2004 11:42 FAX 408 71 333 CITY CUPERTINO •
CITY OF CUPERTE'gO
CAcel�TlNof PERAUT APPLICATION FORM
Fee ED Fee Descri tion
BREMSIGNAD Rmdl Si Add Branch
BREMSIGNS Remodel Si Mar uee
Bg�HEATR Theatrical Li tin Fix
BREMVENFAN Veut Fan Sin le Duct
BREMVENSXS Ventilation 5 stems
BSCBLVD Scb S ecific Plan
BSEISMICOM Seismic Commercial
BSEISMICRE Seismic Fee Res
BSPECIAL S ecial I=ection
BSWIM riniga, Pool
BTEMP TLmEorary Power
BTEMPPERM Temporary BldgPermit
W
FI"SVCS Tem Dist Svcs
BUSLIC Business License
LECTRIC Electricals foot
ERM TFEE Elec Permit Issuance
TERWEE Mechanicals . foot
ERMTTFEE Mech Permit Issuance
ERMUFEE Plumbing Permit Issue
DDT nr'Piumbine Fee so foot
I
•
3 of 3
Z003/003
CITY OF CUPERTINO
so
BUILDING DIVISION PERMIT
CONTRACTOR INF0RM'.AT10N
BUILDING ADDRESS:
FISCHER PLUMBING & CONST
PERMIT NO 04060225
20177
OWNER'SSNAME:
PERMIT ISSUE DATE
LLYOD YAMADA
2766 SCOTT RIAM
E:
SANITARY NO. CONTROL 340.
408 72 7 -242
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 hereby affirm Nn I em licensed under lardlians of Chapter 9 (commencing
with5ectio '! B)of DivisianJmthc Busine-s•aR�brofesriou C eamylicenwn
m Tall rare �V 3jr�%
KITCHEN REMODEL
License lac.
i
Da Can ser
ARCHITECTS DEC ION
1 undersand my plain shell W tined u ping a mentis
Licensed Professional
OW NER-BUILOER DECLARATION
al I am exempt from the Corclor's License Law far The
1 hereby Affirm that m
following reason. (Section 7031.5, Business and Pretensions Cade: Any lily ar county
which requires a Permit to conswcr, alter, improve, demolish. or repair any sanctum
igoon
prior In its issuance, also ras ulna the applicant nonsuch aconitia rile a signed statement
Lianw law(Chepmr9
Sq. Ft. Floor Area
Valuation
thai is E...dP...art. the Provial.M.flWContrselor
monsomming with Samon7000) of Divishi of The Business and Professions Cide) ur
that he is exempt thetefrom and the basis for ties Alleged exemption, Any violation of
3 16&N2(1133tber0 0
Occupancy Type
Section 7031.5 by any appliam for a permit subjects the Applicant to , civil penalty of
not mom Nen five hundred dollen (S700).
'
❑ L u owner of the or omployw with campenssreas
Required Inspections
ft stray,
ads (Sm.
is mad tarsals
rete a^thewens. and ft amsctarei+nmsLiaede awdaTorniopply.7oan Baer
of
and case: Thr Contractor. l.ieeme law eau tet apply lo use owner ser
ertywh holds his
propertywhos.p.mimprow thermmandwho.
moffeeddough
Outi intended or It.
own cePloyeuiproWdedmrovemimpros:mantsinnot
udon, doe Ownled,
within one yetiser mprolefor Ne owner
rudder, the buildingsuimprovementla=to you
e
builder will have The Wmen Or proving Net W did not bulla or improve for purpose of
,
ate.).
El 1, AS Owner of the propeny, am udusivaly communing with licensed controllers in
construct me project (Sec. 70a, Busi^eta end Professms Cnde:) The Camomile, U.
/
am law does not apply in an owner of property who builds or improves Sharma, and
who canonical far such pmjects with a contractor(s) licensed pursuant to the Counsellor
License alaw
0 In exempt under Sec. ,B$PCfor this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby eBirm under pemlty, of perjury one of du fallowing declaretiam:
1 have and will maintain a Cardinale of Consent m self-insum forworseescompen-
sstion, es provided for by Seldom 7700 of the labor Code, for the performance of the
work for which this Permit is issued.
❑ I have and will maintain wortle, Compensation Insunnce, As required by Soction
3700 of the labor Code. far the performance of the work forwhich this perook is issued.
My Woulme p ma on aurm carrier and Policy
/ST!2
'
Cartier. Policy No.:
CERTIFlCATE OF EXEMPr10N FROM S.
COMPENSATION INSURANC
(This sectim nose Out W manpleud if She Leann Is for on hundred dollars (I IM)
'
it, leu.)
1 certify thal in the perferep nco of the work for which this Permit is issued. I shell not
employ any person in any manner An as m become robjecuo The Workcn' C^mpersalum
Lew. of California. Da¢
Applicant
NOTICE TO APPLICANT: If, after making this Canificau of Exemption, you Should
become subject or the Worker's COmpenretian previsions of the Labor Code, you mut
forthwith comply with well Provisions or mi+Permit Shall be deemed revnked.
I'
Ousure lending agency for du Pcrfarmana of
Kinn that ere isostrae.
i, Permit is Wood 3
me wash Nur which mias ca (Sec. 7097, Civ. C.)
LName
Lender'smba', Addreas
1 minify that I have lead thi, applicud^n and rate ten the above Information is
'
correct, I agree To comply with all city and county ordinances and sun laws relating In
iWilding construction, and hereby emharie, representatives ofthis city to enter upon the
' alcove-mentioned pmpeny for Inspection purposes.
(We) Agree To SAM. indemnify red keep harmless the City or Cupcnim against
j liabilities,judgments. casts and expenses which may in any way accwc against said City
in consequence of the granting of this Permit.
I APPLICANT UNDERSTA D ILL COMPLY WITH ALL NON-POINT
Issued by:9 Date
SOURCE RECU T(
6`
Re-roofs
nature Appli _ Date
igu
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Shaapplicant ar(umre buih��JJJrJrJrJIII'IIIng accupenurarc or handle amOmmalorial
CC thelWill
d by IW Cupertino M Code. CTapmr 9.13, sena SW Health red Safetycode.
de. S
genion 3ss3x(.)?
All roofs shall be inspected prior to any roofing material being installed.
oyer ff.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupat all equipment at devJas which
tt haumaus air contaminants as defined by dw Bay Ares Air Quality Management
all new materials for inspection.
District?
❑Yes o
I have real me havamousmatedals requucremm under Chapter 6.95 of the Calirm.
ria Hulce&Safety Cor, Secvons35505,25533 and 35534.1 understood mm iflao Wilding
does noS mrtenJy Ww ,tenant mat' u my maponsRahty re mtily the occupant of the
mgairtmcnal renter T eT usam OrA nmau Or OcmPanay.
Signature of Applicant Date
6-z 5-0
All roof coverings to be Class "B" or better
o nor NodsdAgent Dau