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CITY OF CUPERTINO
a77-777
BUILDING DIVISION PER
CCI,NTRATnR YNF,ORMAN,
BUILDINGADDRESS:
KINNEY CONSTRUCTION INC
PERMIT Na4100110
1928 OAKDELL 2L
OWNER'S NAME:
PERMIT ISSUE DATE
DRD BURKE
EWA
1041 TERRA N
0 4
HONE:
SANITARY NO. CONTROL NO.
(650)359-9763
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO '
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hcrchp affirm Inas 1 am liccnud andp. tFyisions of Chapter 9 (commencing
license is
with Stiction ynM)) of Division J of 1M1c➢usincssr-and Pm2nitinns Cndc. and my
mmBfo Inde
-
REVISION --NEW HEACTER/FOOTING
Liccnsc CI X. Lk.k
Dale t OOmmetoO
NEW PERMIT ISSUED/ ORIG. #04100101
_l
ARCHITECTS DEC A_
.1j,gpMrstand my plans shall Mused as public records '
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affrm mall am exempt from the Contractor's Liccnsc Law far the
following reason. (Section 7031.5, Business and Professions Coal Any city or County
which requires a permit to construct, alter, improve, demolish, or repair any sireclme
prier In its issuance, also requires the applicant for such permit to file a signed statement
Sq. Ft. Floor Area
Valuation
that he is licensed purumuLtO the provisions of floc Contractor's License Law(Chimer9
O
(COmmcncing with Section ](N107 0l Division J Of the Business trod Pm@scions Cnde) Or
Ill. MC exempt Ihemfa d and me basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of
net marc than five hundred dollars (s500).
32 618048.00
[D 1, as owner or the property, or my employees with wages as theirxolc compensation,
Required Inspections
e
will do me work. and me structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
q p
property who builds or improves dieretic, and who doessuch work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, me building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or to prove for purpose of
lc
❑ I, as owner of the property, , Business exclusively contracting with licensed contractors d,i.
El1,
cense pmjecl (Sec. WA, Professions Code:) Contractor's
Q
\ C
wneorand
Law d
dicmoc,and.
cense Lew doasnot roan or who d i pro nd
apply o
ant
\ v
to the
sed pursuant
who conLacBfor such project with a contracmr(s) licensed pursuant to the Comndofs
ch r with
se Law.
L]
\\\s
❑ exempt under Scc. . B & P C far this rcmon
incl
1 am
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of refill One of the following declarations:
I have and will maintain a Cctifcate of Conti to self-ieaom for Worker's ComPem
salwa, u provided for by Section 3700 Of the Labor Code, for the pdifmmvncc of the
work for which this Permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, ex required by Section
37M of the Labor Code. for me peRormanec or the work for which this Permit is issued.
My Worker's Compensation Insman a carter and Policy number
d ^Ct Ur{p . Policy No.:
RTIFICATE OP EX MPTION FROM WOR ERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is franc hundred dollars (EI W)
or less.)
I century that in the performance of the work for which this permit is issued, l shall not
employ any Person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT. If, after making this Ce nilicatc of Exemption, you should
become subject to the Worker's Com pe nation provisions of the Labor Cade, you must
ford with CO surly with such provisions or this Permit shall IN, deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby that there iss agency I'nr the Perl'Ormanee of
ed(Sec.30lending
ichaffirm
' the work fur which this pernit is issued (Sec. 3TN7, Civ. C.)
ndr's Name
U
Lendeer's Address
j 1 certify Nam l have read this application and scam that the above insonation is
' cored. 1 agree to comply with all city and county ordinances and state laws relating to
building Construction, and hereby autharim representatives of this city to enter upon the
above c mentioned properlyformspection purposes.
'
(We) agree to cast, indemnifyexpo and keep harmless the Clay of Cupertino against
j coarsing may in anyway accmc against said City
Q
�� 1\l\
in Of of this re reit.
Of the granting Of this recruit.
' APPLICANT UNDERST NDS AND WILL COMPLY WITH ALL NON -POINT
A APPLICANT
ISSUed by: - Dffie
SOURCER IONS.
Z11k
Re -roofs
Type Of Roof
natum OfA omr r Dale
US MATERIALS DISCLOSURE
Will the applicant or fumrc building Occupant slam or handhe hasarJous mvtchel
as defined by the CupeninO v1pei,ad Codc, Chapter 9.12, and the Health and Safety
Codc, Section 25532(x)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs
If a roof is installed without first obtaining an inspection, I agree to remove
Will the epplicanlm furore but ag Ottupanl use equipment or devices which
emit M'mrdoto it conmminanm as defined by the Bay Arca Air Quality Management
all new materials for inspection.
DisteiaP
C] Yes
I have read me mandowunabarichi requirements under Chunmr 6.95 of the Cabral
,is Heald,&Safety Code, Se ns 25505, 233 and 25534.1 understand mm if me building
'
dors not ammally ha c.rrc Rrt !'n puns.1ility m notify the oecupanl of me
-ma
regwmmtn�w ma�„f, r.�r•.teaf Dteepporayy.,�nll
�1
�Wignature of Applicant Date
( All roof coverings to be Class "B" or better
soar of ammarized agent Dalt
0
�•
CUPERTINO
OCITY OF CUPERTINOO
PERMIT APPLICATION FORM 6- - s O
/6 (OP 0
APN # 2-6
Date: /6) I � 1&-,
B ildin ddress: Mailing ddress (if different from building address):
`P��tc�
1 a- �s��•l
Owner's Jartle:
Phone #: _ n
BBOILER1
_
ntractor:
Lic se #:
Boiler > 100K to 500K Btu
MECHANICAL
C Phone:/,:,So -:�6n-Y763
Cupertino Business License#:
cc' � rr,,rrc,JS Fax: -3
BBOILER4
Building Permit Info:
Bldg Elect ❑ Pligab ElMech El
Job escription: �`�\ �V Q\W-C� O$ ccni�tc� VSA\�
Residential ommercial ❑
Ot
Sq.Ft. Floor Area:
$/Sq.Ft.:
Cost of Project:
Occupancy Gro :
Type of Construction:
Please check t ' box if the pr ' is a
BUILDING
second -story additio .
Project Size: Standard ❑ Lar e ❑ Ma'or ❑
BUILDING
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBOILER1
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler > 500K to 1M Btu
MECHANICAL
BBOILER4
Boiler> IM 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
Elee600V <= 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
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L
1 of 3
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CUPERTINO
OCITY OF CUPERTING
PERMIT APPLICATION FORM
Quantity Fee ID
Fee Description
Fee Group
BMISCELL
Miscellaneous Fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
BNUCOMIv1E
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
Pb1g 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
ISewers
PLUMBING
BPSPRINK
Lawn S rinkler/Backflo
PLUMBING
BPSTORM
Storm/Ram 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
BRENU URNOV
Relo Fumace > 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
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
2 of 3
WC0ERTINO
� QITY OF CUPERTINO*
COPERMIT APPLICATION FORM
_ Fee ID
Ouantity
Fee Description
Fee Group
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Remodel Signs, 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
BTEMPSV.CS
Temp Dist Svcs
ELECTRICAL
BUSLIC
Business License
BUILDING
ELECTRIC
Electrical sq foot
ELECTRICAL
EPERNUTFEE
Elec Permit Issuance
ELECTRICAL
MPERMFEE
Mechanicals . foot
MECHANICAL
MPERMITFEE
Mech Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issue
PLUMBING
PPLBG
Plumbing Fee sq foot
PLUMBING
ZADDCHG
Address Chane
BUILDING
•
3 of 3
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CITY OF CUPERTINO
' ' F `°
INFORMATION::.:
'
BUILDING DIVISION PERMIT
fC0NTRkQT01
BUILDING ADDRESS:
KINNEY CONSTRUCTION INC
PERMIT NN100110
1928 OAKDELL PL
OWNER'S NAME:
PERMIT ISSUE DATE
EDWARD BURKE
1041_ TERRA
4
NE:
SANITARY NO. CONTROL NO.
(650)359-9763
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
I her ch affirm that 1 am licensed mody,ar� any at Chapter 9 (aunmcncing
Job Description
with5 loran prf Division Sof the Businex n_(i GrrhaLiima Cm1d;mdmy1imnseis
u«�15ec1.sd a l�'
REVISION --NEW HEACTER/FOOTING'
sees
Date _CamtractO
NEW PERMIT ISSUED/ ORIG. #04100101
ARCHITECTS DEC
'j,pj dersland my plans shall be used as public records
Liremsed Pmfencunal
OWNER -BUILDER DECLARATION
1 hereby o1Trm that 1 am exempt from the Contractor's License Law for the
following notion, (Section 7031.5, Business and Professions Code: Any city Or county
which requires d permit to Construct, alter, impmve, demolish. or repair any structure
poor to its issuance, also requires the applicant for such Permit o file a signed statement
that he is licensed msuamm the previsions of the Contractors License lsw(Charter 9
Sq. Ft. Floor Area Valuation $0
(commencing with Section 7000) of Division 3 of the Business and Professions Came) or
that he is exempt therefrom and dm basis for the alleged exemption. Any violation of
Section 9031.5 by any applicant for a permit subjects the applicant to a civil penalty of
them five
APN Number 4e Occupancy Type
not more hundred dollar, ($5007.
32618048.00
E] 1, as owner of the property, or my employees with wages as their sole compensation,
will do Ne wurk, and Ne structure is not intended or offered for sale (See. 7044, Business
Required Inspeeuons
and Professions Code: The Contractors License Law does not apply to an owner of
propeny who builds or improves thereon, and who does such work himself or through his
own employccs, provided that such OR pavements arc not intended or offered for sale. If,
however, Ne building or improvement is sold within one year of completion, me owner
builder will have me burden of proving that he did not Wild or improve for purpose of
❑ 1. as owner of the propeny, am exclusively contracting with licensed contractors to
Conswet the paject(Sec. 7044, Business and Professions COde:)The Cornractor's Li.
cense Law does not apply to an owner c(propeny who builds or improves thereon, and
who contracts for such projects with a Canonicals) licensed pursuant to the Contractor's
License Law.
❑ l am exempt under See. ,B&PC for this mann
Owner Data
-
WORKER'S COMPENSATION DECLARATION
Ihereby affirm under Penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insum for Worker's Compete
$don, as provided for by Section 3700 of the Labor Code, far Ne perf rmmnce of the
work for which Nis Permit is issued.
[:1 1 have and will maintain Worker's Compensation Insurance, ac required by Section
37W of the labor Code, for the performance of the work for which this Permit is issued,
My Wmloo'sMCompensation In c earticr and Policy number
a tee \ U Policy No.:
RTIFICATE OFEX PITON FROM WORKER
COMPENSATION INSURANCE
Tbisse,onmraced notim,mi Iced dific permit isforonchundred dollars(5100)
or less.)
1 certify ton, in the Performance of the work for which this Permit is issued. I shall not
employ any porton in any manner so az to became subject to the Workeri Compensation
Laws of California. Dam
-
Applieant
NOTICE TO APPLICANT: IL after making this Ceril3catc of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked
'
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a commotion lending agency for the performance of
Ne work for which this permit is issued (Sao. 3(197, Co, C.)
Lender's Name
Lender's Address
I ec tify that l have read this application and Safe that the shove information is
correct. 1 agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby sufamim representatives of Nis city 10 enter upon the
"
above-mentioned property for inspection purposes.
(We) acme to save, indemnify and keep Landless theCity of Cupertino against
/}`A
and any way
which may in anyway accrue against mid City
inconsequence fthegran
of thisexpenses
of@egrand ngof this permit.
pe
A
APPLICANT
APPLICANT UNDERS' NDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE R ONS.
Re -roofs
Type of Roof
oat COfA i rntr r Data
US MATERIALS DISCLOSURE
Will Ne applicant or future building Occupant store or handle harardmis material
as defined by the Cupertino IvL�n�, cipal Cute, Chapter 9.12, and the Health and Safety
Code, Section 25532(an
All roofs shall be inspected to any roofing material being installed.
Ycs
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the epplicantor luetic building occupant use equipment or devices which
til hazmduus air contaminants as defined by the Bay Arca Air Qual'ny Management
ki
all new materials for inspection.
suict9
❑Ycs
I have read ho huvar requirements under Chapmr6.95 Dfthe Caiifor.
ria Health&Safety CrdC, Sc 'ms 25505, N33 and 25534.1 mthomand prat ifthc building
does not currently h itis yresponsibilitymnndl'y the rccupant of the
requircmcntawmu of Occupancy.
/Q� IWignature
of Applicant Dale
f All roof coverings to be Class "B" or better
mgr m autburircd aceto Datc