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05030149a0C w lut y�z SR= ;iC 0� ase r2> KI'c ENT 0 C z.. F� m� d � Z)z UO_ OU Fa �z CITY OF XPERTINO �' CON CTORANFORMATION :. BUILDING DIVISION PERMIT ,RA BUILDING ADDRESS: 3 OLD TOWN 17T PERMIT "0 5 0 3 014 9 OWNER'S NAME: PERMIT ISSUE DATE MARK & SUE PERKINS 03111.Z2onc; E: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDO ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby Net 1 am licensed under of Chapter 9 (commencingbemes p ai Proom with Scouon]t111U)o(DivimionJo(dl Bldnessand Professions Code. and mylicenseis a)) of in full fora end e m m ( tie.If 79eSg'�,3._ _ KITCHEN REMODEL Dae' o� CorromNr Wn, -_srIL�� CONTRACTOR: ARTISTRY IN WOOD ARCHrrECI'S DECLARATION 1 understand my plans shall he used as public ¢cords Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm Not I am exempt from the Cmumeonr's License Law for the following mason. (Section 703 L5, Business and Pmfesdus Code: Any city or county which requires a permit to consruc, ether, improve, demolish, or repair any stmcmw prior to its i¢mance, als. requines tk .pliant far mah Permit 0 file. si,rumi mmeromi that k uliecneed pursuant to the pmvisios of the Contracture Liam Law (Chapter 9 Sq. Ft. Floor Area Valt!pgaj)000 (eanmencing with Secede. 700M of Division 3 of use Business and Pro(eummes Cale) or that k is eumpt tkrefmm and the thou for the alleged exemption. Any violation of Section 7031.5 by any applicant for aPermit subjects the applicant toacivil Penalty of APN Number Occupancy Type P Y YP trot more thm fiw dollars dors ($500). 35611032.00 Q I,ummrofinepmpeny,mmycmploymwiNw psu Neirmiccompenna on, will do tk work, and the structure is notinunded oroRemd foraae (Sec. 7044, Busisu and Pmressitm Cock: The Co.useme, License law dose rot apply in a. owner of Required Inspections propedywht huilds.rimproe dlreon, andwho dassuch work himulfor through his awn employees,provided pr such improwmcmdarcnot ear of completion. due formic. builder. Nebuildingorimprovement is sold within ow year of completion. Ne owner. builder will have the burden of proving that In, did not Wild or improve foe purpose of mat. .+( F// ❑ 1, as, tweet of property, am exclusively contracting with leeched Immunes t. construct the ]O4a, Business and Pmretiam Code:) Tk Contretots Li eaProject(Sec. rem Law does n apply to an owner of property who Milds or improve thereon. a d convects for h�m,,cts with. vactor(s)littn rsuantm onelaw. '^ am rept un . ,It Cfar 's.a Owner DeI WORKER'S COMPENSATION DECLARATION - - 1 hereby affirm under penalty of perjury one of the following decimations: 1 bam and will maintain a CeniBate of Consent o self -insure for Werkei sComism- union, as Provided for by Sccuu. 3700 of the Labor Code, her the perfomtantt of the work for which this permit is issued. ❑ I have and will maintain Worker's Compemuom I.... as required by Secutn 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Cnaraeeuot reed not kcomplemd if the permit isforome hundred dollabin](0) or less.) 1 certify Net in the performance of the work for which this permit is issued,) shall not employ any person in any minnCr sq o come subject m the, WodxrS'Comperomem Lawsof Cali( . Date:,///Lt's r Applicant ` _ NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should beome subject o Nc Worker's Compemtion previsions of the Labor Code, you must forthwith comply with such provisions or this permit shall k deemed revoked. CONSTRUCTION LENDING AGENCY 1 kreby uRrm that Nem is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3091, Ci, C.) Lender's Name Lender's Address 1 ttnify that 1 have mad this mi,licasitn and mute Nn tk above information u wildin 1 agree ct comply with all city and roomy mmoe of and cure laws resting m Wildingconstruction.pro,and bombs auNon p reoseer, ars of Nis city to reit upon dI above-mentionedproperty for inspection keep (We) agree to uses indc and kith hart dm City of Cupertino against ju xpea in m uegoodarw expespewhich may in any way name against said City ineniu encumbrance A eonugoNT of the granting of this permit.WWILL APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT 1 Issued by: son�cEngcj�/ Date Re -roofs Y��o Signature of Appl'° r' DateZ HAZARDOUS LS UUSS MATERIADISCLOSURE Type of Roof Will do applicant or future building occupant score or handle bh ardous material as defined by the Cupertino Municipal Code. Chapter 9. 12. and the Hcalth and Safety Cmle, Sccuon 35533(.)? All roofs shall be inspected prior to any roofing material being installed. Will the applicant or furore building occupant use equipment or devices which If a roof is installed without first obtaining an agree to remove inspection, I P dt hazardous air contaminants as defined by the Bay Area Air Quality Management Diane,? all new materials for inspection. JJ. ❑Yes 16No I haw mad the haaafdous materials reen quiremts under Chapter 6.95 of the Califon nit Health d: Safety Cade, Seemns 35505.35533 and 25534.1 understand Nat ifthe Wilding does. not currently how a Imam, Nat it is my resposibility o notify the occupant of Ne rcyuwhichmu4 meth=e:uca¢ofOnvpulry� Signature of Applicant Dale All roof coverings to be Class "B" or better Owner or authorised agent Date CITY OF CUPERTINO U G S O s ,z F-' • '� �r� y ( `l Y'`' IINF,OR �IQN BUILDING DIVISION PE TCONTRACT(JR BUILDING ADDR[SS: PERMIT "05030149 O, 5 0 3 014 9 NEWS NAME: PERMIT ISSUE DATE MARK ti, SUE PHONE: SANITARY NO, CONTROL NO, ARCHnECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 horeby affrm mat I am hecoend under provisions or Chapter 9 (commencing with Section 7p(m) of Division 3 ofthe Business and Psutrssions Code, and my license is In mO famcmde y -`,S3 KITCHEN REMODEL Liccnu Leg Dam+L1iC—.._ Cnnuae 2�-.>�r - CONTRACTOR: ARTISTRY IN WOOD ARCHITECTS DECLARATION I understand my plans shall he used as public records Licensed Prornaonal OWNER-BU:MCR DECLARATION that 11. exempt fma the Contractor's License Law for the 1 hre. .affirmsco 8131.0.Busircas and Co de: Any oily or county fallowingmason improve, dkhnns which ¢quires a permit ns cnnslm0. ilea improve, demolish, m repair any structure permit rC lnevisninanl far Contractor'saw(Chapt enl prior LLlslcense tthe F[. Area ValtJ�f}m�1000 pumas in encinnwdpuction7")ofDivisionofdueStsiness ndPrxlaw(Chap¢ry that (commencing xempt Section7110 it ncbasison3of the Businexempton. A.,ot i 1.6imCartel of Nat he u exempt therefrom and Ne basis (m Ne dlcgcd exemption. Any violation of that he is A I-V her Occupancy Type Section 7031.5 by any applicant for a permit subjects fie applicant to a civil penalty of not mote than rim hundred dollars ($51103 3 5 611 . 0 0 ❑ I, az owner offer propcny, or my employees with wages m their sole compensation, Required Inspections will do the work. and the sumctum is nothicened ororread far side (Soc.]Oi4, Bombers and Professions Code: The Continences Liana Law does not apply no ea owner of 9 P property who builds or impmm,i Iheaen.mdwho dissmeh work himself or through his own employ=, provided that such improvements am not intended or offered for sale. If. however, the building or improvement is said within one year or completion. the owner builder will have the burden of proving the be did not build or improve fix purpose of sate.). ❑ 1, as owner of the property am exclusively contracting with licensed contractors to consume, the project (Sec. 9014. Business and proressiecs CoJc:) The Contractors Lt. u Lawdoesn tapply loanowneroomicny who buildsurimpmvuthcmm.and. Ihonnmaets far hjrojc is wish =tot s) liechoi.1p I'rauamm, dt,2Cc uxcmes \\ _ 1 ueOKLaw. \ t]lame tort an rSec. B& P C fa_rthi`a rcazon Date \` warn v WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ono of the following declarations: I haw and will maintain a Co1Ifate of Covent to scir-tnsua far Worker"Compo. salon, az provided for by Section 37M of ile labor Code. for the performance or the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation insurance, as required by Section 3700 of the labor Code, for the peRormarec of me work for which this permit is issued. My Worker" Cam Mosatien Immo nce carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (rhissection need notte compleed if the permit is for one hundred &It=($100) or loss.) 1 cuGfy that to de performance of the work for which this permit is issued, l shall not mployany'paraminany mpnnS til az m become subject to the Workers Compensation "we of Calif n.///b..� ' Applicant 'M Applicant APPLICANT. If, after making this Coni Scare of Exemption, you should orae subject m the Worker's Compensation provisions of the later Code, you most forthwith comply with such provisions or his permit shall bu deemed revoked. C CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency I'or the performance of > the work far which this permit is issued (Sec. 3097, Civ. C.) ' Atondo's Namc 2 Lender's Address , p 1 comity that I have mad this application and stare that the about information is m COOCCL l ogee comply with all city and county ordinances and cute laws r upon and hereby authonpurpo runtatisrs of this city to erten upon tM / U movangconstruction.tione tolsam for inspection shove -(We) W ogee bra, y e,ju agree to cosi, indemnify and heap harmless the City of Againtno against may in any way same agamsuaid Ciry h incon of Z o(Oc queen grsuandcxpcnselwhtch APPLICANTC S A permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT UNDERSTANDS Issued by: Date SOU�CEAfiGUl,A7JONS�� ApY^"•�n=Lor Re -roofs Type of Roof Signature mf ApplicaHAZARnaor Data a HAZARDOUS MATERIALS DISCLOSURE Willy t applicant or fMuni building a or handle material as de e. Chapter 9.1 Health by the Cupertino Municipal Code Chapter 9.12. and the Health anJ Safety code. cation 25532(a)9 Sec All roofs shall be inspected to any roofing material being installed. Yes Na prior If a roof is installed without first obtaining an inspection, I agree to remove Will thc applicant or fugue buildingaecupanl use equipment or devices which emit hamrdous air contaminants as dcGncd by the Bay Area Air Quality Management all new materials for inspection. District? yy ❑Ycs No I have read the hmandous materials requirements unti rChapmrb.95 of the Catlin nu Health & Safety Cod,, Seeuens25505.25533anit 25534.1 undersand thatif the building , docs not curzently have a tenant that it is my respunsimliiy to nouly the occupant of the reyabem,n0 which must be mm prior to issuan¢ofa.Ccnifcam tar Occapanq. Signature of Applicant Date / /7 All roof coverings to be Class "B" or better Own,,mmahorir<dagent / Dae r�C.� CITRYYOf CUPEkTINO Assessor's Parcel Number: 3,s 6 V 3 z Name of owner. YM 4'Rk Projectaddress. 'iO3 0CD`'ow+1 C:C e_u `tio (fA- Contact person.Phone. Fax. yOQr-36h-1 ?7 L i Net square footage of lot. / O S Square footage: First floor: Second floor: Garage: TOTAL: Existing Proposed • Are there at least two 10 foot by 20 foot clear spaces inside the garage? 4n N Is privacy protection planting required for the project? Y On what floor(s) is work being done? / Brief description of work. Code editions: 2001 CBC 2001 CPC L, J__J j2e 0).P,/ n„ ,., LU m% ) W Ge -4-A -GJ (Y - N)2001 CFC (Y - N)2001 CMC (Y- N) (Y - N)2001 NEC (Y - N) Effective 11/1/02 p No Sdr�C_VVIR14 ev� 3 \uJ uj� t��u APR 12005 j Plan Review Process Work Book Page -8-Revised 4/28/04 F -I L �O� O�TowrJ �T Cu�CA- i � I 0 C arr o • CUPEkTINO • u 0 CITY OF CUPERTIPM PERMIT APPLICATION FORM es�3 0«7 APN # -3 J Z� Fee Description Date: Building Address: Mailing Address (if different from building address): °303 DL -D LT Boiler <= 100,000 Btu MECHANICAL Owneor's Name: Boiler> I OOK to 500K Btu Phone #: BBOILER3 Boiler> 500K to 1M Btu p n Contractor: r 6b . -C L �R� 1s�w/ i ti wea./ License #: 78 5 S3 Contact:f Phone: Yvr-�� 173� Cupertino Business License#: �-- nN7' 64-&s coro. 4b9-- Fax: yo -3%°5-1776 BUILDING Building Permit Info: Ind/Off/Comm/Quasi BUILDING Bld 'bg Elect)K Plumb Mech� Job Description: r j&)�N WeMad� Hotel and Motel BUILDING Residential ® Constax - Resi/Mobile Commercial ❑ Sq.Ft. Floor Area: Elec 600V <= IOOOA $/Sq.Ft.: /o j Elec 600V > 1000A ELECTRICAL Cost of Project: /' DODO Occupancy Group: Type of Construction- Energy Please check this box if the project is a BENERGYADD Energy Add Multi second -story addition: ❑ Project Size: Standard R Large ❑ Major ❑ BUILDING Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3